Cannabis and the Brain
Cannabis products are everywhere these days. As a growing number of states loosen their medical and recreational cannabis laws, millions of Americans are using the cannabis sativa plant, typically known as marijuana, to relax or treat pain, anxiety, insomnia, and other conditions. Yet more data is needed on its impact. “The nation has warmed toward the use of cannabis, but policy continues to outpace the science,” says neuroscientist Staci Gruber, EdM ’95, PhD, who’s working to change that.
Gruber, a Harvard Medical School associate professor of psychiatry, directs both the Cognitive and Clinical Neuroimaging Core and the Marijuana Investigations for Neuroscientific Discovery (MIND) program at McLean Hospital. She and her team are using cognitive and clinical measures, as well as neuroimaging techniques like functional MRI, to help elucidate how cannabis affects the human brain. They have discovered, for example, that individuals who start heavy recreational marijuana use before age 16—when the brain is still developing—may perform more poorly on cognitive or behavioral tasks involving the frontal cortex, such as memory, attention, and judgment, than those who don’t use cannabis or who started using it later in life. A recent paper that Gruber co-authored underscored these findings using results from a simulated driving test. Neuroimaging has also revealed changes in white matter, the neural fibers critical for efficient communication among brain regions, in early-onset cannabis users.
Gruber is especially excited about her team’s research on medical cannabis and its effect on cognition, brain structure, function, and quality of life. “Almost no literature exists on the long-term impact of medical cannabis,” says Gruber, who launched the MIND Program in late 2014 to address that gap. “So many people are desperate to find anything that works to alleviate their symptoms. It would be fantastic to know what actually does and does not work for patients over time.”
Encouraging results have emerged from MIND’s first investigation, a longitudinal observational study of individuals using medical cannabis for various conditions and symptoms. The team conducts multiple assessments before participants—who choose their own products—start treatment. Further testing happens at three, six, 12, 15, 18, and 24 months after their treatment begins. Even after a few months, patients performed better on cognitive tasks requiring executive function; “Rather than getting worse, they’re actually getting better,” Gruber says. This contrasts with poorer cognitive performance seen among some heavy recreational marijuana users relative to non-users. Patients in this pioneering study have also reported improved mood, energy, and sleep, and reduced use of conventional medications.
What explains these improvements? Gruber says patients may be thinking more clearly because their symptoms are alleviated, and/or because they are using less conventional medication such as opioids. In addition, medical cannabis patients tend to be older than recreational users, and she says there’s some preclinical data suggesting that cannabis may help boost the body’s aging endocannabinoid system—a natural system that helps regulate key functions such as sleep, mood, appetite, and memory.
The MIND program is also conducting medical cannabis research studies involving veterans, women with menstural- and menopause-related problems, and chronic pain sufferers. In addition, Gruber’s lab has launched the nation’s first clinical trial to compare the effectiveness of two different formulations that include cannabidiol (CBD)—a non-intoxicating component of cannabis—for treating anxiety. Patients will receive either a full-spectrum product that is high in CBD and contains other cannabinoids and terpenoids (organic compounds that provide aroma, flavor, and may also have their own effects on the body); a single-extracted compound form of CBD from the same source; or a placebo. Gruber wants to know whether the full-spectrum version will work better to reduce anxiety, which affects millions of Americans. This project has received a small grant from the larger $4.5 million gift to HMS from Harvard alumnus Charles R. “Bob” Broderick, AM ’05, to fuel cannabis-related discovery.
Gruber’s 20-plus-year quest to understand how cannabis affects the brain began with a life-altering college summer internship at McLean, located in Belmont, Massachusetts. “I fell in love with clinical trials and neuropsych assessment and testing and thought, ‘I can’t imagine doing anything more exciting than this,’” she recalls. She remained at McLean and collaborated with McLean researchers throughout her college, graduate, and post-graduate years and then joined the faculty. Gruber says she is honored and humbled to work with the dedicated patient volunteers in her studies. “And if we’re doing something that helps improve the quality of life for any patient group, we’ve changed the world.”
Is CBD Useful in Cognitive Decline? Get the Facts with Dr. Litwin
CBD is a hot-topic nutraceutical! But can it really help with cognitive decline and Alzheimer’s disease? Where does it fit in a full Functional Medicine approach? Sort fact from fiction with Dr. Litwin and Lara Zakaria, our Nutrition Team Manager, in this short, informational video. Full transcript below…
For more help with cognitive decline, visit our Functional Memory Rx.
Lara: 00:01 Hi everybody. My name is Lara. I’m one of the nutritionist here at other Sandy Hook Clinic and I’m here with Doctor Litwin and we’re going to be talking about cognitive decline today. And most specifically we’re going to be talking about CBD and marijuana. It feels like you can’t go anywhere without hearing about CBD and all its benefits and there’s so much information about it and there’s some folks that are starting to recommend it for cognitive decline as well. So before we even dive into that topic, can you just give us a little bit of a background on what CBD is and what’s the difference between CBD and marijuana?
Dr. Ken Litwin: 00:38 Sure. I know what you Lara. Every place I go they went off for me a CBD drink or something. So it’s very trendy. Sometimes people don’t really know the difference between marijuana and CBD. And let me just clarify that. CBD is something that you find in marijuana, called cannabidiol. It’s an example of a cannabidiol or both. And there are many and some of them are actually made by in our bodies. You know, we don’t need to eat them or take them as medication. It’s part of our endocannabinoid system. So human beings have evolved with these substances in plants, and we’re learning more and more about how these cannabinoids and the ones that are in our bodies already a work to help regulate our system and far as a hormones, neurotransmitters, mood, inflammation, immune system, and they really have far-reaching effects.
Dr. Ken Litwin: 01:59 So they’re very important and we need to know more about them. Marijuana contains two main things: THC, which is the main ingredient that may cause some harmful symptoms like psychosis. And CBD, which is thought to be more balancing by negating some of the effect of the THC and sort of achieving some balance. Where people get CBD from now is from hemp grown outside of the United States. And it’s imported as hemp oil or products containing CBD. And those products do not contain THC. Because they’re not permitted to. And because there isn’t any THC in hemp. That’s the difference. And there are plenty of other plants that have can have cannabinoids besides hemp and marijuana that we can use to our advantage.
Lara: 03:19 So it sounds like the benefit really is the cannabinoids more so than the source of the cannabinoid. And you’re saying that there’s multiple sources where it can come from. It doesn’t necessarily have to be for marijuana. So should that point is there any good research connecting the benefit of the cannabinoids to cognitive decline?
Dr. Ken Litwin: 03:41 Okay. So you know because marijuana is restricted. It’s a class one drug in the United States and in many other countries, there isn’t any research in humans on it. And what you have is evidence on CBD in laboratory experiments and particularly mice. And in the mice experiments they have mice that are genetically engineered to get Alzheimer’s, they basically used CBD in these mice and found that it was associated with a delay in the progression of their development of Alzheimer’s or they didn’t get it at all. And the earlier you use it in the, in the mouse’s disease process, the better it works. And the reason for that is probably because CBD has affects on reducing amyloid formation and helping amyloid removal and in decreasing neuro inflammation by bringing control to the cells in the brain called glial cells. So that’s the evidence we have for CBD or cannabinoids in cognitive decline and dementia. We don’t really have any in humans.
Lara: 05:18 Okay. So that said, with the emphasis on CBD, regardless of the lacking research at this point, how are you translating that into your practice? Are you using CBD with your patients?
Dr. Ken Litwin: 05:34 Okay. So I’ve used CBD as one tool I have for people who have dementia or cognitive decline maybe not so much for prevention of, of cognitive decline, just because I’m focused on getting all their other factors that may be contributing to cognitive health in terms of optimal state like sleep, exercise, nutrition, getting all the other factors like chronic toxin exposure, heavy metals, all those kinds of things. So, you know, once I’ve gotten all those things going, then yeah maybe I’ll consider CBD because it could be helpful. But it’s expensive. So I have a lot of other options that are less expensive that also help with neural inflammation and amyloid formation and the amyloid removal like turmeric or an omega three fatty acids in fish oil or resveratrol. And those are more affordable and have actually more evidence for them in cognitive decline, dementia, then CBD has.
So the only case where I would definitely use CBD or medical marijuana would be in the case of a client who has late-stage Alzheimer’s and they’re having agitation at night, which we call sundowning. And that’s because that condition is associated with nursing home placement when, when a spouse or family can no longer handle their family member, their relative family member getting up at night and all hours of the night doing all kinds of things. And there’s this thing in nursing homes where, um, there’s a disinhibition of sexual interest in late stage Alzheimer’s. You can imagine that causing a ton of problems. So what do we have for that condition? We have nothing that’s FDA approved, so what we do (what is done conventionally) is we use off label antipsychotics which have a risk of death. So if I had a family member who had Alzheimer’s and had sundowning at night, I would definitely use CBD or medical marijuana on that type of patient. And there is evidence that it is actually helpful. There’ve been studies where they use synthetic THC and that has been helpful.
Lara: 08:24 Sounds like there’s still some work to be done in terms of the research, but there’s some definitely good reasons to use either medical marijuana or CBD for that matter in certain cases for cognitive decline. But from what I’m gathering is that you’d rather use it more in late stages and preserve cognitive function using some other techniques and some other phytonutrients and phytochemicals or in earlier and prevention that sound about,
Dr. Ken Litwin: 08:56 Yes, I think until I have more evidence to support the use of CBD or other or medical marijuana or things like that, then I’m going to focus on the other things. But if I have, if I have a patient who wants to try it, I’m okay with that.
Lara: 09:16 I mean, and I’m sure it also depends if there’s some other factors with the patient, you know, it’s supposed to help with pain and anxiety and things like that.
Dr. Ken Litwin: 09:23 That’s true. T here’s evidence for marijuana or CBD helping other things. And if those are present, I might be more likely to use it.
Lara: 09:37 Thank you very much, Dr. Litwin. It’s very helpful. If you have a question, please don’t hesitate to comment below and thanks again for tuning in. Thanks.
Brain Food – Eating to Fight Cognitive Decline
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