It is amazing to me that with all my education I had never heard about the endocannabinoid system. This goes also, for my nurse and physician colleagues. While it has been know about for quite some time I believe it has been ignored due to its association with THC/cannabis/marijuana. As I worked through the certification program (ICCT) it became obvious that its main role is homeostasis (balance) of all the systems in the body and works hard to accomplish this. However, at times it needs a bit of help, thus CBD, which comes from the hemp plant and THC which comes from the cannabis plant. I would like to share all the information from the certification program but it sits in a binder that is 5 inches thick. That said, I will share some of the highlights, focusing on CBD. Every module in the certification program notes numerous clinical articles thus evidence based. If anyone questions the routine use of CBD in the noted indications there is literature out there to support its use.

Extraction: The extraction process/CBD oil production should be organic, Non-GMO, pesticide-free hemp that is tested for contaminants (heavy metals, pesticides/fungicides and mycotoxins (fungus) and the producer needs to use a safe solvent and verified extraction process. While there are a few routinely used extraction processes (ethanol, butane, Super critical, Co2) The super critical Co2 is by far the best. So what does one look for when trying to decipher between products. First,is this a full hemp extract (containing phytocannabinoids-CBD being one (113 reported) phenolic compounds (10,000 structures) and terpenes (essential oils etc) of which there are 100 reported. the one most studies is limonene for those who are familiar with essential oils and is the final certificate of analysis available (tells what is actually in the product and how much including does it have 0.3% THC or less to be legal and is there a THC free option).. Second, what is the medium used in the product i.e. olive oil, MCT oil, Palm oil, coconut oil or hemp oil and lastly,what is the mg per dose and volume of the bottle.

How Does It Work: (gets a little complicated) There are 2 cannabinoid receptors everywhere in the body, CB1 and CB2. It is these 2 receptors that work within the systems of the body attempting to create balance when things are off. Of course, every system in the body, nervous, GI, endocrine, etc has their own specific receptors with chemicals/transmitters that attach to the receptor and trigger a response. CB1 and CB2 receptors are, as I said, everywhere. and like other receptors require a chemical to trigger a response. THC works directly with CB1 and CB2 (which gives it some of its unique medicinal indications versus CBD although a lot of overlap).while CBD works indirectly through 2 transmitters called ananamide (aside from a myriad of other clinical indications, plays a major role in how we feel emotionally) and 2-ag which then are metabolized through 2 enzymes called FAAH and MAGL (not worth spelling them out).which also play a significant role in how CBD works. As mentioned above, the extraction process is critical as all of the cannabinoids, terpenes and phenolic compounds work together (synergy) to create a positive clinical outcome.

How is it metabolized: Both CBD and THC are metabolized by 3 liver isoenzymes (When combined account for the majority of how drugs and other chemicals) CYP2C19, CYP3A4, and CYP2D6. Why is this important? What I have found is that folks are buying CBD oil and other CBD products without knowing all the facts. As mentioned above, most drugs are metabolized by the three isoenzymes. This can result in significant/serious drug interactions with CBD, and if someone is on a lot of drugs (or any), the potential for drug interactions should be discussed with their clinician (unfortunately most clinicians are ignorant of this fact).

Side effects: While there may be some minor side effects/gut related issues (not including drug interactions) A review of 132 original studies by Bergamaschi et al. describes the safety profile of CBD and high doses up to 1,500mg per day and chronic use have been repeatedly shown to be well tolerated by humans.

Indications: The list is huge and I continue to routinely find additional indications. Generally speaking, it has anti-inflammatory (autoimmunity), antioxidative, antiemetic, antipsychotic (bipolar for example), endocrine (thyroid/hashimotos-graves), sex hormones/fertility, etc.), emotional (depression/anxiety), gut and neuroprotective properties. As an example, migraine, fibromyalgia and irritable bowel syndrome are connected in their pathology with CBD playing a balancing act between the 3. When you look at the major cannabinoids (CBD, CBG, CBGA, CBC, CBCA, CBN and all the terpenes) and the role that the endocannabinoid system plays hard to find an indication that does not fit.

Dosing: Not going to go into a lot of detail here as dosing varies based on what one is trying to treat. However,it is important to know dosing ranges as CBD in any form is expensive. If any additional questions (drug interactions/dosing), as this blog is being read, can contact me via email ( or phone (940-435-9655).


We all know that an appropriate weight is critical for overall health. Despite that, achieving a healthy weight can be extremely difficult (having successfully worked with the HCG diet for a number of years), secondary to various eating disorders, some genetics, lifestyle and hormonal imbalance. What most folks don't know is that an undetected hormone imbalance (I test for this with a Saliva Test with results back in a week) can be a deterrent and a contributor to unhealthy weight. Women with a hidden (sex) hormone imbalance frequently find that they can't lose weight as easily as they used to or they now have immovable belly fat they never had before. This can occur at any age although primarily during perimenopause and menopause when the progesterone to estrogen ratio gets out of balance resulting in "estrogen dominance." In men, as testosterone and dhea levels go down, it is not unusual to see men with belly fat and "breasts" due to the conversion of testosterone to estrogen. Related imbalances of cortisol (adrenals) and insulin in both sexes can impair thyroid function and raise risks for metabolic syndrome and diabetes. The following are endocrine/hormone imbalances that impact weight:

Estrogen (estrogen dominance)/progesterone: Weight gain in hips and thighs, water retention, low thyroid, sluggish metabolism

Testosterone/DHEA: decreased lean muscle with increased body fat, decreased metabolic rate and abdominal obesity.

Cortisol (adrenals and sensitive to physical and emotional stress also tested through saliva along with the sex hormones). belly fat, increased appetite, sugar cravings, impaired thyroid metabolism.

Vitamin D3 deficiency (extremely common and one of the things I test for via blood work): Hyper insulinemia, belly (visceral-around organs) fat storage.

TSH elevated (suggests hypothyroidism-see thyroid blog): hypothyroidism, low metabolic rate, difficulty losing weight, obesity

Fasting insulin elevated: insulin resistance, abdominal obesity

The Saliva Test is easy and results are quick - call me to order kit

The thyroid gland plays a major role in the metabolism (converting food to energy), growth and development of the human body and is part of the endocrine system that includes sex hormones, growth hormone and the adrenals (ACTH). Many books, articles, etc have been written about the thyroid and can be very confusing and intimidating in its complexity however, let me see if I can simplify it a bit. 2 structures in the brain, the hypothalamus, determine if you need more thyroid hormone, (T4 and T3) and sends a message to the pituitary to release TSH (thyroid stimulating hormone) which tells the thyroid to make more T4 and T3, the 2 primary thyroid hormones. For the thyroid to make the hormones the body needs Iodine (T4 has 4 iodines etc.) and historically we would get the iodine from our diet however, if you think about it where do we get iodine from? Unless we eat a lot of kelp and iodized salt or take a supplement we all tend to be iodine deficient. Before I even consider putting a client on thyroid hormones I always try a thyroid supplement that includes iodine, zinc and selenium all critical for adequate thyroid function (ThyroMedica Plus is the supplement I use).. The thyroid makes a lot more T4 than T3 as T4 is much weaker than T3 but ultimately T4 is converted to T3. Important to note here, that T3 is what actually gets into the cells and impacts metabolism, etc, however theres is some evidence that T4 may also stimulate receptors making it a hormone versus a prohormone and there may be some value in adding T4 to a T3 protocol. T4 also converts to reverse T3. Reverse T3 has a very interesting role. When within normal limits, it stays behind the scenes, but when the body has been exposed to extreme physical or emotional stress T4 makes a lot of reverse T3 which then competes with T3 at the cellular level thus minimizing the metabolic effects of T3 giving the body an opportunity to slow down.

There are a number of common problems associated with a thyroid that is not functioning properly and include, hyperthyroidism (too much thyroid and may present as anxiety, irritability, hyperactivity and hand trembling), hypothyroidism (too little and may present as insomnia, hair loss, fatigue and tiredness, depression, difficulty concentrating, muscle pain, dry skin, cracking nails etc.) and Hashimoto's and Graves disease. These are autoimmune diseases where antibodies attack the thyroid. Hashimoto's, in particular, has become very common, as I see it in a lot of my clients. It can be easily detected by testing for thyroid peroxidase antibodies and anti-thyroglobulin antibodies (must test for both as one may be normal and the other positive). So what causes this autoimmunity. For the most part, in my experience, there appears to be 2 main causes. The primary cause is associated with gluten (the gut) and going gluten free ( has a number of other benefits as well, but another story) for a period of at least 3 months seems to decrease the number of antibodies. I have also found that viruses, in particular, Epstein Barr (EBV) has been shown to be a cause of autoimmune disease in general and associated with Hashimoto's. So how do we treat these various thyroid related problems?

As I mentioned, with the exception of Hashimoto's and Graves, I prefer to start with the above mentioned supplement that frequently will normalize thyroid markers. If I am treating Hashimoto's (Graves/hyperthyroidism is another story) I use something called low dose naltrexone (LDN) which addresses the EBV as well as the autoimmunity. There are a number of ways to treat hypothyroidism (here again can get pretty complex/confusing). Endocrinologists and other primary care clinicians tend to use just T4. More commonly, a glandular is used. A glandular is extracted from animals (porcine in most cases) and contains everything found in a thyroid gland, i.e. T4, T3, T2, reverse T3, etc. The clinician usually starts out with somewhat of an arbitrary dose to see how the patient responds. I prefer to start out with a low dose and allow the patient/client to titrate (slowly go up in dose) until they feel the benefit). If there is an elevated reverse T3, I will just use T3 and titreat in the same manner however some folks "seem to feel better" with some T4 thus supporting the idea of a T4 receptor.. When monitoring, there are certain labs that I focus on using "functional medicine" ranges but more importantly, labs are secondary to how you feel. Unfortunately, folks are dosed based on labs not symptoms, or lack of.

Recent Post

©2018 ASK DR. RICK | All Rights Reserved.