Issue link: https://www.e-digitaleditions.com/i/1426211
23 nurse focus cannapatientcare.com october/november 2021 | cannabis patient care Wohlschlagel (1,2). "Cannabinoids dampened down the immune re- sponse and it didn't kill the immune cells, but it definitely shifted them to be calmer. Basically, that's how I explain it to a patient. Can- nabinoids reduce helper T cells and increase regulatory T cells—and this is not what you want to do if you're using an immunotherapy." "Doctors should be learning that there are cannabinoid recep- tors in our bodies," she added. "They should know what our own endogenous cannabinoids do as well as what the cannabis plant can and can't do. If a tumor is not vulnerable to those high doses of cannabinoids you've been using—if it's not working and you're going to be going on an immunotherapy, or you're already on an immunotherapy, please, please, please be careful." Wohlschlagel also explained that the size of your dose plays an important role when it comes to immunotherapy. "If people were using less than 40 or 50 milligrams total of THC and/or CBD, it didn't seem to interfere as much. But maybe over 50 milligrams, that was when we saw interference with immunotherapies," she said. "I started spreading the word and suggesting that patients go down to half of that. That allows a patient to use 5 milligrams of THC here and there throughout the day, keeping their total down to under 20 or 25 milligrams or as low as possible for symptom man- agement and reduce the risk of immunosuppression." For success stories, Wohlschlagel has seen remarkable cases of patients with subtypes of cancer that already had strong preclini- cal research for THC-rich cannabis behind it, such as HER2 positive breast cancer. "It's not 100% of the time that it would work, but I noted that most of the women with breast cancer I was interview- ing that were success stories were those with HER2 positive breast cancer," she explained. She added that using the cannabis medi- cine along with Taxol and Herceptin seemed to possibly result in better than expected outcomes. For the patients that did see success with medical cannabis, Wohlschlagel noted that the product types they used varied from patient to patient. "Most patients who really have plenty of access to products will use an edible form at bedtime and use an inhaled route during the day. Some will use sublingual sprays and lozeng- es, but those are not as available. But for symptom management, the inhaled route acted quickly," she said. "Patients can easily judge the dose they need because with the inhaled route they only have to wait five or 10 minutes to know what the effects are go- ing to be. Whereas with an oral preparation, you don't feel it usu- ally for about an hour until it hits the liver and gets pumped to the blood. However, when you inhale it, the cannabinoids are delivered immediately to the bloodstream through the lungs and you feel it and quickly figure out what amount made you feel best." There is still a major stigma associated with medical canna- bis use. Wohlschlagel commented that sometimes she sees fam- ily members of patients who are very comfortable talking about cannabis for their parent or loved one, but the person who's the patient is really resistant. "Whenever possible, especially if the patient's out of treatment options, they're metastatic, the treat- ments aren't working, or they can't tolerate the conventional treatments, we definitely can discuss cannabis use in bold- er ways. Sometimes they want to do what in football would be called a Hail Mary pass. I'll just gently explain it all knowing that then they're making an educated decision and if they choose not to, now, it's an educated choice, but it's usually started by stig- ma," she said. "Part of it was the stigma, the worry about addic- tion, the worry about the taboo around 'weed.' But over and over it was often because they had tried an edible form of canna- bis that was too potent and had a horrific experience. So, it's not Beyond Cannabis: Diet Matters When Talking Cancer Treatment WOHLSCHLAGEL SHARED THAT her experience working with cannabis and patients led her to studying more cancer biol- ogy and human biology because we make our own cannabi- noids from the oils we eat, namely omega-3 and 6 fatty acids. She explained that there is a link to getting your diet wrong and cannabinoid receptors being present on some tumors— at least there is a suspicion by researchers that there is a link. "That's where some of the scientists are looking," she said "Now I make sure that if a person isn't really a candidate to use a lot of cannabis, every patient learns about eating the fat properly. I explain to them that you've been eating this, this way. You've been having a lot more omega-6 fat than ome- ga-3 fat. It's very typical in our American Western diet. Scien- tists have said that if you do that, you skew the cannabinoid system in the body." "The endogenous cannabinoid system has been found to produce much more of the omega-6 cannabinoids and much less of the omega-3 cannabinoids and similar chemicals that may provide anticancer benefits. At least one form of cancer has been found to almost always have a cannabinoid recep- tor number 2 attached—HER2 positive breast cancer. That's also a cancer that seems to occur more often in countries which use a lot more of the omega-6 fatty acid called linoleic acid and is very inflammatory, aggressive, growth factor driv- en. This is one of the breast cancer types where Spanish re- searchers could really identify clearly anti-cancer potential with THC and likely synergize with conventional treatments," said Wohlschlagel. As part of her consultancy with patients, she also exam- ines their nutritional patterns. She says she assesses their in- take of omega-3s and 6s. "If I don't think a person would ben- efit from a lot of cannabis, I'm going to really make sure they understand that this is not saying that the cannabinoids don't matter. But we could look at their dietary fats and return them as the scientists guide us to a more balanced intake and that will likely affect the cannabinoid production and that might give them benefits without using cannabis," she added.