Cannabis Patient Care - August 2022

Cannabis Patient Care - August 2022

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12 doctor focus cannabis patient care | vol. 3 no. 2 Cannabis for Autoimmune Disease: Benefits Beyond Symptom Relief? B Y D R . D U S T I N S U L A K A UTOIMMUNE DISEASES OFTEN cause pain, inflam- mation, spasticity, itching, and gastrointestinal dis- tress. Cannabis, well known for its analgesic, anti-in- flammatory, antispasmodic, antipruritic (anti-itch), and gut-balancing effects, often works well for improving symptoms in people with autoimmune conditions. But can cannabis impact the underlying disturbance leading to these symptoms? This article reviews the clinical evidence examin- ing the efficacy of cannabis in the treatment of common auto- immune conditions and takes a deeper look at the preclinical evidence suggesting that cannabis may be able to modify the autoimmune disease process. At the end of the article, I pro- vide tips for implementing cannabis-based therapies in indi- viduals with autoimmune diseases. What Is Autoimmune Disease and Why Does It Occur? Inflammation is a normal physiological defense against infec- tion and tissue damage; it serves its role in the healing process and quickly ends, under normal circumstances. Sometimes, however, the immune system becomes dysregulated, and inflammation persists, causing tissue and organ damage. In autoimmune diseases, inflammatory symptoms persist because one's immune system attacks targets on otherwise healthy human cells. More than 80 conditions have been categorized as autoimmune, and the symptoms vary widely depending on the tissue or organ targeted by the aberrant immune activity. There is no single cause of autoimmune diseases; most occur at the intersection of genetics and environment. For example, many autoimmune conditions run in families, but not in a clear pattern of genetic inheritance, and identical twins rarely man- ifest the same autoimmune disease (1). This suggests a genetic predisposition to autoimmune diseases, but environmental fac- tors play a major role: microbial or viral infections, vaccinations (2), or major life stressors often precede autoimmune disorders. Autoimmune conditions occur in about 8% of the population. The most common include type 1 diabetes, inflammatory bow- el disease (Crohn's disease and ulcerative colitis), thyroid dis- ease (Hashimoto's thyroiditis and Grave's disease), multiple sclerosis, rheumatoid arthritis, Sjögren disease, psoriasis, and lupus—among many others. Though not consistent among all autoimmune diseases, many individuals with one have a higher likelihood of developing a second autoimmune condition (3). Many patients with autoimmune diseases are told that their immune system has become confused and is now attacking healthy tissue, but until recently the mechanisms of that con- fusion have been poorly understood. Recent research suggests molecular mimicry is one of the leading mechanisms by which in- fectious or chemical agents may induce autoimmunity. It occurs when the T or B cells of the immune system react to a foreign antigen with a similar molecular structure to peptides normal- ly found in human cells. Under certain conditions such as genet- ic predisposition or psychological stress, the antibodies or T cells will continue to react to the human tissues long after the infec- tion or foreign chemical is gone. Other immune malfunctions, such as impaired immune tolerance, likely also play a role (4). Some autoimmune diseases impact specific organs, causing related problems and their downstream symptoms; for exam- ple, diabetes attacks the pancreas and results in loss of insu- lin production, which causes high blood sugar, which, with- out careful management, causes a host of other problems; and Hashimoto's attacks the thyroid gland and results in loss of thyroid hormone production. When the immune system attacks the musculoskeletal system or the skin, symptoms usually in- clude swelling, pain, and itching. When the immune system at- tacks the nervous system, symptoms often include spasticity, weakness, sensory disturbances, and psychiatric symptoms. Cannabis for Symptom Relief During the 13 years in which I've treated patients with cannabis, I've witnessed hundreds of people with autoimmune diseases report improvement in symptoms and quality of life when using this versatile medicine. But that's not unexpected, as I could say the same about many categories of diseases. Why is canna- bis so broadly effective across such wide variety of conditions? The main reason is its capacity to interact with the endocan- nabinoid system (ECS), a master regulator of the other bodily systems, including the immune system. Other reasons include

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