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Welcome! Welcome to our Cancer and Cannabis Issue.

Being a survivor of both breast and ovarian cancer, I feel a kinship with the people in these stories you are about to read. We tried to share with you not just the information on why and how they chose cannabis, but their personal stories of struggle and success. Something not spoken of often is the long term effects of chemotherapy and other cancer treatments. Things such as phantom pain, chronic pain, insomnia, lymphedema, depression, and anxiety last sometimes much longer than the body hosted the cancer cells. We encourage survivors who are struggling with long term effects after cancer treatments to check out how cannabis may help. Cannabis is an individual medicine; as such, each person reacts differently to it.

OUR GOAL IS TO EDUCATE ON THE WIDE RANGE OF HELP AVAILABLE AND TO OFFER HOPE.

e a d in g r r o f u o y T h a n k r m a g a zi n e ! ou

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TABLE OF CONTENTS MARIJUANA MINUTE WITH NURSE JORDAN CANCER & CANNABIS OUTDOOR ADVENTURES & CANCER BR AIN BRE AST LIVER LEUKEMIA SKIN STOMACH

10 19 42 48 50 Di s 52 LIST 54 58 60

GORDON

MARA

LANDONâ&#x20AC;&#x2122;S STORY

GOLDSTEIN

BONNI

FEATURE STORIES

36 5

OUR TEAM FOUNDER / EDITORIAL DIRECTOR Nancy Moss COPY EDITOR Dawn Hayford GRAPHIC DESIGN / PRODUCTION Melissa Morris TECHNOLOGY DIRECTOR Alex Moss SCIENTIFIC RESEARCH Sarah Moss SOCIAL MARKETING TEAM Green House Healthy ACCOUNTING / LOGOSTICS Kara Cave EVENT MARKETING Sarah Pope

CONTRIBUTING WRITERS

PHOTOGRAPHERS

Jordan Pearson

Dr Debra Kimless

Melissa Morris

Antonio DeRose

Heather DeRose

Linsey Kelsey

Ben Owens

Maxine Taylor

Jacqueline Collins

Matt Jackson

Sarah Moss

Jacob Seace

Brian Houck

Michelle Martin

Russell Gearheart

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@GETGRAMNOW The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you have regarding a medical condition. Copyright Â© 2019. This magazine is protected by US and International copyright laws. Reproduction without written permission is prohibited.

FEATURED WRITERS Michelle Martin is a freelance journalist who considers herself lucky to live in Seattle, WA where, on occasion, she can see two mountain ranges and salmon spawning all in one short bike ride. Her work has appeared in The Denver Post, Alaska Beyond, and on Bellevue College’s radio station KBCS among other places. She has a degree in biology and once envisioned a romantic career studying primates in the jungle. Then, a three-week stint planted in one steamy spot spying on howler monkeys left her with a crick in her neck and a suspicion that reporting on the science was more her calling than doing the science. Michelle clings to the idea of a free press that shares stories with heart and investigates solutions. She has reported on topics ranging from citizen science to healthy habits to solutions to the opioid epidemic. She volunteers in habitat restoration projects and on the STEM committee of a local elementary school. She likes to eat blueberries, cherries, and strawberries from her yard and has been known to attempt to grow vegetables as well. She lived in Belgium for a year as a Rotary Exchange Student and found traveling to be one of the easiest ways to gain new perspectives on the world and how others experience life.

MICHELLE MARTIN

Matt Jackson is a PhD analytical chemist specializing in translational research, where research moves out of the lab and turns into real products that can be used in the clinic. Matt has developed microscale devices—similar in size to computer processors—that can process fluids instead of electricity and extract the rarest of cancer markers from a tube of blood. This can tell clinicians how well cancer therapies are working in real-time and, for those critical patients, if a different treatment may prevent relapse.

Matt has worked closely with oncologists and has learned many different “scientific languages.” He uses this to delve deep into different areas of scientific research, pull out key concepts, and explain it in a way that (hopefully) everyone can understand. He has also been on the other side of treatment and has helped his family through battles with cancer. He knows how overwhelming it can be to make decisions about your health and life, especially when information from doctors is compressed into a few chaotic minutes of rushed conversation. So, when it comes to medical writing, Matt strives to absorb and fact-check as much as information as possible, and then serve as an interpreter for those on the front lines of healthcare. In his free time, Matt advocates for mental health awareness and is a volunteer counselor on the National Suicide Prevention Lifeline. He is also an avid abstract painter using all mediums.

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COMMONLY ASKED QUESTIONS ABOUT CANNABIS & CANCER In this column, our readers have the opportunity to ask our staff nurse anything they want to know about using cannabis plant medicine. She will provide quick and concise answers to big questions. In this issue, our focus is cancer and how cannabis interacts with the disease process. Medical marijuana is now available in 33 states and recreational marijuana is available in 11 states. This surge in legalization is leaving many newly-diagnosed patients with questions. In 2018, it was predicted that 1.7 million1 new diagnoses of cancer would be given. Receiving this news can be scary. The more the patient and family can be informed about their diagnosis, the better. Read below for some commonly asked questions about cancer and cannabis.

HOW DOES MARIJUANA HELP CANCER? Marijuana helps cancer by assisting with direct symptom relief. U.S. research has shown that the use of cannabis to relieve symptoms caused by chemotherapy is greatly effective. This is due to the antiemetic, or nausea-relieving capabilities of cannabis. THC has been licensed for palliative care as a pharmaceutical and is currently on the market for cancer patients in two drugs, Dronabinol2 and Nabilone. Both have been shown to be effective for nausea and vomiting. Cannabis can also elevate mood, assisting with anxiety and depression often felt by the patient. Pain relief is another positive effect felt from the use of cannabis plant medicine. According to a study done in 20163 by Dr. Abrams for Current Oncology, research showed that not only can cannabis assist with neuropathic pain caused by chemotherapy, it can also prevent it. Proof that these symptoms can be managed with cannabis or cannabinoid therapy is huge for the medical community and patients alike.

WHICH CANNABIS STRAINS ARE BEST FOR CANCER? This can be a difficult question to answer due to the fact not all strains or cultivars are available in each state that has legalized plant medicine. Cultivars can be specific to an area or breeder. Stories have begun to surface from individuals that have used cannabis for their cancer treatments. These individuals are sharing success stories of what was effective for them on an individual basis. The results will not be the same for each individual due to the unique variances in the endocannabinoid system. Some prefer high THC strains, whereas others are using CBD only for relief. Other patients are choosing to use a hybrid cultivar of CBD and THC to assist with their symptoms. The term hybrid comes from the mixing of various genetic traits to make a blended strain of cannabis. The high-THC cultivar known as Northern Lights4 is at the top of the list for many patients thanks to its ability to provide relief from nausea and vomiting caused by chemotherapy treatments. CBD naturally assists with pain and inflammation. The CBD-rich

cultivar Charlotte’s Web was once only available to medical marijuana patients in Colorado and now is readily available online for anyone that can find their way to the website. A hybrid cultivar known as ACDC contains both CBD and small amounts of THC. This type of hybrid allows the patient to have little to no psychotropic effects and all the healing effects of CBD. [Choosing the right strain for cancer can be tricky. As research continues for the best answers if you or someone you know wants to use cannabis for their cancer, I highly recommend that you keep a journal. To do this you would simply write down the name of the cultivar, the method you consumed it (smoke/vapor, capsules, edibles, topical, tincture, etc,) how much you consumed, and the effect it provided you. This way you have ongoing documentation of what works for you and what doesn’t.]

CAN CANNABIS CURE MY CANCER? While there are several studies showing the possibility2 of cannabinoids like THC and CBN obliterating cancer cells, whether or not cannabis can truly cure cancer is still to be determined. This is not a black and white question, there is a lot of grey area. Results are favorable but they vary for each individual. No two individuals should expect the same results. However, studies are promising in animal models. An article5 published in the Journal of the National Cancer Institute in 1975, mice were given THC for 20 consecutive days and their tumor size shrank. Another study6, published in the International Journal of Oncology in 2017, said that the combining of cannabinoids, such as THC and CBN may amplify the cancer treatment benefits. Cannabinoids may have antitumor effects shown by various mechanisms such as the induction of cell death, the inhibition of tumor metastasis7, and the inhibition of cell growth. The more research that can prove these qualities, the more theories can be developed and dosing formulations can begin to surface.

WHAT KILLS CANCER THC OR CBD? Which came first, the chicken or the egg? The answer depends on the person being asked. Some patients have found relief in CBD only treatment. Others require THC as a catalyst to CBD. Research has shown that both have been effective in killing cancer cells. The main problem with cancer is how fast the cells multiply. This is called cell proliferation. One reason we could hear so much about cannabis helping cancer patients is that cannabis is known to inhibit cell growth, or better known as being an anti-proliferative.8 The method of consumption is also a factor to consider when treating cancer with cannabis. Smoking or vaping will not produce the same effect that consuming cannabis via tincture or capsule will. It is important to distinguish that difference. 1. https://www.cancer.gov/about-cancer/understanding/statistics National Cancer Institute 2. https://www.ncbi.nlm.nih.gov/pubmed/16501583?dopt=Abstract “Cannabinoids and Cancer: pros and cons of anti-tumor strategy” British Journal of Pharmacology. Maurizio Bifulco, Chiara Laezza, Simona Pisanti, Patrizia Gazzerro. January 29, 2009. 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791148/ “Integrating cannabis into clinical cancer care” Current Oncology. Dr. Abrams. March 2016. 4. https://www.marijuanabreak.com/best-marijuana-strains-cancer “5 Best Marijuana Strains for Cancer Symptom Relief” Marijuana Break. July 3, 2019. 5. https://academic.oup.com/jnci/article-abstract/55/3/597/912322?redirectedFrom=fulltext “Antineoplastic Activity of Cannabinoids” Journal of the National Cancer Institute. A. E. Munson, L. S. Harris, M. A. Friedman, W. L. Dewey, R. A. Carchman. September 1975. 6. https://www.spandidos-publications.com/10.3892/ijo.2017.4022 “Anticancer effects of phytocannabinoids used with chemotherapy in leukaemia cells can be improved by altering the sequence of their administration.” Katherine A. Scott, Angus G. Dalgleish, Wai M. Liu. May 29, 2017. 7. https://www.fasebj.org/doi/abs/10.1096/fj.11-198184?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=fasebj “Cannabidiol inhibits lung cancer cell invasion and metastasis via intercellular adhesion molecule-1” The FASEB Journal. Robert Ramer, Katharina Bublitz, Nadine Freimuth, Jutta Merkord, Helga Rohde, Maria Haustein, Philipp Borchert, Ellen Schmuhl, Michael Linnebacher, and Burkhard Hinz. December 23, 2011. 8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171598/ “Cannabinoids as therapeutic agents in cancer: current status and future implications.” Chakravarti, Bandana et al. July 17, 2014.

DO YOU HAVE QUESTIONS FOR NURSE JORDAN? We would love to publish your question in our next issue. Please submit your questions here ____________ 11

LETâ&#x20AC;&#x2122;S

Grow! SUBSCRIPTIONS AND M O N T H LY ISSUES COMING JANUARY 2020

CULTIVARS

(FORMALLY KNOWN AS STRAINS) ERAN ALMOG Eran Almog is used to help patients who are seeking relief from nausea, pain, and sleep disorders. It helps fight indigestion, pain, and inflammation. Developed by Tikun Olum and named after a patient, it is favored by patients in Israel. It has terpenes such as alpha-pinene, beta-myrcene, and limonene which give it a woodsy, citrus taste.

MASTER KUSH Master Kush is a popular hybrid with an interesting history. Master Kush was bred from two landrace cultivars, meaning it is a local cultivar that has developed over time and without other species crossing with it. Master Kush brings on full body relaxation and a more sharpened awareness without the heavy effect some cultivars produce. Used often to stimulate appetite, help with depression, pain, stress, and insomnia.

BLUE TRAINWRECK Trainwreck and blueberry are the foundation for this cultivar which is known for its flavors of sweet blueberry and a the more earthy trainwreck. It is used to relieve symptoms of nausea, headaches, pain, and stress.

PINEAPPLE EXPRESS Pineapple Express is a hybrid of the Hawaiian and Trainwreck parent cultivars. Pineapple Express is an uplifting, energetic cultivar that is used by patients for fatigue to help them get through their day.

PENNYWISE Pennywise is a hybrid of Harlequin and Jack the Ripper. It has a CBD, THC composition ratio of 1:1. This makes Pennywise an effective daytime medicine for those who do not want or need a psychoactive effect. It is used to help with cancer treatment side effects, epilepsy, arthritis, and PTSD.

cul·ti·var - /ˈkəltəˌvär/ - noun A plant variety that has been produced in cultivation by selective breeding.

CBD CANCER BY BEN OWENS

With CBD’s increased availability, more and more patients are testing the waters to see what cannabinoids can help with their ailments, illnesses, and symptoms thereof. CBD, or cannabidiol, has infiltrated everywhere from the local dispensaries and smoke shops to nearby Natural Grocers and Whole Foods markets. While products containing CBD and hemp-derived cannabinoids abound, how do you know which products actually contain CBD and what those products can do for you? When it comes to cancer, there is plenty of anecdotal evidence supporting cannabinoid use as part of treatment. Studies are beginning to back this information up. In this article, we’ll dive into the potential that CBD has with regard to cancer treatment, examine research to date, and give you information on identifying legitimate products for use.

CBD’S TREATMENT POTENTIAL

HOW TO SHOP FOR CBD CBD can be derived from both hemp and cannabis plants, but you’ll need to live in an area with legal medical or adult-use cannabis if you’re hoping to acquire cannabis-derived CBD. All cannabis-derived products must be bought and sold in a legal, state-licensed dispensary. These products are all required to be subject to various state-mandated tests for both cannabinoid content as well as impurities and residual compounds from fertilizers, pesticides, heavy metals, molds, and more. Since the hemp markets are largely unregulated at this time, and the FDA has only approved a single use case for their sole approved CBD supplement, Epidiolex, the hemp industry runs rampant with “snake oil” salesmen. Some products contain legitimate quantities of cannabinoids, as advertised, while others may not have any included at all.

While studies are slowly on the rise,1 anecdotal evidence suggests that many of the commonly used applications2 for CBD products could also benefit those with cancer during their treatment. CBD products are used globally for inflammation, pain reduction, neuropathy, topical analgesics, appetite stimulation,3 anxiety relief, and even help sleeping. Many of these help with the symptoms of cancer treatments, such as chemotherapy and radiation, that can affect appetite, ability to sleep, pain management, and anxiety related to your diagnosis. Additionally, CBD has started to be used in post-cancer treatment4 regimens for PTSD, post-cancer pain, insomnia, and helping to maintain overall homeostasis within the endocannabinoid system. According to the National Cancer Institute, “The potential benefits of medicinal Cannabis for people living with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep. Although few relevant surveys of practice patterns exist, it appears that physicians caring for cancer patients in the United States who recommend medicinal Cannabis do so predominantly for symptom management. A growing number of pediatric patients are seeking symptom relief with Cannabis or cannabinoid treatment, although studies are limited.”5

A QUICK NOTE ON THC & THE ENTOURAGE EFFECT When the 2018 Farm Bill passed, it specifically legalized hemp and hemp-derived products so long as they contained no more than 0.3% THC. This is considered the legal threshold, and some states have restricted or broadened this requirement. While hemp plants primarily produce other cannabinoids, there is a small amount of THC produced naturally, just as CBD is produced in small amounts in high-THC cannabis cultivars. Studies have shown that CBD works best when in the presence of THC and other cannabinoids, even in very small doses. If your area allows, choosing cannabis and hemp products that have as much of the spectrum of natural cannabinoids as possible (including THC), may offer the most benefits. If you live in an area with legal access to products that contain cannabinoids like CBD, talk to your doctor about how adding a CBD regimen could make a difference in your quality of life and the effects it could have on any treatment you are undergoing. While testimonials from patients and success stories are great, in a largely unregulated hemp market, it’s best to be careful with which products and claims you trust. Stick to tested, legal products and don’t be afraid to ask a doctor, pharmacist, or local herbalist for assistance.

CBD SHOPPING TIPS

1 2 3 4 5

Buy from a trusted source. Your local gas station is probably not your first stop for legitimate medical products. They may have them, but your best bet is to start at a licensed dispensary that tests their products, a national chain that must abide by both federal and local laws, or a brand that you recognize from other legitimate marketplaces. Make sure that your CBD product has verifiable testing information. All legitimate products will have a Certificate of Authenticity (COA) and/or lab test results. Check to see if these test results vary from batch to batch (they should). If they don’t, the company is likely using the same test results for every product, an inaccurate and potentially unsafe method of labeling. Look at the labels. Does the label smear when it gets wet? Does it have a UPC (that you can plug into your favorite search engine and check against other records)? Does it have required FDA warnings? Does it appear to be tampered with? Brands that are producing legitimate products will be abiding by all applicable laws to the best of their ability, including following best practices for labeling of supplements and consumer goods. Is more information available about the brand, product, or retail location? If the brand or product has no website, no social presence, and/or no actual contact information for you to follow up with them, that product is likely a risky option. Choose CBD retailers that make it easy to speak with someone, learn more about the product, and see what employees and other customers are saying. Avoid any product that claims to be “Full Spectrum” and “Zero THC”. By definition this is a misnomer. You may have noticed many products that claim to be full-spectrum; these products, by definition, should contain every cannabinoid in the hemp plant, including small trace amounts of THC. Any product claiming to be full-spectrum and contain zero THC is falsely advertising their products. Alternatively, broad-spectrum CBD products may contain only a selection of CBD.

Referencecs: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852356/ ”The current state and future perspectives of cannabinoids in cancer biology.” Śledziński, Paweł et al. “The current state and future perspectives of cannabinoids in cancer biology.” Cancer medicine vol. 7,3 (): 765-775. Feb 23, 2018. 2. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476 Grinspoon, Peter. “Cannabidiol (CBD) — what we know and what we don’t.” Harvard Health Blog. August 24, 2018. 3. https://www.medicalnewstoday.com/articles/324745.php Chun, Christina. “CBD for cancer: Everything you need to know.” MedicalNewsToday. March 19, 2019. 4. https://www.curetoday.com/community/bonnie-annis/2019/04/fighting-post-cancer-pain-cbd-worked-for-me Annis, Bonnie. “Fighting Post-Cancer Pain: CBD Worked for Me.” Cancer Updates, Research & Education. April 5, 2019. 5. https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-p “Cannabis and Cannabinoids (PDQ®)–Health Professional Version.” NIH National Cancer Institute. June 18, 2019.

COLLECTED BY SARAH MOSS

RESEARCH CORNER A Safety Study of Sativex in Combination With Dose-intense Temozolomide in Patients With Recurrent Glioblastoma.

In the Clinical trial done by GWpharmaceuticals using Sativex ( a cannabis extract of equal parts THC and CBD) and temozolomide in recurrent glioblastoma multiforme. Editors Note | Recurrent Glioblastoma (the cancer Senator John McCain had).

STUDY FACTS The median survival rate of those: 1. in the placebo group was around 369 days 2. in the sativex and temozolomide group was greater than 550 days

The 1 year survival rate of those: 1. in the placebo group was 56% 2. in the sativex and temozolomide group was 83% In the review of the clinical trial it concluded the the CBD:THC offers â&#x20AC;&#x153;some efficacyâ&#x20AC;? in the treatment of recurrent glioblastoma multiforme with used in conjunction with dose- intense temozolomide.

Appraising the â&#x20AC;&#x153;entourage effectâ&#x20AC;?: Antitumor action of a pure cannabinoid versus a botanical drug preparation in preclinical models of breast cancer. The isolated THC or whole plant botanical preparation: 1. along with tamoxifen was found to inhibit the growth of cancerous cells 2. when used with chemotherapy gave longer time between recurrences

Isolated THC activates the CB2R (cannabinoid 2 receptor of ER+/PR+ HER2-) cancerous cells which turns on an immune response to kill the cancerous cells.

When the whole plant botanical preparation is used on the same cancerous cells: it is more effective in decreasing the cancerous cell growth and activity through multiple different mechanisms not just the CB2R.

Triple negative breast cancer is difficult to target because the cancerous cells put out no obvious distress signals that can be targeted specifically, meaning we must use a more broad spectrum chemotherapy that kills cancer cells but also healthy cells alike. When using cisplatin (chemotherapy) in combination with either the THC or whole plant botanical preparation the cancerous cells growth and activity declined significantly. The whole plant botanical preparation in combination with chemotherapy was more effective at decreasing cancerous cell growth and activity than the isolated THC in combination with chemotherapy.

THC isolated was more effective in activating the CB2R to activate the immune response.

Whole plant botanical uses a multitude of different immunological responses to decrease cancer cell growth and activity.

https://nph.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1469-8137.2002.00482.x

CANCER CANNABIS HELPS

Sucks

Cancer sucks. That is my professional medical assessment. Cannabis medicine can help.

I am a board-certified anesthesiologist but the majority of patients that I help guide are cancer patients. I have come to understand how cannabis medicine can help patients with cancer is mostly from trial--and the first patient was myself. Yes, I was diagnosed and treated for breast cancer in 2005. Fortunately, it was discovered early. Unfortunately, the treatment left me with a neuropathic pain so severe that I was no longer able to practice as an anesthesiologist. The medications that my colleagues prescribed had side effects that I could not tolerate. I was left with using diet change, meditation, and a lot of willful determination to get through my day. That was until I discovered cannabis medicine, in my case, topical cannabis medicine. Applying a topical preparation of cannabis was life altering. I was able to spend my day doing things besides concentrating on pushing away the pain. I needed to share this revelation with patients.

CANCER TREATMENT IS DIFFICULT In my quest to help patients solve their painful symptoms after breast cancer treatment, I was introduced to patients with other cancer diagnoses and goals, beyond treating neuropathic pain. I expanded treatment protocols from just topical to a sublingual administration, in addition to a diet change. Since I am an anesthesiologist and not an oncologist, and patients and their physicians are requesting my input regarding cancer treatment options, I needed to set up every patient for the best success possible. This includes food. I mandate a whole food, all plant diet as there is clinical evidence showing that it really matters. Patients have different goals depending upon where they are in their diagnosis and treatment. Cannabis and diet change can contribute at any point.

REMISSION: Of course, this is every

patientâ&#x20AC;&#x2122;s goal. I always support patients whose goal is to live, no matter how severe their disease. I have seen patients in hospice extend their lives beyond expectation using diet change and cannabis. Was it directly related? No one can say definitively. There is evidence in animals that cannabis can help kill cancer cells, prevent metastasis, and diminish the blood vessels that fuel cancer cells. Patient data using cannabis for cancer treatment has not been substantiated in a traditional double-blind randomized trial methodology. However, I have what is called anecdotes, but I prefer to refer to is as patient clinical reports. I have helped to guide patients with prostate cancer, breast cancer, pancreatic cancer, colon cancer, lymphoma, lung cancer, and other cancers who have used cannabis and diet, in combination with traditional cancer therapy or as an alternative therapy, who are currently in remission. Some of these patients are in remission for years. Some lived longer than expected.

REDUCTION OF SYMPTOMS: Cancer

treatment is difficult. Some patients are unable to complete a cancer treatment protocol because of the side effects some of which include: severe nausea, vomiting, wasting, pain, depression, anxiety, and extreme fatigue. These symptoms negatively impact the patientâ&#x20AC;&#x2122;s quality of life while going through treatment, which can last for months to years. Cannabis use has aided in improving appetite, energy levels and mood. Patients report that they are able to better participate in their lives while continuing their cancer treatment. After all, being able to participate actively in life, and engaging in social activities while going through cancer treatment, rather than being sidelined by the treatment, is a tremendous therapeutic success in and of itself.

CANNABIS USE HAS AIDED IN IMPROVING APPETITE, ENERGY LEVELS AND MOOD

EMPOWERMENT: The diagnosis of cancer is very destabilizing.

Patients feel out of control, a passive recipient, and at the mercy of the medical professionals and the pharmaceutical industry. Implementing a regimen that includes options where patients are the decision makers helps to empower and to make them feel like an active participant in their care. So where do you start if you are a patient or a concerned friend or family member? You need to find practitioners who can help guide you with the use of medical cannabis and diet. These may be separate practitioners. For medical cannabis guidance, the Society of Cannabis Clinicians (www.cannabisclinicians.org) has a list of treating cannabis practitioners that you can search by zip code. This website is a wealth of information and has a resource link that can be searched by condition. This includes articles and white papers that can help you understand a starting point for cannabis treatment. For a clinician who understands the impact of nutrition on gaining and maintaining good health the website www.plantbaseddoctors.org has a list of treating practitioners that can be searched by zip code. The websites www.PCRM.org and www.nutritionfacts.org have a wealth of information regarding a whole food plant diet and its impact on health.

Remember--with all treatment methods, including cannabis medicine--all patients respond differently. Goals and benchmarks need to be established to determine efficacy of the treatment and how to adjust the medication. This is no different from traditional therapeutic treatment. The recommendation for cannabis medicine is to start at a low dose and titrate slowly using the goals and benchmarks as your guide.

, l el w B e De b Dr.

ANNOUNCING THE OPENING OF OUR

CLINICAL TRIAL REGISTRY Pure Green, a pharmaceutical grade medical cannabis company, is now accepting patient registration for the following indications:

Chronic Pain

Anxiety

Neuropathic Pain

Insomnia

Menstrual Pain

Pain from Autoimmune Diseases

Pain from Sickle Cell

Post-Radiation Treatment Pain

Chronic Pain After Surgical Procedures

Migraine

PTSD

Opioid Reduction or Replacement

ALL STUDIES ARE IRB (INSTITUTIONAL REVIEW BOARD) APPROVED AND ARE FREE TO PATIENTS.

TO ENROLL

Please email the following information to Pure Green’s Clinical Administrator at mbrown@pure.green First and last name Phone number Just like your doctor’s office, your medical privacy and compliance with HIPAA is paramount. A clinical coordinator or a doctor will call you personally.

Best time to call you Home state ADD A SPECIAL MESSAGE Feel free to ask any questions or share any details. www.pure.green

Debra Kimless, MD, Chief Medical Officer of Pure Green, will be overseeing the trials.

Bonni A N I N T E RV I E W W I T H

GOLDSTEIN BY MICHELLE MARTIN

"CANNABIS AS MEDICINE IS NOT SOMETHING TO TAKE LIGHTLY"

Bonni Goldstein is an M.D. and medical director of Canna-Centers Wellness & Education as well as Medical Advisor to Weedmaps.com. She is the author of “Cannabis Revealed: How the world’s most misunderstood plant is healing everything from chronic pain to epilepsy.” Dr. Goldstein studied medicine at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, now Rutgers. It was during her clinical rotation in 1988 that she discovered her calling in pediatric medicine.

When she was in medical school in the late 1980s, she was taught that cannabis is a drug of abuse. But, she’s a self-described science nerd, and her intense curiosity led her on a path to becoming a prominent pediatric cannabis specialist. Goldstein didn’t start off bucking the system. She did her residency at Children's Hospital Los Angeles. Then she stayed on the next year to help them run the residency program. She started working as a critical care transport physician. In this role, she would travel to area hospitals where seriously ill kids came in with dire medical conditions, such as cardiac arrest or breathing problems related to an undiagnosed heart con-

dition. Her team’s job was to go to the area hospital, stabilize the child, and bring them back to Children’s where there were specialists who could care for them.

“Sick children make doctors nervous,” Goldstein says, especially when it’s a hospital without a pediatrician. “And there were a few times where I walked in, and we had to literally save the child's life and make sure they were stable before we would even put them in the ambulance.” Later, Goldstein transitioned from that job into pediatric emergency medicine, which she did for about 13 years. “I got a little burned out after I had my own son and was trying to be a mommy and a doctor,” Goldstein says. “I really enjoy being a doctor, so the way I did it was I worked graveyard shift for the first five or six years of my son's life, and then was a mom during the day.” Finally in 2006, she took a leave of absence to teach science, catch up on her rest, and to reassess what she was doing. A friend, who was struggling with an illness asked an innocent question that would send Goldstein on a completely different path.

“She asked me what I knew about medicinal cannabis,” Goldstein says. “I knew nothing.”

IT'S NOT MAGIC. IT'S NOT FAIRY DUST

She did some research for her friend and was at once intrigued by the science of the endocannabinoid system—how cannabis interacts with the human system. She took a job in a medical cannabis doctor's office in Southern California. “Within the first two months of working there, I just fell in love with the practice and delved into the science. That was 2008, and then in 2011, I took over the practice.” She has a few adult patients who have been her patients for many years, but as far as new patients, she’s only accepting pediatric patients. The most common conditions she treats are cancer, epilepsy, autism, ADHD, some genetic syndromes, and gastrointestinal disorders. “I have pediatric patients that were having 40 seizures a day, and they no longer have seizures as long as they take their cannabis,” Goldstein says. The science of the endocannabinoid system is what intrigued Goldstein. It’s is a system in our bodies that is made up of chemical compounds called endocannabinoids and receptors called cannabinoid receptors. Our bodies have all kinds of different receptors. Each one acts like a lock, and chemical compounds we make in our body act as the keys. For example, we have serotonin receptors, and we make serotonin; we have dopamine receptors, and we make dopamine. “We make endorphins that fit in our opioid receptors. We don't have opioid receptors for the pharmaceutical opioids. We have them because we make our own opioid-like compounds,” Goldstein says. It turns out that we make our own inner cannabis-like compounds called endocannabinoids. Goldstein says that the goal of these compounds is to balance messages that cells are sending each other. Take epilepsy and autism. These are both conditions that are neuroexcitatory conditions. The brain is over-firing and in a healthy brain if there's over firing, the endocannabinoid system goes into action. It's triggered by that over-firing, and it sends these chemicals—these endocannabinoids—out to tell the cells to stop over-firing. “It’s not magic. It’s not fairy dust,” Goldstein says. “It’s where are these compounds working?” They're interfacing with our endocannabinoid system. We also know that it's more complex. CBD works outside on other receptors and systems other than the endocannabinoid system. Ultimately, our understanding of how cannabis is medicine is based on its interaction with the endocannabinoid system. For people who have an imbalance in that system, the compounds in cannabis can provide augmentation or supplementation to make the endocannabinoid system function better.

It all comes down to where the receptors are located. So those cannabinoid receptors are dense in the brain, the immune system, and the gut. And so, when you think about those diseases that can affect your brain, immune system, and gut, there are a lot of conditions. “These receptors are also in our heart, kidneys and liver, our connective tissue in our skin,” says Goldstein. “So they're everywhere.”

WHY CANNABIS?

One reason why cannabis works for some patients might be because a patient suffers from a deficiency in their own endocannabinoids (endo for internal). Goldstein says there is some evidence to show that there is an underlying endocannabinoid problem in epilepsy and autism, two of the main conditions that she treats. She points to a study out of Stanford University last year that documented that children with autism have statistically significant lower levels of endocannabinoids. “The way I look at this is would you ever leave a child deficient in any other compound,” Goldstein says. “We don’t leave someone deficient in thyroid hormone. We don’t leave someone deficient in vi-

tamin D. For someone with type 1 diabetes, we give them an external source of insulin.” “Cannabis as medicine is not something to take lightly,” she says. “It's very, very important to me that people separate medical use versus recreational use. They are not the same thing,” Goldstein says. “Remember medical use is informed. It is supervised. It is controlled. And the goal of the use is to treat the medical condition.” Referring back to the insulin example, she says she would not give insulin to someone who did not need it, because it could be harmful. The same goes for cannabis. Goldstein only sees patients after a prescreening suggests they might have an endocannabinoid deficiency or imbalance. Goldstein says she’s a pretty conservative physician. She starts with low doses and titrates up, aiming for the lowest dose to get the desired effect with the least amount of side-effects. Her office also asks every patient if they have side effects and vast majority say ‘no,’ Goldstein reports. And just like other medications for con-

REMEMBER, MEDICAL USE IS INFORMED. IT IS SUPERVISED. IT IS CONTROLLED. AND THE GOAL OF THE USE IS TO TREAT THE MEDICAL CONDITION

ditions such as high cholesterol or depression, patients often try different preparations before they find one that is both effective and tolerable. Fortunately, in California, cannabis is very regulated through dispensaries, and some companies have worked very hard to have a consistent preparation, Goldstein says. “I spend a fair amount of time educating parents on what they're looking for. And the reality is that there is no one size fits all. And often patients try different preparations to find what works best.”

CANNABIS AND CANCER

Goldstein points out that with cancer there are different goals. One is treating symptoms—symptoms from cancer itself and side effects of chemo, radiation, or other treatments for cancer. The other goal is to kill cancer cells. She has treated patients with many types of cancer, including lung cancer, brain tumors, gynecologic cancers, leukemia, lymphoma, pancreatic cancer, prostate cancer, and breast cancer. Though Goldstein has had positive results, she says it’s really difficult to draw any conclusive results from these. “People come at different stages in their cancer,” Goldstein says. “Unfortunately

many people come at the very end, stage four and have been given two months to live.”

dose? How long do you have to take it? All of those questions remain for cancer.

Still, she can say with confidence that patients can take cannabis for symptomatic treatment—to gain appetite, help with anxiety, sleep, and side effects from chemotherapy and radiation—that those patients benefit from cannabis. She also says that she feels anyone with a diagnosis of cancer should consider starting medically supervised cannabis earlier than later.

For now, most of the basic scientific research is happening abroad, because cannabis is still a schedule one drug in the United States.

One reason is that she says there is clearcut evidence that phytocannabinoids from the cannabis plant—when put in a test tube or even an animal with cancer—can slow the growth of the tumor and can cause the cancer cells to die and can block some of the signaling messages that cancer cells send to metastasize and to grow their own blood vessels. “The big question is, of course, what about humans?” Goldstein says. “Well there are exactly two clinical trials. Both have been in patients who have glioblastoma multiforme. It's the cancer John McCain had. A very deadly, aggressive brain cancer that has a terrible prognosis.

ONE GOAL OF TREATING CANCER PATIENTS IS TO TREAT THE SYMPTOMS FROM THE CANCER AND IT'S SIDE EFFECTS. THE OTHER GOAL IS TO KILL CANCER CELLS

“The second clinical trial is being done by a pharmaceutical company and they have posted some of their results online. They took 21 patients with recurrent glioblastoma multiforme and divided into two groups. One group got chemo only. The other group got chemo plus THC and CBD. All they have reported at this point is that at the end of one year, the survival for chemo alone was 53 percent. And the survival for those that had cannabis added into the chemo was 83 percent. So there's clearly something there, right?”

WHAT EVIDENCE IS MISSING?

There are more than 400 compounds reported in the cannabis plant. As a physician, Goldstein wants more research to answer critical questions, such as which compounds or a combination of compounds in the cannabis plant kill the cancer? She is pleased by ongoing research in Israel right now looking at this question. She wants to know how she knows her patient who is coming to see her is going to get the right combination to kill this specific type of cancer that they have? What’s the best way to take it? How much should you take? What’s the

“We are so far behind,” Goldstein says. “We've lost 80 years because of prohibition.” Even so, Goldstein carries on. She has many success stories. “One patient I wrote about in my book was 15 when he came to see me,” Goldstein says. “He had stage 4 bone cancer called osteosarcoma. And he went into remission after three months of very high doses of cannabinoids. He was given about three months to live and had over 20 tumors in his chest. And now, he just turned 20 this year and remains cancer free. And there's a handful of other patients too. I don't see any reason not to use cannabis.” Goldstein cautions however, that cannabis can change how other medications behave by either increasing or decreasing their activity. “You have to be careful about that,” she says. “Being informed is the key.”

“People say ‘cannabis cures cancer,’ but that is just a sweeping generalization,” Goldstein says. “Cancer is not really one diagnosis. It is hundreds of different diagnoses, different processes. Cancers all are different. So I don't want to call that a myth. It can have some effect on the cancer, but again we're missing a lot of really important research.” She also says that cannabis is not 100 percent benign or safe. “I would say that’s about 80 percent true,” Goldstein says, “but I have seen cannabis increase seizures in children. I've seen cannabis aggravate autism. You have to be cautious.” Goldstein works with other physicians who spend a couple of days to a week shadowing her. “The can see the real world use of cannabis, the way that I approach it, and the way that I help patients come up with a protocol or a plan. I've had a lot of doctors come from California but also doctors from New York, Maryland, Florida, Missouri all come out and spend time in my office to learn.”

A FEW EDUCATIONAL RECOMMENDATIONS FROM

Dr. Goldstein “There's a wonderful book called “Cannabis Pharmacy” by Michael Backes. I haven't read all the books out there, because I mostly read the scientific literature. There’s also a lot of nice information on the website projectcbd.org and Whole Plant Access 4 Autism at wpa4a.com— it’s a great place to start if you’re just starting to research cannabis.”

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BY JORDAN PERSON

S â&#x20AC;&#x2122; N O D N A L STORY

Children using cannabis for cancer and other ailments has become common in 2019, but in 2012, Landon Riddle made headlines for his family’s decision to treat his cancer with cannabis. Countless news outlets plagued the family, riddling them with questions about how and why they would make the decision to forego chemotherapy and to treat Landon solely with cannabis plant medicine. Seven years later, GRAM felt it was time for a follow up into the life of the first little boy that successfully treated his cancer with cannabis, now growing tall and strong at the age of nine years old. We sat down with Landon’s caregivers: Sierra Riddle, his mother, and Wendy Riddle, his grandmother, in early Summer 2019, and learned that Landon is thriving.

“FORTY-FIVE DAYS INTO HIS CHEMO TREATMENTS HE NEEDED A WHEELCHAIR; HE STOPPED WALKING AND TALKING, AND WAS MORE SICK WITH EACH PASSING DAY.” Our story begins in September 2012, when 2-year old Landon’s glands began to swell and his voice became raspy. When his grandmother, Wendy, took him to the doctor, they originally passed off his condition as a virus, a virus that would eventually be diagnosed as aggressive leukemia (TCell-ALL leukemia). Tests showed a mass of leukemia cells in Landon’s chest. “This was not the type of mass that could be removed,” Wendy recalls. Landon was given a 10% survival rate upon diagnosis and the doctors told Sierra and Wendy

that he could have been dead in 48 hours if they had not brought him in. The news that no parent or grandparent ever wants to hear, that the child they love so dearly has cancer, shook the family to its core. They started chemotherapy immediately, an intense treatment on Landon’s tiny body. The pharmaceuticals they began giving him to combat the symptoms of chemotherapy seemed to make his symptoms worsen. Wendy

recalls, “Forty-five days into his chemo treatments he needed a wheelchair; he stopped walking and talking, and was more sick with each passing day.” Sierra and Wendy watched as Landon quickly declined. Physicians continued to combat his increase in symptoms with more pharmaceutical medications, prolonging his journey with cancer. “Landon was prescribed Oxycontin, Fentanyl, Morphine, Ativan, and Zofran on top of all his chemo drugs. He was even prescribed Marinol at one point for his vomiting, and

that is a synthetic form of THC. The scariest part was these narcotics were not approved by the FDA for children and had no actual dosing recommendations for children, especially as young as Landon was,” Sierra explains. At this time, Wendy made a post in “Offer Hope for Landon,” the Facebook group that they had started for Landon asking their few thousand followers for suggestions on alternative treatments for cancer. Almost immediately, Wendy received several messages. But the message that stuck out was one from a dear friend. This angered Wendy at first. “He’s just a child,” she thought. This friend, Kathleen, explained that she was in remission herself from pancreatic cancer. “I was scared to death to try cannabis at first, but after his third air lift, that was it,” Wendy says. Landon took the prescribed chemotherapy drugs for 3½ months until his family would make the life-changing

decision to treat Landon with cannabis. “Since none of the doctors could give us dosing or a starting point with the cannabis oil we followed the Rick Simpson dosing protocol which indicates that for cancer you get the patient up to a gram of oil a day in 90 days. We followed this protocol as closely as possible for the first six months,” Wendy explains. “Before we started the cannabis oil, Landon was needing a blood transfusion and platelet transfusion every 4 to 6 days. Once we started him on the cannabis in January 2013, he only needed one more blood transfusion and platelet transfusion. Once the cannabis oil saturated his full body system he never needed another blood transfusion, platelet transfusion, or any narcotics.” While Wendy remained in Utah, Sierra and Landon relocated from St. George, Utah to Colorado Springs, Colorado with a wish, hope, and a prayer. Around the same time that Landon was having his

fight with leukemia, there was also a young girl in Colorado that was using a strain that was named after her, now known as Charlotte’s Web. The creators of this strain, the Stanley brothers, worked with Landon to create dosing that was specific to his needs. Up until 2012, the strain had primarily been used for children with seizures. When Landon’s journey with cannabis began, Sierra reached out to several physicians and kept being told, “Landon was the youngest child to use cannabis for leukemia so dosing was unknown.” Sierra and Landon would eventually live with Amanda and Joel Stanley after they first arrived in Colorado. Landon began his daily dose of Charlotte’s Web, an aggressive dose of medicine for an aggressive disease. “The strain had a two-to-one ratio of THC to CBD at that time (roughly 24% & 12%, respectively) and Landon would take that same exact dose for one year, approximately 1000mg of THC and 500mg of CBD every day. It sounds like a lot to some people

WE WERE CONFIDENT WE WERE MAKING THE RIGHT DECISION FOR LANDON REMEMBER TH AT THE HOLISTIC REALM IS NOT JUST CANNAB IS; THINK OUTSID E THE BOX. 32

who have used cannabis for their own health, but we were willing to try anything at that point and we were confident we were making the right decision for Landon,” says Sierra. “January through July of 2013, Landon would use both chemo and cannabis, but during that time we began weaning him off of the pharmaceuticals. He did not do any blood transfusions, and we kept going with his cannabis treatments. We were not always honest with doctors of our plans for Landon, that we wanted to just use cannabis, but truly we couldn’t be honest out of fear,” said Wendy. The fear factor came from the doctors that were treating Landon. “They reported us to Child Protective Services, they threatened us with forced chemo and medical foster care,” Sierra exclaimed. Landon’s family then had to hire an attorney to help their case. They were able to demand Landon’s constitutional right to compassionate cancer treatment. Monthly checks began to ensure that Landon remained in remission. Photos of Landon and blood tests were submitted to verify that he was in fact in remission. After using Charlotte’s Web successfully for a year, the family began crafting their own oil for Landon’s needs. “We use five strains every time we make his oil. We constantly change it up so his body does not create a tolerance,” said Sierra. Thanks to that change, “we have had no need to increase his oil usage. We even do once a year endocannabinoid cleanses because we realize Landon has been on cannabis longer than he has been without it. We give his system breaks to help his body reset. The worst part of pediatric cancer may be what are known as “late effects.” Late effects are symptoms that children experience months or years after receiving chemotherapy and radiation treatments. These symptoms affect the mind and the body. “Just because treatment stops does not mean that all the issues are gone. Landon has already had at least fifty spinal taps in his little life. His organs have been checked for damage. Cancer is the gift that keeps on giving; you can’t exchange it, and it’s non-refundable,” Sierra expresses. Seven years after their fight with leukemia, the stress and angst heard in the voices of Sierra and Wendy is still all too palpable.

learning, and memory retention. “Landon is in second grade but according to his age could be in fourth grade, but he still has trouble reading. Basic things like 1+1=2 he learns, but the next day, he can’t recall the information,” says Sierra. He has a hard time socializing in school and being around healthy kids. “He is very aware. One day someone brought cupcakes to school for a birthday of one of Landon’s classmates. Landon told the kids in his class that he couldn’t eat one because sugar causes cancer, and he had cancer,” expresses Sierra. PTSD is common in cancer patients but Landon Riddle was one of the youngest to ever be diagnosed in Colorado according to his family. “They wanted to put him on Xanax and Adderall, and he was only four years old!” exclaimed Sierra. The family continued to choose cannabis plant medicine over the pharmaceutical options. They watched Landon continue to improve. Alternating delivery methods of cannabis has assisted with the treatment of his varying symptoms. “If he was throwing up he could not get capsules or oil down so we taught him how to use a vape pen during his vomiting episodes. Some parents thought I was crazy, but I just wanted my baby boy to stop suffering. I was willing to do anything,” said Sierra. The term “chemo brain” came up a few times during our interview. Chemo brain is a diagnosis and term often used by cancer survivors to describe thinking and memory problems caused by cancer treatments.2 It causes Landon to have separation anxiety and is believed to amplify the PTSD because he can not recall things. Landon still undergoes occupational therapy and will soon be starting psychological therapy, according to his mother. Landon’s cannabis usage continues to this day and will for the rest of his life, preventatively. His dose is far less than it was when they were aggressively treating his cancer. “He still consumes his oil in capsules but now uses his CBD during the day at 100mg and then takes his ethanol based THC extraction at bedtime and uses 50-100mg depending on how he is feeling,” says Wendy.

According to the National Cancer Institute, the risk of developing a second cancer is very high.1 Childhood cancer survivors have issues with growth and development, moods, feelings, actions,

Sources: 1. https://www.cancer.gov/types/childhood-cancers/lateeffects-pdq#_387 “Late Effects of Treatment For Childhood Cancers” National Cancer Institute. 2. https://www.mayoclinic.org/diseases-conditions/chemobrain/symptoms-causes/syc-20351060 “Chemo Brain” Mayo Clinic 3. https://cbdhut.co/ourstory/ “Our Story and Mission” Landon’s Health Hut

“Landon is an old soul,” Sierra tells us. “He has been through so much for a child his age, so that makes him different. He prefers to be around adults more than children his own age. He knows that he is different from other kids, and he simply doesn’t want to be the cancer kid anymore, he just wants to be Landon.” “When we were going through Landon’s treatments, I constantly had parents reach out to me asking for help. I decided to start a company on behalf of my son, with the hope that someday he will take it over. One day he says, ‘I want to be a policeman,’ the next day, he changes his mind. My hope is that Landon’s Health Hut will be his legacy,” Sierra tells us. Landon’s Health Hut3 creates natural and organic CBD health products. Their mission is to reverse the unhealthy path our nation is on by giving you pure, all natural, and organic CBD alternatives to traditional medication. For any parents reading this article that have considered treating your child with cannabis but still have concerns, Sierra’s advice about the incredible progress Landon has made is this, “The number one, most important thing you can do-be your child’s advocate. Do not take to heart everything [physicians] tell you. Do your research. Don’t be a ‘Complacent Carol!’ Ask the physicians questions. Ask them things like, ‘Has the FDA approved all dosing for all of the medications you want my child to take?’ Remember that the holistic realm is not just cannabis; think outside the box. You may be told a treatment is illegal or unavailable here in the US, but the same treatment may be used widely in the UK. It is scary to think that physicians care more about the treatments then they do about our kids. This is why the most important thing you can do is be your child’s advocate.” On November 15, 2019, Landon Riddle will be 7 years in remission from cancer, and 5 years chemotherapy free. “This makes Landon part of history,” Sierra tells us, “He is the first child to cure his cancer with cannabis. My hope is that he grows up and sees the legacy he created at a young age. I hope that he can take root in the power that what he did unknowingly changed the course of history and that it’s ok to be different.”

PHOTO | NATALIYA ARDITI

Mara A N I N T E RV I E W W I T H

GORDON BY HEATHER DEROSE

GRAM recently had the opportunity to speak with Mara Gordon. Sheâ&#x20AC;&#x2122;s worked with over 1,000 cancer patients and used cannabis to treat her chronic pain and help countless others. She is passionate about the medical benefits of cannabis and its impact on the 7 billion people and animals that share our planet. She plans to continue to be involved with cannabis and making it available for those who need it for the rest of her life.

AS A PROCESS ENGINEER, I WAS LOOKING FOR PATTERNS AND PROFILES IN THE USAGE OF CANNABIS

GRAM Tell us a little about yourself – what is your focus in the industry.

I am Mara Gordon and am the co-founder of Aunt Zelda’s, The Oil Plant, Zelda Therapeutics, and Calla Spring Wellness. My focus is in the development of cannabis treatment protocols for seriously ill patients in California, and I also use my platform to advocate for change in the healthcare system.

GRAM Tell us about how you got into cannabis. MG: Before founding Aunt Zelda’s, I worked as a process

engineer, helping Fortune 500 companies create intelligent software. Throughout my life, I have found myself to be the primary caregiver for friends and family who were facing catastrophic illnesses—my husband, Stewart Smith, and I also had our own health challenges, mostly debilitating back and neck pain. I personally was prescribed over 23 pharmaceuticals, including fentanyl, methadone, and Norco. Although we lived in states where cannabis has been legalized (Colorado and California), not a single physician mentioned cannabis as a pain treatment option.

A friend mentioned to me that she combatted her fiancé’s chronic neck pain with pot brownies, and after some initial skepticism, we decided to give cannabis a try. After experimentation in the kitchen with oil-heavy baked goods, we found my Aunt Zelda’s carrot cake recipe to be the perfect fit. Soon, friends began to comment on the health improvements they were seeing in us, and we were frequently asked to help these friends or their loved ones.

PHOTO | NATALIYA ARDITI

As a process engineer, I was looking for patterns and profiles in the usage of cannabis, and in order to make cannabis a reliable medicine, it was necessary to lab-test and track the usage, so we asked our friends to provide feedback as to how much they were taking and how they were feeling. The word of the carrot cake began to spread, and it was quickly clear that there was not a way to easily scale this baking operation, let alone consistently dose, so we began bottling and selling the oils on their own. Soon, the family of a 6-year-old with a brain tumor came to us for help, and from there, we began the manufacturing of extracts to address the needs of seriously ill patients.

GRAM You’ve worked with over 1,000 cancer patients, what can you tell us about cancer and cannabis?

MG Cannabis is one of the most important and interest-

ing tools available to medical professionals and patients when addressing a cancer diagnosis. Many first come to Aunt Zelda’s looking for help dealing with the side effects of allopathic treatments. In many cases, as they see reduction of the tumors in size and speed of growth and metastasis, they increase the dose to a therapeutic cancer-killing dose. As for what that specific dose is, it depends on the individual. For example, a 40 year old woman with triple negative breast cancer may do well on < 100mg THC and 200mg CBD daily. Another woman with the same diagnosis may require a much higher dose—or lower. That is why, when establishing a therapeutic dose, it is important to keep an open dialogue going between the patient and medical provider—check the blood work to track liver counts and tumor markers, examine scans for tumor changes, determine whether the current dose is achieving the objective.

Once the objective has been established (side effects or cell death) we begin the treatment protocol with a ratio of 1:1 or 1:2 or 2:1 taken in multiple doses throughout the day. These ratios are not the same as products with ratios. For example, a ratio of 1:1 may look something like this: 100mg THC taken in 2 doses (10mg in the morning, 90mg at bedtime)

100mg CBD taken in two doses (50mg late morning,| 50mg early evening)

As you can see, these are not in the same product, but instead a total daily consumption of 1:1. If a 2:1 ratio is recommended, which is the case in many types of cancers, then that protocol may look more like this:

100mg THC taken in 2 doses (10mg in the morning, 90mg at bedtime) 50mg CBD taken in two doses (25mg in the late morning, 25mg taken early evening)

Keep in mind these are examples that may differ widely from patient to patient.

GRAM What can you tell us about cannabis and cancer treatment in children?

MG We have found children to be very promising to work

IT DOES MAKE SENSE TO INCORPORATE CANNABIS INTO ONE’S LIFESTYLE, BUT IT IS NOT A PANACEA. 38

with because there is no resistance associated with psychoactivity. Children tend to adjust quickly when titrating. Also, we have seen children require far higher doses than adults for the same diagnosis. This may be related to metabolism and the presence of cannabinoid receptors in places not seen in adults. At this point, it is theoretical the reasons why. However, we are moving forward with treatments based upon outcomes. There is no fatal dose, so no risk of overdose if the amount given is in excess of what is required.

GRAM Do you think cannabis can aid in cancer prevention?

MG That is a very difficult question to answer as there

have been no long term studies to prove out this hypothesis. One of the roles of the endocannabinoid system within the body is to regulate homeostasis. When everything is running smoothly there is less opportunity, theoretically, for malignant cells to multiply and spread. The same way regular exercise, a healthy diet, sufficient sleep, and community are all integral parts of maintaining our physical and mental health, adding activation of the CB1 and CB2 receptors makes sense. Does a healthy diet guarantee longevity or absence of disease? No, any more than any one treatment works for everyone. It does make sense to incorporate cannabis into one’s lifestyle, but it is not a panacea.

GRAM What would you recommend for patients new to cannabis?

MG I suggest patients begin with ⅓ to ½ a milligram of

THC and no more than 5mg CBD when first beginning to use cannabis. In many instances topical applications are the best initial entry point as there is little if any psychoactivity. Many, in fact, find that as little as 2.5mg THC is the ideal dose for them—unless treating serious diseases. Aunt Zelda’s introduced a 1:1 ratio infused oil with 10mg THC and 10mg CBD per mL, which means each drop delivers 1/3mg of both THC and CBD. The CBD may modulate the effects leaving the patient feeling less effect without decreasing the health benefits. I feel it is important to also mention that many patients report CBD making them feel anxious or sleepy. It is not as “without side effects” as many brands would like consumers to believe. Take it with caution.

GRAM Do you have a preference on type of consumption method when recommending cannabis?

MG My preferred methods of ingestion in the following order: 1. Sublingual or buccal infused oil or extract, 2. tincture, 3. certain types of edibles, 3. lab-tested flower, 4. vape unadulterated oils in safe devices. Aunt Zelda’s is producing a cartridge using the same oils patients ingest to be used with the Hanu Stone vaping device. It is important when vaping to be certain there are no additives in the oil, and that the device itself contains no toxic metals or chemicals. Also, the temperature used to heat the oil can be problematic.

GRAM Tell us about your company. MG Aunt Zelda’s specializes in profile-specific, full-spectrum

oils with high concentrations of cannabinoids, terpenes, and other beneficial compounds. Our whole-plant extracts are produced using organic ethanol and our infused oils feature organic olive oil.

Our vision for treating patients is clear: start with organic material that has been accurately tested, process in a good manufacturing practice facility (c-GMP) to create high-quality medicines, have patients consult with medical professionals who are educated in the endocannabinoid system, understand dosing for different diagnoses, and educate budtenders, dispensaries, and the public. In harmony with traditional medical care, we continue to be committed to all patients who can benefit from optimal treatment with cannabis.

GRAM What makes you passionate about this industry? MG It is not accurate to say I am passionate about the indus-

try as much as I am passionate about the medical potential of cannabis. In fact, what I do has very little in common with much of ‘the industry’ as it is presently depicted. A woman recently told me how excited she was about her company’s commitment to releasing new SKUs each month through the end of the year. Creating new SKUs in order to compete for the finite recreational dollars is required in her industry. In mine, by contrast, we do extensive research and development on formulations based upon patient data showing efficacy in treating a variety of conditions. Once we do limited testing with patients, the product is then made available for sale. The road to market is not a quick one. However, the medical cannabis

patient uses the same product indefinitely as they treat their condition. Think of it this way—a recreational product is used to create an experience (happy, mellow, energized, etc.), and a medical product is used to remove something (pain, insomnia, inflammation, anxiety).

GRAM What changes do you hope to see in the cannabis industry 5-10 years from now?

I hope to see cannabis descheduled in the USA with control kept at the state level for recreational products, and the FDA or equivalent for medical. Controls will be put in place to block large conglomerates from monopolizing the space. If I compare medical cannabis to the pharmaceutical industry, CVS and the independent compounding pharmacy each play an important role in health care. It doesn’t have to be either-or. There will be people who are happy with lower quality mass produced medicine, but there will also be many people with special needs that cannot be met by the mass market.

There are too many layers of licensing in CA with unreasonable fees and taxes throughout. Ideally, everyone will buy from a licensed regulated market. This is necessary in order to diminish safety concerns—both health and security. Education needs to be included in medical schools and nursing programs so professionals can converse intelligently with their patients, and monitor their cannabis use, and there needs to be a degree program similar to what is available for pharmacists and lab technicians in dispensaries (pharmacies). More accredited clinical trials will be completed. Products will be covered by a combination of health insurance and a Health Savings Account. Also, I would like to see cannabis as a first line of defense instead of a Hail Mary when nothing else has worked. More lives will be saved, and quality increased, by this shift.

GRAM What are your future ambitions – where do you hope to go next?

MG There are 7 billion people on this planet with endocan-

nabinoid systems—not to mention the animals—who can be helped by cannabis. Aunt Zelda’s will work to get medicine into the hands of everyone who needs it. I am 60 years old and plan to be involved with medical cannabis indefinitely. The next place I go is the next place that I am required to make this a reality.

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TREATING CANCER WITH

CANNABIS in the OUTDOORS BY BEN OWENS

In the summer of 2003, my perception of cancer would change forever. Every year, we picked a place to go camping for a couple of weeks each summer as a family, exploring local areas, seeing the sights, and spending time in the great outdoors, away from familiar settings and routines. These trips bring back fond memories, even as I write this. That summer was different though; it was during this trip that I learned that my mother had been diagnosed with breast cancer. The news came as a shock to both my sister and I, having been sat down by our parents during one of the last nights of the camping trip. We had been told that the trip might get cut short but weren’t told why; now we knew. My mother’s doctors had said that they would not recommend waiting any longer. Cancer changes things. It not only affects those diagnosed with it, but also those that feel the ripple effect of those changes. Cancer quite literally cut my summer camping trip in half (we went on the second “half” a few days later) and I will always remember that summer trip to the Outer Banks as full of those poignant moments where you try to soak up as much time with your loved ones as possible. Whether you or your loved one received the news by a campfire or in a hospital bed, a diagnosis of cancer changes everything about your life. Specifically, it reignites a desire to spend as much time as possible with those that are closest to you, doing what you love for as long as you are able. When my family received the news of my mother’s breast cancer, we could have stayed home, avoided any extracurriculars, and basically reduced her life to hospital beds and looking out of a window, but we didn’t. Instead, we packed up our belongings for

the second time that month and headed out for another camping trip, this time to the mountains of Asheville, NC. As a family, we decided that “making the most” of our time meant doing what we loved, and what she loved, as long as we could. For many, cancer seems like a cruel sentence, handed down by those on high, explicating that you are no longer supposed to enjoy your favorite activities with the people around you. Thanks to cannabis, many patients now have an option for extending the time that they have with their loved ones and retaining their ability to go hike, camp, run, or even take a walk in the park. Not only is a cannabis regimen helpful in mitigating symptoms and enhancing quality of life during treatment, spending time in nature has also been shown to have an impact on a patient’s ability to fight diseases and expedite recovery time.

THE SCIENCE BEHIND NATURE’S IMPACT ON HEALTH Studies have shown that the belief in nature’s healing powers isn’t just an old wive’s tale; there have been countless studies in the United States and worldwide that explicate the benefits of spending time in nature. One study examining twenty years’ of data on the role of nature in cancer patients’ lives found that the primary themes that naturally evolve from the research: “Connecting with what is valued; being elsewhere, seeing and feeling differently; exploration, inner and outer excursions; home and safe; symbolism, understanding and communicating differently; benefitting from old and new physical activities; and, enriching aesthetic experiences.”1 These themes suggest a variety of benefits that patients experience when outside or exposed to nature.

The Japanese regularly encourage people to visit natural areas to help relieve stress and improve health in a practice known as shinrin-yoku, or “forest bathing,” where you are encouraged to take in all that the forest atmosphere has to offer. The study mentioned above goes further, offering the following conclusion based on two decades of scientific research:

“Nature provides patients with unburdened physical and psychic space invested with personal significance. Findings propose nature’s role as a ‘secure base’ offering patients a familiar and nurturing context from which new perspectives can emerge and caring connections can be made with themselves, others, the past, and the future. As such, nature supported patients to navigate the clinical and personal consequences of cancer. Comprehensive representation of cancer patients’ nature experiences identified patient values and care opportunities embedded in clinical and personal environments, which may be considered for future research and care service development.”1 42

Studies have shown that time spent in nature, among forests, or even simply having a window in your hospital room can impact immune health, reduce stress, lower blood pressure, improve your mood, help with focus and the reduction of attention fatigue or ADHD-like symptoms, and expedite recovery from surgery. Personally, hiking offers me a chance to regain balance and find clarity in my thoughts; I can get away from distractions, stimulate my senses, and be reminded of the beauty found in the simplest moments.

CANCER & CANNABIS Taking a walk outdoors, going for a hike in nature, and even making sure to look out the window every now and then are great ways to take advantage of the benefits that nature can offer for our bodies, especially after a cancer diagnosis. Additionally, medical cannabis use has been shown to ease the symptoms of cancer and allow patients and their families to make the most of the time that they have. That could mean easing the nausea from cancer treatments like chemotherapy and radiation so that you can go camping for the weekend in spite of ongoing treatments or simply keeping up with a regular cannabis regimen so that your cancer stays in remission. Not only is there anecdotal evidence to support these claims, science is beginning to back them up as well. Studies on cannabis use and cancer are showing that tetrahydrocannabinol (THC) has the ability to inhibit cancer cell growth in our bodies, which suggests that regular use could help keep cancer at bay and even help fight back.2 Studies on patients that utilize cannabis for the treatment of cancer and the effects of cancer treatment symptoms report cannabis’ efficacy in helping with nausea3 and related symptoms, as well as an increased life expectancy for those patients.4

I was introduced to cannabis in the outdoors and believe that this association of nature with cannabis consumption allows us to reap the benefits of both our experience and our consumption in ways that either alone could not. If you have the ability to combine a cannabis treatment with your conventional cancer treatments, it is likely that you will experience a better quality of life and have the ability to participate in outdoor activities, even in small doses, due to cannabis’ ability to mitigate incapacitating aspects of the diagnosis. When combined with time spent in nature, these benefits can compound, helping you to focus, connect with loved ones, truly participate in the memories being made, and even expedite your recovery time. Make sure to heed the tips above for a positive, memorable experience that is likely to also be beneficial to your health, and stay tuned to this column each issue for more news, tips, and research surrounding the benefits of using cannabis on your adventures in the great outdoors. Even if you only spend a few minutes of time outside every day, take advantage of the increased mobility thanks to medicinal cannabis use and compound those benefits with the ones nature offers. To get you started, here’s a few helpful tips for making sure your outdoor outing is enjoyable, memorable, and accessible to everyone.

1 2 3 4 5

Choose an outing based on your ability; don’t over-exert yourself. The point of the adventure is to feel better, rather than exhausted and worse than before you left. If you are accompanying people who are in treatment, consider their abilities and plan an outing that will allow everyone to enjoy the experience. Pick a destination worth seeing, especially if you or the other people in your group spend a lot of time indoors; make it a destination that everyone is excited to reach. Sometimes, it can be helpful to offer a few options to your group and see what catches their interest, as most people don’t have a ready-made list of destinations they want to visit. Look for accessible trails and locations like Wilderness on Wheels, a handicapaccessible property in Grant, Colorado that features camping, fishing and a mile-long boardwalk hike accessible to all visitors. Accessible outings are great because everyone can participate, even if you require walking assistance or you’re confined to a wheelchair. Know how cannabis affects you before consuming it for a public outing; take it slow if you’re nervous. Cannabis can help ease the aches, pains, and other symptoms associated with your diagnosis, but it can also be overwhelming when taken in excess and/or in new settings. You can always consume more, but you can’t consume less. Take pictures or write about your adventure. One of the many things I was advised to do as a young scout was journal about my outings and adventures. At the time, it seemed silly, but, looking back, it is one of the things I am most grateful for from my family campouts and hikes. My mother has kept a journal of our family outings for as long as I can remember, and it is something that we treasure; it allows us to look back on fond memories, remember funny stories, and keep track of how we grow and develop as individuals. If you’re going on an outing with someone who has been given a terminal diagnosis, these jotted down memories and candid photographs can be an invaluable way to remember the good times you had together.

References: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5445345/ “Blaschke, Sarah. “The role of nature in cancer patients’ lives: a systematic review and qualitative meta-synthesis.” BMC cancer vol. 17,1 370. 25 May. 2017. 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360617/ Guzmán, M et al. “A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme.” British journal of cancer vol. 95,2 (2006): 197-203. 3. https://www.ncbi.nlm.nih.gov/pubmed/18816298 NL, Cluny et al. “The effects of cannabidiol and tetrahydrocannabinol on motion-induced emesis in Suncus murinus.” Basic Clin Pharmacol Toxicol. 2008 Aug;103(2):150-6. 4. https://www.gwpharm.com/about/news/gw-pharmaceuticals-achieves-positive-results-phase-2-proofconcept-study-glioma “GW Pharmaceuticals Achieves Positive Results in Phase 2 Proof of Concept Study in Glioma.” GW Pharmaceuticals Website. Feb. 7, 2017.

5 HELPFUL TIPS FOR GETTING OUTDOORS DURING TREATMENT

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DISEASES | DISORDERS | DISCOVERIES

IS CANNABIS THE ANSWER?

Many people know how cannabis can help cancer patients through side effects of chemotherapy treatment, but it can also help those affected by brain cancer. Compounds found in cannabis, called cannabinoids, have been shown to reduce tumor cell growth in cancer.

BY HEATHER DEROSE

A brain tumor is a mass or growth of abnormal cells in the brain. There are many different types of brain tumors. Tumors can be noncancerous (benign), and others are cancerous (malignant) and can begin in your brain (primary brain) or cancer from another part of your body can spread to your brain (metastic tumor). According to the American Brain Tumor Association, over 700,000 Americans are living with a brain tumor today, and only about 32 percent of brain and central nervous system tumors are malignant. Over 28,000 children in the U.S. are fighting brain tumors today, and nearly 16,000 people will die as a result of a brain tumor this year. Among children ages 0-14, brain tumors are the second most common cancer and are the leading cause of cancer-related deaths in this age group. Doctors are still unsure why some cells begin to form tumor cells. They believe it may have to do with the genes, the environment, or a combination of both factors.

Treatment is based on several factors including age, overall health, medical history, type, location and size of tumor, and how likely it is to spread or recur. Treatment options include observation, anti-seizure/anti-epilepetic drugs (AEDs), steroids, and surgery. If the tumor is considered a high-grade tumor or aggressively spreading, treatment after surgery may be necessary, which can include radiation, chemotherapy, targeted therapy, tumor treating fields, or clinical trial options if there’s one available.

Over 120 types of brain tumors exist. Each type may have a unique treatment approach. Many brain tumors are removed with surgery because of the local damage by the growth and pressure caused on crucial areas of the brain. Brain tumors can also block the flow of fluid around the brain, which can cause increased pressure and inflammation on the skull. With thousands of brain tumor surgeries performed every year, some patients and doctors are looking into cannabis for treatment and protective qualities.

Studies about tumors and cannabis are finding promising results. The “Inhibition of tumor angiogenesis by cannabinoids” research study found a basis for anti-tumor action of cannabinoids and inhibiting tumors to develop new blood vessels and growth within a person. Another study called Cannabinoids and Cancer from Israel also found cannabinoids interfering with the actions of tumor cell growth factors by decreasing new blood vessel formation spreading the cancer. The study states that additional cannabinoid receptors may exist and could explain some anticancer effects, but without knowing more it is very difficult to determine the structural-activity relationship for the cannabinoid anticancer effects. The study summarizes that cannabinoids may represent a new class of anticancer drugs that may delay development of cancer growth and inhibit blood vessel formation and the spreading of cancer cells. There are several other studies that summarize the same anticancer effects of cannabiniods.

CANNABINOIDS SHOW AN ACCEPTABLE SAFETY PROFILE WITH MINIMAL SIDE EFFECTS Cannabinoids show an acceptable safety profile with minimal side effects, especially when compared to other treatment options, and they have promising results inducing tumor cell death and slowing and preventing cancer cell growth. This is why some brain cancer patients are opting to try cannabinoid therapy for treatment before opting for brain surgery. Since cannabinoids regulate key cell signaling pathways involved in cell survival, invasion, blood vessel formulation, and spreading, it makes sense that patients are exploring cannabis therapy after receiving a brain cancer diagnosis. With the federal government of the U.S. holding a patent on cannabinoids as antioxidants and neuroprotectants, it only strengthens the case to consider cannabis therapy options. Adding cannabinoids for their neuroprotectant properties to limit neurological damage with a brain cancer diagnosis may provide benefits as well as help treat the cancer. With nearly 16,000 brain cancer deaths in the U.S. every year and brain cancer being the leading cause of cancer related deaths among children, researching further treatment options for cancer with cannabis is needed to help save and improve the quality of life for so many people. The promising results of cannabinoid studies continue to give hope to all the people and families affected by a brain cancer diagnosis.

1. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=180&id=1aTxXkya4erJhI1BQiqhC6Ln-gOCPQlvu&Itemid=1000000000000 2. https://www.abta.org/about-brain-tumors/brain-tumor-education/ 3. https://braintumor.org/brain-tumor-information/treatment-options/ 4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/basics-of-brain-tumors 5. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=180&id=1TILrepnMbRWdJd8ZH2SoZzBTHFXImSSt&Itemid=1000000000000 6. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=180&id=1MAOyGjUt6CZp9kQN3T0pH0fXUxvurqWU&Itemid=1000000000000

Fighting

BREAST CANCER

with Knowledge BY BEN OWENS

At least one in eight women will develop breast cancer in her lifetime. More than 300,000 women and 3,000 men are estimated to be diagnosed with new cases of breast cancer in 2019 alone. Second to lung cancer, breast cancer is the second main cause of cancer death. 85% of breast cancer occurs in women with no family history of breast cancer. These instances of cancer occur as a result of genetic mutations that happen as part of the aging process or as a reaction to experiences throughout our lives. Due to advances in treatment science, early screenings, and increased awareness of symptoms and signs, the mortality risk associated with breast cancer has decreased.Â Incidence rates have been on the decline since 1989, but there are still roughly 3.1 million breast cancer survivors living in the United States. With the recent trend in cannabis legalization, many patients and survivors have turned to cannabis for relief from symptoms of their cancer and/or conventional treatments, and science has begun to back up the efficacy claimed in anecdotal evidence.

WHAT IS BREAST CANCER?

IN 8 1 T S AT LEA N WILL WOME BREAST OP DEVEL R IN HER E CANC TIME LIFE

Breast cancer is a cancerous growth that begins in the breast tissues of both women and men, though it is significantly more common among women. As with all cancers, breast cancer begins with an abnormal mutation of cells.1 Cells may be replicating that should not be or sticking around when they should decompose. This abnormal cell growth results in a tumor, which, when malignant, can be the beginning of cancerous growth. For breast cancer, this process begins in the breasts and, in advanced stages, can move to glands and lymph nodes (metastatic cancer), which can then spread throughout the bodyâ&#x20AC;&#x2122;s cell network. Even if your family has no history of cancers, these genetic mutations can happen to your cells as a result of getting older or simply through daily life encounters with pollution, chemicals, and everything else we come in contact with.

TYPES OF BREAST CANCER

There are three main types of breast cancer: invasive, noninvasive and metastatic.2 Additionally, there are five (0 - 4) stages of cancer, with a higher number correlating with increased severity due to the disease spreading further.3 INVASIVE BREAST CANCER | There are multiple forms of invasive breast cancer, but the most common is invasive ductal carcinoma (IDC), making up about 80% of all breast cancer instances. According to breastcancer.org, “Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Ductal means that the cancer began in the milk ducts, which are the “pipes” that carry milk from the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue.”4

NON-INVASIVE (IN SITU) BREAST CANCER | Unlike their invasive counterparts, non-invasive breast cancer has not invaded tissues surrounding the breast.5 These cancers stay “in the same place,” or “in situ,” and are sometimes referred to as carcinoma in situ. These types of breast cancer do not grow into or invade tissues within or surrounding the breast area. Some cancers can possess both invasive and non-invasive cells that have mutated and such instances are treated as cases of invasive cancer.

METASTATIC BREAST CANCER | Also referred to as Stage IV Breast Cancer, Metastatic Breast Cancer is a type of breast cancer that has spread to other parts of the body, most commonly the liver, brain, bones, or lungs.6 As a cancerous tumor grows, cancerous cells may break off from the original infected breast tissue, traveling through the lymphatic system or entering the bloodstream.

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CANNABIS & BREAST CANCER

Cancer organizations are beginning to recognize the efficacy and prevalence of medical cannabis applications as they relate to cannabis treatments. BreastCancer.Org lists common anecdotal evidence of cannabis helping with pain, nausea, appetite stimulation, insomnia, and anxiety surrounding treatment and diagnoses, and goes so far as to offer advice and cautions as to beginning a cannabis regimen for breast cancer treatment.8 According to Virginia F. Borges, M.D., MMSc., professor of medicine and director of the Breast Cancer Research Program at the University of Colorado Cancer Center, cannabis is helpful in mitigating side effects of prescription drugs that are used to control side effects. “By adding in medical marijuana, it often allows me to cut back on the number of drugs I prescribe [to patients],” explains Borges. “With a high-quality source for medical marijuana and knowing how it affects an individual, using medical marijuana can put more control back in the hands of my patient. If someone is feeling good, she may only need to take one or two drops per day. If she’s not feeling good, she may need three or four drops per day. Many of the prescription drugs don’t have this flexibility. Any time you can give control back to a person when they’re living with cancer, it’s a good thing.” In spite of doctors and healthcare professionals beginning to accept cannabis as a part of treatment, studies are still in their ear-

ly stages when it comes to supporting these anecdotal claims with clinical data.9 The main problem is the legality of cannabis on the federal level and the focus on the harms of cannabis in previous studies that received funding. There has been a lack of focus on the benefits of cannabis until recently, and studies that have been performed or are currently being performed suggest cannabis can play a role in treatment but have not found enough “robust scientific evidence to prove that these can safely and effectively treat cancer.”10 Most of these studies have been carried out on cancer cells or animals with cancer, which makes it difficult to generalize these limited laboratory results to humans beyond anecdotal testimony.11

While studies may still be in their early stages, testimony from patients and the results of animal studies suggest that cannabis, specifically active cannabinoids such as THC and CBD, could help play a role in both the mitigation of negative side effects of treatment and prescriptions as well as preventing cancer cells from spreading any further.11/12 In the meantime, modern cancer treatments continue to advance to allow for early detection and appropriate treatment as determined by your surgeon and oncologist. If you’re considering using cannabis in addition to your conventional treatment, you may want to introduce the idea with one or more of your doctors and see what their opinion is and if they have any recommendations for your medicinal use.

1. https://www.breastcancer.org/symptoms/understand_bc/statistics ”U.S. Breast Cancer Statistics.” BreastCancer.Org. Feb 13, 2019. 2. https://www.breastcancer.org/symptoms/types “Types of Breast Cancer.” BreastCancer.org. Oct. 16, 2018. 3. https://www.cancer.ca/en/cancer-information/cancer-101/what-is-cancer/stage-and-grade/staging/?region=on “Staging Cancer.” Canadian Cancer Society. 4. https://www.breastcancer.org/symptoms/types/idc “Invasive Ductal Carcinoma (IDC).” BreastCancer.org. March 9, 2019. 5. https://www.breastcancer.org/symptoms/diagnosis/invasive “Non-Invasive or Invasive Breast Cancer.” BreastCancer.org. Sept. 19, 2018. 6. https://www.breastcancer.org/symptoms/types/recur_metast “Metastatic Breast Cancer.” BreastCancer.org. June 10, 2019. 7. https://www.cancer.org/cancer/breast-cancer/treatment.html “Treating Breast Cancer.” American Cancer Society Website. 8. https://www.breastcancer.org/treatment/comp_med/types/medical-marijuana “Medical Marijuana.” American Cancer Society Website. BreastCancer.org. Oct. 10, 2018. 9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852356/ Śledziński, Paweł et al. “The current state and future perspectives of cannabinoids in cancer biology.” Cancer medicine vol. 7,3 (): 765-775. Feb. 23, 2018. 10. https://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer-the-evidence-so-far/ Arney, Kat. “Cannabis, cannabinoids and cancer – the evidence so far.” Cancer Research UK. July 25, 2012 (updated May 2018). 11. https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-p “Cannabis and Cannabinoids (PDQ®)–Health Professional Version.” NIH National Cancer Institute. June 18, 2019. 12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360617/ Guzmán, M et al. “A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme.” British journal of cancer vol. 95,2 (2006): 197-203. July 11, 2006.

Liver

AND THE EFFECTS OF CANNABIS

BY HEATHER DEROSE

WITH SURGERY OR TRANSPLANT BEING SOME PATIENTS ONLY OPTION, MANY ARE TURNING TO CANNABIS FOR ITS ANTICANCER EFFECTS 52

Among one of the most important organs in the human body is the liver. The liver filters blood coming from the digestive tract before passing it to the rest of the body. The organ also detoxifies chemicals and metabolizes drugs. During its functioning, the liver secretes bile which goes into the intestines. You cannot live without a liver, but you can live with only part of one. The American Cancer Society (ACS) estimates about 42,030 new cases of liver cancer will be diagnosed in the U.S. this year and approximately 32,000 people will pass away because of these cancers. They also say liver cancer occurrence has more than tripled since 1980 and develops more often in men than in women. Liver cancer is more common in other countries outside the U.S. and over 800,000 people are diagnosed with liver cancer each year worldwide. The most common risk for liver cancer is infection from the hepatitis B virus (HBV) or hepatitis C virus (HCV), which lead to cirrhosis of the liver. Cirrhosis of the liver is when the liver cells become damaged and are replaced during the recovery process by scar tissue. In addition, the risk of developing liver cancer is higher if one consumes several alcoholic drinks a day.1 Liver cancer prevention includes reducing your risk of cirrhosis by eliminating or limiting alcohol and maintaining a healthy weight. One can also reduce their risk by preventing hepatitis B and C.

THERE’S A GROWING NUMBER OF PEOPLE CHOOSING CANNABINOID THERAPY FOR TREATMENT

The endocannabinoid system (ECS) is present in the liver and is involved in the control of various liver functions. According to the study, “Endocannabinoids in Liver Disease,” cannabinoids may offer therapeutic benefit in reducing liver injury and promoting tissue repair in fibrotic liver.3 Cannabinoids and the ECS are implicated in stopping cancers to develop in blood vessels, slowing cancer growth and spreading, and causing death of cancer cells. Some studies suggest abnormal regulation in one’s ECS may promote cancer by allowing certain conditions that allow cancer cells to increase and spread throughout the body.4 There is a growing body of preclinical studies showing cannabinoids providing anticancer effects in regulation of cancer growth and spreading of cancer cells.5 With thousands of people losing their lives every year to liver cancer and studies showing cannabis has the ability to help slow the growth and prevent spreading of cancer cells, there’s a growing number of people choosing cannabinoid therapy for treatment. Some patients may need to have surgery to remove the tumor or have a liver transplant if they’re in an late stage of liver cancer. By adding cannabinoid therapy, patients can also receive the benefits of cannabis to promote recovery. Some patients may require additional treatment after surgery such as chemotherapy, and cannabis has been shown to help patients stimulate appetite and provide comfort to the nausea caused by the treatment. Another study found that the use of cannabinoids protects the liver from binge drinking by reducing oxidative stress and increasing regeneration of cells.6 This information has patients turning to cannabis to provide protection and to aid in liver cancer diagnosis. With surgery or transplant being some patients only option, many are turning to cannabis for its anticancer effects. If a natural plant medicine, such as cannabis, can work so effectively within the body against damage and cancer cell growth, it should be available for all patients, and doctors to try and learn more about it in their prevention and treatment plans. Changing the scheduling of cannabis at a federal level would greatly increase the opportunities to learn and help more people throughout the U.S.

References: 1. https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/risk-factors.html 2. https://www.mayoclinic.org/diseases-conditions/liver-cancer/care-at-mayo-clinic/mac-20353668?mc_id=google&campaign=1648183892&geo=9023598&kw=%2Bcancer%20in%20the%20%2Bliver&ad=316813663904&network=g&sitetarget=&adgroup=65798995849&extension=&target=kwd-583533214304&matchtype=b&device=c&account=1733789621&invsrc=cancer&placementsite=enterprise&gclid=EAIaIQobChMIvdTXqYGV4wIVD7XACh0yfgcDEAAYAiAAEgLujfD_BwE 3. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=226&id=17E6a4uLLeB1SnLfuoNPbCoyqOky9AkuB&Itemid=1000000000000 4. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=180&id=1IYFiyifsb3rZOtw3Rynt3JIVF-YXNWb3&Itemid=1000000000000 5. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=180&id=1lHahBzkNkUwRLUBA3-6OoVTlPRvNyQTK&Itemid=1000000000000 6. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=226&id=1Oz_FKNWs2ecQAvPdyR4Qx_cp6Hlt-xnH&Itemid=1000000000000

According to the Mayo Clinic the current liver cancer treatment options range from surgery, such as liver transplant, to ablative therapies: chemotherapy, radiation therapy and biological therapy.2 Cancer that spreads to the liver is more common than cancer that begins in the organ itself, this is called metastatic cancer.

U N D E RS TA N D I N G

& THE BENEFITS OF

WRITTEN BY JORDAN PERSON

Leukemia does not discriminate. It knows no age, nor color; it can affect anyone. Leukemia is a type of cancer that occurs in the bloodforming tissues of the body including the bone marrow and lymphatic system. Bone marrow is the spongy material inside our bones where our blood cells are made. The lymphatic system is what processes the body’s waste products and transports lymph, a fluid rich in which blood cells, throughout the body to assist in fighting infections. Since white blood cells are the body’s defense to fight infection this makes treating leukemia very complex.

LEUKEMIA DOES NOT DISCRIMINATE. IT KNOWS NO AGE, NOR COLOR; IT CAN AFFECT ANYONE.

Leukemia is classified in two ways,1 the first of which is by how fast it progresses and whether or not the leukemia is acute or chronic. Acute diseases have a fast and intense onset, compared to chronic diseases which are slow-building conditions. Secondarily, leukemia is classified by the specific type of white blood cell that is being attacked. There are four main types of leukemia: ● Acute lymphocytic leukemia (ALL): most commonly seen in children, but it can also occur in adults. ● Acute myeloid leukemia (AML): most common in adults but can also be seen in children. ● Chronic lymphocytic leukemia (CLL): Adults diagnosed with CLL may have minimal symptoms for several years before needing treatment. It is the most common form of chronic leukemia in adults. ● Chronic myeloid leukemia (CML): is slow-growing, but it can change into a fast-growing, hard-to-treat cancer overnight. There is also a rare type of leukemia called hairy cell leukemia 2 that receives its name from the cell’s hairy appearance when viewed through a microscope. It occurs more commonly in men and older adults but is not as common as the four main types of leukemia described above. Treatment is often timely and very aggressive. The treatment is dependent on the type of leukemia the patient has. A physician determines the best course of treatment based on factors like age and overall health. Chemotherapy is the most used form of treatment for leukemia. Chemotherapy3 is a treatment that can be given via intravenous infusion, by mouth, through the skin, or by injection. Chemicals are used to inhibit the growth of cancer cells. While this treatment is very effective for killing cancer cells, the toll that it takes on the patient’s body is nothing to ignore. “Chemo brain” is one of the most common complaints from patients receiving chemotherapy. A recent study done at Stanford University4 showed three different types of cells in the brain being affected causing cognitive impairment. Symptoms of chemotherapy include memory loss, irritability, mental fogginess, and difficulty multitasking. These symptoms make school difficult for children and that difficulty continues as an adult, making simple tasks like holding down a fulltime job difficult for adults long after treatment. These symptoms can last for months and up to years, and the side effects of chemotherapy

vary from person to person. In addition to chemo brain, there are physical side effects including nausea and vomiting, hair loss, infection, anemia, weight changes, numbness and tingling, and fertility problems.5 Another method of treatment for leukemia is radiation therapy. This treatment uses high doses of radiation to shrink tumors or kill cancer cells. Occasionally, surrounding healthy tissue can be damaged during radiation therapy. Radiation can be done internally or externally. It is offered as a treatment in conjunction with chemotherapy or on its own. It can be used prior to surgery, during surgery, or after surgery. Something to note about radiation is there are lifetime dose limitations. A physician will make the recommendation of what the maximum dose that can be received will be on a case-bycase basis. Stem cell treatment is also used for the treatment of leukemia. A stem cell transplant replaces the diseased bone marrow with healthy cells. The patient must first undergo radical radiation and/or chemotherapy to destroy the diseased cells. Afterward, a transfusion is done of blood-forming stem cells. A stem cell transplant is very similar to a bone marrow transplant. Infection and bleeding are both risks and side effects common to stem cell treatments. A less discussed but much needed part of treatment is the need for mental health support during leukemia treatment. Coping can be difficult, so having a good support system is vital. Seeking assistance via counseling or support groups is highly recommended. The more a patient understands the disease process, the easier they can cope with the process and need for treatment. In recent years, an increased amount of research on using cannabis as medicine has changed the treatment options for leukemia patients. The effects of cannabinoids are proving to have a major effect on leukemia. In a study6 done at the University of London and published in the International Journal of Oncology, doctors discovered that THC (Δ9tetrahydrocannabinol) and CBD (cannabidiol) killed leukemia cells. They also noted that, if used in conjunction with chemotherapy, the success rate improved significantly. Another study7 done at Complutense University in Madrid, Spain in 2003, showed the direct benefit of palliative care from using cannabis to assist with the side effects and symptoms that chemotherapy causes. Scientists noted that cannabinoid treatment was capable of relieving nausea and vomiting, providing pain relief, and stimulating the appetite. Science also showed the anti-tumor capabilities of cannabinoids in laboratory animals. Cannabinoids caused death of tumor cells and inhibited further growth of cancerous cells. These new studies are wonderful news for leukemia patients. The possibility of less toxic treatments is becoming a reality. The use of invasive treatments such as chemotherapy, radiation, and stem cell treatment remain valid for the treatment of leukemia, but children and adults can seemingly benefit far more from the use of cannabinoid plant medicine as treatment or in conjunction with conventional methods. 1. https://nationalpcf.org/leukemia/ National Pediatric Cancer Foundation. 2. https://www.mayoclinic.org/diseases-conditions/hairy-cell-leukemia/symptoms-causes/syc-20372956 Mayo Clinic. 3. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/chemotherapy National Cancer Institute. 4. https://med.stanford.edu/news/all-news/2018/12/chemo-brain-caused-by-malfunction-in-three-types-of-brain-cells.html Stanford University. December 6, 2018. 5. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/chemotherapy-side-effects.html American Cancer Society 6. https://www.spandidos-publications.com/10.3892/ijo.2017.4022 “Anticancer effects of phytocannabinoids used with chemotherapy in leukaemia cells can be improved by altering the sequence of their administration.” International Journal of Oncology. May, 29, 2017. 7. https://www.nature.com/articles/nrc1188#Abs1 “Cannabinoids: Potential Anti-Cancer Agents” Department of Biochemistry and Molecular Biology I, School of Biology, Complutense University. Manuel Guzmán. December, 2003.

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CANCER

Skin

OF THE

BY MATT JACKSON, PH.D.

Our bodies have cozied into this Earth, perfectly suited to thrive through the seasons. Nevertheless, our environment is harsh. Even those with the healthiest lifestyles confront toxins in the air we breathe—and the sun, our source of warmth, bombards us with UV rays that can damage DNA and mutate our skin. These mutations are like a roulette wheel. The universe casts a ball of UV rays, and the ball bounces its way to an outcome. If it lands on red, our skin cells repair and live. If it lands on black, they die, and healthy cells take their place. But every so often, it lands on green, and the mutated cells don’t repair or die. They divide like a virus, clearing out normal tissue, feeding on the nutrients, and forming a cancerous, malignant tumor.

THERE IS SCIENTIFIC EVIDENCE THAT CANNABIS CAN FIGHT SKIN CANCER 58

If you find that prospect terrifying, you’re not alone. No one likes to be out of control, but thankfully, it’s not a perfect metaphor. As long as you’re not using a tanning bed—if you are, please stop!—an occasional day without sunscreen or one sunburn rarely causes melanoma, the tumors most associated with skin cancer.

Why? To form cancer, mutated cells must do two things: they must grow rapidly, and they must escape our body’s internal security measure of programmed cell death. Biologically, that’s not like a roulette wheel, where 1 in 37 slots are green. It’s more like being struck by lightning in your lifetime, which happens to 1 person in 3,000.1 The likelihood you develop skin cancer depends on many factors, like how consistently your skin

is damaged—playing roulette over and over—and your genetic makeup. For example, people born with a mutated MC1R gene, which is almost all people with red hair and fair skin, are 2–15 times more likely to develop melanoma.2

So what can you do, besides wearing sunscreen? You can be on the lookout for signs of an abnormal mole and see a dermatologist regularly.3 If they spot something suspicious, they can remove it and test if it’s malignant. If caught before the cancer has spread, there’s a 98% cure rate.4 But it’s more serious if the cancer has spread to the lymph nodes and beyond, most often to the brain, liver, and bones.5

Metastatic melanoma is aggressive and doesn’t respond well to normal chemotherapy. Only 1 in 4 people survive 5 years,4 and most don’t live beyond a year.5 Your best bet? Modern therapies and clinical trials. Scientists have developed new medicines such as immune checkpoint inhibitors, which can give your immune system back its power to fight cancer cells. Modern therapies can cure—but they are expensive, can have serious side effects, and are not always effective. In a major clinical study of the immunotherapy agent pembrolizumab (Keytruda), only 16% of melanoma patients went into remission. But 42% of patients didn’t respond at all, and 25% dropped out of the study due to side effects.6

Doctors might be excited by these breakthrough therapies, but if you’re fighting for your life and that roulette game is on tilt, you’d search for anything that could help save your life. Enter: cannabis, specifically THC, CBD, and cannabis’ other components.

To the most skeptical among us, myself included, this may sound like snake oil, but there is scientific evidence that cannabis can fight skin cancer. Studies of mice with melanoma show that THC treatment was as effective as temozolomide (TMZ) chemotherapy in stunting cancer growth. Further, THC combined with CBD in a one-to-one ratio (meaning equal parts THC and CBD, like Sativex)7 was even more effective.8 These treatments alone could not cure melanoma, but think about that for a second: THC was as effective as chemotherapy. How is that possible? Remember that cancer cells must bypass programmed cell death. TMZ chemotherapy damages DNA, so when cancer cells divide, they’re more likely to die. THC and CBD cause the same thing to happen but by an entirely different mechanism. They

interact with cannabinoid receptors in the ECS that act like light switches, illuminating a pathway to cell death that’s normally shut off.9 Along with other cancers, melanoma cells have an abundance of cannabinoid receptors not found on normal skin cells, and this makes them susceptible to cell death via THC and CBD.10

With any cancer treatment, there is a risk of resistance. Even within one person’s tumor, not all cancer cells are identical. As the cancer grows, it accumulates new mutations in a sped-up evolution. A few cancer cells can develop mutations that make them resistant to one therapy. So even if that therapy kills most of the cancer cells, those few resistant cells can go on to form a new tumor that is harder to treat, much like antibiotic-resistant bacteria. Cannabis is no exception. Researchers have observed resistance to cannabis after treating brain cancer cells. They suggested that combining cannabis with other therapies could help avoid relapse.11 This approach is promising because the likelihood that a cancer can randomly develop resistance to two therapies is much less. Combining THC with TMZ to treat mice with brain cancer produced remarkable results. Alone, they curbed cancer growth, but together they actually shrunk the tumor!9 And that, frankly, is amazing. A word of caution: these studies were preclinical, meaning the studies weren’t done with humans, and there are some big differences between mice and humans. Despite mounting evidence that cannabis can help stop cancer cells, there aren’t many studies in humans. Humans have used cannabis for millennia, but criminalization has stunted research. If you search for clinical trials involving cancer and cannabis,12 they are restricted to palliative care, such as treating pain and nausea.11 Almost four years after the preclinical evaluation of Sativex to drive melanoma cell death in mice,8 similar studies in humans have not begun.

THC WAS AS EFFECTIVE AS CHEMOTHERAPY For many scientists and clinicians, there are too many unknown factors and contradicting data to stake a scientific backing on using cannabis to treat skin cancer in humans, especially for aggressive cancers such as melanoma.13

But unlike them, it is not my job to make a steadfast decision for you. My job is to use my scientific background to relay evidence. Cannabis appears effective in combating skin cancer, but it’s probably not a silver bullet. The most promising results have been achieved by combining cannabis with a first-line chemotherapy agent to mount a synergistic assault on the cancer and avoid resistance.

If you or a loved one are battling skin cancer, my heart goes out to you, and if you are considering using cannabis as a treatment, talk with your doctor. They might not suggest cannabis without prompting, but they’re likely open to talking about it. After all, there is some striking evidence to consider.

References: 1. https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html 2. Box, Neil F., Wei Chen, Richard A. Sturm, David L. Duffy, Rachel E. Irving, Anne Russell, Lyn R. Griffyths, Peter G. Parsons, and Adele Green. “Melanocortin-1 Receptor Genotype Is a Risk Factor for Basal and Squamous Cell Carcinoma.” Journal of Investigative Dermatology 116, no. 2 (2001): 224-29. doi:10.1046/j.1523-1747.2001.01224.x. 3. https://www.skincancer.org/skin-cancer-information/atypical-moles/warning-signs-and-images 4. https://www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/survival-rates-for-melanoma-skin-cancer-by-stage. html 5. Tas, Faruk. “Metastatic Behavior in Melanoma: Timing, Pattern, Survival, and Influencing Factors.” Journal of Oncology (2012): 647684. doi:10.1155/2012/647684. 6. Hamid, Omid, Caroline Robert, Adil Daud, F. Stephen Hodi, Wen-Jen Hwu, Richard Kefford, Jedd Wolchok, Peter Hersey, Richard Joseph, Jeffrey Weber, et al. “Five-Year Survival Outcomes for Patients with Advanced Melanoma Treated with Pembrolizumab in KEYNOTE-001.” Annals of Oncology 30, no. 4 (2019): 582-88. doi:10.1093/annonc/mdz011. 7. https://www.gwpharm.com/healthcare-professionals/sativex# 8. Armstrong, Jane L., David S. Hill, Christopher S. McKee, Sonia Hernandez-Tiedra, Mar Lorente, Israel Lopez-Valero, Maria E. Anagnostou, Fiyinfoluwa Babatunde, Marco Corazzari, Christopher P.F. Redfern, et al. “Exploiting Cannabinoid-induced Cytotoxic Autophagy to Drive Melanoma Cell Death.” Journal of Investigative Dermatology 135, no. 6 (2015): 1629-37. doi:10.1038/jid.2015.45. 9. Blázquez, Cristina, Arkaitz Carracedo, Lucía Barrado, Pedro J., Real, José L. Fernández-Luna, Guillermo Velasco, Marcos Malumbres, and Manuel Guzmán. “Cannabinoid Receptors as Novel Targets for the Treatment of Melanoma.” The FASEB Journal 20, no. 14 (2006): 2633-35. doi:10.1096/fj.06-6638fje. 10. Zhao, Zigang, Jie Yang, Hua Zhao, Xiangdong Fang, and Hengjin Li. “Cannabinoid Receptor 2 Is Upregulated in Melanoma.” Journal of Cancer Research and Therapeutics 8, no. 4 (2012): 549-54. doi:10.4103/0973-1482.106534. 11. Velasco, Guillermo, Claudia Sánchez, and Maria Guzmán. “Anticancer Mechanisms of Cannabinoids.” Current Oncology 23, no. 2 (2016). doi:10.3747/co.23.3080. 12. https://clinicaltrials.gov/ 13. ”CBD Uncertainty: Sales Soar But Science Lags On Hemp Health Effects.” WFPL News Louisville. April 15, 2019. https://wfpl.org/cbduncertainty-sales-soar-but-science-lags-on-hemp-health-effects/

T YPES OF S TOM ACH C ANCER

There are four main types of stomach cancer, as well as a few rare cases such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma.2 The main difference between the types of cancer is typically the location of the primary site of the cancerous growth. In addition to type, there are nine stages of stomach cancer, indicated with a number (0-4) and a letter (A-C); letters indicate if the cancer has spread while the stage number indicates severity and chance of survival.3 ADENOCARCINOMA This is the most common type of cancer. 9095% of all stomach cancer is adenocarcinoma and develops from the cells of the innermost stomach lining (mucosa). LYMPHOMA This type of stomach cancer infects immune system tissue that is found in the walls of the stomach. GASTROINTESTINAL STROMAL TUMOR (GIST) Although rare, this form of stomach cancer begins in the stomach wall cells, known as “interstitial cells of Cajal.” Not all gastrointestinal stromal tumors are cancerous, and they can be found anywhere in the digestive tract but are most commonly found in the stomach. CARCINOID TUMOR This form of stomach cancer begins in the hormone-production cells of the stomach and rarely spreads to other organs.

STOMACH CANCER

BY BEN OWENS

T Y P E S & T R E ATM E N T S

This year alone, more than 27,000 people in the United States will be diagnosed with stomach cancer, and more than 11,000 will die from the disease, the majority of whom will be male. Stomach cancer is a cancer that largely affects the older population, with 60% of new diagnoses affecting those 65 years of age or older.1 While new cases of stomach cancer have been on a decline over the last decade in North America, stomach cancer is still one of the leading cancer-related causes of death in the world. Many believe that advances in the refrigeration of foods as well as a rise in the use and availability of antibiotics may have contributed to this decline. Still, 1 in 95 men and 1 in 154 women will develop stomach cancer during their lifetimes.1

WHAT IS STOMACH CANCER Stomach cancer, or gastric cancer, is the third leading cancer-related cause of death in the world.1 As with any cancer, stomach cancer begins with malformed cells that refuse to die or divide and multiply without need. In stomach cancer, this process begins in the stomach, specifically the lining of the stomach and is greatly affected by age, diet, and stomach diseases. While the entire abdomen region is often referred to as simply the “stomach,” stomach cancer specifically affects the stomach and does not include colon, intestinal, pancreatic, liver,m or other abdominal organ cancers. Due to the commonality and mildness of symptoms such as heartburn and indigestion, most stomach cancers go undiagnosed until the cancer has advanced much further and a later stage diagnosis is given. The life expectancy for stomach cancer is poor, with a relative 5-year survival rate for stage one diagnosis that decreases drastically in more advanced stages.2

TYPICAL TREATMENTS As with most cancers, there are a few main treatment options including surgery, chemotherapy, medications, and clinical trials.3 Unlike other forms of cancer, radiation therapy is an option, but it is not commonly used due to the risk of impacting other abdominal organs unless severe pain or bleeding occurs. Typically, treatment involves a combination of surgery, removing the tumor and/or partial or total gastrectomy (removal of the stomach). Chemotherapy is used before and after surgery (neoadjuvant and adjuvant, respectively) to help shrink tumors for removal and kill off any leftover cancerous cells that were unable to be removed during surgery.

CANNABIS & STOMACH CANCER

Studies on stomach cancer and cannabis as a supplement to conventional cancer treatments are only in their early stages, but studies on cannabis and cancer cells as a whole suggest that cannabis could play a role in easing symptoms and inhibiting cell growth. Since 1986, cannabis has been used as an antiemetic drug for cancer patients receiving chemotherapy. Cannabis has been shown to reduce inflammation as well as ease anorexia and cachexia, commonly reported as among the most inhibiting symptoms to quality of life due to stomach cancer.4,5 Studies of patients in states with legal cannabis programs show that there is a strong interest in cannabis for cancer patients.6 This all being stated, smoking, specifically tobacco smoking, has been shown to irritate and contribute to stomach cancers, so combustible modalities such as blunts may be best avoided if you are specifically treating stomach cancer. Stomach cancer is one of the deadliest cancers, with hard-to-detect early signs and a short survival rate. Early symptoms such as heartburn, indigestion, or difficulty swallowing, especially if you are over the age of 55, could suggest the onset of early stage stomach cancer. If you notice a buildup of stomach fluids, anemia, black and bloody stools, symptoms of fatigue, loss of appetite, or extreme weight loss, talk to your doctor to prevent more serious issues. If you suspect you may have stomach issues, try switching up your cannabis consumption, choosing edibles and vapor options rather than smokable and combustible options that could worsen your condition.

1. https://www.cancer.org/cancer/stomach-cancer/about/key-statistics.html “”Key Statistics About Stomach Cancer.” American Cancer Society Website. 2. https://www.cancer.org/cancer/stomach-cancer/about/what-is-stomach-cancer.html “What is Stomach Cancer.” American Cancer Society Website. 3. https://www.medicalnewstoday.com/articles/257341.php Nordqvist, Christian. “Everything You Need to know about Stomach Cancer.” MedicalNewsToday. Jan. 5, 2018. 4. https://www.ingentaconnect.com/content/ben/ccp/2010/00000005/00000004/art00006 M. Liu, Wai et al. “Cannabis-Derived Substances in Cancer Therapy - An Emerging Anti-Inflammatory Role for the Cannabinoids.” Current Clinical Pharmacology, Volume 5, Number 4, 2010, pp. 281-287(7). Nov. 1, 2010. 5. https://www.karger.com/Article/Abstract/57152 Gorter R, W. “Cancer Cachexia and Cannabinoids.” Forsch Komplementärmed 1999;6:021. Oct. 1999. 6. https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.30879 Pergam, Steven A. et al. “Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use.” Cancer, Volume 123, Issue 22, 2017, pp. 4488-4497. Sept. 25, 2017

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Cannabis

PREVENTING CANCER

WITH CANNABIS, FITNESS, & FOOD BY ANTONIO DEROSE

Cannabis gets a lot of attention for its use in treating the symptoms of cancer, and the side effects associated with the chemotherapy treatments many cancer patients undergo, and for good reason. So much so, The American Cancer Society officially “supports the need for more scientific research on cannabinoids for cancer patients, and recognizes the need for better and more effective therapies that can overcome the often debilitating side effects of cancer and its treatment.”1 Although they don’t have an official recommendation of cannabis for cancer treatment, they do note that Marinol, one of the very few pharmaceuticals containing THC which has been approved by the FDA in treating nausea and vomiting caused by cancer chemotherapy, has been shown to be helpful in easing those symptoms based on numerous studies.

However, instead of focusing on treating the symptoms of cancer and other diseases, it would benefit us greatly if we focused on preventing these conditions in the first place. Preventing cancer can be encouraged through the consumption of cannabis, certain foods, and physical activity. There are scientists researching cannabis as being a cancer-preventative medicine. In 2018, a review of ongoing clinical trials evaluating the safety and efficacy of cannabinoids in treating cancer was published in Cancer Medicine, a peer-reviewed, interdisciplinary journal publishing research from global biomedical researchers across the cancer sciences, in the areas of cancer biology, clinical cancer research, cancer prevention, and more. Although the review ultimately concluded more research needed to be conducted to determine how useful

cannabinoids can be in treating cancer, it also states, “Many in vitro and in vivo experiments have shown that cannabinoids inhibit proliferation of cancer cells, stimulate autophagy and apoptosis, and have also a potential to inhibit angiogenesis and metastasis.”1 This at least suggests cannabis is helpful in the prevention of cancer. However, those studies were conducted on exogenous cannabinoids, meaning the ones our body obtains from outside sources like THC and CBD found in cannabis. Our body also produces natural cannabinoids on its own, known as endogenous cannabinoids. When we exercise, it stimulates your endocannabinoid system by naturally producing the endogenous cannabinoid, anandamide, which has been found to cause the euphoric sensation after exercising, often referred to as a runner’s

high. Surprisingly enough, research from Israel indicates anandamide to also be antiproliferative, encourage apoptosis, and inhibit metastasis as well. These anticancer relationships with both endogenous and exogenous cannabinoids suggest that a lifestyle incorporating physical activity and cannabis could help prevent cancer. You can round out your preventive care plan in the kitchen by eating more fruits and vegetables and fewer animal products.

sumption of meat, especially red and processed meats, with an increase in the risk of several types of cancers. The analysis goes on to state, “Vegetarian and vegan diets increase beneficial plant foods and plant constituents, eliminate the intake of red and processed meat by definition, and aid in achieving and maintaining a healthy weight,”2 and concludes by stating the evidence clearly indicates a plantbased diet in being a useful strategy for preventing cancer.

An analysis of many research reports examining the evidence between plantbased diets and cancer risk was published in Cancer Management and Research, which focuses on the optimal use of preventative and integrated treatment plans. The analysis indicates an abundance of scientific evidence linking eating plant foods like fruits and vegetables with high amounts of fiber, antioxidants, and other phytochemicals, while also maintaining a healthy weight, reduces the risk of cancer diagnosis and recurrence. It also reviews the research linking the con-

All of these reviews and research studies are suggesting cannabis, fitness, and food to be beneficial in preventing cancer. Even though more research needs to be conducted on cancer prevention in general, this at least gives us a starting point in creating a cancer prevention plan versus a cancer treatment plan. It begins with supplementing exogenous cannabinoids like THC and CBD found in cannabis. Then it continues by

producing our body’s own endogenous cannabinoids, like anandamide, which is produced when we exercise. Finally, the prevention plan is rounded out by remembering that food is medicine and choosing to eat more plant-based foods while also eating less meat. When you combine all three, you’ve got a solid plan that, science so far suggests, may help with preventing cancer from even beginning.

1. https://www.theroc.us/index.php?preview=1&option=com_dropfiles&format=&task=frontfile.download&catid=180&id=1MAOyGjUt6CZp9kQN3T0pH0fXUxvurqWU&Itemid=1000000000000 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048091/

M XINE TAYLOR’S CELESTIAL EVENTS Maxine Taylor became America’s First Licensed Astrologer after mounting a legal challenge to legitimize astrology in the 1960’s Bible Belt state of Georgia. She became CNN’s Original On-Air Astrologer when the network launched.

S E P T E M B E R 2 019 ARIES (MARCH 21 - APRIL 19) Focus on all the small details of daily activities; cross all T’s and dot all I’s. Your vision for yourself expands this month, so get clear on where you want your career to go, and move upward. Begin new projects before the 13th, when you will want time alone to work behind the scenes. Then, enjoy your own company.

LIBRA (SEPT 23 - OCT 22) You enjoy your own company much more than others’ right now, so do only what you want to do. Work behind the scenes to secure your own solitude and privacy. You see a bigger picture, but may not be able to put it into words just yet. Your work picks up by mid-month, and a new project can keep you busy.

TAURUS (APRIL 20 - MAY 20) Now is the time to play, to have fun, and to enjoy yourself. If you have children, include them in your social activities. As the month moves along, you will be able to combine work and pleasure, to focus on increasing your income and possibly involving yourself in joint financial, mutually-profitable projects.

SCORPIO (OCT 23 - NOV 21) Your friendship circle is very important to you, so accept all social invitations. However, you will want more solitude and privacy as the month moves along. The secret is to balance the two. You can increase your income by yourself or in mutuallysuccessful joint ventures, particularly around the 15th.

GEMINI (MAY 21 - JUNE 20) Your home and family are the center of your world this month, so focus on domestic, even real estate, projects and issues. By mid-month your social life expands, and you’ll be ready to visit with friends. Around the 13th, your career is activated, and you may have the opportunity to advance. Go for it and move upward!

SAGITTARIUS (NOV 22 - DEC 21) You career is activated this month, so throw yourself into it, be the leader, and focus on your next advancement. Look at your finances realistically, get clear on your course of action, and let it rip. Your optimism is contagious and people want to be with you, so mix business with pleasure.

CANCER (JUNE 21 - JULY 22) If you find yourself feeling antsy and bored, travel could be the answer, particularly around mid-month. It allows you to see a bigger picture and recognize new options. Your work and your relationships look good, yet you may feel unsettled. Both meditation and contemplation will give you the answer. LEO (JULY 23 - AUG 22) Your ability to create money this month is terrific, and the more attention you give to your finances, the more they will grow. If you are thinking of creating a financial partnership, make it a win/win venture for best results, and put it in motion before the 13th if you can. Both work and play look good, so have fun! VIRGO (AUG 23 - SEPT 22) You are doing what you want, how you want, if you want, when you want. Yes! While interaction with other people is strongly activated around the 13th, you are taking a stand for yourself and will not let others run over you. Balance is the operative word. You are in position to move upward in your career. Go for it!

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CAPRICORN (DEC 22 - JANUARY 19) Keep your bags packed because you’ve got one foot out the door this month. You are ready to spread your wings and fly. If you can travel as part of your business, great! Now is the time to express your beliefs, to take a stand for them if need be, and take responsibility for being your own person. AQUARIUS (JANUARY 20 - FEBRUARY 18) Now is a great time to be a detective and get to the cause of all issues. Persevere, and you will get your answers. Now is also a great time to make group investments because you know that what is good for the group is good for the individual. By midmonth, your financial investments can bear fruit. PISCES (FEBRUARY 19 - MARCH 20) All your relationships, whether personal or business are activated. Get out there and be with people. Your popularity soars, so take advantage of it and expand your career, your sphere of influence, and your friendship circle. Right around the 13th, you will appreciate your own worth and value, and you’ll be able to put yourself first.

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O C T O B E R 2 019 ARIES (MARCH 21 - APRIL 19) You may feel torn between being with the people who mean the most to you and being by yourself in order to analyze issues, get to their cause, and find a solution. Around the 13th, you’ll be able to put things in perspective and hit the ground running. That’s the time to put yourself first and do your thing your way. TAURUS (APRIL 20 - MAY 20) While your focus is on your work this month, you’ll want to take time to socialize, especially with that one special person. If that slot is empty, you’ll want to get out there and meet people. You will need some private time around mid-month to balance the energy you are putting into your job and social activities. GEMINI (MAY 21 - JUNE 20) Gemini, October is the time to party! So have fun! Even your job and daily activities may be more enjoyable this month. If you can mix business with pleasure, that would be ideal. If you have children, they will want more of your attention, so be prepared to combine your social activities with theirs. CANCER (JUNE 21 - JULY 22) You are a naturally nurturing sign, and your home and family come first to you at all times, but especially this month. Focus on all the people who mean the most to you, and take care of domestic projects. By mid-month, you’ll be able to put your attention on your career, which will then be your focus of attention. LEO (JULY 23 - AUG 22) Your mind is racing ahead with new ideas at breakneck speed, and you’ve got to share them. You see the far horizon as well as all the steps it will take to get there. It feels like there’s so much to do, and you want to get it all done at once. Take it one step at a time – and take time for a quiet evening at home. VIRGO (AUG 23 - SEPT 22) Money is the name of the game, and money is the current focus of your attention. And whatever you give your attention to grows! By mid-month you can be involved in joint financial ventures. You are filled with great ideas to share with others. In addition, short distance and duration travel looks really good.

LIBRA (SEPT 23 - OCT 22) October is the time to do things your way. Put yourself first, especially where money is concerned. Spend some of it on yourself. Get clear on your values and stick to them. If you are ready to look more beautiful, now is the time to kick your appearance up a notch: a new hairdo, a new wardrobe, a new you! SCORPIO (OCT 23 - NOV 21) You require more solitude and privacy this month in order to plan for the future as well as to simply do whatever you want your way. You may be very protective of your time alone. This could be a good time for a weekend getaway by yourself. By mid-month, you will be able to get busy at work and put your plans into action. SAGITTARIUS (NOV 22 - DEC 21) Your friends mean the world to you now, so enjoy them. Don’t be surprised, though, if there are times you feel the need to be by yourself. This is because you need to recharge your batteries. And this need to recharge increases as the month moves forward. If you don’t have time alone, you may need more sleep. CAPRICORN (DEC 22 - JANUARY 19) October is the time to throw yourself into your career, to express all your ambitions and move into a position of leadership. You will be able to mix business with pleasure, which is the best of both worlds. And by mid-month, you’ll find that you enjoy spending time at home with family members, just chilling. AQUARIUS (JANUARY 20 - FEBRUARY 18) You are a visionary. As such, you see the big picture and think in terms of concepts and principles, rather than ideas. In October, you will be able to express the beliefs and the principles by which you live in your career. Prepare your ideas early in the month, and share them with others around midmonth. PISCES (FEBRUARY 19 - MARCH 20) October is a time of personal transformation for you. It’s a time to re-examine how much time, energy and money you have been giving to others and decide if you want to continue doing that. This can be eye-opening. By mid-month, as your values change, your efforts will pay off financially.

COOKING CANNABIS with

TREAT YOURSELF

This snack mix is a staple at Nancy’s house. It’s a great everyday snack, yet looks elegant served in a fancy dish. Stored it in an airtight container, it should last two weeks -- ALTHOUGH IT’S USUALLY EATEN THE FIRST DAY! The beauty of this recipe is that it is a base recipe in that by changing ingredients and spices you can change it from a sweet to a savory treat. This can be changed to incorporate the flavors you are craving -- change the cinnamon to garlic powder and use corn syrup instead of maple syrup, and you have a sweet garlic chili nut mix.

THE COMBINATIONS ARE ENDLESS. Change pretzel sticks to cereal mix ( i.e. Chex Mix) and mixed raw nuts to raw peanuts, add in some melted peanut butter to the corn syrup to make a glaze: you have a peanut cereal mix.

MEDICATING THE MIX Do the math on how much cannabis to add to your recipe Check your formula for determining potency of your finished product. Example: 12 servings x 5mg = 60 mg THC or CBD per recipe The recipe yield is 12 servings of approximately ½ cup each

Cannabis

SNACK MIX

Recipe

Ingredients: 3 cups mixed raw nuts 2 tbsp butter Cannabis tincture or distillate premeasured 3 tbsp brown sugar (or coconut sugar or brown sugar substitute) ½ tsp cinnamon ¾ tsp mild chili powder 2 tbsp maple syrup (or sugar free syrup) 2 cups pretzel sticks 1 tsp flaky or coarse sea salt Preheat the oven to 325ºF. In a small saucepan, melt the butter on low, add the tincture or distillate, and mix well. Add the brown sugar, cinnamon, chili powder & maple syrup, whisk together. In a large mixing bowl, toss the nuts & pretzel sticks together. Pour the butter mixture onto the nut mix & toss until evenly coated. Sprinkle on the salt & toss well. Roast for 20 minutes or until light golden brown. Allow to cool completely & break up the mixture. Store in an airtight container for up to 2 weeks.

! y o j n E 69

JOIN US AS WE

Grow

LOOK FOR OUR BOOTH AT THESE AMAZING EVENTS AND TELL US YOU READ ABOUT THE EVENT IN THIS ISSUE AND RECEIVE A SPECIAL GIFT!

SEPT 4 - 6 | CANNABIS SCIENCE CONFERENCE | PORTLAND, OR

This conference pulls together cannabis industry experts, instrument manufacturers, testing labs, research scientists, medical practitioners, policy makers and interested new faces. The overall goal of this conference is to improve cannabis science.

SEPT 23-24 | CANNMED 2019 | PASADENA, CA

CannMed features the greatest minds in medical cannabis. With a booming industry anticipated to exceed $500B by 2028, understanding the complex science and its medical benefits for patients in need is how this conference series was born. Medicinal Genomics invites all attendees or sponsors to experience firsthand why CannMed continues to lead the way in cannabis science.

SEPT 25-28 | CANNABIS WORLD CONGRESS | LOS ANGELES, CA

The Cannabis World Congress & Business Exposition is a business-to-business trade show event for the legalized cannabis industry. It is the leading forum for dispensary owners, growers, suppliers, investors, medical professionals, government regulators, legal counsel, and entrepreneurs looking to achieve business success and identify new areas of growth in this dynamic and fast-growing industry.

OCT 11-12 | COMMERCIAL CANNABIS CONFERENCE & EXPO | DETROIT, MI

Commercial Cannabis Conference & Expo aims to take a stand for a healthy and strong Michigan commercial cannabis industry, bring industry, business and government leaders together to foster strong partnerships, effective compliance, greater patient outcomes, and commercial success, offer a springboard for patients and caregivers that want to get into commercial, catalyze investment opportunities and partnership, and much more.

OCT 23-26 | CANNABIS WORLD CONGRESS | BOSTON, MA

See you there!

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Grass Roots America Magazine - September/October 2019

Articles inside

COOKING WITH CANNABIS |

MAXINE TAYLOR'S CELESTIAL EVENTS

FITNESS + CANNABIS

THE USUAL

STOMACH CANCER | Types & Treatments

CANCER OF THE SKIN

DisLIST

UNDERSTANDING LEUKEMIA + THE BENEFITS OF CANNABIS

LIVER CANCER + THE EFFECTS OF CANNABIS

FIGHTING BREAST CANCER WITH KNOWLEDGE

BRAIN CANCER | Is cannabis the answer?

CANNABIS IN THE OUTDOORS

YOUR AD HERE

Mara Gordon

Landon's Story

Bonni Goldstein

CANCER SUCKS | Cannabis Helps

RESEARCH CORNER

CBD + CANCER

CULTIVARS | Formally known as strains.

Let's GROW!

Medical Minute

GRAM Featured Writers