This is part 2 of our in-depth interview with Cannabis Pain and Healing Guru Dr. Michael Moskowitz. His story is so astounding, and the interview is so in depth, that we had to split it into several parts. Part One of this interview is about his experience with intense pain and his journey back from a probable cancer diagnosis and how he used cannabis in its various forms to get back to health. In this part he talks in depth about Cannabis, THC and CBD in its various forms for pain management and anxiety.
Charlotte Parker: Could you tell us what neuroplasticity is in the brain?
Dr. Moskowitz: For probably half a century, we’ve known that children’s brains were what we called plastic, which means that the brain that children are born with is not the brain they end up with at the age of 25. It goes through massive changes and the brain makes new brain cells, makes new connections, makes new neurotransmitters that move back and forth between those connections, and so, for instance, when a child is born, they are born with more brain cells than they are going to need and very few connections.
What happens over the first three years of life is the brain makes connections between those cells and those connections are called synapses and that’s where information’s passed from one nerve to another. We end up with 1000 trillion, which is a quadrillion synapses in our brains and 100 billion nerve cells. We start off with about 125 billion nerve cells and trim away a lot of the redundant connections we make over actually the first 13 years of life.
We trim away a number of those and end up with a system from age 13 to age 25 that is going to mature from the bottom to the top, the back to the front and the right side to the left side and at the very end we develop that last little bit of prefrontal cortex and the top left side of the brain and that’s when people tend to develop more empathy and connection to other people, and some wisdom; it is the start of that.
“I used to have diabetes, I don’t have diabetes anymore. I used to have high cholesterol, I don’t have high cholesterol anymore. It basically normalized my body.”
Over the course of our lives, we thought that this whole process initially 50 years ago stopped at age 3, it turns out we go through this process our whole life, and every week of our life we make and break 7.5 trillion synapses every single week.
Those synapses are where one nerve cell passes information on to another and every nerve cell averages about 10,000 synapses each, so that’s how our brains work, that’s how they run our bodies, that’s how our bodies send information into them and the brain makes decisions. All this stuff happens over the course of your life and even now as you and I are talking, we are changing each other’s brains by our conversation, and as this conversation gets played out to the public that’ll also have effects on whoever listens to it. Their brains will be changed forever based upon listening.
It’s nothing that I’m telling you such profound stuff, it’s just this is the way our brains work; it’s what we do. With no effort at all, every week, we constantly are changing these synapses.
Charlotte: That goes on forever as long as we are alive, in a sense?
Dr. Moskowitz: Correct, and most of it is very positive and your brain adapts and adjusts, but when problems come up, there are times when the brain makes the wrong neuroplastic changes and chronic pain is one of those times. It serves zero purpose. The whole purpose of pain is to inform a person that there’s something wrong and stop doing whatever you’re doing with that part of your body that hurts,or lie still, or do something else. You’re rewarded when you do that by the pain going away. When I shattered my femur, which is the largest bone in your body and is really quite painful when you do it, I had 10 out of 10 pain. When I laid down on the ground and just rested and didn’t move anything, it went to zero until the paramedics came and put me in a splint then it went right back up to 10 again. That’s normal pain.
“It depends on the person, which is the other big thing I’ve learned over the years about cannabis. Everybody reacts differently.”
When my leg hurts me now, 22 years later, when I step a certain way or do something that’s not normal pain, that’s abnormal pain. There’s nothing wrong with my leg anymore; it’s healed. It doesn’t have any pain generator coming from it but my brain remembers certain positions my leg was in where it hurt. It can sometimes give me that pain if I step past that limit that it accepts. I have pathways that were built in. I worked on changing those and I did dramatically change them.
I injured my neck as well in the subsequent years and had a lot worse pain from that for many years. That’s abolished, it’s gone. That was gone before I started using the medical cannabis for my prostate. Since I started doing it for that, I’ve seen that it helps with sleep. It helps to calm people down. It helps to give them energy. It helps with weight.
I used to have diabetes, I don’t have diabetes anymore. I used to have high cholesterol, I don’t have high cholesterol anymore. It basically normalized my body.
Charlotte: You attribute this to the medical cannabis that you that you’ve been using or that you recommend?
Dr. Moskowitz: Well, it’s the only thing I did. I lost 38 pounds on it.
Charlotte: How did you lose all that weight on the CBD?
Dr. Moskowitz: CBD is a remarkable weight-losing substance. It converts yellow fat that happens with aging. After age three that’s pretty much all we make. It converts yellow fat into brown fat. It’s called the tanning of fat. Yellow fat is weight gaining and inflammatory and brown fat is weight-losing and anti-inflammatory. The problem is we don’t have much of it past the age of three. CBD turns yellow fat into brown fat.
Charlotte: If one lost weight, in many cases, it would be beneficial to their health. How much CBD or what kind of CBD would you recommend for that purpose?
Dr. Moskowitz: It depends on the person, which is the other big thing I’ve learned over the years about cannabis. Everybody reacts differently. In general, to lose weight you need higher doses, which I was taking incidentally because of my prostate. I would recommend if people really want to lose weight on this, they should try to get about 50 milligrams of CBD twice a day into their system. I’ve now seen this happen with a lot of other people. A lot of my patients have used it to lose weight. The problem with it is THC tends to increase appetite and make people want to eat. Food tastes great and people go for it. That’s why another reason I recommend if you’re looking to lose weight and you’re using any THC product, try to switch it over to just using it at night so that you don’t have any of that in your system significantly to counter the CBD weight-losing effects.
Charlotte: Is this something that you can still also get from the Synergy Wellness?
Dr. Moskowitz: Yes. The reason I’m bringing them up is they’re a great service. They really are very, very dedicated to medical unlike most dispensaries, they are people that work with them really do understand the medical aspects of cannabis and I’ve trained a number of them in it. We did a research study together. We’ve done a lot of work together on all this and they are excellent. They know what they’re doing and they had great products before I knew anything about them. They’ve got greater products now that we’ve been working on some of these things.
The tradition has been to put it in medium-chain triglyceride oil or usually olive oil or coconut oil. I’ve convinced them to put it in a long chain triglyceride sesame oil because science shows that sesame oil causes a lot of substances including cannabis substances, cannabinoids, to absorb into the immune system and into the bloodstream at a higher rate. Sesame oil increases the absorption of cannabinoids threefold for CBD and two and a half for THC into your bloodstream.
“Cannabis neither raises nor lowers the effectiveness of the immune system, it normalizes it. If it’s too high, it brings it down to the middle. If it’s too low, it brings it up to the middle.”
Once it gets past your stomach and whatever is absorbed there is absorbed. Once it gets into your small intestines, the sesame oil makes it unabsorbable in the bloodstream but shunts it into the lymphatic system and the immune system. CBD absorbs 250 times more than normal into the immune system and THC 100 times more than normal into the immune system. In the immune system, THC has no psychotropic effect. Its only psychotropic effect is in the brain. In the immune system, these things really are incredibly helpful because they work with the other elements in the immune system to normalize the body’s immune response.
One of the problems that happens is as we age, our immune responses become either less effective or overly effective and people develop autoimmune diseases. They develop problems like that when it’s over effective. When it’s less effective, they’re more prone to infections. Cannabis neither raises nor lowers the effectiveness of the immune system, it normalizes it. If it’s too high, it brings it down to the middle. If it’s too low, it brings it up to the middle. If it’s too much off to the right or left, it brings it back to the middle. It’s really quite amazing. I’m utterly convinced that cannabinoids are anti-aging substances.
Charlotte: Wow. It works with the endocannabinoid system that’s already in our body?
Dr. Moskowitz: Oh, god, yes. That’s the whole reason cannabis has any kind of medical effect. It’s very interesting. This is a system that basically was only fully embodied and understood by us 25 years ago. It’s been in our bodies. It’s worked fine for time immemorial but in the last 25 years, we’ve figured out what makes up the system and it’s a pretty simple system. Currently, it’s made up of two transmitters, two receptors and five enzymes.
Anandamide is one of the neurotransmitters. 2-AG is the other one. Anandamide is the third most common neurotransmitter in our body. We didn’t even know it existed until about 30 years ago.
The cannabinoids work in the brain, they work in the body to regulate things and bring them back to the center, as I said. That is the goal of neuroplasticity in the brain which is regulate that, bring everything back to normal and then send out signals to the body to get it to normalize as well. Cannabis does this automatically. This is what we use the endocannabinoid system for if you’re not using cannabis and if you are using cannabis, it tends to enhance that system and then go out in the body and all the places that system works and work with it.
“I’m utterly convinced that cannabinoids are anti-aging substances.”
Cannabis works on everything from the immune system to the serotonin catecholamine system, which is what we use to regulate mood. The endocrine system in our body, the several different receptor systems that control temperature, bone health, that control the strength of the blood-brain barrier that control inflammation in the brain; all of this, cannabis works on and more actually. This is the same thing the endocannabinoid system works on and cannabis enhances that.
When we’ve tried to make artificial cannabinoids to do things like suppress appetite or calm people down, it’s been disastrous. We’ve had one that was out there that’s purpose was weight loss and it caused significant suicidal ideation and depression and had to be pulled from the market.
There was another one that they were testing. They tested it on animals, it seemed to be fine on them. They put it into people. In the sixth dose, it caused brain damage in five out of the six subjects they were testing. One of them died. Three of them, it’s never gone away. This is like three, four years ago now. The other one cleared up but that’s pretty serious stuff. The reason is because they were all geared to manipulate the endocannabinoid system. That system is critical for our well-being and people’s bodies got overwhelmed.
The cannabinoids in the plant we’ve been living with and using for the last 30,000 years. That plant has genetically been adapted by us, and it has a genetic effect on our bodies, even if people have never taken it because the whole way genetics work is not just what you’re born with, but what you experienced during life. At this point in time, pretty much everybody’s mingled with somebody that’s used cannabis, their DNA has been mixed, and so we’ve all been affected by this stuff over time.
Charlotte: If a person is smoking marijuana, that’s out there, you get regular marijuana or you take the edibles or the tinctures. Is that the same thing? Can that affect you positively if you’re just a regular user of marijuana or edibles, is that a positive thing? Can that affect you or do you have to take these special things?
Dr. Moskowitz: No, it’s all positive. Cannabis is a pretty positive plant. The negatives happen around people getting high and getting in car accidents and things like that, but the plant itself has a very positive effect. If you just look at THC, it’s got 16 identified medical effects that are remarkable and only one of them is euphoria, and it’s by far the best analgesic that exists. It’s really quite incredible.
Charlotte: Now if somebody’s suffering with anxiety, is there something in particular that they could take? You’ve mentioned something about the whole plant or is there something special for that?
Dr. Moskowitz: CBD is quite good for anxiety. The other one that’s really good for anxiety is THCV.
Charlotte: What’s that?
Dr. Moskowitz: It’s Tetrahydrocannabivarin, and it’s a variation of THC. It’s very rare and hard to find, it comes in certain plants, and it’s a real benefit for that. That’s also a benefit for diabetes and cholesterol and things like that. If you look at anti-anxiety properties though, THC can be helpful as well in lower doses, and that’s the trick is not do it in higher doses that make a person feel dramatically altered, but in lower doses, it can really help a lot with anxiety. Those are the big three, THC, CBD and THCV.
Charlotte: Where can one get the THCV?
Dr. Moskowitz: Again, I’m not trying to be an advertisement for Synergy and by the way, I have nothing to do with them financially or anything like that. They have a plant from a local grower here who it’s the only one that exists that we know of anywhere it’s called Black Beauty.
Charlotte: Can you smoke that or do you take that as a tincture?
Dr. Moskowitz: They have it in tincture form but that’s the only form they have it in. They have it in an alcohol tincture, they have it in an olive oil tincture, and they have it in a sesame oil tincture. They’ve also got it mixed in with CBD isolate and not with CBD isolate. You’ve got a chance to get CBD, THC, and THCV from them. That does all three of those, or you can just use that in conjunction with using some other stuff like CBD. Again, you can go to a dispensary and find THC gummies, CBD gummies. You can find other edibles, you can find, tinctures there. You can find all kinds of things there, and they’re all medicinal, they’re all valuable.
“If you just look at THC, it’s got 16 identified medical effects that are remarkable and only one of them is euphoria, and it’s by far the best analgesic that exists. It’s really quite incredible.”
It’s how you use them, how you mix them, and how you rotate them that matters in treatment.
Charlotte: Now, you said you’re retiring in approximately 11 months?
Dr. Moskowitz: Yes.
Charlotte: What happens to your practice and your wisdom? What’s going to happen if people need you?
Dr. Moskowitz: I’m hoping I’m going to hold on to my wisdom. [laughs] As far as my practice-
Charlotte: Let’s hope that. Yes, but you–
Dr. Moskowitz: -we’re closing it. The patients that we’re treating, we’re moving to other practices and they won’t have this kind of neuroplasticity knowledge nor the medical cannabis knowledge, but I’m working on putting out some things first about neuroplasticity that’ll make it much more accessible and useful to a lot of people. That’s my project I’m working on right now, and then I’m planning to probably write another book on medical cannabis to address a lot of the things I’ve learned since I wrote the first book and put this out there as a more practical treatment.
Stay tuned for Parts 3 and 4 Coming Up!
Note: Please do not use any of the above information without consulting with your physician. The above is exclusively the experience of the person being interviewed.
Michael H. Moskowitz, MD, is the President of Bay Area Pain Medical Associates. He is Board Certified in both Psychiatry and Pain Medicine and has served as a member of the Examination Council for the American Board of Pain Medicine and as the Chairman of the Educational Committee of the American Academy of Pain Medicine.
Dr. Moskowitz’ clinical practice in pain medicine uses the Biopsychosocial approach and he is a pioneer in the development of treatment approaches to brain neuroplasticity and pain. He co-founded Neuroplastic Partners and built the top rated website in the world on neuroplastic treatment (http:// www.neuroplastix.com). He coauthored, with Marla Golden, the Neuroplastic Transformation Workbook, used by practitioners and people with persistent pain to guide them through non-medication, brain based approaches to treating persistent pain.
Since 2015 Moskowitz has specialized in the use of medical cannabis for the treatment of pain and anxiety and he wrote a book on the subject, Medical Cannabis: A Guide for Patients, Practitioners and Caregivers.