24 February 2015

Medicinal Cannabis: Much More Than Just THC and CBD

More than 60 cannabinoids play important roles in providing the therapeutic benefits associated with cannabis therapy. They work in conjunction with around 420 additional compounds like terpenoids, amino acids, proteins, sugars, enzymes, fatty acids, esters and flavonoids, just to name a few, to give cannabis its versatility in treating a multitude of medical ailments. Naturally, you consume all of these compounds when medicating with whole plant cannabis. The question is how do all of these compounds work together to provide therapeutic relief? The answer can be found in a concept called the “entourage effect”.

The Entourage Effect: Chemical Teamwork
First described in 1998 by Israeli scientists, the basic idea of the entourage effect is that cannabinoids within the cannabis plant work together, or possess synergy, and affect the body in a mechanism similar to the body’s own endocannabinoid system. This theory serves as the foundation for a relatively controversial idea within the pharmacology community, that in certain cases whole plant extractions serve as better therapeutic agents than individual cannabinoid extractions. 

"Synergistic effects can be produced if the constituents of an extract affect different targets or interact with one another in order to improve the solubility and thereby enhance the bio-availability of one or several substances of an extract. A special synergy effect can occur when antibiotics are combined with an agent that antagonises bacterial resistance mechanisms"...

The entourage effect theory has been expanded in recent times (Synergy research: Approaching a new generation of phytopharmaceuticals. Phytomedicine, March 2009) with a definition of the four basic mechanisms of whole plant extract synergy as follows:
  1. Ability to affect multiple targets within the body
  2. Ability to improve the absorption of active ingredients
  3. Ability to overcome bacterial defence mechanisms
  4. Ability to minimise adverse side effects.

Affecting Multiple Targets
Many studies have demonstrated the effectiveness of cannabis as a therapeutic agent for muscle spasms associated with multiple sclerosis. One particular study, Medicinal cannabis: is delta9-tetrahydrocannabinol necessary for all its effects? determined that whole-plant extracts were more effective than THC alone. Researchers compared 1mg THC vs 5mg/kg cannabis extract with the equivalent amount of THC and found the whole plant extract to have significantly more anti-spastic effect. The researchers attributed this result to the presence of cannabidiol (CBD) within the cannabis extract which helps to facilitate the activity of the body’s endocannabinoid system.

Improving Absorption Of Active Ingredients

The entourage effect can also work to improve the absorption of cannabis extracts. Cannabinoids are chemically polar compounds, which makes them at times difficult for the body to absorb in isolation. Absorption of topicals provides a prototypical example of this problem. The skin is made up of two layers which makes it difficult for very polar molecules like water and cannabinoids to pass through. With the assistance of terpenoids like caryophyllene, absorption of cannabinoids can be increased and therapeutic benefits achieved.

Overcoming Bacterial Defence Mechanisms
The entourage effect also accounts for cannabis extracts being effective in treating various bacterial infections. There are a number of studies which show the antibacterial properties of cannabinoids. However, bacteria develop defence mechanisms over time to combat the effects of antibiotics ultimately allowing them to become resistant to therapies which were previously effective. Thus, it is beneficial that whole-plant cannabis extracts have non-cannabinoid constituents that also have antibacterial properties. These molecules attack bacteria through pathways which differ from cannabinoid pathways. Given the attack on multiple fronts, the development of bacterial resistance is limited.

Minimising Adverse Side Effects
Finally, the entourage effect allows certain cannabinoids to modulate the negative side effects of other cannabinoids. The most fitting example of this is CBD’s ability to modulate the perceived negative effects of THC. Many patients have heard about (or experienced) the increased anxiety and paranoia sometimes associated with cannabis consumption. Thanks to the entourage effect, research has shown that CBD can be effective in minimising the anxiety associated with THC, lowering users’ feelings of paranoia. So, THC, CBD and the remaining cannabinoids don’t compete with one another, they work in tandem alongside the other components of cannabis to provide therapeutic relief for a wide variety of ailments.

Adapted from an article by Dr Malik Burnett MD
The Entourage Effect of Whole Plant Cannabis Medicine

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