Use Cannabis for Better Health with Dr. Misha Kogan

If it's a chronic pain, think cannabis for sure. Sleep, any kind of sleep disturbances, think cannabis. Nausea, vomiting, chronic of any kind, think cannabis. So those are definitely top three. The following really close spasticity of any kind. And then I'll tell you something that you probably never heard of, and that is typical dermatologic conditions.

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I'm Dr. Ed Levitan. Welcome to the Five Journeys podcast where.

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Hi, and welcome back to another episode of the Five Journeys podcast, Live like youe Matter. I'm Dr. Wendy Trubo. This is. This is Dr. Ed Levitan. And our guest today is Mikhail Kogan, Dr. Misha Kogan. He is the medical director of the George Washington University center for Integrative Medicine. He's also an associate professor of medicine at George Washington University school of medicine. Dr. Kogan has recommended medical marijuana to thousands of patients and is a frequent lecturer on medical cannabis to professional audiences across the nation.

Welcome.

We're so psyched to have you here.

Thank you. So wonderful being here. Great.

What were you going to say?

Yeah, I want to first actually kind of say is we're going to talk mostly about cannabis and cannabinoids and. And you are a fully trained and working functional medicine physician and have a practice and does a full spectrum of functional medicine. I just want to kind of put that in context for our listeners, because.

This is the real deal.

It's not, yes, we're going to be talking about cannabis, but it's. You come from a huge wealth of.

Knowledge, not just cannabis.

So then what is medical cannabis and what's the difference between that and recreational cannabis?

I guess maybe. Well, if you figure that question out, you'll probably be a lot richer than you think. Well, there's no real, true, true separation. I think the separation is legal. Separation is ethical. Separation is intent. So the intent to use is probably what's separates how you're using it, you know, and what you're using it for. This whole idea that somehow higher concentrations or more CBD and that, you know, the higher dose per bottle, per vial somehow means more medical. That's. I. A couple of months ago, I was at New Jersey. New Jersey had a hearing when they were approving recreational canvas. And so I was asked to speak to the Governor there was, and it was pretty hilarious because like they were completely clueless about some really basic stuff like well, if you take 10, 5 milligram gummies, guess what, that's 50. And so that could be, you could be quite overdosed with 50. And so the recreational versus medical is really the intent. I think there's a whole idea that more and more states approve a recreational for. I mean, we all know why it has nothing to do with. It's all about the money, right? Because the taxation in some states is up to 30% and more. So if you collect 30%, if you collect 30 cents on a dollar for each dollar generated, you can imagine Colorado is busking in cash from the cannabis industry and everybody wants to follow the suit. So, so that's really the reason.

I don't think we should only be cynical though because the there is definitely benefit to bringing it out from the sub rosa and putting it in being monitored now, you know, okay, it's organically grown, you're not getting pesticides and chemicals, you know, it's not laced with fentanyl, you know that it's safe.

And guess what? And you don't drink alcohol. And your mortality in a state goes down by 10% from car accidents. Mortality from opiate overdose going down by 30 to 40%. Mortality from alcohol goes down by another. Don't quote me on that one, don't remember. So, yeah, I mean there's clearly exit strategy. The cannabis is probably the best exit drug we have in our society at the moment. I don't know if the psilocybin and ketamine and other things will be next, but on a grand scheme those are tiny fractions compared to how many people use cannabis in the country.

All right, So I mean for a brief stint of time worked as what we call pot docs and certified people for marijuana. And the most fascinating part to me was the impact of medical marijuana on cancer treatment. Do you have any experience in that? Can we talk about that?

We can talk about it as far as you want to go. We can talk about actual symptoms, which of course that's where the evidence is. And then we can be very provocative and say that the most crazy cases of cures I've ever seen, every single one had cannabis, including cases of stage four. And then now there is no cancer three months later.

Well, why is that? I mean it's definitely has anti cancer properties, but what, that's, what's that about?

So that's another. If you figure that one out, you'll be probably as Rich, you'll be as rich as musk. So we don't really know. We know that in petri dishes cannabis is quite effective for most cancers. It induces apoptosis. So literally it kills the cancer cells. What happens in the human body is a very different story. In animal models it can also be quite effective. The only thing we know in humans is there is a signal, strong signal I would say for brain tumors. Anybody who has a brain cancer probably should be on some cannabis unless they're taking biologic immune modulators. And then things get much more complicated because cannabis is a potent anti inflammatory drug. And so if you're giving somebody pro inflammatory treatment, you don't want anti inflammatory treatment there. There's some early studies from Israel particularly suggesting harm. So it's not a. If you read cannabis for cancer on Internet you get like thousands hits and a lot of the hits are like oh I cured my cancer and so can you. Or you get this chiching chung up in smoke saying that I cured two different cancers in the same body. So a lot of this is just a kind of a hype and probably a commercial gain only without real evidence. But the cases are there, the signals are there. I think what's really fascinating is that put those things aside for cancer in terms of palliation and I have four boards, I have an internal medicine, integrative, palliative and geriatrics. And so in palliative medicine we don't have any better tool. The funny part, I just took my palliative research 10 years later and there was no single question on the entire board on cannabis that does tell you the scope of affairs. We have a whole industry here that treats a lot of different cancer symptoms with cannabis highly effectively. And then we have a standard of care and they're completely clueless and they actually advising patients not to do it. Not because then if something works then they can't give them something that something else and suddenly they find themselves unable to effect manage the patient because the tool's not applicable when a p. I.

Mean so obviously if you're on an immunologic modulating cancer protocol, you would not be a good candidate for thc.

I think it depends on what you're trying to do. If you are on, if you're on a palliative treatment and even with immunologic treatment, but you really have tons of symptoms and you can't manage them. I still easily prescribe because I wouldn't, you know, like my intent there is to help the patient in the moment how they feel. Yeah, yeah. So that, that's. And that's where we have tremendous amount of evidence. And actually in 2017, National Academies of Sciences, Engineering and Medicine put a really profound report. In fact even now, five years later, which in. In field of cannabis. Five years, it's like a century in medicine. Right. Because it's like things are moving so quickly. But even still, that report I consider the most profound and the largest evidence that we have for the benefit. And they literally said it's grade A treatment for pain, chronic pain of any kind, including fibromyalgia, for nausea and vomiting during cancer and for spasticity, particularly in multiple sclerosis. So we have a conclusive evidence. And despite that, most of the societies still don't recommend using cannabis because of the Schedule 1 control substance. Cancer is hard because it's such a big field and nausea, vomiting in cancer and pain in cancer. I'd say it's so clear and so effective and often just so patients preferred because if they take more pills or if they take especially pain pills, we know so many side effects. Also in studies often euphoria is considered a side effect. When you have a patient with advanced cancer. I'm yet to hear from single person to say euphoria is a side effect. So it, you know, it, it. It's also depends on the fact that it just actually improves quality of life for people who suffering a lot with all kinds of chronic conditions.

All right, so we've talked cancer. So what would you do for. What is your kind of start starting point for insomnia? I have a lot. See a lot of Lyme patients that even if I give them pharmaceuticals don't do very well. So. And sleep is so vital. And the nice thing about. Well, actually let me ask you is the. Does cbd. Well, does cannabis affect sleep architecture in a negative way?

That's a great question. So THC does not in every person, but it does. So THC does it. And especially at the doses that are more than 5 milligrams, it can negatively impact architecture. CBD does not. So that's actually the reason why most of the time you want to at least try to a cbd. But really it's more practical. Patient is in the. Since I see patients from all over the world, I mean, if they're in a place where they can get legal thc, then what. Right. So how do you do that? Well, then you just go with CBD alone. But other practicality is the cost. I know that they will end up with sending taking 100 to 200 milligrams. And that's going to cost them way, way, way more than 1 to 5 to even 10 milligrams of THC. So I look at this because it's going to be long term. They're not going to be on it for a couple of months. I mean there's probably going to be a long term especially if you're treating chronic Lyme, right? I mean you're not telling them oh you're going to be better in three months. I mean this is going to take a while, a few years, probably at least a year I would say on average. So you have to get them prepared. But nowadays I go to after I teach them basic sleep hygiene and some mindfulness, I go straight into it because acupuncture is more expensive, can work sure herbs more expensive in a way because you get doses titration. I'm in a tri state area of Maryland, District of Columbia and Virginia and every state has medical. I can get everybody in my own area where they come to see me face to face. I can get them cannabis. But if they're calling from other states, usually we start to find out is it legal and then if not then we'll start with cbd. CBN always, always comes up. People always ask me so should I just take straight up cbn? It does work for some people but it's just not as interestingly enough predictable. So usually I say sure, you can do some CBN but try to take it with some cbd. There seems to be a better efficacy and then you decide what else they need. If they have a Lyme, right? You want a lot of anti inflammatory effect and they probably have some pain. So if they not sleeping because they're hurting at night, I'd get a lot of cbda, cannabidiolic acid because it's a very good, it's like Motrin at bedtime. It's actually more effective than Motrin if you titrate the dose up. Problem with cbda again cost. You can get Motrin for a couple of pennies literally per tablet and CBDA is going to be way more expensive. So you also keep running into these practicalities. You know, if they have a lot of anxiety and they're just like they can't cool their brain down. I keep titrating cbd, that seems to be the best. So you also have to start kind of thinking in parallel what else is happening. And then if they also have neuropathic pain, they can't get cb, THC well, give them cbg. CBG can be very effective for neuropathic pain.

So what do I tell the dispense? What do I tell my patient to go look for dispensary? Or what does the patient. What. What are they looking for? What's the actual prescription? Which is not a prescription, obviously, but.

Well, you. You need to educate them more. One thing you can simply tell them, get Dr. Kogan's book, open the chapter on sleep and follow exact cases, because, you know, I have cases in each chapter and follow directions. So you can give them resources. First of all, because the. You can spend half an hour with the patient telling them precise finding the strain specifically, like you're going to what we used to call Indica, which is just don't use those words because they don't mean anything. Everything hybrids pretty much. And even like Indica can have stimulatory effect on some people. And Sativa can have depressing. It doesn't. It's really all about terpenes in a way, how that entourage effect or combination of major cannabinoids with other minor cannabinoids causes the effect on the body. But it's a little different on everybody. So there's still experimentation. Even in the best case scenario. You're gonna tell them, okay, go get your calming strain. Couple of milligrams of THC from dispensary. Take it like an hour or 30 minutes before bedtime and titrate it. Absolutely. But you don't actually know. It may be stimulating even at low doses. So for most people it's one, but then for some people it's another. So you have to kind of prepare them that. Okay, if that happens, don't panic. Just. We'll keep with the process. At the end of the day, if they stick with the process, the efficacy is so high that everything else we do. I always tell people, well, the gaba, sure, great. Ltheanian, sure. But we all know that the level of efficacy is 30% get response. We feel great. But here, I'd say 80 to 90% once you get there. It's getting them there requires a lot of information. Coaching. And so I actually feel strongly that the future is all about coaches. We docs should not be doing this. We're too expensive. We don't have time to call the patient every week and say, hey, what's going on? Where are you? What's your dose? Have you tried this? Okay, why not? When you tried that? Oh, that happened. Okay, so now we're going to do this. That's the level of feedback, I'm sure somebody's going to try to automate it. I'm sure there's already works on the apps and things like this where this is going to be built into some kind of a platform where you feed the computer something and it'll. But, but you know, that's also lacking human aspect and maybe difficult.

Tell me something. Do you. Are you recommending that people do tinctures or edible something they're swallowing versus something that's sublingual? Because the sublingual will last like four hours. So it wears off just when they need to be sleeping. And then. So are you saying do an edible because you can't titrate as easily.

So, so start with sublingual titrated to when they falling asleep. Well, and then once you know the rough pills, you transition to the edible. If you're a young person and the situation is horrible, like, you know, somebody's like really not sleeping and you can even start sometimes just start straight with edible and just tell. Okay, if you overdose and you grind the next day, don't be surprised. We'll cut the dose down sometimes. What I'll tell them, I'll tell them, go get five milligram gummies, cut them in quarters and start with one quarter, you know, or even less. I mean it really. So that's another option. So you can do the oral, but that depends on what kind of insomnia they have. If they can't fall asleep, tinctures probably going to be more predictable. More. Not just more predictable, but more consistent effect. The other problem with edibles. Well, it depends on what's in your stomach. If your stomach is relatively full and there's a lot of fat in it, you're going to have one level of absorption or one speed of absorption. If you don't, it'll be a little bit different. If you keep it in a mouth long enough, you're going to have partial sublingual absorption and then partial. So that's another way you can have them chew it, hold it in the mouth for five minutes and then swallow. So they're gonna get both. So there, there are all these intricacies and that's why I think the coaching, like it's just most people will not learn that unless they're so interested in it. So people, we have a lot of enthusiasts who coming in and they're like, oh, I want to know everything. They will buy my book, they'll read the whole thing and then they'll have like 10 gazillion questions because they already like tried stuff on their own. So those are much easier to work with patients. But if you have somebody who's completely clueless and, and by the way their primary care said oh, cannabis will kill you or something, something stupid like that, you're still, we're still hearing that periodically. Not, not a lot. Thank God that still happens. And so then they going against the grain there and, or like the, the like 90, like my, my favorite story. So where I'd have like 95 year old grandma who has some really advanced Alzheimer's with a lot of psychosis and nothing works. And of course cannabis is amazing in the cases like this. And so the kids would bring the mom or parent and the kids and I'd start at some point they're just coming in for geriatric appointment right to see me. And so I'd say well we're going to start with cannabis. And kids like what, isn't that illegal? And the grandkids in the corner, I told you so, I told you so for years and you didn't listen to me. Now look, you know, so that always gets me cracked up.

So what are the other top three to five things that you want to think of for cannabis? Like I know anxiety is probably a huge one there.

Anxiety is huge. Anxiety has some evidence for cbd but the problem with anxiety it's it, it has a lot of different like causes and I wouldn't think of cannabis for anxiety as first line because I just, you know I would try to treat the cause of anxiety. Right. If it's a more psychologically driven stuff, you know, we send them to psychologists or if it's more of just, you know, they're wrapped up in their mind and they need to drop into the body will send them to mind body teacher or just MBSR or whatnot. But for, I'd say for the top three, well, definitely pain in all kinds of variations of pain. If it's a chronic pain, think cannabis for sure. Sleep, any kind of sleep disturbances, think cannabis. Nausea, vomiting, chronic of any kind, think cannabis. So those are definitely top three, the following really close spasticity of any kind. It doesn't matter whether it's multiple sclerosis, spasticity or anything else like a post stroke for example, people get a lot of like they're just, they have contraction on one side and the body is really hard and spastic. So you know, can be very effective. And then I'll tell you something that you probably never heard of and that is typical dermatologic conditions. So eczemas, any kind of rashes, anything that is localized. I mean of course if it's a whole body, you wouldn't put it topically. But the topical cannabis is heavily underutilized and I don't understand why. I know this is one area where pharma is hugely investing into topical cbd. I mean there's like a half a dozen of companies running to the top, including Pfizer bought paid $6 billion for like some startup very recently because it's a huge market like eczemas. Psoriasis. I published the case on psoriasis, CBD or thc. It's not exactly clear what ingredient is better, but I've probably cured hundreds if not thousands of different eczema and psoriasis cases just with topically. Just put it locally there. If this, if, if their process is not widespread. If it's widespread, it starts complicated. But if it's a minor problem, amazing. And then all man, all things gut, whether it's ibs, whether it's Crohn's disease, whether it's ulcerative colitis. Ulcerative colitis. Suppositories. I mean I've had few dozen of patients, they don't take any drugs, they just take the rectal suppositories and that's it. And that manages their ulcerative colitis of.

Cbd, THC or combination.

Combination, yeah. Usually it's either one to one CBD to THC because those are the easiest to find if they can make their own. I sometimes would put other things like cbda, cbga because that seems like it's also very effective to as an anti inflammatory. So think of anything that is within a reach of delivery system. So if it's an easy delivery system and it's an inflammatory conditions, totally worth a try.

We should put it in our daughter's ears. Seriously, she always has ear infections.

You could totally try it. You could totally try it. You could totally try it. And it wouldn't, I mean because you know like how much THC is she gonna absorb from the ear? A tiny amount. My kids use topical CBD. Like my. I have 13 and 15 year old, 13 year old has this condition where the bones grow fast. So he has this aching in the joints and so he was like going professional skateboarding. But now he can't do it because. So we start putting him on some CBD topically and he loves it.

And is that a special preparation or you just do a.

No, I'm just commercially available.

Yeah, we have cbd. We have cream cbd.

And it's been.

I use it for pain.

Yeah, exactly. That's what you want, but you want it as concentrated as possible. So you don't want to use like 100 milligram per jar. It's just nothing like probably start with 500 and up. So 10, a thousand, 1200. And the 2oz jar, which 2oz are usually standard size, so keep going up as much as possible. Sometimes you have to have THC too, so. So it's not really clear, but once you need to thc, then of course you have to get a card and like, it's a lot more complicated.

I'm assuming that all of our listeners have 8,000 additional questions and want to follow you. How can people reach you?

Gwcim.com. so that's our website, www.gwcim.com. everything is on the website. I have my own website, but the main one, you can find us there. And all the information is there, as well as a coaching information for how to get in touch with me and a coach. And then of course you can just get the book. So if it's just medical marijuana, Dr. Kogan's guide to Cannabis and CBD on Amazon, and it's a Random House, big publisher, so it's everywhere. There's also an audible and I'm proud of the person who read it. It's the same person who did Life of PI. So it's. He's got a great voice. That's a very. And the book is written quite simply, so it's not a. It's definitely not a medical book the way it's written. It's like for just a average person to read.

Awesome.

Awesome.

This has been fascinating.

Yeah, we can talk for hours.

Yeah, we totally could. So thank you for joining us for another episode of the Five Journeys podcast Live like youe Matter. Our guest today is Dr. Misha Kogan and we talked all about cannabis. You should get the book. Get his book. It's a great book. Thanks for joining us.

Thank you so much. I hope I'll see you guys soon. Sometime in Boston.

Definitely.

Absolutely.

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