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sulak and cbd tincture

Sulak: Absolutely. Triphasic or multiphasic, because we see that it can go up and down and up and down. Each direction is a phase, right. So if I start sub-therapeutic and someone gets benefit, that’s one phase. If they go up even higher and they lose benefit, that’s another phase. But then often, when they really crank the dose up high, that benefit will return. Sometimes when it returns, it returns with side effects or the benefits may be a little bit different than they were at the low doses. And there’s probably a phase at ultra-low doses, where people can take such a small amount and get benefit down there as well.

Sulak: I’ve been extremely impressed with the acidic cannabinoids. I used to not believe that they would do what people were saying they would do and a couple of years ago a mother of one of my seizure patients brought in a bottle of CBD that was working to reduce the seizures, and I said great let’s test it. We had just set up our lab. So we looked in that bottle. There was no CBD , there was no THC . It was all THCA , and a very small amount. And since then, I’ve been paying a lot of attention to what THCA and to some extent CBDA can do for people. And what I’m finding is that they’re effective at reducing symptoms, sometimes at a tenth or even a hundredth of the dose that it would require if they were using the neutral, or decarboxylated, cannabinoids THC and CBD .

Sulak: That’s a great question, and I get asked that question a lot. There’s really no way for someone like me, or any practitioner, to meet a patient and learn what’s going on with them and say I know exactly what you need to do in terms of cannabis dosing. It just doesn’t exist because people have such a varied response to the medicine and there’s so many different types of medicines. And from what I’ve seen in my practice, there’s this huge dosing range where some people do well with really low doses, other people do well with really high doses. There’s all the different delivery methods. So instead of trying to figure out exactly what someone should do, what I found works the best is to give someone a starting point, and then give them a methodology, a program for titrating from that starting point to determine what works best for them based on their individual goals.

Project CBD : One issue that I think is really a challenge for both patients and physicians when it comes to cannabis therapeutics is the whole issue of dosing and how one begins a correct dosing regimen for their condition and their situation. You’ve done a lot of work in this area – kind of pathbreaking really. How do you determine an appropriate dosage recommendation for a patient?

Sulak: Absolutely, Martin. Even the people that come to me that really don’t want a psychoactive experience, you know I encourage them to do that during the day; but for folks in the evening or maybe even just once a week on the weekend, I usually recommend that they do something THC -dominant to get some of that consciousness that cannabis has to offer to help them get a new perspective on their lives, to help them solve their problems creatively, and just to laugh and enjoy themselves. And also, THC -dominant cannabis sometimes just works better for people. Sometimes it works better for pain, better for anxiety, better for spasticity, and is more likely to help with sleep.


Project CBD : Would there be a situation where you might go higher on the THC and lower on the CBD in this context?

One 2005 animal study found that a single milligram of THC a day “resulted in significant inhibition of disease progression” for animals with heart atherosclerosis. “This effective dose is lower than the dose usually associated with psychotropic effects of THC,” the study noted, implying that cannabinoids may have health benefits even if the physical effects associated with higher doses can’t be actively felt.

Unfortunately, there’s not much clinical evidence for the benefits of microdosing available just yet. Most current studies involving CBD and THC are conducted using high doses of isolated cannabinoids instead of small doses of whole-plant goodness.

Microdosing with CBD oil | Microdosing with CBD oil as a sublingual is probably one of the easiest methods to follow: just bring your favorite oil with you as you go about your day, and measure out your microdose every few hours. Don’t forget to hold the oil under your tongue before fully ingesting, just as you would with traditional CBD dosing.

What the Research Says About Microdosing

Just because it hasn’t undergone clinical research yet, doesn’t mean microdosing doesn’t offer benefits—or that it won’t be studied more extensively in the future. Most discoveries in the health and wellness space, afterall, start as trends used effectively by individuals before researchers catch up to the moment.

Regardless of what your preferred daily dose is, there’s growing evidence that spreading your intake out over the course of the day through microdosing can heighten the benefits of CBD.

– Dr. Dustin Sulak

“Dosing cannabis is unlike any therapeutic agent to which I was exposed in my medical training [. ] ultra-low doses can be extremely effective, sometimes even more so than the other extreme.”

“Start low and go slow,” the widespread refrain for finding the right dose of cannabis, is actually only half the phrase, Dr. Dustin Sulak explains on The Cannabis Enigma podcast. “But [people] often leave off the rest of the sentence — it’s start low, go slow, and don’t be afraid to go all the way.”

And I think that this is most obvious in people that are brand new to Cannabis, at a certain dose of THC, they might feel like while they’re getting good therapeutic results, but they’re also getting dizzy, clumsy, forgetful and so forth, so we’ve got different areas of the brain at work here, pain signaling areas, and then motor function areas, and it’s been shown that the motor systems will develop tolerance more quickly, so you talk to that same person a week later and they’re saying, “Yeah, the same dose is still working for my pain and it’s no longer making me feel clumsy,” and whatever those other side effects were.

Full transcript:

Dr. Sulak: I believe we are so far from it. I mean, I don’t know if we’ll ever get there. Cannabis has such mystery behind it, I think if we’re looking at 8 cannabinoids and 20 terpenes, this is the tiny tip of the iceberg, and I honestly don’t know what’s below the water, and maybe there’s flavonoids and other classes of compounds that we should be looking at but it’s just so complex. I’ve seen varieties that have very similar terpene and cannabinoid profiles that are quite different based on my patient reports. So I think we all get excited to solve this mystery and to understand this medicine. And I do think that terpenes are a great lead, they can tell us a lot and we can learn about them, but I really caution people to think they… From thinking they have all the information they need to kind of classify and categorize these strains, because there’s a lot more going on there that we don’t understand.

Dr. Sulak: Sure. So tolerance to Cannabis, especially THC, builds when our cannabinoid receptors, which are like these little antenna on the surface of ourselves, when they become over-stimulated, then the cells likely to pull that receptor inside and then it’s no longer available for stimulation. And the THC doesn’t have an effect on that cell like it used to. Interestingly, the same thing would happen if we build tolerance to THC, then we’re also undermining the effects of our endocannabinoid system, we’re making it so that the endocannabinoids no longer have access to that receptor as well. Now it’s been shown within the brain, as well as within the rest of the body, that different parts of the brain and different tissues will develop tolerance to Cannabis at different rates, and so you could have one part of the brain that’s become tolerant and another part that is still very sensitive.

This is a common phrase that people are using in Cannabis, but they often leave off the rest of the sentence, which you did also, it’s start low, go slow and don’t be afraid to go all the way. And I didn’t come up with that, that, I actually learned from one of my geriatrics mentors when I was in residency. But it’s absolutely true, because Cannabis has this incredibly broad dosing range, someone like my size and adult might respond to two milligrams a day and someone might respond to 2000 milligrams a day, and within that range, it’s safe and effective, and everyone could have an optimal dose. Now, those are outliers, I’d say probably most of my patients are using somewhere between five and 50 total milligrams of cannabinoids per day, but some people really need a lot less and some people need a lot more. When I’m designing a treatment plan to help someone figure out their optimal dosage, I’m really tying this to concrete goals, so I’m figuring out, “What are we trying to accomplish here?” If they’re not sleeping well, that’s where I start, but people usually have other things that you wouldn’t necessarily know unless you dug in.