This is essentially the transcript of the class I completed on treating Alzheimer's disease with cannabis. I changed very little of the narrative. I wanted you all to hear it the way I did. The good doctor was very thorough, and he didn't need me to translate at all. May it help you in your search for answers about this most dreaded disease.
The good news is that it's possible to delay the onset and progression of the dementia of Alzheimer's with as little as 2.5 mg of THC and CBD once a day. That means most of us are protected already. Now, protect your loved ones as well.
Treating Alzheimer's With Micro doses of Medical Cannabis - Dr. Gregory Smith, MD, MPH
Alzheimer's is the most common form of dementia, a chronic, degenerative disease. Symptoms sometimes don't start until the damage has been ongoing for decades.
10% of the population show signs, in some form, by age 65 and 50% by age 85. In the US 200,000 people develop Alzheimer's by the age of 65, usually caused by one of three abnormal genes. It may be difficult to distinguish normal aging changes from Alzheimer's.
Other forms of dementia can occur due to strokes or concussions.
The first area affected is short term memory, followed by problems with organizing thought and language.
The dementia of Alzheimer's disease is caused by chronic brain inflammation occurring in specific areas of the brain where chronic protein debris has collected. These toxic effects take decades to kill brain cells and cause dementia and eventually behavior problems that can include
- language
- mood swings
- social withdrawal
- disorientation with time, place or person
- other behaviors, such as agitation
Late in the condition there's loss of bodily functions
Other medical conditions can increase the chance of getting Alzheimer's:
- depression
- hypertension
- stroke
- concussions
These conditions can also make the dementia of Alzheimer's worse. They can work synergistically to make a worst case. It's important to have a handle on your medical conditions.
Ongoing mental and physical exercise, avoiding obesity and other nutriceudical intake can decrease the chance of onset of Alzheimer's.
It's important to note that some medications, recreational drugs or alcohol, which have effects on memory, thinking and concentration can temporarily make the dementia of Alzheimer's worse.
The Progression of Alzheimer's Disease
Damaged proteins cause inflammation. Oxidative stress underpins most degenerative inflammatory and aging phenomenon. Oxidative stress refers to excess toxic byproducts that overload our cell's ability to clean up waste. This results in an accumulation of toxic waste proteins. This is akin to rust developing in and around the cells. The body's inability to clean up the rust causes corrosion (cell death).
The fundamental damage to the cells are:
- Amyloid proteins plaque outside the brain cells
- Tau tangled proteins inside the brain cells, create an atmosphere like thick, chunky egg whites.
The body's immune system (chemical messengers) attempt to surround the cells and eat the toxic waste materials to remove them from the body. As this is repeated over the years the area of damage gets bigger and bigger and cells eventually die. Then less brain messaging occurs in these parts of the brain, because there's less cells to send messengers. The most effective treatment is accepted to be early detection and use of meds and nutraceuticals to slow the progression of the disease, since it's unlikely to have a medication halt or restore dead brain cells.
In Alzheimer's, this brain death occurs in areas responsible for processing memory, language and other higher functions.
Detecting the disease as early as possible is the goal. The early and mid-stages of Alzheimer's is when cannabis, diet and nutraceuticals are most likely to have the most impact on halting or slowing the progression of the disease.
Warning signs of Alzheimer's disease:
- Poor decision making, demonstrating poor judgement or difficulty maintaining a budget.
- Difficulty having or keeping a conversation going.
- Losing track of date, day or season.
- Misplacing things and not being able to retrace steps.
It's necessary to be able to determine normal cognitive changes that occur with aging such as:
- Making poor decisions, every once in a while.
- Missing a payment, here or there.
- Forgetting what word to use, sometimes.
- Forgetting things early in the day, but remembering them later.
- Losing things, every once in a while.
Early warning signs that suggest a need for professional evaluation.
- Memory loss that's disruptive to daily life.
- Planning and problem solving becoming challenging.
- Completing normal tasks becomes difficult.
- Confusing place and time.
- Difficulty interpreting spacial relationships and images.
- Problems with words and speaking or writing that did not exist before.
- Losing the ability to retrace steps and misplacing things.
- Decreased or poor judgement.
- Withdrawal from work or social activities.
- Changes in mood or personality.
The Endocannabinoid System
The ECS is a feedback system to turn down the volume in various systems in the brain and body. The ECS operates in many parts of the brain, specifically working with memory, appetite, response to stressors, sleep and reward centers. The ECS works throughout the body via the immune system. Our body has natural chemicals made in the body to stimulate the ECS receptors.
There are different types of ECS receptors. CB1 receptors are predominantly in certain centers of the brain and is mostly effected by THC, and CB2 receptors, found in the immune system cells in both the brain and the body, and predominantly effected by CBD.
How Cannabis Impacts Alzheimer's
Both THC and CBD are potent antioxidants that reduce the damaging effects of oxidative stress at a cellular level.
When the CB1 receptors on brain cells are stimulated by THC this results in a more rapid removal of excess amyloid proteins from the cells, so that the excess proteins don't accumulate. CB1 receptors are most plentiful in the hippocampus part of the brain. That is the area of the brain most effected by Alzheimer's disease, and it has to do with memory and organization.
CBD stimulates CB2 receptors on the immune cells in the brain. This turns down the damaging inflammatory activity of the immune system and decreases the number of damaging phagocytic cells that are mobilized to the area of protein plaques.
Independently of the ECS, THC actually has two other effects to halt the effects of Alzheimer's disease. It inhibits an important step in the process that leads to the clumping of proteins into amyloid plaques. Also, THC improves a function of mitochondria inside the cells, and the mitochondria are the motors that drive cellular function.
The end result is that cannabis can halt or delay the decades-long process of brain cell degeneration.
Acetylcholine is just one of of many neurotransmitters used by the nervous system throughout the body. Brain cells send messages to other brain cells by releasing a chemical called acetylcholine. Once the chemical is released and has done its work it is rapidly broken down by an enzyme called acetylcholinesterase.
All of the FDA approved drugs for the treatment of Alzheimer's work in the same way - they block this enzyme, acetylcholinesterase from breaking down acetylcholine. Therefore, by having more acetylcholine available, the damaged Alzheimer's brain cells are able to send more messages than they would be without the medication.
Interestingly, THC is also a powerful acetylcholinesterase inhibitor. In fact it is more powerful than any of the FDA approved medications. It also crosses the blood-brain barrier much more rapidly and effectively than any of the FDA approved medications.
Cannabis-based medicines have all of the benefits discussed above, plus they are better than the FDA approved medications at being acetylcholinesterase inhibitors.
The Blood-Brain Barrier (BBB)
The brain has a protective membrane in the blood vessels that is not found in other parts of the body, which dramatically reduces the ability of medications, toxins and infections from getting into the brain. So only about 1% of FEA approved medications get through the blood-brain barrier and actually work on brain cells. The rest of the medication has no effect on Alzheimer's. The blood-brain barrier actually has natural transport receptors that actively move both THC and CBD across the blood-brain barrier. So a much higher percentage of THC and CBD makes it to the brain cells and it gets there much faster. This makes cannabinoid medicines very effective for treatment of brain conditions such as Alzheimer's.
FDA Approved Medications
There are several FDA approved medications that all work in basically the same way - they increase the amount of messaging in these damaged areas by blocking the enzymatic breakdown of the messaging chemical acetylcholine, and the medications are called acetylcholinesterase inhibitors. Current FDA approved medications include Aricept, Razadyne, Namenda, Exelon, and Namazaric.
These medications don't cross the blood/brain barrier very well, with only 1% of the medication being able to make the cross and be utilized by the brain.
These medications are best used in early to moderate stages of Alzheimer's, and they actually only work for about 6-12 months, and then they stop doing anything. None of these FDA approved medications actually halt the progression of Alzheimer's, they only help with some of the symptoms.
Other Beneficial Effects Of Cannabis
Cannabis has effects on other medical condition that are common with Alzheimer's such as arthritic pain and loss of appetite. The low doses recommended to stop the progression of Alzheimer's may not be high enough doses to have a measurable impact on these other symptoms. However, it's important to mention that THC and CBD work hand in hand with all the regularly prescribed medications for these behavioral symptoms.
Cannabis Doses
Both THC and CBD provide different means of treating Alzheimer's. Because THC and CBD cross the blood/brain barrier so quickly and effectively, only very low doses of cannabis are needed on a daily basis to have a measurable impact. This means that the patients don't get appreciable euphoria, or high from the dose, but it is having a medical effect. Also, probably only a once a day dose is necessary for these effects.
Usually the cannabis medication is started with an initial bedtime dose to reduce the impact of adverse effects, but it can be taken at any time of the day. It also doesn't matter how the medication is taken. Although elderly patients tend to prefer a bedtime edible dose, you can use tinctures, edibles, smoked or vaporized medication. It all eventually gets into the bloodstream and then into the brain.
Given all these facts, and considering the desire not to have any annoying high or euphoria from the cannabis, or behavioral side effects such as anxiety or temporary worsening of short-term memory, it's best to start with cannabis that has a 1:1 ratio of CBD to THC - that means equal amounts of CBD to THC - and then go with a low dose (1.25 - 2.5 mg, or the equivalent of one to two "hits" of a standard joint) at bedtime.
Possible Cannabis Adverse Effects
Cannabis, in any form, smoke, edibles, creams, patches, or vaporized is very safe and never caused a fatal overdose. There are thousands of years of human history using cannabis, and it is clear what issues to look out for. The most obvious safety issue is from getting euphoria, or "high". This results in problems with balance, coordination and loss of short-term memory, all symptoms already present in many Alzheimer's patients. So, like many medications and alcohol, patients using cannabis should not operate a vehicle or work on or around dangerous machinery or environments where they might get in trouble if they became euphoric, or high, or had issues with balance
Almost all patients will quickly learn how to dose their cannabis within one or two weeks so they don't get any euphoria or balance issues. Too large a dose of THC can result in paranoia or a feeling of agitation or anxiety. So the most important phrase when we are learning about dosing with cannabis is the following:
You have all the time in the world to gradually get up to the correct dose, which will probably be a very low dose. But start at the very, very low dose, slowly move up until you get the therapeutic effect.
There are other adverse effects or side effects that have been known to occur. Most of these side effects have been known to occur in recreational users, not people using cannabis for medical purposes. This is research done over the last few decades, and again, mostly with recreational users using very high THC with low amounts of CBD and using frequent doses several times a day. Not the kind of cannabis use that goes on with medical conditions, but you should know what to look for.
There are several studies that show that as many as 9% of regular recreational users of high THC cannabis can get physically dependent, or addicted to THC. This is especially true of adolescent users and in people who take higher doses of THC several times a day. However, this is a mild addiction. People are able to withdrawal from cannabis in one to two weeks with only mild side effects
Here is some of the signs that THC dependency may be developing.
- Tolerance to the effects of cannabis, meaning that more cannabis is needed to get the same effect.
- Withdrawal from the effects of cannabis such as irritability, trouble sleeping or depressive symptoms.
- Using more cannabis than was intended or recommended.
- A persistent desire to stop taking cannabis, or to cut down and being unsuccessful at it.
- Spending lots of time obtaining, using or recovering from the use of the cannabis.
- Giving up important activities in favor of using cannabis.
- Using cannabis knowing that it's causing problems in your life.
It is very unlikely for a person to get dependent or addicted to a once-a-day low dose of cannabis used for medical purposes. You and your medical professional should maintain awareness of this possibility and address it early on.
Dosing Cannabis
There are several goal in using cannabis for Alzheimers patients. In persons at increased risk for developing Alzheimer's later in life the goal is actually to prevent or actually delay the age of onset of symptoms. Once someone has Alzheimer's disease the goal is to halt the progression. And then finally, the goal it to have the acetylcholinesterase inhibitor effects which are similar to the effects from the FDA-approved medications. They just reduce symptoms. They're not halting the progression of the disease, they're just improving the symptoms for a short period of months.
Cannabis is an adjunct medication. It is very important to understand what this means. It is used in combination with FDA-approved medications. Cannabis, and cannabis-related medications are very safe, well-tolerated, especially when started slowly. It is also important to note that they are relatively inexpensive medications.
CBD has no adverse effects unless it is used for a very long time in very large doses of hundreds of milligrams, which we're not going to be discussing in this course. That's for use with some seizure conditions. We're going to be using much lower doses than that.
One of the big problems with using cannabis to treat conditions is that there's very little consistency from batch to batch of buds or edibles. There are few state laws and no federal laws addressing quality, consistency, manufacturing practices or other standards that we would expect from pharmaceutical foods. The best way to overcome this barrier is to start with a very low dose of medication - the bud, vapor, edible, patch etc. - and wait for a long enough time to determine effect before changing the dose.
The wide range of dosing of the medication allows the patient to start at very low doses and gradually titrate the dose up if necessary. Very low to low doses of cannabis are all that have been shown to be necessary to halt the progression of Alzheimer's disease. Try for a 1:1 ratio of THC:CBD
In addition there are a wide variety of paraphernalia that has been designed over the years to deliver the doses of the cannabinoids and to assist with appropriate dosing of the medication, so that you know that you are getting the right number of milligrams, 1.25, 5, 10, whatever the dose we want to be sure that you're using a device that is delivering that dose accurately and repeatedly the same.
The method by which the drug is used dramatically effects the onset of action and duration of action and any adverse effects, and we're gonna talk a little bit about that later. There's some social and cultural stigma associated with smoking marijuana and in my observation older patients prefer not to smoke marijuana and much prefer edibles, and in some cases during the day a vaporizer.
The potential side effects of cannabis are mild, self-limited, and easy to monitor. However, cannabis does have the ability to acerbate some of the symptoms associated with later-stages of Alzheimer's, such as paranoia, anxiety, and short-term memory loss, due to the effect of higher levels of THC. So the focus is on starting with low doses of medication and gradually moving up the THC to a maximum of 10 MG per dose, and then keep moving up the CBD dose way past 10 mg, if necessary.
The goal is to get to the sweet spot. What o mean by this is too little medication may not have any measurable effect However, too high of a dose, especially the THC, can result in adverse effects. With chronic degenerative conditions such as Alzheimer's it is quite simple to dose the medication. Only small doses of THC and CBD are needed on a daily basis to halt the progression. The patient can just stick to the small dose and take it every day, and re-evaluate once a year with some tests discussed later.
The THC and CBD in these doses is generally more than is necessary to halt the profession of Alzheimer's disease. This is because the medication quickly crosses the blood-brain barrier and has effects on the brain cells with each daily dose. Because that are such small doses there's very few adverse effects and almost no euphoria. It is important to remember to re-evaluate the dosing, and there are tests available to determine how this medication is working. But the primary goal is to halt the onset or the progression of the Alzheimer's dementia.
Measuring the Effects of Cannabis
The correct dosing of the medication is vital to success. Studies have shown that only a tiny amount of THC and CBD need to get to the brain cells to have the desired medical effect. The disease smolders in the brain. The effects of cannabis will take months to become apparent.
Your medical professional will determine your baseline cognitive function with some simple screening tests. After starting the cannabis these same tests will be used several months later to determine if the medicine is working, or if a change of dose is called for. So the outcome that you and your doctor will be looking for is to a halt of the progression of the dementia symptoms.
Reversal of the symptoms would be nice and can occur, but it's usually only temporary, and this is due to the temporary effects of the acetylcholinesterase blocking effect of cannabis, and this reversal of symptoms is usually just for a few months and then the symptoms recur. That's not something to be looked for. What we want to stop is any worsening or objective progression.
You and your doctor cannot judge the adequacy of the medication after a few doses. It needs to be taken daily for several months before an assessment can be made as to its efficacy. Usually only a once a day dose is required, and this is best at bedtime when any adverse potential side effects would be less noticeable.
If the initial dose doesn't halt the progression of symptoms the once a day dose can be gradually be increased every three months, depending on the condition. CBD and THC should be increased up to 10 mg before considering adding a second, or eventually a third dose throughout the day.
In essence, it doesn't matter how the THC and CBD are taken. Whatever works best for the patient. You can take edibles and tinctures orally, you can use mouth sprays, which is almost as effective as vaporizer smoked cannabis, or you can use dermal patches that allow for slow absorption over 24 hours of THC and CBD into the bloodstream. However you do it the THC and CBD will eventually get into the bloodstream and then are quickly transported across the blood-brain barrier where they can interact with brain cells.
For those patients only using CBD a starting dose is 5 mg at bedtime. This is increased to 10 mg depending on the response to the tests that will be given. If only CBD is being used, then once a day dose is all that is usually needed, and you can go quite high. It's not unusual to be 60 mg or more when it's only CBD being used to stop progression. However, we stop at 10 mg for any one dose when it comes to THC, so if we need to go higher than 10 mg of THC a day we go to a second dose. So maximize the first dose at bedtime to 10 mg of THC and then you can add a second dose, and all the way up to a third dose, and those can go all the way up to 10 mg.
These are unusual doses. Again, we're gonna stay at or below 10 mg and just one dose.
Let's look at two different scenarios where you would use medical cannabis. Before starting the cannabis, take one of the quick tests to assess your baseline dementia score. The two most commonly used tests are the SAGE or the Memozor which are discussed below. Repeat this test after three months to determine if this dose is working for you. You keep increasing the dose as necessary until you find that it's working. Once the correct dose has been determined the test can then be re-administered once a year to confirm that it's still working on a yearly basis.
Start the cannabis at a specific dose, then retake the test after three months. The score should stay the same or actually improve. This means that the dose is working. Remember the goal of the daily dose is to halt the onset or progression of dementia. If the score gets worse, then the dose is not strong enough to be having an effect.
It is important to remember that medical cannabis is a maintenance medication, like high blood pressure medication. It does not rapidly change the condition right after taking it. Instead, over months and years of daily use it halts the progression of damage to the neurons.
Scenario One: When the patient is symptomatic with some Alzheimer's disease.
When the patient has already been diagnosed with Alzheimer's disease and the doctor agrees with adding medical cannabis to the treatment, start at a low dose of medical cannabis, and an edible, at bedtime. Bedtime is preferred because of the relaxing properties of the medication and to reduce the adverse effects when taking the medication.
Starting dose should be 2.5 mg each of CBD and THC. Again, that's a 1:1 ratio.
In rare cases when a patient is very elderly or particularly concerned about using medical cannabis you can start with a dose of 1.25 mg each of CBD to THC. Most edibles come in a 10 mg dose" so the starting dose would be one quarter of the edible, or 2.5 mg. If you're using a joint, then 2.5 mg is equivalent to two inhalations of a joint. And the same thing with a vaporizer - two inhalations of a vaporizer.
All edibles or tinctures will usually have the dosing on the label so you can calculate 2.5 mg. And since its in a 1:1 ratio, you're gonna get 2.5 mg of both THC and CBD.
If after three months the SAGE of Memozor test show that the dose is working then just keep taking the same dose once a day, and you can repeat the test annually to confirm that the same dose is working.
If the test results show a worsening score, then double the dose, which would bring it to 5 mg of each cannabinoid, which is 1/2 of an edible or 4 inhalations of a joint or a vaporizer. This dose increases to 10 mg next, if the 5 mg dose is not sufficient. If the full 10 mg dose of 1:1 THC:CBD isn't working we don't want to increase the THC dose anymore. Stop at a 10 mg dose, but we can increase the CBD dose, and a good way to do that is to add a vaporizer throughout the day with high CBD, very low THC oil. Something like 18:1 or 15:1. That means there's 15 to 18 times more CBD than THC available in the vaporizer oil. The goal is to vape about 10 mg of CBD a day in addition to the bedtime dose of medication.
So we're adding CBD in addition to the bedtime dose of medication, but we're not increasing the THC, we're stopping at the 10 mg dose at bedtime.
Scenario Two refers to using cannabis to prevent the onset of Alzheimer's disease.
In this scenario the SAGE or Memozor test would be normal, the patient isn't showing any symptoms, the patient is trying to prevent something that could happen later in their life. So the goal is to take a typical preventative dose and repeat the screening test once a year.
Working With A Medical Professional
Even though cannabis is legal in 26 states, and probably many more in the near future, state medical boards and the physican community in general has been very slow to recognize cannabis as a legitimate medication. For this reason only a small percentage of physicians in states where medical cannabis is legal are willing to consider using medical cannabis for the treatment of Alzheimer's or any other disorder. In fact, Dr. Smith was at a recent conference speaking to some 400 doctors, and over 90% of the doctors had never heard of CBD and didn't know what the endocannabinoid system is. So, after taking this class, you know more about the endocannabinoid system and medical cannabis, CBD and THC than over 90% of the doctors in the country. That's one of the reasons Dr. Smith wrote the first textbook for medical professionals on medical cannabis.
There are two excellent websites to find a compassionate physician who's both trained and experienced with using medical cannabis for Alzheimer's or other conditions. The first website is at [BMedical Marijuana Doctors & Medical Marijuana Cards[/B] and the other is --------, which we can't link here.
These are good resources for patients or family members to find out about doctors in your area, and also where you can learn more about medical cannabis , and you can find dispensaries. And you can learn about different strains of cannabis and the milligrams of CBD and THC in the different strains.
Again, most doctors do not have any experience in medical cannabis. They did not learn about the endocannabinoid system in medical school. They have not learned to dose or use cannabis as a medication. Most doctors, unfortunately, feel that medical cannabis laws were created to bypass prohibition against the recreational use of cannabis. So this is one of the reasons dr. smith wrote the textbook and one of the reasons he gave this class to empower patients with the ability to work with a medical professional to add medical cannabis to their treatment regimine.
If you get your doctor to do a little research on the topic medical cannabis he may quickly understand the potential impact and cooperate with the cannabis treatment. In addition, once your doctor reviews the safety of cannabis, especially at these low, once a day doses, this should alleviate most of his or her concerns about using cannabis to treat Alzheimer's disease.
Again, contemplation of the use of cannabis, or CBD oil only, or over the counter nutraceuticals should be carefully considered with the guidance of a healthcare professional. If the decision is in support of using cannabis or CBD only treatments, it should be started at a low dose, progress slowly, and be monitored by the patient or the healthcare professional.
Other Resources
SAGE: Self-Administered Gerocognitive Examination
This is a self-scoring test for the early detection of Alzheimer's disease. It's scored out of 22 points. It's most useful for determining if there are subtle or early cognitive changes. It's a brief test, takes the average adult about 15 minutes to complete. This same test has four different versions and it can be repeated with any one of the four different versions at the three month mark or at the one year follow-ups.
There are several other screening tests for the detection of the early stages of Alzheimer's or dementia. I mentioned earlier the Memozor. That can be found at
Memozor, Free memory games online
This is a much simpler and quicker screening test for Alzheimer's. In addition here's a list of Alzheimer's organizations and local chapters that supply good support and help to both the Alzheimer's patients and their caregivers.
Alzheimer’s Foundation of America - Alzheimer’s Disease and Caregiving Support
Alzheimer's Disease and Dementia | Alzheimer's Association
I also found this excellent site that explains Alzheimer's disease to children.
Neuroscience for Kids - Alzheimer's Disease
The good news is that it's possible to delay the onset and progression of the dementia of Alzheimer's with as little as 2.5 mg of THC and CBD once a day. That means most of us are protected already. Now, protect your loved ones as well.
Treating Alzheimer's With Micro doses of Medical Cannabis - Dr. Gregory Smith, MD, MPH
Alzheimer's is the most common form of dementia, a chronic, degenerative disease. Symptoms sometimes don't start until the damage has been ongoing for decades.
10% of the population show signs, in some form, by age 65 and 50% by age 85. In the US 200,000 people develop Alzheimer's by the age of 65, usually caused by one of three abnormal genes. It may be difficult to distinguish normal aging changes from Alzheimer's.
Other forms of dementia can occur due to strokes or concussions.
The first area affected is short term memory, followed by problems with organizing thought and language.
The dementia of Alzheimer's disease is caused by chronic brain inflammation occurring in specific areas of the brain where chronic protein debris has collected. These toxic effects take decades to kill brain cells and cause dementia and eventually behavior problems that can include
- language
- mood swings
- social withdrawal
- disorientation with time, place or person
- other behaviors, such as agitation
Late in the condition there's loss of bodily functions
Other medical conditions can increase the chance of getting Alzheimer's:
- depression
- hypertension
- stroke
- concussions
These conditions can also make the dementia of Alzheimer's worse. They can work synergistically to make a worst case. It's important to have a handle on your medical conditions.
Ongoing mental and physical exercise, avoiding obesity and other nutriceudical intake can decrease the chance of onset of Alzheimer's.
It's important to note that some medications, recreational drugs or alcohol, which have effects on memory, thinking and concentration can temporarily make the dementia of Alzheimer's worse.
The Progression of Alzheimer's Disease
Damaged proteins cause inflammation. Oxidative stress underpins most degenerative inflammatory and aging phenomenon. Oxidative stress refers to excess toxic byproducts that overload our cell's ability to clean up waste. This results in an accumulation of toxic waste proteins. This is akin to rust developing in and around the cells. The body's inability to clean up the rust causes corrosion (cell death).
The fundamental damage to the cells are:
- Amyloid proteins plaque outside the brain cells
- Tau tangled proteins inside the brain cells, create an atmosphere like thick, chunky egg whites.
The body's immune system (chemical messengers) attempt to surround the cells and eat the toxic waste materials to remove them from the body. As this is repeated over the years the area of damage gets bigger and bigger and cells eventually die. Then less brain messaging occurs in these parts of the brain, because there's less cells to send messengers. The most effective treatment is accepted to be early detection and use of meds and nutraceuticals to slow the progression of the disease, since it's unlikely to have a medication halt or restore dead brain cells.
In Alzheimer's, this brain death occurs in areas responsible for processing memory, language and other higher functions.
Detecting the disease as early as possible is the goal. The early and mid-stages of Alzheimer's is when cannabis, diet and nutraceuticals are most likely to have the most impact on halting or slowing the progression of the disease.
Warning signs of Alzheimer's disease:
- Poor decision making, demonstrating poor judgement or difficulty maintaining a budget.
- Difficulty having or keeping a conversation going.
- Losing track of date, day or season.
- Misplacing things and not being able to retrace steps.
It's necessary to be able to determine normal cognitive changes that occur with aging such as:
- Making poor decisions, every once in a while.
- Missing a payment, here or there.
- Forgetting what word to use, sometimes.
- Forgetting things early in the day, but remembering them later.
- Losing things, every once in a while.
Early warning signs that suggest a need for professional evaluation.
- Memory loss that's disruptive to daily life.
- Planning and problem solving becoming challenging.
- Completing normal tasks becomes difficult.
- Confusing place and time.
- Difficulty interpreting spacial relationships and images.
- Problems with words and speaking or writing that did not exist before.
- Losing the ability to retrace steps and misplacing things.
- Decreased or poor judgement.
- Withdrawal from work or social activities.
- Changes in mood or personality.
The Endocannabinoid System
The ECS is a feedback system to turn down the volume in various systems in the brain and body. The ECS operates in many parts of the brain, specifically working with memory, appetite, response to stressors, sleep and reward centers. The ECS works throughout the body via the immune system. Our body has natural chemicals made in the body to stimulate the ECS receptors.
There are different types of ECS receptors. CB1 receptors are predominantly in certain centers of the brain and is mostly effected by THC, and CB2 receptors, found in the immune system cells in both the brain and the body, and predominantly effected by CBD.
How Cannabis Impacts Alzheimer's
Both THC and CBD are potent antioxidants that reduce the damaging effects of oxidative stress at a cellular level.
When the CB1 receptors on brain cells are stimulated by THC this results in a more rapid removal of excess amyloid proteins from the cells, so that the excess proteins don't accumulate. CB1 receptors are most plentiful in the hippocampus part of the brain. That is the area of the brain most effected by Alzheimer's disease, and it has to do with memory and organization.
CBD stimulates CB2 receptors on the immune cells in the brain. This turns down the damaging inflammatory activity of the immune system and decreases the number of damaging phagocytic cells that are mobilized to the area of protein plaques.
Independently of the ECS, THC actually has two other effects to halt the effects of Alzheimer's disease. It inhibits an important step in the process that leads to the clumping of proteins into amyloid plaques. Also, THC improves a function of mitochondria inside the cells, and the mitochondria are the motors that drive cellular function.
The end result is that cannabis can halt or delay the decades-long process of brain cell degeneration.
Acetylcholine is just one of of many neurotransmitters used by the nervous system throughout the body. Brain cells send messages to other brain cells by releasing a chemical called acetylcholine. Once the chemical is released and has done its work it is rapidly broken down by an enzyme called acetylcholinesterase.
All of the FDA approved drugs for the treatment of Alzheimer's work in the same way - they block this enzyme, acetylcholinesterase from breaking down acetylcholine. Therefore, by having more acetylcholine available, the damaged Alzheimer's brain cells are able to send more messages than they would be without the medication.
Interestingly, THC is also a powerful acetylcholinesterase inhibitor. In fact it is more powerful than any of the FDA approved medications. It also crosses the blood-brain barrier much more rapidly and effectively than any of the FDA approved medications.
Cannabis-based medicines have all of the benefits discussed above, plus they are better than the FDA approved medications at being acetylcholinesterase inhibitors.
The Blood-Brain Barrier (BBB)
The brain has a protective membrane in the blood vessels that is not found in other parts of the body, which dramatically reduces the ability of medications, toxins and infections from getting into the brain. So only about 1% of FEA approved medications get through the blood-brain barrier and actually work on brain cells. The rest of the medication has no effect on Alzheimer's. The blood-brain barrier actually has natural transport receptors that actively move both THC and CBD across the blood-brain barrier. So a much higher percentage of THC and CBD makes it to the brain cells and it gets there much faster. This makes cannabinoid medicines very effective for treatment of brain conditions such as Alzheimer's.
FDA Approved Medications
There are several FDA approved medications that all work in basically the same way - they increase the amount of messaging in these damaged areas by blocking the enzymatic breakdown of the messaging chemical acetylcholine, and the medications are called acetylcholinesterase inhibitors. Current FDA approved medications include Aricept, Razadyne, Namenda, Exelon, and Namazaric.
These medications don't cross the blood/brain barrier very well, with only 1% of the medication being able to make the cross and be utilized by the brain.
These medications are best used in early to moderate stages of Alzheimer's, and they actually only work for about 6-12 months, and then they stop doing anything. None of these FDA approved medications actually halt the progression of Alzheimer's, they only help with some of the symptoms.
Other Beneficial Effects Of Cannabis
Cannabis has effects on other medical condition that are common with Alzheimer's such as arthritic pain and loss of appetite. The low doses recommended to stop the progression of Alzheimer's may not be high enough doses to have a measurable impact on these other symptoms. However, it's important to mention that THC and CBD work hand in hand with all the regularly prescribed medications for these behavioral symptoms.
Cannabis Doses
Both THC and CBD provide different means of treating Alzheimer's. Because THC and CBD cross the blood/brain barrier so quickly and effectively, only very low doses of cannabis are needed on a daily basis to have a measurable impact. This means that the patients don't get appreciable euphoria, or high from the dose, but it is having a medical effect. Also, probably only a once a day dose is necessary for these effects.
Usually the cannabis medication is started with an initial bedtime dose to reduce the impact of adverse effects, but it can be taken at any time of the day. It also doesn't matter how the medication is taken. Although elderly patients tend to prefer a bedtime edible dose, you can use tinctures, edibles, smoked or vaporized medication. It all eventually gets into the bloodstream and then into the brain.
Given all these facts, and considering the desire not to have any annoying high or euphoria from the cannabis, or behavioral side effects such as anxiety or temporary worsening of short-term memory, it's best to start with cannabis that has a 1:1 ratio of CBD to THC - that means equal amounts of CBD to THC - and then go with a low dose (1.25 - 2.5 mg, or the equivalent of one to two "hits" of a standard joint) at bedtime.
Possible Cannabis Adverse Effects
Cannabis, in any form, smoke, edibles, creams, patches, or vaporized is very safe and never caused a fatal overdose. There are thousands of years of human history using cannabis, and it is clear what issues to look out for. The most obvious safety issue is from getting euphoria, or "high". This results in problems with balance, coordination and loss of short-term memory, all symptoms already present in many Alzheimer's patients. So, like many medications and alcohol, patients using cannabis should not operate a vehicle or work on or around dangerous machinery or environments where they might get in trouble if they became euphoric, or high, or had issues with balance
Almost all patients will quickly learn how to dose their cannabis within one or two weeks so they don't get any euphoria or balance issues. Too large a dose of THC can result in paranoia or a feeling of agitation or anxiety. So the most important phrase when we are learning about dosing with cannabis is the following:
Start Low and Go Slow
You have all the time in the world to gradually get up to the correct dose, which will probably be a very low dose. But start at the very, very low dose, slowly move up until you get the therapeutic effect.
There are other adverse effects or side effects that have been known to occur. Most of these side effects have been known to occur in recreational users, not people using cannabis for medical purposes. This is research done over the last few decades, and again, mostly with recreational users using very high THC with low amounts of CBD and using frequent doses several times a day. Not the kind of cannabis use that goes on with medical conditions, but you should know what to look for.
There are several studies that show that as many as 9% of regular recreational users of high THC cannabis can get physically dependent, or addicted to THC. This is especially true of adolescent users and in people who take higher doses of THC several times a day. However, this is a mild addiction. People are able to withdrawal from cannabis in one to two weeks with only mild side effects
Here is some of the signs that THC dependency may be developing.
- Tolerance to the effects of cannabis, meaning that more cannabis is needed to get the same effect.
- Withdrawal from the effects of cannabis such as irritability, trouble sleeping or depressive symptoms.
- Using more cannabis than was intended or recommended.
- A persistent desire to stop taking cannabis, or to cut down and being unsuccessful at it.
- Spending lots of time obtaining, using or recovering from the use of the cannabis.
- Giving up important activities in favor of using cannabis.
- Using cannabis knowing that it's causing problems in your life.
It is very unlikely for a person to get dependent or addicted to a once-a-day low dose of cannabis used for medical purposes. You and your medical professional should maintain awareness of this possibility and address it early on.
Dosing Cannabis
There are several goal in using cannabis for Alzheimers patients. In persons at increased risk for developing Alzheimer's later in life the goal is actually to prevent or actually delay the age of onset of symptoms. Once someone has Alzheimer's disease the goal is to halt the progression. And then finally, the goal it to have the acetylcholinesterase inhibitor effects which are similar to the effects from the FDA-approved medications. They just reduce symptoms. They're not halting the progression of the disease, they're just improving the symptoms for a short period of months.
Cannabis is an adjunct medication. It is very important to understand what this means. It is used in combination with FDA-approved medications. Cannabis, and cannabis-related medications are very safe, well-tolerated, especially when started slowly. It is also important to note that they are relatively inexpensive medications.
CBD has no adverse effects unless it is used for a very long time in very large doses of hundreds of milligrams, which we're not going to be discussing in this course. That's for use with some seizure conditions. We're going to be using much lower doses than that.
One of the big problems with using cannabis to treat conditions is that there's very little consistency from batch to batch of buds or edibles. There are few state laws and no federal laws addressing quality, consistency, manufacturing practices or other standards that we would expect from pharmaceutical foods. The best way to overcome this barrier is to start with a very low dose of medication - the bud, vapor, edible, patch etc. - and wait for a long enough time to determine effect before changing the dose.
The wide range of dosing of the medication allows the patient to start at very low doses and gradually titrate the dose up if necessary. Very low to low doses of cannabis are all that have been shown to be necessary to halt the progression of Alzheimer's disease. Try for a 1:1 ratio of THC:CBD
In addition there are a wide variety of paraphernalia that has been designed over the years to deliver the doses of the cannabinoids and to assist with appropriate dosing of the medication, so that you know that you are getting the right number of milligrams, 1.25, 5, 10, whatever the dose we want to be sure that you're using a device that is delivering that dose accurately and repeatedly the same.
The method by which the drug is used dramatically effects the onset of action and duration of action and any adverse effects, and we're gonna talk a little bit about that later. There's some social and cultural stigma associated with smoking marijuana and in my observation older patients prefer not to smoke marijuana and much prefer edibles, and in some cases during the day a vaporizer.
The potential side effects of cannabis are mild, self-limited, and easy to monitor. However, cannabis does have the ability to acerbate some of the symptoms associated with later-stages of Alzheimer's, such as paranoia, anxiety, and short-term memory loss, due to the effect of higher levels of THC. So the focus is on starting with low doses of medication and gradually moving up the THC to a maximum of 10 MG per dose, and then keep moving up the CBD dose way past 10 mg, if necessary.
The goal is to get to the sweet spot. What o mean by this is too little medication may not have any measurable effect However, too high of a dose, especially the THC, can result in adverse effects. With chronic degenerative conditions such as Alzheimer's it is quite simple to dose the medication. Only small doses of THC and CBD are needed on a daily basis to halt the progression. The patient can just stick to the small dose and take it every day, and re-evaluate once a year with some tests discussed later.
The THC and CBD in these doses is generally more than is necessary to halt the profession of Alzheimer's disease. This is because the medication quickly crosses the blood-brain barrier and has effects on the brain cells with each daily dose. Because that are such small doses there's very few adverse effects and almost no euphoria. It is important to remember to re-evaluate the dosing, and there are tests available to determine how this medication is working. But the primary goal is to halt the onset or the progression of the Alzheimer's dementia.
Measuring the Effects of Cannabis
The correct dosing of the medication is vital to success. Studies have shown that only a tiny amount of THC and CBD need to get to the brain cells to have the desired medical effect. The disease smolders in the brain. The effects of cannabis will take months to become apparent.
Your medical professional will determine your baseline cognitive function with some simple screening tests. After starting the cannabis these same tests will be used several months later to determine if the medicine is working, or if a change of dose is called for. So the outcome that you and your doctor will be looking for is to a halt of the progression of the dementia symptoms.
Reversal of the symptoms would be nice and can occur, but it's usually only temporary, and this is due to the temporary effects of the acetylcholinesterase blocking effect of cannabis, and this reversal of symptoms is usually just for a few months and then the symptoms recur. That's not something to be looked for. What we want to stop is any worsening or objective progression.
You and your doctor cannot judge the adequacy of the medication after a few doses. It needs to be taken daily for several months before an assessment can be made as to its efficacy. Usually only a once a day dose is required, and this is best at bedtime when any adverse potential side effects would be less noticeable.
If the initial dose doesn't halt the progression of symptoms the once a day dose can be gradually be increased every three months, depending on the condition. CBD and THC should be increased up to 10 mg before considering adding a second, or eventually a third dose throughout the day.
In essence, it doesn't matter how the THC and CBD are taken. Whatever works best for the patient. You can take edibles and tinctures orally, you can use mouth sprays, which is almost as effective as vaporizer smoked cannabis, or you can use dermal patches that allow for slow absorption over 24 hours of THC and CBD into the bloodstream. However you do it the THC and CBD will eventually get into the bloodstream and then are quickly transported across the blood-brain barrier where they can interact with brain cells.
For those patients only using CBD a starting dose is 5 mg at bedtime. This is increased to 10 mg depending on the response to the tests that will be given. If only CBD is being used, then once a day dose is all that is usually needed, and you can go quite high. It's not unusual to be 60 mg or more when it's only CBD being used to stop progression. However, we stop at 10 mg for any one dose when it comes to THC, so if we need to go higher than 10 mg of THC a day we go to a second dose. So maximize the first dose at bedtime to 10 mg of THC and then you can add a second dose, and all the way up to a third dose, and those can go all the way up to 10 mg.
These are unusual doses. Again, we're gonna stay at or below 10 mg and just one dose.
Let's look at two different scenarios where you would use medical cannabis. Before starting the cannabis, take one of the quick tests to assess your baseline dementia score. The two most commonly used tests are the SAGE or the Memozor which are discussed below. Repeat this test after three months to determine if this dose is working for you. You keep increasing the dose as necessary until you find that it's working. Once the correct dose has been determined the test can then be re-administered once a year to confirm that it's still working on a yearly basis.
Start the cannabis at a specific dose, then retake the test after three months. The score should stay the same or actually improve. This means that the dose is working. Remember the goal of the daily dose is to halt the onset or progression of dementia. If the score gets worse, then the dose is not strong enough to be having an effect.
It is important to remember that medical cannabis is a maintenance medication, like high blood pressure medication. It does not rapidly change the condition right after taking it. Instead, over months and years of daily use it halts the progression of damage to the neurons.
Scenario One: When the patient is symptomatic with some Alzheimer's disease.
When the patient has already been diagnosed with Alzheimer's disease and the doctor agrees with adding medical cannabis to the treatment, start at a low dose of medical cannabis, and an edible, at bedtime. Bedtime is preferred because of the relaxing properties of the medication and to reduce the adverse effects when taking the medication.
Starting dose should be 2.5 mg each of CBD and THC. Again, that's a 1:1 ratio.
In rare cases when a patient is very elderly or particularly concerned about using medical cannabis you can start with a dose of 1.25 mg each of CBD to THC. Most edibles come in a 10 mg dose" so the starting dose would be one quarter of the edible, or 2.5 mg. If you're using a joint, then 2.5 mg is equivalent to two inhalations of a joint. And the same thing with a vaporizer - two inhalations of a vaporizer.
All edibles or tinctures will usually have the dosing on the label so you can calculate 2.5 mg. And since its in a 1:1 ratio, you're gonna get 2.5 mg of both THC and CBD.
If after three months the SAGE of Memozor test show that the dose is working then just keep taking the same dose once a day, and you can repeat the test annually to confirm that the same dose is working.
If the test results show a worsening score, then double the dose, which would bring it to 5 mg of each cannabinoid, which is 1/2 of an edible or 4 inhalations of a joint or a vaporizer. This dose increases to 10 mg next, if the 5 mg dose is not sufficient. If the full 10 mg dose of 1:1 THC:CBD isn't working we don't want to increase the THC dose anymore. Stop at a 10 mg dose, but we can increase the CBD dose, and a good way to do that is to add a vaporizer throughout the day with high CBD, very low THC oil. Something like 18:1 or 15:1. That means there's 15 to 18 times more CBD than THC available in the vaporizer oil. The goal is to vape about 10 mg of CBD a day in addition to the bedtime dose of medication.
So we're adding CBD in addition to the bedtime dose of medication, but we're not increasing the THC, we're stopping at the 10 mg dose at bedtime.
Scenario Two refers to using cannabis to prevent the onset of Alzheimer's disease.
In this scenario the SAGE or Memozor test would be normal, the patient isn't showing any symptoms, the patient is trying to prevent something that could happen later in their life. So the goal is to take a typical preventative dose and repeat the screening test once a year.
Working With A Medical Professional
Even though cannabis is legal in 26 states, and probably many more in the near future, state medical boards and the physican community in general has been very slow to recognize cannabis as a legitimate medication. For this reason only a small percentage of physicians in states where medical cannabis is legal are willing to consider using medical cannabis for the treatment of Alzheimer's or any other disorder. In fact, Dr. Smith was at a recent conference speaking to some 400 doctors, and over 90% of the doctors had never heard of CBD and didn't know what the endocannabinoid system is. So, after taking this class, you know more about the endocannabinoid system and medical cannabis, CBD and THC than over 90% of the doctors in the country. That's one of the reasons Dr. Smith wrote the first textbook for medical professionals on medical cannabis.
There are two excellent websites to find a compassionate physician who's both trained and experienced with using medical cannabis for Alzheimer's or other conditions. The first website is at [BMedical Marijuana Doctors & Medical Marijuana Cards[/B] and the other is --------, which we can't link here.
These are good resources for patients or family members to find out about doctors in your area, and also where you can learn more about medical cannabis , and you can find dispensaries. And you can learn about different strains of cannabis and the milligrams of CBD and THC in the different strains.
Again, most doctors do not have any experience in medical cannabis. They did not learn about the endocannabinoid system in medical school. They have not learned to dose or use cannabis as a medication. Most doctors, unfortunately, feel that medical cannabis laws were created to bypass prohibition against the recreational use of cannabis. So this is one of the reasons dr. smith wrote the textbook and one of the reasons he gave this class to empower patients with the ability to work with a medical professional to add medical cannabis to their treatment regimine.
If you get your doctor to do a little research on the topic medical cannabis he may quickly understand the potential impact and cooperate with the cannabis treatment. In addition, once your doctor reviews the safety of cannabis, especially at these low, once a day doses, this should alleviate most of his or her concerns about using cannabis to treat Alzheimer's disease.
Again, contemplation of the use of cannabis, or CBD oil only, or over the counter nutraceuticals should be carefully considered with the guidance of a healthcare professional. If the decision is in support of using cannabis or CBD only treatments, it should be started at a low dose, progress slowly, and be monitored by the patient or the healthcare professional.
Other Resources
SAGE: Self-Administered Gerocognitive Examination
This is a self-scoring test for the early detection of Alzheimer's disease. It's scored out of 22 points. It's most useful for determining if there are subtle or early cognitive changes. It's a brief test, takes the average adult about 15 minutes to complete. This same test has four different versions and it can be repeated with any one of the four different versions at the three month mark or at the one year follow-ups.
There are several other screening tests for the detection of the early stages of Alzheimer's or dementia. I mentioned earlier the Memozor. That can be found at
Memozor, Free memory games online
This is a much simpler and quicker screening test for Alzheimer's. In addition here's a list of Alzheimer's organizations and local chapters that supply good support and help to both the Alzheimer's patients and their caregivers.
Alzheimer’s Foundation of America - Alzheimer’s Disease and Caregiving Support
Alzheimer's Disease and Dementia | Alzheimer's Association
I also found this excellent site that explains Alzheimer's disease to children.
Neuroscience for Kids - Alzheimer's Disease
