OneMedicine Podcast

Rob Lutz 00:02
Hello and welcome to The OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader, some you will know and others you'll probably meet for the first time. We cover topics important to you always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today. Welcome to The OneMedicine Podcast. I'm your host Rob Lutz. And with me today is Dr. Chris Meletis, MD. Welcome, Chris.

Dr. Chris Meletis 00:31
Thank you.

Rob Lutz 00:32
Glad you could join the show. Chris is a well known expert on the endocannabinoid system. You can find a few of his chapters on Today's Practitioner in the Endocannabinoid Resource Center. Thank you for sharing those. And I'll share links to the site with the endocannabinoid and some of those chapters that I mentioned. As well as a link to the book that Chris has put together, it's really in my mind kind of a textbook about the endocannabinoid system. Very thorough, well written and great references and so forth from your peers. Since there's so much information about the endocannabinoid system, so many directions that we could go in this conversation, and we have limited time, we've agreed to really just talk about CBD and its potential applications in clinical practice, make this more practical for our audience who are medical professionals, and how to use CBD--how you use CBD, Chris, in your practice. Before we get started, and I'll stop talking so much and let you really share your knowledge, I'll give you a quick bio for the audience on who is Chris. And then I've got a few questions I like to ask my guests during the course of the show. And we'll get to that and then we'll jump into the topic. Dr. Chris Meletis is an educator. He's a licensed naturopath, I should point out. He's an educator, international author, and lecturer. His personal mission is changing America's health, one person at a time. Chris has authored 18 books and over 200 national scientific articles in journals, including Natural Health, Alternative Complementary Therapies Townsend Letter for Doctors & Patients, Life Extension, Natural Pharmacy, NDNR, and several journal articles on PubMed. Chris served as the Dean of Naturopathic Medicine and Chief Medical Officer for seven years for the National College of Naturopathic Medicine, now called the National University of Natural Medicine. He was awarded the 2003 Physician of the Year by the American Association of Naturopathic Physicians. He has a deep passion for helping the underprivileged and spearheaded the creation of 16 free natural medicine health care clinics in the Portland metropolitan area of Oregon. And full disclosure, Chris also serves as a consultant for TruGen3, who is the sponsor of the Endocannabinoid Resource Center on Today's Practitioner, and also for Tru Niagen. So, Chris, again, before we jump into the topic here, there are three questions I like to ask my guests. And first is, what do you call the type of medicine that you practice? And what would be three key attributes?

Dr. Chris Meletis 03:10
Oh, well, that's an interesting and complex question. So, of course, I'm a naturopathic physician so I practice naturopathic medicine. With the advent of functional medicine and that term, a lot of people are entering into truly the world of naturopathic medicine, and now we call it more globally exclusively "functional medicine." We're not dividing ourselves by titles, but we're actually unifying more by philosophy. I will say I'm a naturopathic physician with functional medicine focus, and really witness functional medicines, working within the constructs of the human body supporting it, and most of the time getting out of the way of what the body already wants to do to maintain homeostasis. Whether it be nutrition, botanical medicine, diet, lifestyle, and one of the things I mention to the larger audiences I speak to as I compare genetics and epigenetics as we have diet, we have lifestyle, and in between diet and lifestyle, there's some gaps. That's like the tiles on a kitchen counter or bathroom floor. We fill that crack with supplements like grout, but they're called supplements and not substitutes. We're working within the constructs of the human body, supporting it, and at the same time getting out of the way of the human body and its infinite wisdom.

Rob Lutz 04:27
Great, thank you. That's a great answer. So, you're a naturopathic physician; what led you towards naturopathic medicine rather than becoming a conventional MD? Clearly, you probably could have done that as well if you wanted to.

Dr. Chris Meletis 04:41
Interesting story on that one. It's a long one; I'll try to keep it brief. I actually started my life, I went to Reed College, undergraduate liberal arts Ivy League school here in Oregon. And then my very Greek father--and if any of you have watched My Big Fat Greek Wedding, you know that is a very dictatorial "Hey, this is how it is," and indeed, most things are probably Greek-rooted if not Latin. But that's a whole other conversation. And for those who haven't watched My Big Fat Greek Wedding, if you watch it, you'll know what I'm talking about. My dad came as an immigrant, just like my mom did, to United States, met in the park blocks of Portland, Oregon, I came, and here I am. But my dad said, "You're going to become a doctor," and there was no question I had to become a doctor. That's a structure of Greek culture. It's going to happen. I actually said, Well, okay, I'll become a doctor. And my dad was very economically driven--if you become this, you'll make this much money, you make this if you become this. I went and applied and got accepted to MD medical school, I finished my first two years of basic sciences, and came back during the summer, ready to start doing hospital rotations my third and fourth year of clinical stuff. And my sister was dating this gentleman. And this gentleman said, "Oh, you had a class in nutrition, did you?" And he, without a question, still to this day has a lot more testosterone than I do, and so he double-dared me: "Unless you're just giving lip service to that class in nutrition in MD medical school, why aren't you becoming a naturopathic doctor?" Kind of just like that. And back in the day, this was 1990. I said, "What's a naturopathic doctor?" I knew what chiropractic was, but I was a Kaiser Permanente kid, I was an HMO kid. All I knew is allopathic medicine. That's all I knew. And whatever was back from the Greek village, like eat this herb, the Greek culture, my dad would go to Greece every year. I said, "Oh, are you talking about chiropractic?" He said, "No, I'm not." And he ripped open the telephone book with some bravado and testosterone, and says: "See? Two different addresses." Western States Chiropractic. National College of Naturopathic Medicine. I'm going, "Okay." He said, "You're just giving lip service; don't bother to waste my time." He ends up going into Oregon Health Science University local medical school. I said, "Well, I'm going to go check it out." He double-dared me; I had to take up the gauntlet. I had to do it. Lo and behold, I check out the National College, which was at the time way out on the east side of town. So, this is kind of interesting. This kind of speaks to the concept and the dilemma I had when I was in medical school. I actually ended up talking to the professor of nutrition, because as a recent college graduate I'm taught to expand and wonder and question everything. I said, "Can I just practice like natural intervention on biochemical pathways?"...because at MD school, at the same time as I was taking nutrition, this physiology class, biochemistry class, pharmacology class, and they're all talking about nicotine amide pathways and enzymes and this and that, I said, "That's what we're learning about with vitamin B3." He said, Yeah, if you want to lose your license." This was before Andrew Weil and Deepak Chopra and Dr. Oz, and you name them, the list of people that have now helped us all become more accepted, and the concept more widely appreciated. I applied, I transferred in with advanced standing and became the Dean of Naturopathic Medicine in 1996. And shortly thereafter, that now ex-boyfriend, becomes a student at the Naturopathic College. The bravado continued from there, but hey, it's a fun story. So, I started in allopathic medicine. I appreciate all the science. And the beauty now is what? The science has proven what we've always believed in functional medicine. It's like, wow, it's panning out. There is once again, wisdom in nature.

Rob Lutz 08:28
Absolutely. Yeah, I think about some of the traditional medicine, traditional Chinese medicine, ayurvedic. And those are things have been practiced and used for thousands of years, right? And there was no multimillion dollar marketing department convincing everyone that it should be what you're taking. It was: "This is what worked. This is what helped the people become healthier and manage some disease." So, thanks for that story. And then the last question I have is, we talked about naturopathic medicine, integrative, conventional, functional. Is there a unifying principle you think that runs through all those types of modalities? Is there one thing that really kind of ties them all together?

Dr. Chris Meletis 09:06
I think applied observational empirical wisdom. You mentioned Chinese medicine, there's ayurvedic, of course, as well. There's all these aspects of the truth, even though people didn't know, they see and they observe. One of the big problems we have, and lots of times my patients will ask this question, I think it captures your question is, "Well, why didn't I see that?" Because we're distracted in today's modern world. Indigenous people, and of course with my Greek background, I'll mention Hippocrates. You know, Hippocrates has been quoted as: "Well, food is your medicine and maybe medicine is your food, and all disease begins in the gut"--both of which are tenets with we can pretty much prove these days. But if you think of Hippocrates wandering around Greece, he came home and he says, "I feel terrible, the hot Mediterranean sun..." His significant other said, "Hey, would you like to have food?" "Oh, this makes me feel better. This is medicine." He got the quote, but it was probably her that gave the idea. And the same thing like: "My tummy hurts." And once again when your tummy hurts, pretty miserable human being. I think the concept is empirical observational medicine as demonstrated over the millennia, I think that's really where the medicines act, and across the board, all fields, all aspects, and there's a truth in everything. Lucretius, a Roman philosopher, said, "Truth begets truth." He was also the same one that was quoted, "What is food for one is poison to the other."

Rob Lutz 10:33
True, very true. Well, thank you for that. I love the answers to those questions. We're going to jump in, we're going to talk about CBD, practical applications, and how you use it in your practice. I think that's where we're going to focus over the next 40 minutes or so. I'm looking through some of the questions you posed here for me to make sure we're asking, but talk to me a little bit about how you use CBD in your practice?

Dr. Chris Meletis 11:00
About a decade ago, I started using CBD in my practice. Of course, the farm bill and making it legal and taking away some of the jurisdictional issues was helpful because otherwise it was kind of thrown into overall Cannabis sativa category, which, of course, at the federal level has still some questionable legal applications to it--even though, of course, in clinical practice, it pans out quite well. I started using CBD and I started doing the research into CBD and I realized that we have an endocannabinoid system, thanks to Mechoulam and work out of Israel and some other places, the Czech Republic. Also there's some parallel work that was being done. They had been doing work on THC, but they realized, wow, we have a system. It's called the endocannabinoid system, some say cannabinoid system. Well, if you have this, what about the receptors? And what really caught my attention is when they started talking about how NSAIDs work--non steroidal anti inflammatory drugs like ibuprofen, naproxen, and so forth--and we always said, well, it works on this mechanism. And one of the things I learned in the early '90s is applying an herb from a quasi-pharmaceutical perspective, it's just that quasi-pharmaceutical, there's a full array and of course, in a THC world, we call it, the Entourage Effect. In the hemp world they've adopted the term Hemptourage Effect, to kind of allow that same concept. Now it's like, how do NSAIDs really work? And when I started reading that NSAIDs in part, particularly the cyclooxygenase--or COX--meds, they actually inhibit FAAH. And FAAH within our body, an enzyme, actually breaks down anandamide. Of course we know that word "ananda" in Sanskrit means bliss. So, this is our bliss, our stress. Are we stressed out? Yes, my undergraduate thesis was on psychosocial stress and immunosuppression. I was kind of already wired for the natural medicine thing before I knew about natural medicine. If that's an enzyme that's working, and we have this endocannabinoid system, we also have 2-AG and we have TRPV1 and 5-H1AA and all this in our bodies, if we have all these receptors for CBD, shouldn't we be using it? That's how I started applying it. I use it a lot for stress. I use it a lot for adrenals. I use it for inflammation, and I believe there is such a thing as endocannabinoid tone, and endocannabinoid deficiency. Just like we could get tired of working out, and right before we started, you mentioned bicycling a lot and skiing and all of this. It takes energy; it takes biochemical pathways. If we have a biochemical pathway in our body, why aren't we using it, then? It's the same thing as when I graduated 1990, we learned about berberine and goldenseal or Oregon grape, now known as mahonia and berberis vulgaris and say, well, it works because it's antimicrobial. We kind of lose sight of the fact that it has PPAR, the PPAR pathways and other pathways in which it works. On the endocannabinoid side of things, why not support it? I've been using it for stress, sleep, pain, inflammation, and also as part of overall--and we'll probably talk more about this today--adrenal support.

Rob Lutz 14:16
Yeah, that is something I want to make sure we talk about is adrenal support. One thing I've heard about is there are other botanicals that support the endocannabinoid system, right? Like echinacea, is it the CB1 or CB2 receptor? It seems like there are a lot of other plants that have a substance or cannabinoid within them that would support that system as well? Is that true?

Dr. Chris Meletis 14:44
Correct, just like in the world of cannabis sativa or cannabis indica, there's a lot of terpenes and a lot of plants have the same terpenes and we're so linear and we're like plow horses down to the field with our little blinders on. And I didn't finish my train of thought: Back in the 1990s, they said, well, St. John's wort works by hypericin. And you might remember this: St. John's wort might be as effective for mild to moderate depression as Prozac. And then that next year, there's a 42,000% increase on retail sales of St. John's wort. Then they backed away a little bit and said: Well, maybe it wasn't hypericin, maybe it was hyperforin. No, we were trying to make everything into... Reductionism, right? Reductionism.

Rob Lutz 15:26
Trying to get it into almost like a pharma model.

Dr. Chris Meletis 15:28
Yeah. I mean, if you think about St. John's wort, a beautiful little flower, and if you ever find St. John's wort growing, and you squeeze the little yellow flowers, it actually will stain your hands purple like blood.

Rob Lutz 15:44
Wow.

Dr. Chris Meletis 15:46
You have to think that's kind of interesting, imagining Hilda, up in the Swiss Alps or Germanic Alps, and "Oh, so-and-so is very sad. Let me give her some little flowers." She nibbles on the little yellow flowers and plant. And she said, "Well, I'm not quite as unhappy." How did medicine get discovered? You and I, before we started recording, [talked] about Lewis and Clark. Indigenous people have been trying to be part of and communing with the land for a long time, and this is how...

Rob Lutz 16:13
So much more observant, right?

Dr. Chris Meletis 16:14
Much more observant, and much less distracted. We're a very distracted society.

Rob Lutz 16:19
I agree. We will get back and talk more about the adrenal and how you're using CBD. I'm curious, do you ever combine CBD or hemp oil with any other botanicals in your treatment with a patient?

Dr. Chris Meletis 16:35
Oh, yeah. Well, when I'm doing something, once again, one shoe doesn't fit all. We all came to our current state, we have how old we are biologically, chronologically. When our patients come to us, they come in a state of fixed and brokenness. We're looking to support various pathways. I'll add turmeric a lot. I'll do things like boswellia serrata. Sometimes I'll use systemic enzyme. It's really trying to categorize things. I have a dear family member which has a lot of inflammation, has autoimmune Hashimoto's disease, but also has the gene called a PAI-1 gene, which is life threatening and causes life threatening blood clots. And as the universe speaks, and I guess when we call it functional medicine, we talk about mind, body and spirit. So, I was giving a lecture, my dear family member, which I was actually given heparin injections for because they were within 24 hours and dying, they had a clot from their ankle to the popliteal fossa in the back of the knee, and then from the knee all the way into the groin, and about the size of a hot dog in terms of a blood clot you kept healthy. So, I ended up having another family member give the injections while we're stabilizing the clot. And so I give this lecture and after giving this lecture down at A4M conference in Vegas, this was about 6 or 7 years ago. Lots of people will ask you questions after you give a little talk. And there's one person who sat down while I was talking to another person and said, "I'm just here to listen." After the person left, I said, "So, what do you do?" He says, "I'm a thrombotic specialist." Well, what's the likelihood that a thrombotic specialist would be sitting with me, and I was this close before I just flew out of losing a dear family member? And, I said, "Well, if you don't have any questions for me, can I ask you a question?" He said, "Sure." I said, "I have a family member; they have a clot." "Do they smoke?" No. "Are they vegetarian?" They are vegetarian. "Are they on birth control?" No. And the list goes on, and I answer the questions. He says, "They have a PAI-1 4G polymorphism. What? I never heard of PAI-1, I know about other clotting factors. But once again, how the universe works, that separation of things. In that case of that particular patient, that person uses CBD, along with ashwagandha [unintelligible], but they're using a systemic enzyme on a daily basis. That will be different than a person that comes in and they just have a super high C-reactive protein, interleukin 6, then we're going to use more turmeric and essential fatty acids. We all meet our patients where they're at. It's what I call common thread prescribing. There's going to be all these little tick boxes as we take our little history and hear how they got to where they are. Okay, now this person doesn't have the essential fatty acids. In the case of the blood clot person also, they're vegetarian, strict vegetarian, and they detest fish. The last time they ate fish was fish sticks when they were a little kidh, and they were forced to eat them.

Rob Lutz 19:29
I'm curious: Do you think there's any...is there some kind of a synergy that happens that makes those other botanicals more effective with the patient because of the CBD or are they just really kind of working separately? Is there any synergy that's happening there?

Dr. Chris Meletis 19:43
I think both. Let's look at capsaicin. Capsaicin, of course, cayenne. When I was 26 years old, I had herpes zoster shingles. It will make a grown person cry and I will tell you that.

Rob Lutz 19:58
Yeah, that's painful.

Dr. Chris Meletis 20:00
Oh it's very painful and we know we can apply capsaicin topically and it will actually, supposedly back in when I had it, 30...32 years ago, 33 years ago, and you would apply it and they said: Well, it depletes substance P. Substance P is,of course, for the pain side of things. Now we know that CBD also works the same way in part that the capsaicin does. It works on the TRPV1 and we thought all the way along--just like with NSAIDs it works a certain way--well, we thought cayenne only worked one way, substance P. No, also works on TRPV1. Well, so does the endocannabinoid. That's a synergy on CBD. At the same time, I'll give an example of a patient of mine. She came in and she had rheumatoid arthritis diagnosed. Autoimmunity ran rampant in the family, type 1 diabetic child, and her thenar area in between the thumb and the index finger was always swollen, always inflamed, and always painful. We did sed rate, we did C-reactive protein, and they were always no. She said: How can this be normal? It wasn't until we look at interleukin 6 through a normal chemistry and blood works request diagnostics, of course LabCorp and other labs out there that does the same thing. And we said: Oh, wow. We needed to actually use stephania and we needed to use some boswellia. We had to go for a different mechanism that tapped up interleukin 6 pathway. We create the foundation that we cater it to much like building a house, the various rooms and applications for the structure of which we're working with.

Rob Lutz 21:42
Really personalize it for that patient and solve their issues.

Dr. Chris Meletis 21:46
I look for both synergy and autonomy of different approaches. And now humbling myself as I said that--onto our current knowledge. So, this is what CBD does. This was turmeric does. This is what boswellia does. This is what stephania does...that we know currently. And later on, we're going to find like with echinacea when we used to give echinacea for colds. That was the thing back in the '90s. Echinacea, goldenseal. Who would ever have thought we were working on endocannabinoid system? I think the key here is stay humble and realize whatever we know, we know. But we don't know a whole lot still.

Rob Lutz 22:21
Right. We're going to keep learning.

Dr. Chris Meletis 22:22
Yes.

Rob Lutz 22:25
Talk to me a little bit about terpenes. You touched on it a few minutes ago. When you get the full plant, it's got CBD, it's got all these other things in there. What are the terpenes? What do they do? How do you look at those?

Dr. Chris Meletis 22:41
Once again, terpenes, also outside of the cannabis plant, there's just a lot of terpenes. And we see it a lot of times in essential oils, the linalool and limonene, and caryophyllene and all of this. Each of those individually have unique properties and leafly.com will actually go through those and so do I go through in my book, which is free on your site. We look at the uniqueness of each application. It's bringing x to the functional medicine. Functional medicine meets the patient, but then so does the CBD, and in unison, there's a concert. I often give the example of a large orchestra, there's a string section, the brass section, the wind section. And of course, the orchestra leader. In this case, the orchestra leader for our conversation is the endocannabinoid system. But then all these other things are coming to play in--that little tink of the bell, the triangle, or whatnot, or the xylophone adds the dimension to things. I actually will go ahead and look at a full spectrum CBD whenever possible; I'd rather use the whole plant extract of echinacea or turmeric, or whatnot. There's benefits without a question. I mean, I've been on a scientific advisory board of a large company which has a specific liposomal turmeric which UCLA studied that crosses the blood brain barrier and delivers so much free curcumin. There's a benefit there. Or when we go for a pomegranate extract. And we're saying, well, we need so much punicalagins in order to be interactive with our microbiome of all things. So punicalagin from pomegranate interacts with our gastric mucosa and microbiome to create urolithin A. Just like with the endocannabinoid system, our microbiome allows a plant to become in the active form. OMG. It's a whole other conversation. That's my most recent book, "MMM Theory," which is Microbial Mucosal Milieu Theory, which is free on Kindle Unlimited on Amazon. And so it's free; I'm not pitching anything. Well, what about all our little microbiomes? And now that endocannabinoid system and the microbiome, there's something called the endocannabinoid ohm, endocannabinoid ohm actually plays an integral role in maintaining not only an interaction between lactobacillus and microbiome, but also that it actually creates a micro-environment for all of the cells in our body to work. We've started looking at that like, okay, humbled again. And as we move toward more and more towards AI, and computer and machine learning, okay, well, where will that lead us? But we still need to look at our plants around us. And whether we look at a forest, and they've actually looked at forest bathing, for example, and now we look at a plant. And if you and I were to go out in the forest--because we both, from our conversation, enjoy going outdoors and so forth--could we survive if there was no bottles of pills? Well, our ancestors did. Wherever your ancestral lineage is, in every listener, wherever, hundreds and hundreds of years ago, everybody lived before there was the antibiotic. And I'm not picking on antibiotics, but we lived off the land and with the land. And so I think, a full spectrum plant whenever you're going to use a whole plant, and I give the example, if I offer you beta carotene, you say: Okay, well, beta carotene is a antioxidant. Hopefully, it has some other carotenoids in it. But what would you rather have a carrot, or beta carotene pill? I have a feeling Rob, you might say carrot. Unless you're allergic.

Rob Lutz 26:14
There are a couple of studies--I think we said red blood orange study--Vitamin C absorption, compared to taking, let's say, 1000 milligrams of a USP Vitamin C?

Dr. Chris Meletis 26:26
Yes, yes, yes.

Rob Lutz 26:26
And because of all the other components, cofactors that were in the orange, you had much higher levels of vitamin C after eating the orange as opposed to 1000 milligrams, even though there wasn't 1000 milligrams of vitamin C in that orange. The other example that someone shared with me years ago that I found interesting, was talking about dandelion as a diuretic. And if you take kind of the standardized aspect of dandelion that was a diuretic, it depletes you of potassium. But if you take the full herb, it's high in potassium. It's interesting how there's this kind of natural balance built into things that we don't understand. It's that whole mystery kind of thing that we've touched on a little bit here today. But I find those types of things very interesting.

Dr. Chris Meletis 27:10
And they're brilliant points. I'm glad you have brought them up because, indeed, staying humble as we tout things. That reminds me when I was a dean at the Naturopathic University, I interacted a lot with a local MD medical school, and one of the third-year residents in asthma allergy category, it was an immunologist third-year resident. So, they were way along on their training. We had a big debate on what was the cause of asthma? And I said: Well, there's a correlation with low magnesium levels and bronchospasm, and they said: No, there's not. It's all in the inflammatory pathway. We were both correct. And the person actually was big enough to come back later on and say: Actually, I went into the research, and yeah, you're right; there is a magnesium component. But that's the beauty of functional medicine. If we all come and know that we all are humble, and we need to go ahead and realize that every field of medicine brings something. I don't practice Chinese medicine, and yes, I'm trained in four classes in Chinese medicine as part of my naturopathic program, because I was back in the day, and I'm trained in pharmacology, but I am not a pharmacist, and I'm not a big drug person. If a person needs a lot of medication intervention, short term or long term, I'm going to send them off to an internist; that's all she or he does in large part. And likewise, I refer to nutritionists, chiropractors, because everybody has a little spot in our field of functional medicine. Whoever's listening, if you're a chiro, the research shows, and part of an NIH grant, which I was part of, we were educating a fourth-year medical student and medical school in general in Oregon, and they said, the neurological exam of the chiropractor was more thorough than a neurological exam of the neurologist. Because you spent four years looking at that inner structure and infrastructure...wow, once again, I just think, keeping humble and my hashtag is humane humans for humanity. The more humane we are and the more we're seeking humanity. But that's not what defines us as human beings. We're all in a collective together.

Rob Lutz 29:19
Absolutely. When I look at all these different modalities or types of medicine, all their intention is to heal, right? And they take a slightly different view or how they're coming at it or what their specialty might be. But if we all take a step back and say: We're here, you're in this profession to make people healthier, and that's why all your peers in these different modalities are doing the same thing. To be humble and say: Hey, you know what? I think you should go see a chiropractor or a pharmacist or whatever it might be, someone who's more focused in that one area. You've discovered that they're going to benefit from that. And that's what I like about this integrative functional medicine space in general is it's...they are humble, and they want to heal the patient. And however we get there is how we get there.

Dr. Chris Meletis 30:07
The patient wins, we win. Team win.

Rob Lutz 30:09
Yeah. So, they spent a lot of time with their intake and really listening to the patient. And it's very patient-focused, patient-centric. All right, so we talked about terpenes. I know we want to talk about dosage and those types of things, but I think you touched on just in the beginning, a little bit about adrenal health and your use of CBD. Can you just talk a little bit more about that, maybe talk about a patient--not using their name, of course--but talk to me a little bit about how you discovered that. This seems to be something that you've come up with, and what do you do?

Dr. Chris Meletis 30:47
Certainly, and I'm sure a lot of our colleagues have figured this out, too. And the reality is the concept of endocannabinoid deficiency proposed by Ruscio, as well as endocannabinoid tone. If I work a hard life, and I have--of course, as healthcare providers, we have the end level and functional medicine healthcare providers--we hear a lot of sad stories. We have become part of the inner sanctum for our patients and they share usually fairly freely. We have all the angst that a counselor might hear often, along with seeing the functional aspects of their health, either thriving, surviving or not either of those two, and we're part of that journey. And so, when we look at a cortisol level and we see the a.m. level, we're looking at the noon level, the evening level, the nighttime level, we see that gentle curve down, which then of course, melatonin kicks up, and that's the sleep-wake cycle. But when we become worn out at the adrenal level, why would we not think we're wearing out other pathways? Just like we were talking about biochemistry and plants, well, what about the endocannabinoid system? It's receptors, it's driven. And a study on cosmonauts really took this home. They look at cosmonauts; these are trained military folks, just like our astronauts are here in the United States. They're part of that structure of the military system. They're gestalt, they've got their stuff together, because you can't lose yourself up in space is what I've heard. I guess you could if you opened the window and somebody might fly out, but that's different stuff. And so they found that the cosmonauts were just steady as one could go on the adrenal glands. They were controlled, they were composed, but the endocannabinoid system went wonky. It was the compensatory mechanism, because they couldn't mind over matter the endocannabinoid system. They could mind over matter their feelings: I'm calm, I'm cool, I'm collected. The endocannabinoid systems work in the background in a huge way as a compelling study. Wow, what led them to want to look at the endocannabinoid system? They clearly knew something which the average person didn't know. What I will often do is I'll use things like ashwagandha and maca, rhodiola or maybe a schisandra, or ginseng unit, there's a long list. Or from an immunological perspective, maybe a straight list, but then I'm going to treat that patient at simultaneously supporting them with a little CBD broad spectrum hemp product with the terpenes and everything just to bring balance back to the endocannabinoid system. Lots of times we'll have a patient and we're doing everything right. And if five of us on this podcast, all went ahead and said: Hey, well, what would you do differently? Well, I do exactly the same thing. It's like, but there's something missing. There's that challenging case, that resistent, recalcitrant case. And, lo and behold, I have found that CBD when added to an otherwise adaptogenic process works beautifully to rise the ship and I have a saying, which, of course is not my saying but all ships rise in a harbor with a high tide. We just try to nurture the body and the tone and there is such a thing, I truly believe, and I agree with Ruscio, endocannabinoid deficiency and decreased endocannabinoid tone so that we have a decreased adrenal tone.

Rob Lutz 34:06
That makes sense. Let's talk a little bit about dosage. When should your patient be taking? How do you look at that and say, this patient comes in and they're presenting whatever? Give me an example and then how you work with them and test out the dosage and where do you start?

Dr. Chris Meletis 34:27
In functional medicine over the years, as we've gone, as I've spoken to, we've gone to quasi-pharmaceutical aspects of things and some of the clinical trials on CBD used up to 600 milligrams of CBD for public speaking. But now you think about it, and I've sat on multiple IRB institutional review boards, and Delphi panels. Okay, we're going to propose an intervention. We're going to spend a lot of money and time going through that intervention. We have to use a big enough dose that will move the needle. Then it comes down to quality. Is that 600 milligrams of just CBD? How was it extracted? What's the bioavailability? What's the delivery mechanism? There's all these things. Not all supplements, as we all know, the whole audience knows, not all supplements are created equal. And we've learned that the hard way. Patients say: Oh, I've tried magnesium. f we just took them on face value--I tried magnesium--without asking: Well, what kind of magnesium? Oh, magnesium oxide. That's not very bioavailable; it's great if you're constipated. Or, well, I use magnesium citrate, taurinate, aspartate, and a blend. I titrated over the course of three weeks. Well, that's a different answer than "I tried magnesium." So, I'm not going to try magnesium. Magnesium doesn't work for that patient. Wrong answer. And we don't know that. And of course, you could always test and not guess and, of course, quantify with laboratory tests, which is another exciting part of functional medicine these days with so many cool tests to kind of guide us accordingly. But then what I would say is on dosing, I like to go for broad spectrum, but I want to make sure that the continuity of seed and plant to the manufacturing plant is in one continuous aspect that it's tested before it goes into the plant for GMP. And then making sure it's clean, and it's free of everything. And then it's tested as a finished product. But now, thanks to some unique technology, one technology called VESIsorb, it actually has been shown to increase the Cmax curve 4.4-fold. So, you take this product, compare it to a normal CBD that's not customized to be absorbed well, you get 4.4 times higher amount. So, lower amount better, but I truly believe nudging, not shoving. What I mean by that is we take a large amount of vitamin C, but do we need a large amount of vitamin C? Some people do, some people don't. Some may need a little magnesium, a little bit of B vitamins. But so often we'd say: Well, more is better. Unfortunately, we're a westernized culture. Supersize me a la some of those fast food restaurants. No. More is not always better. Our biochemistry at that cellular level is little millimoles here and there. As long as we're absorbing and assimilating it, do we really need to go over the top? And I give the silly example, and anybody that lives along the coast and grew up with an unadulterated childhood and got to play into little tidal pools and so forth, there's something called sea anemones and sea anemones have little tentacles, and they're usually either green or orange or pink. But if a little clownfish or whatever it comes along, it'll kind of just tickle but if you squish that receptor, it closes down. And so often, just like when we do hormone replacement therapy, if we go too high, it's like: Well, I was really doing well on my hormone replacement therapy, and it stopped working. Did it stop working, or did that receptor say: What the heck's going on here. I'm closing down. You've overwhelmed me. And I think that's where on the recreational side of things, people overdo things, and that's where you get the hyperemesis. You end up in the hospital because you've got this strange level. Why does the treatment for hyperemesis see your CBD in large doses or a hot shower. How does a hot shower help with hyperemesis and overdoing THC? The body is once again mysterious.

Rob Lutz 38:18
Right. Very true. As far as dosage, you start low.

Dr. Chris Meletis 38:22
Start low, go slow. And once again, see if it is sustainable. Plus, honestly, in today's world of high inflation--I won't say hyperinflation, that was another era and hopefully we never reach there--things are so expensive. If we can get the job done with a small dose. Now, I will say the time which I'm more cautious on the low dose, obviously, is antimicrobials. Just because we don't want to have a drug resistance, I don't want to have an herbal resistance. Sometimes you have to go in there and just get it done. And at the same time, if a person is super anxious, I'm going to start with a much higher dose. But once again, is it that 4.4 times higher bioavailability like with VESIsorb? And once again, it's quality the product you're using. If I'm using a simple tincture of echinacea, as opposed to an extract that has XYZ active constituents, I might do a higher dose of in herbal medicine. Often we underdose on, let's say, tinctures or glycerites. And we need to actually crank it up a little bit because we've got the whole plant, but we don't have a whole lot of any single constituent and we might be doing that quasi-pharmaceutical science.

Rob Lutz 39:27
Makes sense. That's great. Would you say a large percentage of your patients, you'll integrate CBD into their treatment plan or is it just maybe adrenal deficiency or what are the types of cases where you look to CBD to be part of that treatment plan?

Dr. Chris Meletis 39:47
I would say about half of my adrenal patients, definitely insomnia. I'll add along with melatonin and maybe some essential oils to help them stay calm and chillax. And maybe some L-theanine. I'm a huge fan of L-theanine because it helps with that sympathetic, parasympathetic along with alpha waves. I would say that sleep, anxiety, stress response, and just staying calm, cool, and collected, and also immunological and anti-inflammatory. Those are the big five, immune, and there's a whole category of immune and its applications. And of course, a pharmaceutical company, like GW Pharmaceutical, of course, has gone into this unique seizure model as well in that whole neurological pathway. That's a very, very high dose, right? It's a pretty high dose. The key here is, once again, meeting the patient where they're at and creating--and I've learned this over the 32 years of practice--a sustainable wellness program that they can sustain for a long period of time.

Rob Lutz 40:48
It sounds like you also like to try to build up kind of that foundation for the patient. It's not just, "Hey, you're going to take this high dose of CBD, it's going to solve everything for you." There's probably some underlying issues that you can help support in other ways. To me, that sounds like what you've been talking about a little bit.

Dr. Chris Meletis 41:07
Yeah. And from a philosophical perspective, a decade ago in New York, I asked this question to the audience; I was lecturing on genetics and epigenetics. And I said--it's 7:00 in the morning, New York time, I'm at West coaster. It was 4:00 my time--and of course, I have this wonderful hairdo, aka bald, and I said: Well, I woke up early to do my hair for y'all, some extemporaneous speaking to warm up the 7am crowd. I said, it took a long time for your folks to get in here. Some of you are probably tired. I said: I might be tired, too. I flew in at 11pm the night before. And I said: How many cells in my body have to be tired before I perceive tired? Is it a hundred cells, a thousand cells, a million cells? And because we're made of 37 trillion cells plus, I said: Is that adrenal is that brain? I don't know the answer to how many cells in my body must be tired before I perceive tired. Let's imagine if a puppy woke us about 2am. How many cells in my body have to be tired before I perceive tired and how sleep-deprived do I have to be. Nobody came up with the answer. And I don't know the answer. I said: I'm starting this talk humble; I'll start my lecture on genetics and epigenetics in a moment. And I know quite a bit about that onto what we currently know. I said: Let me ask you a simpler question. How many cells in my finger--and I held up my index finger--have to hurt before I perceive it hurts. And then I said: Of course, I can take Tylenol, acetaminophen, I can take ibuprofen. I can put acid or white willow on it. I can take Arnica. I can I can. I said: But have you ever had a big cut, like in a kitchen knife? There's a lot of blood, but it doesn't necessarily hurt but then you get that little paper cut and oh! So, is it more cells, less cells for you to really have a finger that hurts? And then I said: Well, couldn't I just remove the splinter and wouldn't that treat the cause? I'm always going back to the cause. How did that patient get there? And often it's a combination of things. They were stressed, they were in a challenging relationship. They're worried about their kids, they have loss. And they were born with a chemical and methyltransferase gene polymorphism or MTHF. Identifying what's made them susceptible, addressing the cause and then slowly backing out of the ditch.

Rob Lutz 43:22
Love it. Is there anything else that we want to talk about here today regarding CBD? I think you'd mentioned you'd actually received a call from a colleague recently, maybe yesterday, that one of his patients was having a reaction to CBD.

Dr. Chris Meletis 43:39
Yeah. And actually it was the colleague themselves. They know I write a lot and lecture a lot on this topic. And they said on a text: Hi. Kind of bashful. I said: Hi back. And I know this colleague well, and it's just "I had the worst..." and so then they start unloading: I was dizzy. I was disassociative. I had just taken CBD that night because I was feeling stressed, and my heart was racing. I'm saying: It's not CBD. CBD is a non-psychoactive. It has psychological benefits, but it's not going to be that euphoric thing. And in their youth they had done a lot of recreational items, so they knew what that was. I said: No, you had a lack of quality control product there. Clearly it was some psychoactive, well below the 0.3% THC limit for a hemp CBD product. And once again, that shows the importance. Our patients count on us to vet what we're taking and they picked up a random CBD. And they took it and clearly they had a psychoactive experience as though they were tripping hard. No pun intended.

Rob Lutz 44:49
I think you're right. I mean, I think with not just CBD, but all the products right?

Dr. Chris Meletis 44:54
All of them.

Rob Lutz 44:55
I mean, I'll talk to my parents sometimes like: Well, yeah, this fish oil, vitamin C, whatever was $5 at the pharmacy. Why is this one so expensive? Well, there's a reason why. Good products are more expensive, whether it's a supplement or anything else for that matter. But I do think that's why it's important for a patient, if you want them to stay on the plan, the protocol you put together, use the products that you're prescribing, these are the ones that you trust. You know how they work. And you're more likely to get the outcome you're looking for if the patient follows your protocol and uses the products in most cases that you've recommended.

Dr. Chris Meletis 45:34
Lots of wisdom, lots of savvy there, because lots of times the patient is doing well, then all of a sudden they decide they're going to start shopping around the products, and the protocol is not working. I'll say: Are you doing everything on the protocol? Yeah. Then I say: Well, can you bring in all the bottles; I just want to review them. They are like: Oh, yeah, I found that one at... I say: Do you know--see, I formulate for 14 different companies, so I have a good sense of what raw ingredients--I said, just the bottle, the label, and the capsule, whatever's in it? CoQ10's more than $5 for 90 pills at 100 milligrams. I say: So, that's not financially feasible to actually deliver it. You're getting something other than, or somebody's feeling really benevolent, and they're giving away basically free CoQ10. Probably not happening in today's world.

Rob Lutz 46:15
Not happening, right. Exactly. Yeah. That's a very good point. We did talk about delivery mechanisms, absorption and things like that. You mentioned VESIsorb, which I know when I was running alternative therapies, we published a study, I think it was their CoQ10 that use VESIsorb and the absorption levels on that. I think that's good to know. And of course, there are other good CBD products out there. But that's one.

Dr. Chris Meletis 46:43
Yeah, there's great products out there. And the thing is, we've all found products that work in our practices. And the thing that's most frustrating when a sales rep comes to us: Well, I can switch out your products for you. I know these work, I know the dosage necessary, and so I become very loyal. As a result in my standing pharmacy, I have some 25 different brands, a little of this, a little of that, and we find what works. And my philosophy is I tell my patients if I wouldn't give it to my wife or my kids or my parents, it's not going to be in our pharmacy.

Rob Lutz 47:18
Yeah, 100%. Well, great. This was, I think, a great show. You've covered a lot of really amazing information for the audience here. Is there one clinical pearl around this topic that you want this audience to walk away with? One thing you want them to think about regarding CBD or endocannabinoid system.

Dr. Chris Meletis 47:39
We have to realize that the human body--mind, body, and spirit--is far more complex than we appreciate and are able to even grasp. And just like what we thought 100 years ago, we kind of had it all figured out. And that we need to just get back to the basics. And as functional medicine is being challenged to become more quasi-pharmaceutical, we just need to keep it to the basics. Diet and lifestyle, and you supplement a good diet and lifestyle. And then mindfulness. In today's world we experienced all as a collective the COVID era, which I'm hoping is done, and it added an undue amount of stress and worry, forgetting whether a virus might have been flying around, but just the collective experience of isolation and fretfulness and the news feeds. And as a result, some of the health consequences we're seeing now and the mental health challenges are due to the fact that we're not connected. The concept of what--God bless him, Stephen Sinatra lectured in Florida right before I did many years ago, and of course, he's passed now--but he was talking about earthing and I was the next person on stage, but because it was a big stage, a thousand people, we had to have the little Michael Jackson clear tube. Maybe it's Janet Jackson, clear tube wired up. I listened to his talk. And the next day, about maybe 100 or 150 mostly medical doctors at A4M conference, they were out walking into Florida crabgrass because he talked about how that part doesn't seem connected with the earth. I think staying grounded, immersing yourself in nature, and losing our technology as frequently as we can, is probably one of the best gifts we can ever do.

Rob Lutz 49:23
Yeah, I love that. I think about lifestyle medicine, your lifestyle is your medicine. And it's either going to be good medicine or bad medicine. If you're doing all the right stuff, you eat well, you're getting outdoors, you're meditating. That's good medicine. And if you're eating processed food and watching your cell phone all day long and not connecting with your friends and family, that's bad medicine, and it will have an impact on your health in ways that could probably be measured, I'm sure.

Dr. Chris Meletis 49:52
Without question. Leaving the cell phone away from the dinner table. And when you have human beings in front of you, there's no need for a cell phone unless you're on emergency call. You're with the person, communing with them. The attitude of gratitude, and we're all familiar with the term TGIF. Thank Goodness It's Friday. And the question is, I live for the weekend. Those are all negative terms. How about Monday, Tuesday, Wednesday and Thursday? Those are also wonderfully splendid days. Embrace each day that we're vertical. And knowing that as human beings, we can make other people's lives around us better or not. And by making happier humans, we have healthier humans.

Rob Lutz 50:30
This is great. Well, Chris, really a pleasure having you on the show. Always love talking with you. And we'll absolutely get you back on the show. I know there are some other topics we want to cover in the future, but really enjoyed this one. And I'm sure our audience did as well. Thank you so much.

Dr. Chris Meletis 50:48
Thank you for everything you do. You have helped our community and our profession and the world a lot, so thanks for all the hard work you do.

Rob Lutz 50:54
Thanks, Chris. Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes they can be found at the link below. If you want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.