Cannabis and Chronic Fatigue Syndrome

In November 2005, my dependably robust health took a sudden swerve into the dark unknown. It started with an occasional dizzy spell. I’d be teaching a college writing class when suddenly I’d feel light-headed and woozy. Excusing myself to run to the restroom, I’d take deep breaths and splash cold water on my face.

My crash-and-burn had begun. Soon new scary symptoms were bursting forth every day or so like an evil menace in a sci-fi movie. I had room-spinning vertigo. All-over pain that made turning my head or biting an apple a self-inflicted torture. Rashes sprang up. Veins bulged. My hair fell out in clumps. Chewing or speaking would make my face throb and tingle before it went completely numb. When I did manage to talk, I struggled to find basic words or form a sentence. Lights, noise, and motion were dreaded enemies. I could hardly keep food down. Before long I had shrunk to a sack of bones. I felt as though I was being swallowed alive, my life-force squeezed out of me.

In a few weeks’ time I had morphed from a high functioning writer, professor, and parent into a sobbing lump of misery who could no longer drive a car, read a book, wash a dish, or hold a pen. I was so weak that a routine task — like taking a shower — would flatten me for hours. I spent my time lying motionless in bed, waiting for the day to end. But nightfall brought no respite. Restful sleep had become a distant memory.

“A very challenging disease”

My doctor ordered tests. And more tests. I saw a neurologist, an endocrinologist, an internist, an oral surgeon, several psychiatrists, and three ear-nose-and-throat specialists. I had an MRI and a CAT scan. My blood was analyzed by state-of-the art, high-tech labs. Various possible diagnoses were tossed around: lupus, Lyme Disease, a brain tumor, multiple sclerosis. mitochondrial dysfunction, temporal mandibular joint disorder… One physician tried to convince me that my illness was due to a buildup of wax in my ears, which he promptly removed and charged me $250.

One by one, all of these unfortunate scenarios were ruled out. But I was no closer to understanding what was happening to me – until my doctor uttered those fateful words: “Chronic Fatigue Syndrome.” He pronounced his diagnosis somewhat dubiously, as if he doubted its legitimacy. He may as well have said, “We don’t know what it is or what to do about it, and at the moment there’s no cure.”

According to the Centers for Disease Control (CDC), about 2.5 million people in the United States and 17 million worldwide suffer from myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS). ME/CFS is a serious condition that can cause significant impairment, rendering 75% of sufferers disabled, with 25% homebound and even bedridden. Eighty percent of Americans who meet the criteria for ME/CFS have not been diagnosed. Adding insult to injury, many sufferers are dismissed as addled with a somatic symptom disorder, which basically means, “It’s all in your head,” and prescribed anti-depressants.

“Chronic Fatigue Syndrome is a very challenging disease,” says Robert K. Naviaux, MD, PhD, who directs the Mitochondrial and Metabolic Disease Center at UC San Diego School of Medicine. “It affects multiple systems of the body. Symptoms vary and are common to many other diseases. There is no diagnostic laboratory test. Patients may spend tens of thousands of dollars and years trying to get a correct diagnosis.”

Drugs, desperation, depression

ME/CFS is now recognized as a real disease by World Health Organization, the CDC, and the National Institutes for Health, with working groups at Stanford, Harvard, and elsewhere. But many doctors still are not adequately trained to deal with a chronic condition like ME/CFS. There are no FDA-approved treatments for ME/CFS, and any medications doctors prescribe are off-label and fraught with adverse side effects.

Modafinil, prescribed to combat sleepiness, can cause severe skin rashes and psychiatric events like psychosis, mania, delusions, hallucinations, suicidal ideas, and aggression. Cymbalta, prescribed for pain and depression, is addictive and can trigger severe withdrawal, as well as suicidal thoughts, nerve damage, and weight gain. Vyvanse, an addictive amphetamine, is another problematic choice.

Like many ME/CFS sufferers, I was desperate. I tried pain, sleep, and anti-depressant medications, but nothing helped, and most made me feel worse. After several months on temporary disability, waiting and hoping to get better, I was forced to quit the teaching job I loved.

Though I hadn’t given up on life, I wondered if I should start planning my own funeral.

Taking a chance on cannabis

Due to the lack of effective FDA-approved treatments, many desperate ME/CFS patients resort to self-medicating. I was one of those people. I scoured the internet, dropping serious scratch on all kinds of alternative therapies in hopes of finding something — anything — that could help.

I gave up gluten, sugar, and animal products. I swallowed handfuls of supplements and gallons of a slimy green concoction I called “bug juice.” A highly recommended massage therapist pounded me to a pulp while tsk-tsking that I was “holding on to trauma.” I received weekly acupuncture from a dear old Chinese gentleman who refused my money when it became clear he couldn’t help me.

I’d heard that some people with ME/CFS found cannabis to be helpful. I hadn’t smoked weed in years, and, frankly, getting stoned sounded like the last thing a completely incapacitated person ought to do. But I was willing to try anything. A resident of California, I obtained a prescription for medical marijuana and went to a dispensary, where I bought a thimbleful of Purple Kush, a strain recommended by a young budtender for pain and sleep.

That night I rolled a shaggy THC-rich joint. I nervously took a hit and coughed. Within minutes something shifted. The background noise of paralyzing pain grew quiet, and something close to calm washed over me. I easily floated off to sleep for the first time in more than a year. In the morning I felt different — not cured, but hopeful. I’d finally found something that helped.

Enter CBD

According to ME/CFS researcher Dr. Nancy Klimas, drugs typically prescribed for sleep — like Ambien and Valium derivatives Restoril and Klonopin — can knock you out but won’t lead to the deep, restorative sleep so crucial for those afflicted with ME/CFS patients. Chronic insomnia inhibits the body’s ability to repair daily cellular damage, and this is especially destructive to ME/CFS patients. To fall asleep and stay asleep is a turning point for those who manage to achieve it, and most notice subsequent improvement in their symptoms.

I continued my nightly toke of THC-rich cannabis, and after a few days I was able to get out of bed and totter around. I left the house for short walks, which grew longer over time. My appetite improved, and I started to gain some much-needed weight.

Then a friend told me about CBD, a non-intoxicating cannabinoid, which was still a novelty in California’s medical cannabis community. He thought it might help my condition. CBD-rich cannabis hadn’t yet become available in most medical cannabis dispensaries, but he sourced some flowers with a 2-to-1 CBD-to-THC ratio.

When I added CBD to my cannabis regimen, more symptoms relinquished their stranglehold. The pace was slow but noticeable. I began to read and write again. One night, I went to see my daughter Melati’s theater performance, the first evening I’d been out in a year. Abundant, grateful tears fell as I watched her onstage. With the help of homegrown CBD-rich cannabis, I was coming back to life.

Biomarker breakthrough

How is it possible that cannabis could help my chronic fatigue when prescription medications couldn’t touch it, or did more harm than good? The answer might lie in new research that aims to explain what underlies the disease.

Until recently, one of the major challenges has been the lack of a clear biomarker — a measurable biological indicator of a disease’s existence — for ME/CFS. But soon there may be a reliable way to test for this disorder.

A 2016 study published in the Proceedings of National Academy of Sciences identified a “characteristic chemical signature” in ME/CFS sufferers, with an underlying biology similar to the state of dauer. “Dauer, like hibernation,” the study explains, “is a means of preserving survival by severely curtailing functions of ordinary life such as energy, digestion and movement.”

Mark Davis, an immunologist at Stanford University, has made some interesting discoveries with T cells, a type of lymphocyte that plays a major role in the immune system. T cell overactivation was found in the blood of ME/CFS patients, similar to what’s found in immunological cases like cancer, multiple sclerosis or infections. A 2015 paper by German scientists reported a marked increase in specific antibodies of chronic fatigue patients. And more evidence of a hyper-inflammatory response was presented in a 2017 study by Davis and Jose Montoya, showing elevated cytokines.

“There’s been a great deal of controversy and confusion surrounding ME/CFS – even whether it is an actual disease,” Davis says. “Our findings show clearly that it’s an inflammatory disease and provide a solid basis for a diagnostic blood test.”

Immune overdrive

With chronic fatigue, the immune system, spurred by who knows what, goes into full aberrant fight mode, activating a hyper-inflammatory response and setting off a carnival of nightmarish symptoms. A 2015 article in Science Advances reported heightened immune activity in ME/CFS patients during the early phase of the disease that was “consistent with a viral trigger or disrupted immune regulatory networks.” But in later stages of the disease, the levels of immune disturbance were much lower. It appears that whatever immunological threat initially triggered the disease could have been resolved – and yet the body continued its inflammatory, foe-fighting stance.

Why would the body keep shadow-boxing against an opponent that’s not really there? Robert Naviaux at UC San Diego explores this question in a beautifully-written article about his work on ME/CFS, mitochondria and “cell danger response” (CDR) — a term describing the body’s cellular metabolic response to chemical, physical and biological threats. Naviaux found that in ME/CFS patients, the CDR persists abnormally: “Whole body metabolism and the gut microbiome are disturbed, the collective performance of multiple organ systems is impaired, behavior is changed, and chronic disease results.”

In ME/CFS patients, inflammation and pain are like conjoined demon twins. When the body responds to a perceived threat, it sends out legions of chemicals into the blood and tissues to beat back foreign invaders. When functioning normally, this inflammatory response is an important, life-saving mechanism, but in ME/CFS sufferers it’s driving pedal-to-the-metal, with severe pain and other symptoms as a consequence.

Given that a runaway immune response and marked inflammation are major players in ME/CFS, it makes sense that both CBD and THC, two potent anti-inflammatory compounds, could be profoundly therapeutic. Anecdotal evidence bears this out. Do a search in any ME/CFS social media support group, and you’ll find accounts from people who have successfully used cannabis and hemp-derived CBD to improve their symptoms.

Anti-inflammatory cannabis

There are many published reports demonstrating the effects of cannabis on inflammation. A 2010 study in Future Medicinal Chemistry indicated that several cannabinoids were found to calm the inflammatory response through multiple pathways, which led to a reduction of associated symptoms. A subsequent report by scientists at the University of South Carolina disclosed that a combination of THC and CBD suppressed neuroinflammation (swelling of the brain) in patients with MS. The same neuroinflammatory symptoms have been observed in brain areas of ME/CFS patients with cognitive impairment and severe neuropsychological problems. Thus it’s reasonable to consider that cannabis could also be efficacious for treating neuroinflammation in ME/CFS.

CBD might also help to alleviate the difficult mood problems that ME/CFS sufferers experience. Brazilian scientists reported that CBD has “acute anxiolytic and antidepressant-like effects” and “therapeutic potential over a wide range of non-psychiatric and psychiatric disorders such as anxiety, depression and psychosis.” This assessment concurs with anecdotal accounts from people using CBD products that are widely available in state-licensed cannabis storefronts and elsewhere via unregulated sources.

There are many claims about CBD’s utility as a sleep aide, but the science is less clear. Several animal studies and some human studies suggest that CBD’s anxiety-relieving properties may help to improve sleep onset and quality. In one study, the administration of a generous dose of CBD (160 mg/day) increased total sleep time and decreased the number of arousals during the night. But low-dose CBD has been associated with increased wakefulness, underscoring CBD’s biphasic, dose-dependent effect.

Cannabis has been shown to be helpful for sleep – with some caveats. In a 2017 literature review pertaining to “cannabis, cannabinoids, and sleep,” THC was found to help patients fall asleep. But THC can also cause daytime drowsiness, and tolerance to THC can develop, rendering it less effective. The review notes that THC combined with CBD in a 1:1 ratio has been associated with sleep improvements among patients with chronic pain conditions. The synergistic interplay of plant cannabinoids can mitigate pain as well as insomnia, while reducing THC’s intoxicating effects.

A lifelong balancing act

If we blend what we know about the pathophysiology of ME/CFS with our current understanding of cannabis therapeutics, one overarching theme emerges: ME/CFS is a disease of total body disequilibrium, and cannabis is a biological equalizer with the potential to treat several symptoms simultaneously.

THC, CBD, and other cannabis components confer therapeutic effects by interacting with what scientists refer to as the “endocannabinoid system.” A principal function of this system is to maintain homeostasis, a state of dynamic equilibrium that keeps everything running smoothly. People with ME/CFS are the living antithesis of homeostasis, their biological processes have gone completely bonkers.

I know this all too well because I’ve been there. It’s been almost fifteen years since I was taken down by a mystery illness. These days I am functioning at about 80 percent of my biological capacity – and that feels like remission to me. I manage my health by eating a mostly plant-based diet, exercise, stress reduction, some supplements, and daily dosing with a CBD-rich tincture, with occasional THC-rich cannabis at night.

I won’t claim that cannabis completely cured my ME/CFS, but I will say that, as part of a broader healing protocol, it has helped immensely.

For more information on ME/CFS, including how to treat it with cannabis:
Health Rising: Finding Answers for ME/CFS and FM


Melinda Misuraca is a Project CBD contributing writer with a past life as an old-school cannabis farmer specializing in CBD-rich cultivars. Her articles have appeared in High Times, Alternet, and several other publications.


Copyright, Project CBD. May not be reprinted without permission.

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CBD research trends in 2019

Recent developments in how CBD (cannabidiol) is regulated in the US have made it much easier to purchase CBD products. Changes to how the federal government views CBD are also making it easier for scientists to conduct CBD research and understand how this cannabinoid interacts with the human body.

CBD isn’t just easier to research at the federal level–agencies like the FDA are paying attention and issuing warnings to help educate consumers, while the National Institutes of Health issued $3 million in grants to research teams looking to study CBD’s pain-relieving properties. And in states where cannabis is legal, state university systems are creating new think tanks and assembling research teams to collaborate on a new generation of cannabis research.

While CBD has demonstrated the potential to help address a wide variety of conditions and symptoms, many questions remain, including what conditions CBD has the most potential to treat, what proper doses might look like, and precisely how CBD brings about the effects it does.

Here are some of the major questions researchers around the world are asking about CBD, and a look at some of the early answers they’re finding.

What CBD research says about epilepsy treatments

We have a pretty good general understanding of the neuroreceptors that CBD interacts with in the body. We also know that CBD and drugs derived from it are effective in treating some forms of epilepsy, including Dravet’s Syndrome and Lennox-Gastaut Syndrome.

What we don’t understand is exactly why CBD helps epilepsy patients. With CBD easier to study–and CBD-based drugs entering the market–researchers are digging further into the molecular mechanisms responsible for CBD’s apparent seizure-reducing properties.

Differentiating CBD and THC

Increasingly, studies on cannabis are shifting focus away from studying effects of the whole plant and toward more focused studies on individual cannabinoids. This research is helping scientists learn more about how cannabinoids act in isolation, how different cannabinoids–for instance THC and CBD–behave in the brain, and more.

CBD research under review

Many studies on the impact of CBD and cannabis in general employ pretty small sample sizes, which limits the data researchers can gather and the conclusions they can draw from it. As the volume of these studies grows, though, researchers are employing that data to conduct review studies on the effects and efficacy of cannabis and its components, including CBD.

Rather than conducting a new experiment, review studies collate and compare the results of previously published, peer-reviewed studies. This allows authors to work with what is effectively a larger data set and more confidently answer questions about the subject.

2019 saw these studies become more common in the cannabis space with review studies aiming to shed light on the efficacy of cannabis–and specific cannabinoids like CBD–in treating pain, as well as the potential negative side effects of CBD.

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CBD to the Rescue

Project CBD received this testimionial from a Canadian medical cannabis patient:

In 2008, I seized up while taking several different medications – in large part due to mineral losses associated with the excess administration of cortisone acetate, an adrenal steroid hormone. This drug was administered as part of an adrenal hormone replacement project in conjunction with several other medications. I’ve spent the last 10 years fighting the life-threatening consequences of that bad reaction.

The seizure left me feeling traumatized psychologically and physically. Muscles around my ears ended up pinching nerves; there was asymmetry of my neck and a slight rotational pressure on my brain stem; and I developed severe refractory lockjaw — any movement of my jaw, be it from eating, chewing or grinding, resulted in intense pain in my neck. The pain was horrendous, persistent, and fluctuated wildly.

None of the medications I was prescribed did anything to touch the pain.

I tried a variety of non-narcotic pain relievers, including anticonvulsants and antispasmodics. I started with Gabapentin in 2009, and quickly stopped when I developed life-threatening rage, depression and suicidal ideation. Then I took Tylenol and Arthrotec for eight years, but these drugs also failed to keep the pain away and my mental health issues took a serious turn for the worse. Things got so bad that I overdosed on two of the painkillers out of anger and despair over their inefficiency.

The reason that these medications did not work isn’t obvious to me, though I suspect it may have something to do with a dietary deficiency of potassium, which is depleted by chronic use of non-narcotic pain relievers. Still, I think that most non-cannabinoid medications are just toying with the body and actually make things worse by not addressing the underlying problems.

For almost ten years, I had a persistent spasm of the neck (torticollis) that would not go away until I started to use a combination of cannabis products. I think that cannabinoid molecules – tetrahydrocannabinol (THC) as well as cannabidiol (CBD) – helped immensely by inhibiting nerve responses, which I believe played a role in my torticollis.

To finally get my jaw to release and to relieve pressure on the nerves and muscles in my neck, I used a combination of smokable cannabis and CBD-rich oils. Throughout the day, I took 5mg each of THC and CBD in a 1:1 oil in lots of divided doses, and it finally got me to a place where now I can say I am pain-free. It has allowed me to move forward and function in a way I had not seen for years.

I am not sure if I am 100% cured, but I will say I am 90% on the way to not thinking about it. It has been a very long and difficult journey, but I am hopeful that I can make additional strides towards employment and financial independence.

Cannabinoids saved my sanity and my quality of life.

Thank you for listening to my story and for the work that you do.

Dennis Sloane, age 38, is a graduate of the University of Manitoba.

Copyright, Project CBD. May not be reprinted without permission.

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New study finds cannabis effective for treating migraines

Health

December 5, 2019

A new study found that Canadian medical cannabis users reduced pain severity and length of migraine episodes by smoking cannabis or cannabis concentrate. (Betelgejze/iStock)

A study published last month in the Journal of Pain found a statistically significant reduction in migraine and headache symptoms and recurrences among patients who used cannabis for treatment.

Researchers concluded that headache and migraine severity were reduced by nearly 50% after using cannabis.

The study, conducted by researchers at Washington State University, sampled the effects of smoking cannabis or cannabis concentrates on migraines and headaches among 1,959 anonymous adult participants over 16 months.

The results were extremely encouraging for patients looking for relief. They’re also surprising–and offer a taste of how incomplete current medical research into cannabis is.

The study data indicated that after using medical cannabis, “severe headache episodes are associated with greater reductions in headache severity,” which means that those suffering the most pain achieved the most relief. This is important, as the most severe episodes can be nearly impossible to treat with standard prescription pain medication. The new study indicates that cannabis may actually take the edge off, even in the toughest cases.

The study revealed some surprising results, too.

The authors found that cannabis’ effectiveness wasn’t dependent on the cannabis strain, ratio of THC:CBD, or dosage. “Results indicate that cannabis reduces migraine severity regardless of the type, dose, THC or CBD content,” they wrote. That could indicate that factors other than cannabinoid ratio and concentration are at play.

Perhaps even more strangely: While patients smoking cannabis flower found they needed higher doses over time to achieve the same results, patients smoking cannabis concentrate found their necessary effective dosage actually decreased over time.

To explain this, the authors point to “evidence that other phytocannabinoids and terpenes present in cannabis flower are reduced in some concentrates,” and suggest that the absence of these compounds in concentrates prevents them from blocking the effects of migraine-targeting cannabinoids from supplemental ingested cannabis.

In other words: The difference in effect between smoking flower and concentrate might not be due to users developing dosage tolerance, “but rather a differential ‘dialing in’ process between those who use flower and those who use concentrates.”

The study framework is a factor worth considering, too. It remains extremely difficult to obtain permission (and the actual cannabis) to carry out clinical research on cannabis use in the United States. For this study, researchers at Washington State University obtained anonymous data from 1,959 Canadian medical cannabis patients who used the app Strainprint.

Strainprint allows individuals to track their personal cannabis dosage, consumption, and effects against symptoms. Limiting the study to Canadian patients allowed researchers a greater degree of certainty with regard to cannabis strains and potencies, as producers licensed by Health Canada are held to a much higher degree of quality control than most US states.

Because the data came from Strainprint, patients had already self-selected for medical cannabis use. There were no control subjects using a placebo, and patients who found cannabis did not reduce their migraine symptoms might have taken themselves out of the data pool by discontinuing cannabis use, not entering data into Strainprint, or choosing not to download the app at all.

Because virtually no research exists on the medical effects of cannabis concentrates, the authors note that their finding is “entirely novel,” and express the urgency for further research in this area.

To summarize the study’s findings:

  • Canadian medical cannabis patients found that cannabis did lessen the severity and length of migraines and headaches.
  • Smoked cannabis concentrate had a stronger effect on migraine alleviation than smoked flower.
  • THC:CBD ratio and strain didn’t seem to matter with regard to effectiveness.
  • For patients smoking flower, higher doses were required over time to maintain the same level of pain relief.
  • Patients who smoked concentrates required lower doses over time to maintain the same level of pain relief
  • No risk for overdose was detected.
  • Study data suggested that terpene profiles and lesser-known cannabinoids play a role in preventing and managing symptoms, and that “dialing in” those compounds could achieve more targeted medical results.

Humans have been using cannabis for pain relief for thousands of years, but only recently have research scientists specifically investigated its efficacy for migraines. Preliminary research from 2004 confirmed that the body’s endocannabinoid system “has numerous relationships” to migraines. A 2014 animal study offered further support for the therapeutic potential of supplementing the endocannabinoid system with cannabis to treat migraines. Patients suffering from migraines have been found to have deficiencies in anandamide, a primary endocannabinoid (ie, cannabinoids made by the human body) which serves, among other functions, to block the triggers that cause migraines. Researchers working with rats found that supplementing the animals’ anandamide deficiencies with cannabinoids reduced migraine symptoms.

Researchers have also noted that cannabis is also a known neuro relaxant, vasodilator (a substance that widens blood vessels), and anti-inflammatory agent. Those abilities, together, address the most critical aspects of both the onset and symptoms of migraines.

Although the new Journal of Pain study was limited to smoked cannabis and cannabis concentrate, and was lacking in some of the formal controls of a clinical environment, it represents the largest and most recent study of its kind to date. Its findings are encouraging for cannabis’ use in treating migraines, as well as the potential for endocannabinoid system therapies in general.

More notably, despite the new study’s relatively small size and limitations, it presents some new and fascinating discoveries which beg to be explored.

(2019) Journal of Pain: Short- and long-term effects of cannabis on headache and migraine

(2018) Frontiers in Neuroscience: Link between endocannabinoid disregulation and migraines and headaches–specifically low levels of anandamide

(2017) Cannabis and Cannabinoid Research: Cannabis for migraines in history, and summary of existing clinical research

(2014) Journal of Headache and Pain: Rat study examining effects of stimulating CB2 receptors with AEA for migraines

(2004) Neuro Endocrinology Letters: Early research into endocannabinoid system deficiencies, as they relate to migraines, fibromyalgia, and IBS

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