Dr. Mary Clifton, MD, Internist, Cannabis Expert
Mary Clifton, M.D., has been an Internal Medicine doctor for almost twenty years. She specializes in weight loss, osteoporosis and menopause, disease prevention, management, and reversal. She regularly speaks at health and inspirational seminars, medical and heath conferences, corporate wellness events, Universities, and for private groups. Mary is the author of the best-selling book, Waist Away, co-author of the book Get Waisted: 100 Addictively Delicious Plant-Based Entrees, and co-founder of the healthy weight loss program
[00:00:01] You're listening to Thinking Outside the Bud where we speak with entrepreneurs investors thought leaders researchers advocates and policymakers who are finding new and exciting ways for cannabis to positively impact business society and culture. And now here is your host Business Coach Bruce Eckfeldt.
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[00:01:07] Welcome, everyone. This is thinking outside the bud. I'm Bruce Eckfeldt. I'm your host. And our guest today is Dr. Mary Clifton. She's an expert in CBD and cannabis. She started as an internist and has over 20 years of experience. Excited to talk with her. I'm always fascinated about the medical side of the cannabis space. As we know, the regulations are interesting on a state by state level. And how it gets into the medical side is a fascinating conversation on how cannabis is helping patients, how CBD and all these other products that are coming out. Fascinating topic with that. Mary, welcome to the program.
[00:01:40] Oh, thank you. Thank you for having me.
[00:01:42] So let's go to your background first, because I'm kind of curious how you got into the cannabis space, how to come up. How do you get into it? Why did you get into it? And then we talk a little bit about what you're doing now and understand what's happening with cannabis and the medical side in terms of this market in this industry.
[00:01:58] Yeah. I mean, I've been talking I've been a doctor for almost 25 years now and I've been thinking about cannabis, but not really thinking about it as it is anything significant until just the past couple of years know I had a couple of remarkable experiences. I experienced the loss of my brother to colon cancer. And then right on the heels of losing my brother, I lost a dear friend to ovarian cancer. And these were relationships where I was asked to manage the hospice at bedside. I mean, I do hospice management all the time. I'm an internist. People are always passing away. And when you take care of an older population. Yeah, but I've never really sat at the bedside and administered the medications myself and watched the response. And and I and I was 24/7 with these particular patients, you know, and the differences in their dying process were so stark, so completely different that with and without cannabis that I thought this just has to be a one out. There's no real data around this. It's it's so remarkable. But I'm just I'm going to do a little research and then I'm gonna go back to doing what I used to do. And then when I did the research, there's a phenomenal amount of research about how these products can help with death and dying processes and all kinds of other things. I mean, simple things like insomnia or anxiety, but more complicated diseases like difficult to control, seizures, autism. There's so much data. And I've always been listening to the mantra that we don't have any data. We can't really make any recommendations. But once I started looking at the research, it was clear that data is accumulating rapidly worldwide and that we have more and more information to help people make great decisions.
[00:03:41] And so, I mean, I'm curious what you saw.
[00:03:43] What are the effects or what are the what are the differences that you you noticed in these situations that you're in and dealing with end of life situations and the impact of cannabis and that. And then I'm curious about the research, because I do I do think we still know many people still are in this kind of world. We don't really have any data about cannabis. It's all in total. So let's talk about that kind of sort of the empirical evidence you have or the experiences that you've had in terms of seeing it in kind of in practice. And then let's talk about the research. So what did you notice in terms of the experiences you had?
[00:04:12] Well, I mean, there's my personal experience with these two individuals is supported by research that at end of life or in severe disease or, you know, in these situations, you see a lot of nausea, uncontrolled pain. It frequently occurs, loss of appetite. And and all of those things were very well modulated by the cannabis. But there's other issues, too, as you approach a dying process of just having, you know, a psychological calmness around what's happening and being able to progress through the series of steps needed to be able to leave this life. It was some sort of grace. And I noticed that also. And that I thought was probably dependent on the person that I was working with rather than the disease or the cannabis.
[00:05:01] But actually, I mean, there's a lot of research around how people are able to sort of contemplate their life experiences. There's four medical components of this of this plant, the reduction in the nausea, the control of the pain, the improvement in appetite. I mean, a lot of cancer patients die from malnutrition and dehydration. So really getting somebody to eat drink is a critical part of end stage cancer management. But it's also critical that. Will have the capacity to process and to to have a product that will allow them to process through what they're going through is is remarkable. I think we have that in cannabis. We probably have that also in some other restricted plants like psilocybin. And I'm hoping in the future we'll be able to bring those forward too.
[00:05:47] Yeah, well, I know that. I know they're starting to work out it. I know. I think Colorado has been passing some legislation on some of the use of that. So what are the what are the medications that typically have been used in these situations that cannabis can start replacing or augmenting or offsetting? Well, excuse us.
[00:06:02] Right now, we're using a lot of opioids for management of nausea. And of course, there's a lot of different not nausea and pain and there's all kinds of different nausea. Medications like Phenergan comes to mind immediately or so for him that are very effective. But I mean, the studies are showing a number needed to treat for nausea and vomiting of like 1 to 6, which is a number needed to treat as a.
[00:06:27] Is this statistical, you know, number derived from all of the research to say, how many people do you have to treat before you prevent one or before you cure or control one? So like if I treat with cholesterol therapies, all the people who come into my office with high cholesterol, I have to treat upwards of 200 to prevent one stroke or heart attack. And that's, you know, if we really massage that data. So to have a number needed to treat at six with cannabis for managing nausea is really exciting. That's a very nice low number needed to treat.
[00:07:01] And it's just that that's just sort of a metric of effectiveness in a general population. Yeah. How how many people would see benefit? Yes. Yeah.
[00:07:10] And then there's similar very nice low numbers for management of insomnia, anxiety, more common chronic diseases that even though they're common, I feel I don't really have great products to offer people. You know, a lot of my anxiety patients are dealing with a lot of anxiety on Sunday and Monday at the beginning of the week, but not necessarily feeling as bad on Wednesday and Thursday as things wind down. But I don't have a mechanism in Western medicine to allow you to treat one day and not treat another day. You know, if I do that with my existing drugs, I create a lot of addiction and problems with sedation. But with with using things like CBD or cannabis, I can allow people to titrate their own meds as they see and maintain their own symptom control and have much more control over their health. That's what I'm so excited about, is the patient empowerment that it's innovative and disruptive that excites me. But then a patient can take control and that's that's wonderful. Then what do you do?
[00:08:10] What is it that all of us kind of do that just because it's a more natural product plant based?
[00:08:15] Well, because you can take it when you want to. You know, I mean, it isn't like I give you a dose of Prozac and you have to take 40 milligrams every single day and you will have withdrawal symptoms, whether you feel like you need it or not. If you're having a good day, you can be half your dose with cannabis at no harm done and then or double it if you're having a rough day. So it puts the control back in the consumer's hands instead of in the doctor's hands and not. And that's exciting to know.
[00:08:43] So let's talk about the research, because I do I do think that, you know, most people are kind of under the general impression that because of the legal classification of the drug of the plant, that there hasn't been any research done on it in the last 50, 60 years. Where have you found research? Who's producing this research? What kind of research is being done? What have you been able to learn from it?
[00:09:04] It's been hard to do research in the United States for a couple of reasons, because it is a Schedule 1 drug like on par with heroin and cocaine. And as well, actually cocaine is not in that schedule, but cocaine does have some perceived medicinal value and some your nose and throat conditions. So it doesn't have medicinal value and it is hard to research. You have to get a lot of data around yourself in order to access it.
[00:09:28] And then the only product that you can research is one type of cannabis that grows, I believe, in Mississippi for like the University of Mississippi grows it in order to use it for research purposes. But I mean, it's not even a strain that anybody uses anymore. So so so the value of doing research on that strain is just you just have to wonder at what we're doing in the United States with this weight, with handcuffing our researchers. But Italy is doing really great work since their legalization, at least for medicinal. And they're doing a lot of survey data on people as they're as they're entering the dispensary. There's been a lot of great survey data accumulated in the US, went out for people who are going to dispensaries and also Israel take them alone.
[00:10:14] And some of the bigger companies there are working on distillation of various cannabis products, different cannabinoids, the THC and CBD, but also CBN, CBC, CPG, trying to figure out if they can. The ratio is a little bit. They can significantly impact inflammation or immune responses and all kinds of conditions. And then they would have really exciting novel new ways to manage immune system dysfunction.
[00:10:43] So you're mentioning a couple of interesting points when it comes to kind of the the application or use of cannabis of all these different connective voids in terms of the ratios and the combinations of people keep talking about this entourage of fact and then people talk wind turbines, all these things. I'm curious what you what you've been able to kind of learn or what your when you when you look at applying cannabis, different conditions and situations, how that is. And then also the kind of mode of application. So whether you're talking about 10 sugars or, you know, some kind of vaporization or like what where you're out with, you know, it's like a really long.
[00:11:21] But I think it's clear.
[00:11:22] I mean, I guess what I see is that the big difference between the big I think the interesting part of the medical side and the adult use side is, you know, it's a little bit more like whatever you want, whatever makes you feel good about the recreational side does.
[00:11:35] You know, we just want to present prevent somebody from having an acute psychosis, you know, try to take it, try to take it in a way that you can titrate. And that's really true of the of the medicinal side. You know, if you if it seems safer to take a gummy bear and but then your onset of action with a edible is 60 to 90 minutes or so and then you can't take it away. You can't subtract it. So so you want to try to use a product like a vape or a tincture that you can hold in your mouth. And then the onset of action is going to be no more than six or eight minutes.
[00:12:09] So if you wait 20 minutes and you still don't feel like you thought you wanted to feel, you can take another dose, you don't have to. Or another serving size as the FDA makes it safe for CVD.
[00:12:21] So are you kidding?
[00:12:23] You can take the products and titrate them and see how they work and then you can keep a little log and you'll have a lot of data. So it's all you know, all of the studies that start with edibles. More people drop out. More people don't like it. They didn't get a response. So the edibles are really not a good starting point. But once you get your response figured out, the edibles are great, you know, because then then you can dose yourself reliably for whatever you're dealing with. So in the mode of administration also varies. I have to say, based on what you're doing, if you've got chronic pain, that's always a seven out of 10. You know, you need to dose with a way that you're going to constantly have product in your system. But if you're if you have a trick knee that gives out after basketball on Tuesdays and Saturdays, then you need a different, you know, more acute onset of action for the trick knee. And that might be where of a pen or a tincture is going or just standard flour rolled or vaporized would would give you, you know, immediate relief to the. I mean, I thought when I started out with this, I was working with an I.T. company. I still am working with them on a similar project.
[00:13:30] But we started out thinking that we would create a sort of a magic wheel and we could tell you what product to use based on your symptoms. Interesting. Yeah, but the reality is almost everything is relying on CBD. The CBD is the workhorse of the plant. Understand that. And so you can start treating pain, anxiety, inflammation, you know, almost certainly with CBD and see if it works. And then if you're not getting the results you're looking for after you've traded and taking your time and you've assured that you have a high quality product, then adding a little THC, you know, going to more of the whole as a whole. But to try to get that entourage effect is is a wise thing to do. But but that I think we don't really it's it's not as complicated as it would initially seem. People run into trouble if they start with an edible or if they try a product for the high THC concentration, there's value to the high THC concentrations and getting high. If you want to get high, you definitely need the THC or if you're trying to manage like nausea, appetite issues, those that are central nervous system seems to be in large part where a lot of that is able to be controlled.
[00:14:44] Got it. And what's your. I mean, just from a medical point of view, you know, these different modes, I mean, everything from consuming concentrates on a future format or things versus vaping versus taking flour, you know, smoking flour or their side effect or we like the idea of smoking a flower. How does it compare to, you know, the nicotine, cigarette smoking? And I think a lot of people are, you know, is this really healthy or is this really the same or sort of a lot of the data around smoking gets, you know, automatically transitioned into cannabis.
[00:15:14] And that's been a problem with a lot of the research. I mean, they will researchers will ask patients if they smoke and then if they say yes, then they'll say, you know, smoking cannabis is dangerous. But I mean, smoking cigarettes is 300.
[00:15:28] Four hundred inhalation a day for smoking cannabis in most cases, even in a heavy user, might be eight to 10 inhalation a day.
[00:15:37] So it's it and there's inflammatory products in tobacco and cannabis has, you know, repeatedly shown to have anti inflammatory effects. I mean, there's things in the smoke that do have inflammatory responses, but there's also timings in a lot of cannabis. The Terrapins that make basal smell tiny or that make pine trees smell piney and that acts as a natural Bronco violator. So there's probably some mediation of any inflammation that goes on in the lungs with the anti inflammatory effect of the product. And it's not 400 inhalation today. So, yeah. So I don't I it's hard to say. So there might be some argument that the smoking of the cannabis might be bad for your vaping might be better, but then you get into some of these vaping oils and there's been a recent sharp increase in the people getting sick with with vaping and most of those I think with tobacco because they're just vaping so much now and getting a lot of exposure.
[00:16:32] Well, it's unclear. I think a lot of these a lot of the reports I've seen, too, has been high use tobacco, high use situation, but also somewhat questionable product quality.
[00:16:42] So, you know, people talk about the bootlegged e-cigarettes and things like that. And people are worried that some of the solvents that they're using in these lesser quality ones are becoming problematic, causing health issues. So I think it's a combination of the amount of use and then the quality of the product that you're concerned.
[00:16:58] I think. I think also, you know, I've worked a lot in hospitals and, you know, the billing department, when there's something that is getting reimbursed, you're often encouraged to identify that on the bill.
[00:17:10] So if there is a lot of of high level billing going on around a vape induced, complicated pneumonia, and I can imagine that there is if anybody who is vaping shows up in the hospital with pulmonary infiltrate, then I can see how the billing department would ask you to consider this being related to their faith.
[00:17:29] And then that could potentially increase the reimbursement for the hospital. And your incentive. See that all day long? Yes, absolutely. Like an advisement to add it to the bill. It's more of like, you know, it's something that's important to do. You know, when you're working in the hospital to maintain their reimbursements. So I really don't know exactly how risky the baby is or how many of these vaping related problems are truly vaping related problems. I mean, withhold my judgment on that for a little bit more time.
[00:18:01] Yeah, I understand. And I'm curious what you were. I mean, you mentioned the kind of the difference in answer time in terms of, you know, obviously taking an edibles is going to work your way through the digestive system, 60, 90 minutes being, you know, goes directly to the lung, directly to the brain. I mean, it's it's near instantaneous or at least, you know, it's pretty close as you can get in terms of time onset. Other factors that you've seen in terms of kind of and effectiveness. I mean, just in terms of, you know, putting something through the Joseph system versus, you know, putting it right into the circulatory system, I mean, is there breakdown? I mean, we're talking about plant chemicals and we digest, you know, digesting things in different ways and stuff. What's the impact of these different modes or even really haven't talked about skin, dermal kind of things. But what what are some of the differences in terms of the end result or effect or what ends up getting through to the systems and how does that work?
[00:18:55] Well, I think the major differences between the various mode of administrations is the onset of action. You know, the the edibles probably. But also anything that you're smoking is going to break down through the side of Crown P. 450 system, which is the same system that's used by a number of different drugs. It doesn't appear to clog up the P. 450 systems like grapefruit juice can.
[00:19:18] But but it with multiple drugs, you could imagine that you could have a drug drug interaction or you could have genetic modifications to the P. 450 system. That could change the way that you break down all of your drugs, not just cannabinoids. There's also issues with genetic differences with CBD receptors. You know, the receptors that naturally occur in your body in the end of cannabinoid system could be up regulated in some people. They could have a lot of it and have a very pronounced effect to taking cannabinoids. Or they could have a very limited number of CB receptors and have kind of a mediocre effect. So that could be also contributing to the way that your individual body is responding to these medicines. So I think there's a number of different factors with it. And I in the end, you also have to worry about the quality of your product. There was a study published in JAMA just a couple of years ago on upwards of 85 bottles of CBD and they found only 25 percent, only 25 percent matched what the bottle said on the outside when they actually applied third party testing. So you have to. Make sure that your product is high quality. I mean, I just talked to a friend whose mother picked up a product from a flea market.
[00:20:37] And she said, what do you think of this? And I said, I'll call you when I think about it. So she sent me the product.
[00:20:43] The woman got a bottle with 20 milligrams of CBD in it in a 10 serving bottle. And I mean, at that point, she could drink the whole bottle. It may have an effect.
[00:20:55] You know, I mean, but 20 milligrams a you're.
[00:20:57] So you're going to dose 2 milligrams per dropper full and. Oh, my word. You know, and then there's a person who tried it and said it didn't work for me. You know where it unless you're hoping for the placebo effect. I don't expect that it would.
[00:21:12] Yeah. So let's talk about that a little, because I think that's one of things I've come to appreciate. And having talked to a lot of folks in this industry on the medical side is just the way that the sort of the laws and the processes set up is that I go to a physician and I'm in a medically legal state. I go to a physician, get get diagnosed with a qualifying condition that lets me get a medical use card and then I go to the dispensary and now I'm kind of back at square one with a bud tender trying to describe my symptoms and then help me navigate this all these kind of products and, you know, different types of strains or cultivars. And you know what I mean, from from your point of view as a physician, what's mean what's working about this right now? What's not working about this? Like how well, how is this a challenge problem is found, bud?
[00:21:54] Tenders really don't have a lot of training. And so they're just relying on their own personal experience. And so you may have a very highly qualified bud tender and then in another circumstance or come back to the dispensary and another day, somebody who really has a very limited personal experience, most of them on average are working behind the counter no longer than six months. And most of their training is on how to run the counter and and not really on products or how products work.
[00:22:23] So Bud, tenure training is helpful, but that's what my site intends to do, is make it possible for you to go to the site and see what research is available on your disease and then think about what products are going to be best. And, you know, short telemedicine consultations are available, you know, in all states where it's legal that will allow you to just get quick questions answered and not, you know, not deplete your pocketbook of any significance, but get you on the mend with with with the right choice so that you can go and say what Turpin you would like and what, you know, end and what ratio of CBD to THC you want to start with. I mean, we're I'm really grateful to the HIV and cancer communities back in the 80s who we really owe a lot to those people who insisted on using their cannabinoids to help control their symptoms and for as at end of life. And and then it just manifested all of this energy around bringing these products back for their medicinal value. I mean, there's data all the way back 5000 years in Chinese writings, 3000 years and Egyptian writings where people have been using these products for chronic pain or stomach issues. And and as recently as 1920 from England, where a professor at Medical King College there suggested breathing cannabis smoke through water to manage a headache, also known as.
[00:23:55] Yeah, yeah.
[00:23:58] It was like that. And then your head, your head, it clears up and you can get back to work.
[00:24:02] And my question was, what kind of work is this person? Very slowly. So I'm curious, I guess, where you're taking your business.
[00:24:13] I mean, clearly, you know, you've learned a lot about the product, about the about the plant, about applications.
[00:24:20] Like where do you see the sort of the profession going, you know, physicians that are interested in getting more involved in cannabis, using cannabis or working with cannabis in different ways? And how are you developing your practice in helping bring this plant to, you know, to people who need it?
[00:24:37] Yeah, I create short videos. I create a series. What I do actually is create like a very long group of videos, 40 minutes of video on cancer, 50 minutes of video on seizure disorder. I just shot autoimmunity for 30 minutes and then I go into it for four providers certification so that if you want to know every detail about auto immune conditions and cannabis. I have that altogether in my provider certification. And then I look through all of that and look for the really great thoughts or things that you need to know.
[00:25:11] If if you're if you're searching and you want to know what to do with your thyroid and if cannabis or other cannabinoids that you know, if any of these chemicals might help. And then I shoot little three minute videos that are all for free on the site. So in most cases, a consumer. Go to this site and get the information they need to feel confident about choosing these products or not choosing these products for for the various conditions that I've researched and.
[00:25:37] And then if you want to know more or if you want to become certified, then the provider certification is available. And that's going through all the processes you would expect to be affiliated with a major university and, you know, and then and then replicate it.
[00:25:51] And what do you mean kind of looking forward in this industry here where I guess where do you see things going? Or at least what do you what do you hope happens over the coming years in terms of, you know, whether it's regulation, whether it's, you know, how the industry develops, you know, new products? Where do you think the opportunities are? Or she just, you know, hopefully happen?
[00:26:08] Well, I mean, I'm a doctor. I think about education and patients. And and I talk to people all the time who cross state lines with the product in their car.
[00:26:18] And because they can't get it in their state or they, you know, are there, like in New York, we have the capacity to get hard pressed tablets, tinctures, but we can't get whole blood.
[00:26:30] And so if you want to smoke Kolbert in New York, I mean, really, I talked to a lot of people with cannabis cards who admit that they're still getting their product from a secondary market. So, you know, the states really need to move quickly to allow available products to be available so that patients can get whole. But and I would love to see legalization for recreation just nationally. And then if you want to use that medicinally, we have data on it if you want to use it safely, recreationally. We have some data that can help. And that way, there's not all of these state to state issues or risk score all the fear that drives people's decision making around this plant. It's too valuable to keep applying silly restrictions and making people feel unsafe. Yeah, yeah.
[00:27:15] I think this has been a pleasure. If people want to find out more about you, about the videos, about the work that you're doing. What's the best way to get that information?
[00:27:22] Oh, well, you can go to CBD and cannabis info dot com. I have about 100 videos there. I'll have 200. Hopefully by the end of this month. And then if you go in there and you're looking for a video and like on cannabinoids and nail biting, you haven't shot that video yet.
[00:27:42] I have a question about something that I didn't answer. Just send an e-mail. All the emails on the site go directly to me. And if I if I don't have the answer for you, I'll find it and shoot a video for you.
[00:27:53] Awesome. It's been a pleasure. I'll make sure that the links are in the show notes so people can click through those, see the videos. This has been a pleasure. Really informative. Always. Like I said, I love talking to the medical side because I think that, you know, there's there's a huge amount of value and potential and yes, you know, efficacy or so this is my pleasure.
[00:28:11] Oh, yes. Thank you so much. Thank you so much for having me.
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