History has shown us the usage of medicinal cannabis over the last 4,000 years, but it wasn’t until 1964 that professor Yechiel Gaoni and professor Raphael Mechoulam described for the first time Tetrahydrocannabinol (THC) as an active component of cannabis. This finding leads to the discovery of an endogenous (internal) system of the human body which naturally interacts with the THC found in Cannabis, Whereafter they named the “Endocannabinoid System” (ECS), honoring the plant that made its discovery possible. The importance of the ECS starts before the beginning of human life as it is involved in the signaling processes necessary for embryonic implantation in the wall of the uterus. All mammals have an Endocannabinoid System (ECS), which is considered one of the most important physiological systems in the regulation and maintenance of essential functions to promote homeostasis, which is defined as the tendency of an organism or a cell to regulate its internal conditions, usually by a system of feedback controls, so as to stabilize health and functioning, regardless of the outside changing conditions.
Between the years of 1990 and 1993, the main receptors of the endocannabinoid system were discovered and named CB1 and CB2; the former are found predominantly in our brains and throughout the central nervous system while the latter is distributed in all organs and tissues in the human body. Mapping these receptors allowed scientists to discover an endogenous cannabinoid named Anandamide; which was named after the word “Ananda” that means Bliss in “Sanskrit”; as they felt at that time they had found the bliss molecule”.
The main components of the ECS are:
1.- CB1 and CB2 receptors
2.- Cannabinoids: endogenous (Anandamide, 2-AG), exogenous (THC, CBD)
3.- Enzymes: Fatty Acid Amide Hydrolase (FAAH) and monoacylglycerol lipase (MAGL)
To better understand the ECS, imagine this biological regulation system works as a key-lock structure, the receptors CB1 and CB2 are the locks, the cannabinoid compounds THC and CBD the keys, and the enzymes FAAH and MAGL, are the hands that put the keys in the locks and twist.
Cannabinoids are the main substances that can bind and activate the receptors CB1 and CB2, however, they don’t work like most neurotransmitters. The majority of nervous impulses in the human body are released at the presynaptic zone and from there they travel all the way to the receptor located in the postsynaptic area, this is known as anterograde transport. However, the ECS operates in an opposite fashion, known as retrograde transport which is directly related to the regulation and inhibition of excitatory impulses in our nervous system. This phenomenon might explain the “anticonvulsant and antiepileptic” properties of Cannabis and the impressive results obtained in the treatment of “Dravet Syndrome”. A good example of this is Charlotte Figi, the girl who inspired the movie “Charlotte’s Webb”. after decreasing her epileptic convulsions from 300 episodes of 30 mins in duration every week, to only 3 to 4 short episodes per month by using a medicinal cannabis strain named after her which has high CBD and low THC concentrations; this is just an example that illustrates the importance of understanding the ECS to maximize the uses of cannabis as medicine.
As we continue to learn more about the fascinating world of the endocannabinoid system, we realize not only that CB1 and CB2 receptors are widely distributed in all organs and tissues of the human body, but also that a healthy and functional ECS is essential to maintain our homeostasis or internal physiological balance.
The main functions of the endocannabinoid system are:
1.- Appetite, digestion, and hunger
4.- Immune response
5.- Reproduction and fertility
6.- Pleasure, pain, and reward
9.- Energy and metabolism
10.- Antioxidant and Neuroprotective
When there is a disturbance of the endocannabinoid system, any of its vital functions can be compromised. This finding made some scientists propose a hypothesis about a medical condition called: Clinical Endocannabinoid Deficiency, which was described for the first time in 2004 by Dr. Ethan Russo in an article published in the scientific journal “Neuroendocrinology Letters”. His theory proposes that any unbalance in the ECS makes us more susceptible to some diseases like migraines, Fibromyalgia, Arthritis and irritable bowel syndrome, to name a few. These specific diseases fail to respond to conventional medical treatments; while the actual evidence has shown excellent clinical response when using medicinal cannabis as the main treatment supporting this hypothesis even more.
Although CB1 and CB2 receptors seem to be the main characters of this story, the endocannabinoid system is a little bit more complex than that, with previously mentioned enzymes FAAH and MAGL also play a crucial role in its balance. To understand this better, let’s imagine these enzymes work like Pacman; and their main function is to eat and destroy all the cannabinoid compounds found in their way. While psychoactive THC acts by binding directly to the CB1 and CB2 receptors mimicking Anandamide, the non-psychoactive CBD acts in a different way by directly binding to the enzyme FAAH and preventing it from doing its main function of eating Anandamide -like Pacman- thus increasing the available levels of the “bliss molecule” in the human body.
As a Physician I’m always aware of dietary supplements and medicines that promise to cure it all, making promises to consumers and patients without any scientific data that supports their efficacy. However, every day I find more evidence that supports all of the current and potential uses of cannabis as medicine. A good example of this is that a simple PubMed search on “medicinal cannabis” today offers over 3000 results on this particular topic. Unfortunately, the majority of traditional Doctors are terrified of recommending medicinal cannabis as a treatment or coadjuvant for any illness. This phenomenon is mainly explained by the huge influence of the pharmaceutical industry in the ways modern medicine is practiced, on top of the lack of knowledge in this area by most healthcare professionals. Have you ever wondered if your Doctor knows the health benefits of this herb? Can he or she provide orientation and guidance in your treatment with medicinal cannabis? Probably not. This sad reality is changing every day as people around the world are looking for safer and low-cost natural remedies as an alternative to traditional pharmaceuticals, that provide true healing instead of just treating symptoms of a specific disease.
To conclude, I would like to comment that based on the literature and my personal experience as a Physician, I am convinced that a balanced and functional ECS is essential for the homeostasis of our bodies. On top of that, with its numerous and complex actions, the endocannabinoid system works as a connecting bridge between mind and body. Understanding this concept can help us visualize the connections between different levels of cerebral activity and physical states of health and disease. As always, I hope this article has been helpful. If you have any questions or concerns, please get in touch or schedule a consultation.
Lifestyle & Cannabis Medicine
Cannabis Pharmacy, the practical guide to medical marijuana. 2014. Michael Backes.
The Journal of cannabis in clinical practice, spring 2010. J H. Miles.
Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in a migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Russo EB.Neuro Endocrinol Lett. 2008 Apr; 29(2):192-200.