Bonni Goldstein: [00:00:00] It was the seizures holding her back. She wasn't a responder to any of the medications. And once she got on CBD, now she's not, and she's still my patient. Now we're going on like 12 years. She's one of my first patients I saw. She's not fully seizure free, but boy does she have a really decent life.
Intro: Welcome to Kaya Cast the podcast for cannabis businesses looking to launch, grow, and scale their operations.
Tommy Truong: Dr. Bonni, thank you for joining me today.
Bonni Goldstein: Thank you for inviting me to be here.
Tommy Truong: It's not very often that I have a medical doctor that's a cannabis expert too, on the pod, so I'm very grateful for this conversation,
Bonni Goldstein: There's not very many of us, but I'm working very hard to increase the numbers of clinicians who understand cannabis medicine.
Tommy Truong: so and I want to ask how, what led you to cannabis? 'cause you're right, not a lot of doctors MDs go into the cannabis industry.
Bonni Goldstein: It's true. So, [00:01:00] um, I worked for many years as a pediatric emergency medicine clinician. I trained in pediatrics at Children's la and then, um, I was about, I don't know, 12 years in, uh, working at night, mostly weekends. ' cause I had a little boy at home that I wanted to also spend time with, and I took a leave of absence.
Just because I was burned out and I was really frustrated with the medical system, with arguing with insurance companies, with, um, just, you know, the usual stuff that goes on in an er. If you've been in er, it's like the last place anybody ever wants to be. But I enjoyed it. I was adrenaline junkie. I enjoyed it, and I enjoyed being able to make a difference in children's lives in that way.
Um, but as I said, I took a leave of absence just kind of to reset myself, my own kind of, you know, sleep deprived, stressed out [00:02:00] self. And a friend, uh, struggling with cancer asked me about cannabis. Remember, in California, we, our law passed in 1996 for medical cannabis. This was around 2007, 2008 ish. And I didn't know very much except, you know what people learn about cannabis in high school and college, that kind of thing.
And I started reading about it to see like, is this real? Is this something she should do? And I got just caught up in the science of it. I had not been taught about the endocannabinoid system and lo and behold, there's this whole body of data, like 20 years worth of data that I never even delved into heard about.
And I watched her have very significant benefits. I think a lot of people go into the cannabis industry because a loved one is suffering and they see benefits and then you become like, really interested in this amazing. [00:03:00] Plant's potential to help people. And so I, I immediately was intrigued. I started working in a practice, that was already established here in Southern California and within, you know, two months of meeting with people and talking with them and understanding how cannabis was helping them.
I was just, that was it. I haven't looked back since,
Tommy Truong: Wow. And it's interesting, we share somewhat the same story. I've, I knew somebody that has, that was going through cancer and it led me to cannabis. And you read about Phoenix years, CB, d, how it just helps with nausea. So if, if anything, it helps you go through treatment,
Bonni Goldstein: and that's what happened with my friend, is that she wanted to quit treatment. And she had two children. And I just thought, you know, that's probably not a great way to go. And I, I still feel bad about, you know, people today who quit treatment when we know cannabis can help [00:04:00] them. And for her it was she had a good prognosis, but she just was, she was just had every side effect imaginable.
You know, she had bone pain, she had nerve pain, she had nausea, she had vomiting. She, she was exhausted, but she couldn't really get any good quality sleep. She had no appetite. All the things that we know cannabis can help with. And it changed a lot for her. It, it made it so she could complete treatment and that that was, you know,
Tommy Truong: That's a godsend.
Bonni Goldstein: it was everything for
Tommy Truong: Yeah. So endocannabinoid system, which I feel like we should change the name because I have a hard time saying, and I'm in industry
Bonni Goldstein: You could say ECS.
Tommy Truong: you see Yes. Yeah. Not a lot of people know about this, so can
Bonni Goldstein: And they still don't teach it in school. Yeah. So let me break it down. Yeah. I'm happy to break it down what it is. So one, one thing I always like to start to say is that like in medical school we learn you have you know, a central nervous system. You have a cardio respiratory [00:05:00] system, you have, you know, um, a pulmonary system, reproductive system.
So you have all these different systems and you kind of learn about them separately. That's how it's taught, which make I'm sure made sense back when they came up with that. But then, you know, you look at why does cannabis help with nausea, but it also helps with chronic pain and it also helps with appetite and it also helps with inflammation.
Like how can that be, like what system, where does it fit? And it's because we have this underlying endocannabinoid system. That is ubiquitous. It's everywhere in the body basically. And it is more, it's a cellular signaling system. So the way to think about it is, think about, and, and I like this analogy.
Think about like a a room with a drum set inside the room. Okay? And there's a door, and the door has a lock, okay? And there's someone [00:06:00] inside the room banging on those drums. You can't even hear yourself. Think your neighbors are complaining. It's loud. Okay? The room is a cell, and on the cell wall is a receptor, which acts like a lock.
So it's like a lock in that door, that doorknob, okay? And there's a key that you can open that door and you can yell to the person in there, dial it down, turn it down, and it dampens down. That, that, uh, that noise is, that's being made, that, that, um, messaging that you're hearing all that, all those, uh, the drums.
So the idea here is that we make inner cannabis compounds that act like keys that go to these cells that are making a lot of noise. They're sending message of nausea, they're sending a message of pain. They're sending an over firing message, producing a seizure. Okay? [00:07:00] They're sending out a message of be inflamed, set off inflammation.
Right? And all of those signals can be very adaptive, right? If you're, you touch a hot stove, you wanna be able to get that signal to your brain and say, Hey, take your finger away, or else your finger's gonna burn up, right? And so there's adaptive messaging. Yes, you should know about, you should have pain, you should have inflammation.
But the problem is, is when it's too much, okay? There's too much noise. You need a, a feedback system to say, dial it down. And we have this inner system that is telling ourselves. So when we have any kind of traumatic insult and infection, inflammation, sometimes our body can go haywire and give too much.
And there's this endocannabinoid system that basically is triggered. You make this inner cannabis compound, it binds like a key in that lock, tells the cell, change the message. That's [00:08:00] all it is, is a feedback loop. It's just me telling my kid to turn down the you know, turn, put, put the drums on your headphones, right?
I don't wanna hear it. It's, turn it down, turn down the message, change the message. And it's really an elegant system. And the way to think about it is evolutionary wise. We dev even like, like these very early creatures like, uh, um, sea squirts and these little hydra that have very, they don't really have brains, right?
But they needed some mechanism for survival, right? And so the type one cannabinoid receptor, that lock that sits on the cell, mostly in the brain and nervous system for the type one it's been described that evolutionary wise, we develop that type one receptor as breaks on the immune system because the [00:09:00] brain wants to be excitatory.
You need, if a bear's chasing you, you wanna turn that on and fight or flight, right? But you need a way to reign that in. And so evolutionary wise, we we. Have this system that comes in and puts the brakes on type two cannabinoid receptors are in, not in the healthy brain, but they dial up in a sick brain.
But they're basically in your immune system, your gut, they're, they're all over your body and they are, it was proposed that they evolved as breaks on the inflammatory system or the immune system in response. Because when you think about it, so I'm gonna give you a really good example. When somebody gets hit in the head, there's an initial injury.
Then there's a secondary injury. And the secondary injury can be worse than the initial injury. And that secondary injury is this massive inflammation, brain [00:10:00] swelling. And when you hear about somebody who has a bad brain injury, that's what's happening. Okay? And what we know is that when somebody has a brain injury, believe it or not, they're cells in the brain.
They're called microglia. They dial up, they're cannabinoid receptors, and then your body dials up your inner cannabis like compounds. And all we're doing when we take plant compounds is augmenting that system is kind of assisting that system. People who have chronic illness, chronic pain poor sleep, or just, you know, chronic sleep deprivation, um, chronic inflammation, a poor diet, they don't exercise.
And they. This is often what happens in my practice. You know, people come to me and they have all these chronic things going on, and it's stomach ache, it's inflammation, joint pain, it's poor sleep. Think about you're checking off these boxes of all these things that the [00:11:00] endocannabinoid system regulates.
It helps regulate. And when you think about where the receptors are, they're pretty much everywhere, but they're highly dense in the brain, the gut, and the immune system. And when you think about it, that's what we need to survive. We don't wanna, we need our brain to be our computer. We need our gut to be able to function, to pull in nutrition, and to avoid pulling in like, you know, toxic compounds or contaminants.
And we need our immune system, which regulates our inflammation. You want it to be adaptive, but you don't want it to be maladaptive and often chronic illnesses when you're in that maladaptive state. And by augmenting the endocannabinoid system, you can help. Get back into balance. So we kind of talk about something called the endocannabinoid system, dis deficiency or really dysfunction and when it's not working.
And there's a ton of literature on this in terms of scientific literature showing that dysfunctional endocannabinoid system, [00:12:00] um, is at least part of root cause for things like autism. So there's studies that show that kids with autism don't make enough inner cannabis, and that compound's called anandamide.
Uh, there's two studies, one from Israel and one from Stanford University that determine that children with autism just don't make enough of those. Interesting. Right? And when you think about kids with autism, they have gut issues, they have brain issues, they have higher inflammation. It's a perfect target.
Target the endocannabinoid system, get it back into balance. And lots of conditions, so depression, PTSD dementia, all kinds of conditions are now, if you just go into the literature and type in endocannabinoid system dysfunction or deficiency, you will see the list of conditions is really very, very long.
And a lot of people ask, well, is the system broken? And then I get sick, or do I get sick? And then the system [00:13:00] can't keep up. It's both. It can be all of the above. It could be one or the other. So you could be born with an endocannabinoid system, um, problem, like coated into your genes.
Tommy Truong: Wow. So if I, in your example, let's say I have a head injury and my body now is overcompensating for it, I'm guessing and taking CB, D tell the body, Hey, chill out, don't overreact, and
Bonni Goldstein: It dials,
Tommy Truong: It dials
Bonni Goldstein: down the inflammatory response.
Tommy Truong: Got
Bonni Goldstein: So, and even COVID, you know, people don't die necessarily directly from COVID, they die from the inflammatory response triggered by COVID
Tommy Truong: Oh,
Bonni Goldstein: and cannabinoids. Can, you know, we haven't done any studies necessarily yet on like, you know, people with COVID. And again, you have to remember the whole legal framework, the [00:14:00] regulatory system is.
Insane that we can't do research on this because, uh, I'll give you an example. I reached out to a brilliant researcher in South Carolina who's done a huge amount of research on cannabinoids in terms of the inflammatory response and all in test tubes in la lab animals, right? Not in humans, not allowed to study humans yet.
So, but he proved in a study that when animals were, so I'll give you, I'll give you the a, a quick lowdown on the study. So animals were injected with this toxin, and the toxin created massive inflammation and sepsis, which is a, you know, full-blown infection everywhere. Just and they split these animals into two groups.
And one group got cannabis and the other group didn't. And the group that didn't get cannabis, all of those animals died after they got that injection. And in the group that got cannabis, all of them [00:15:00] lived.
Tommy Truong: Wow.
Bonni Goldstein: Now, to me, that's enough data. Not everything that you see in animals converts to humans. But that's enough data to then go and say to people who have this particular awful response to a, a, like a, a GI toxin or, you know, um, like a neurotoxin.
Why wouldn't we just, we know what's gonna happen to those people. Why wouldn't we get consent and give them cannabis and see what happens? And it was crazy. I had reached out to, uh, this doctor very early on in the COVID pandemic, and I said, do you think that cannabinoids might be the answer for these people who are going into the hospital and within a week or so are ending up on a ventilator with massive pulmonary inflammation?
We don't have anything to combat. Why aren't we just at least trialing? And his answer to me was that he brought it up to his colleagues that [00:16:00] worked in the clinical part of the hospital. He was in the research part, and they were worried about those people getting high. I am sorry. That is ridiculous.
Because we know that some of those people are gonna die, if not all of them, especially early on in the pandemic.
Tommy Truong: you weigh kind of like what's worse? And that is, that is number one. That's, that's the
Bonni Goldstein: and they're giving, and remember, you're getting all kinds of drugs anyway. Uh, people, they're not, they, when you're on a ventilator, you're mostly sedated. They don't want you fighting the ventilators.
So you're on a, a whole boatload of drugs that are psychoactive. But somehow, THC, you know, the propaganda machine did a really good job about a hundred years ago. And, you know we're still fighting that.
Tommy Truong: What is the science behind? 'cause you've, your practice is treating epilepsy.
Bonni Goldstein: Not all of it, but I do take care of a lot of children with epilepsy and some young adults. Yes,
Tommy Truong: What's the science behind cannabis Helping
Bonni Goldstein: sure. So one of the largest [00:17:00] areas of research where we have a true body of solid evidence is CB, D for intractable epilepsy. Intractable means that it, the, the epilepsy is not responding to other medications out of all the people that get epilepsy, all children in adults as well.
Only two thirds actually respond to medication leaving one out of every three patients that are affected by epilepsy, what we call intractable, which means they do not respond to the medications that have tried. And it, the definition is very specific. After two appropriate anticonvulsive medications have been trialed, either alone or together, the chance of responding after, that's like less than 5%, depending on the study you look at.
So it's very low. I've had patients come to me, seven drugs, 10 drugs, 12 drugs, 20 drugs. I'm not exaggerating, not, they're not on all of those, but over a period [00:18:00] of time they try this, so it doesn't work. We take that out and we add another one, and then we stack this one and this one. And these drugs all have, if you read the scientific literature, the first thing you read is they all have these terrible side effects.
They're sedating. You know, an 8-year-old should not be falling asleep at two o'clock in the afternoon, right? An 8-year-old usually does not need a nap. I've had kids come into my office, so overmedicate and on seizure meds, but still having lots of seizures. They come in and they just, they sit in the little chair and they put their head down and you feel so bad for the family 'cause their child is just basically tranquilized but still having seizures.
Right. So and there's been a huge discovery of in the last 20 years of, uh, you know, new medications coming out, but they still have this one in three do not respond. CBD was looked at, you know, look back in the science, in the historical literature, there are many reports of cannabis helping with spasms.
Right. Which we think may mean seizures in that, that's just in the [00:19:00] historical literature. But one of the first reports was in the 1980s where Dr. Rafael Lum, who is kind of well known as the father or grandfather of medical cannabis, he's the one who discovered isolated THC back in 1964, named it. THC and then went on to study cannabis for 50 plus years.
He, um, he did a study, a small one, I think it was under 10 patients, where he gave them C, B, D, and, uh, these were patients with intractable epilepsy who responded and nobody ran with it though. And that because cannabis is schedule one, it was in the eighties, don't do drugs, dare, you know, all of that. And unfortunately, being categorized there just completely eliminated it as an option.
And then, you know, there were a few more studies after that. And then it was really in 2013 when little Charlotte wa a little girl with Dravet syndrome, which was a very [00:20:00] difficult, severe pediatric epilepsy genetic condition. Was on a documentary on CNN. And her mother, she was sent home basically to die.
The doctor said, we have nothing for you. She was just seizing and seizing, I think 1200 seizures a month. They
Tommy Truong: Oh my God.
Bonni Goldstein: Can you imagine? Right. And watching your child like that is just traumatizing to everybody. And she, her mom had heard about maybe this might work, and she tracked down some cannabis that they called hippies disappointment 'cause nobody got high off it because it was high CBD, low THC.
And they made it into an oil and they gave it to her and she basically stopped having seizures. And that was on a documentary in August, 2013. If people are interested, I believe it's on YouTube, it's called Weed with Dr. Sanjay Gupta from CNN. And he's done some subsequent, but that was when he came out and said, I've changed my tune.
I am [00:21:00] no longer anti-cannabis. This could be a medicine for people. And he really put the mainstream stamp of approval. So thanks to him and in my practice, we started getting calls. I was already in practice, five years, mostly seeing adults. I started getting calls from parents saying, do you have this CB, D, can you help us?
And of course, you know, there's a legality. You don't want your child taken away from you because you're trying something that's not considered conventional or maybe fringe. And at that time it was, and I told people, just keep it to yourself until we, you know, you, you could tell your neurologist, but feel 'em out first.
You know, because this is very new and very controversial. But, you know we started using, I started recommending CBD at the time, it was even almost impossible to find. And then a handful of companies popped up very quickly and I started collecting data and we started seeing this incredible response rate.
And it's not perfect. Nothing is for these families. There's no ma [00:22:00] If ma, if their magic medicine existed, we'd all take it, right? So but for some patients, and it's the majority of patients, what we're seeing with whole plant CBD dominant based on the literature, is somewhere around an 80% response rate.
Some my, I published a report. Of my patients combined with a neurologist, patients in Seattle. And we had an 86% response rate, meaning not, not seizure freedom, but did your child have any seizure reduction from cannabis? 86% of the patients UCLA looked at 115 patients. And just to survey them, they were not treating those patients.
Almost all of those patients were my patients, but they collected this, uh, survey and they found 85% had a response rate. And in Israel there was a report that came out, I think it was 89%. So we're in the 80% right, where patients have some response. Some of these families have been [00:23:00] told, your, your child will never be seizure free.
And what we're seeing now is somewhere between a 10 and 15% seizure freedom in this, what we call difficult to treat group. Why wouldn't we offer that these kids have developing brains? We know seizures can cause brain damage. Okay. I'm not worried about CBD causing brain damage, especially under medical supervision.
It's just not what we see. And now we have 2013 to 2025, let's say, even though we're, it's 2026 right now, early 26, we have now, um, 12 years of data. And in the scientific literature, CBD is considered an acceptable treatment for intractable pediatric epilepsy. Either as the main medicine or as an adjunct, meaning an add-on to other medications.
And there's some evidence in literature that [00:24:00] certain drugs actually there, there may be some benefit of combining certain DR certain medications and that's still kind of being sorted out, but there's some evidence there and I definitely see that in my practice as well. And it's not magic. So how does CBD work?
Right? Well, all cannabinoids are what we call non-selective compounds. They have multiple targets, so it's not just that cannabinoid receptor that CBD or THC targets. They also target a family of receptors or what we call ion channels called trip channels, TRP, and we just call 'em trip channels.
These are little gates that live in the cell wall that allow like potassium and calcium and other ions to go in and out of the cell. And that's kind of how an electrical message is sent. And CBD targets the trip channels. It targets a another type of receptor called GPR 55 receptor. It blocks that receptor 'cause that receptor propagates [00:25:00] seizures.
CBD also makes it so that your body doesn't break down your inner cannabis like compound so easily it AC CBD actually blocks the enzyme from breaking down. Your inner cannabis lets your inner cannabis last longer. Well, your inner cannabis, what's its role? Calm brain firing, less pain, less nausea, less anxiety.
Right. And so by promoting what CBD is doing is it's enhancing your body's own natural system to heal itself. It's so fascinating. Right.
Tommy Truong: Yeah. Wow.
Bonni Goldstein: And CBD has like over 75 targets. I mean, that's like two lectures in and of itself if I ever had to go through all of that. But the reality is, is that for epilepsy, we don't know everything.
I think there's a lot more to discover. It's still in its infancy, but we know specific mechanisms. And so, CB, D, because it targets GPR 55 trip [00:26:00] channels anandamide, it targets also a, a compound called adenosine, which is a endogenous or an inner anticonvulsive anticonvulsive compound. It calms brain firing.
CBD inhibits. The little molecule that, like the little chauffeur that drives it around and lets it last a little bit longer. So again, enhancing the body's own system, but it's all of these effects. And we sometimes call multimodal effects, multi targeted or stacked. Some people call it polypharmacy.
There's a lot of words for it, but it's not just one direct target. It's multiple targets that all lead to lowering of all of that excessive firing in the brain.
Tommy Truong: How long, if somebody were to take CB, D, how often do they have to take it for, to maintain that, that
Bonni Goldstein: Sure. Well, I mean, as long, if somebody has a seizure disorder, they have a seizure disorder. [00:27:00] In conventional medicine, if you can get somebody seizure free for, it's usually a two year. Period. And they do an EEG. And the EEG looks good. Sometimes they'll take you off the medicine if you have an underlying issue, like a genetic syndrome or you know, let's say you hit your head and you had a bleed inside your brain and now you've got some scar tissue that's there, that's a trigger for seizures.
So that's a lifetime of medicine. But I'll tell you right now, I'd rather take plant medicine for my life than for pharmaceuticals for my life. I mean, right. But at the same time, you know, this is not easy. It's not like you go on CB, D and you're seizure free. That is not what happens. There's a very small percentage of patients, and I know a few of them who from the first dose of CBD didn't have seizures anymore, and their parents just kept giving, you know, C, b, D.
But for the most patients, we start at a low dose. You know, the saying, start low and go slow. It kind of applies to this. You start at a certain. Uh, weight [00:28:00] based. And we do weight based in children because they grow. We don't want them to outgrow their, therapeutic dose. So we start a certain, you know, one milligram per kilo per day and you titrate up looking for the dose that gives the best result without any side effects.
And it's not just C-B-D-T-H-C is an anti-convulsant. CBDV is an anti-convulsant.
Tommy Truong: never heard of CBV before.
Bonni Goldstein: Yep. Canna Derin. And it's been on the market now for a couple years and there's, believe it or not, there's one study in human children that came out of Australia, little five little girls with RET syndrome, uh, that they gave CBDV to, and there was like a 79% response rate, meaning significant reduction of seizures.
And I think four out of the five kids, I mean, as far as I'm concerned, you know, seizures are horrific to live with. They're horrific to witness in your own child. Anything and [00:29:00] everything should be on the table as you know, as long as it's not dangerous. We know CBD is not dangerous. You just have to be a good doctor, a good clinician, and make sure you know what medicines the child's on.
Make sure you're staying in close contact to see, you know about the dosing and, and what you're doing. Make sure that there aren't any, you know, reasons not to be on CBD, that kind of thing. But in general, you know, um, one of the best things about CBD that that parents report is many of the, um. Uh, anti-seizure.
Conventional medicines have have side effects. It can suppress your bone marrow, create terrible sedation affect your kidney and, or, I'm sorry, affect your, uh, liver tests. Other, a whole list, a whole slew of side effects. Uh, double vision, believe it or not. You know, these are strong brain drugs, right?
With CBD, what is in, and it's in the literature, not just in my practice, but it's reported [00:30:00] in the literature, positive effects beyond seizure control. So what does that mean? More alert and awake memory is better for some kids. Their speech improves. I had a 9-year-old that came to me who didn't read and write, and she learned to read and write on CBD.
By 11, she was kind of caught up to her grade.
Tommy Truong: Wow.
Bonni Goldstein: It was the seizures holding her back. She wasn't a responder to any of the medications. And once she got on CBD, now she's not, and she's still my patient. Now we're going on like 12 years. She's one of my first patients I saw. She's not fully seizure free, but boy does she have a really decent life.
She's on CBD and CBDV. Her comprehension, her speech, her interactions, her ability to leave the home. And her mom doesn't have to worry that she's gonna have a seizure out in the real world, right? Because now she's a young adult and wants to kind of spread her wings and fly. It's, um, it is, you know, I make it sound like a miracle and I write in [00:31:00] my book, it's not a miracle, it's just science.
And we are smart enough to understand these compounds and we are smart enough to utilize them as medicines. We have to stop with all the reefer madness and the baggage and really the key, I think for, and I'm just gonna say one of the issues we have is that, and clinicians, you know, doctors the medical community is probably the worst at this.
They can't separate medical from recreational use. Right. And I live in the world of medical, so I medically supervise, so I see good results. And here and there you have somebody calls me and says, oh, I have a side effect. And we fix it. We take that away. We change the regimen. You change the dose, the timing, the product, the cannabinoid.
Lots of things you can do to avoid side effects. This conflation of it can't be medical because there's people struggling with it. And we have that with opioids, and yet we still write prescriptions for OI mean, I don't, but other people do write prescriptions for opioids. We need to separate
Tommy Truong: [00:32:00] Mm-hmm.
Bonni Goldstein: medical and recreational use.
And I would say under the recreational umbrella, or let's say adult use umbrella, there's a percentage of people that have problematic use.
Tommy Truong: Yeah, I mean, just like anything, I mean, you can eat too many sardines,
Bonni Goldstein: Yeah. You can't. And you know, when you think about some of the harms in this world, look, we live in a country where alcohol and tobacco are fully legal. They're not even on a, on the controlled substance act. Right? And people die every year from tobacco and alcohol related complications, lung cancer, traffic accidents, cirrhosis of the liver, I could go on.
and it's really just about education. And I would bet that if this country adopted, you know, when I'm, I'm already in my sixties, I can't believe I'm saying that, but I'm in, when I was in elementary school, you know, they taught us sex ed in the fifth grade. I don't, why aren't we teaching about cannabis?
Other substances in [00:33:00] early on before kids are really exposed to stuff. You know, you plant the seed, make good decisions, but also to say, don't do drugs. What does that do? Oh, I gotta figure out what drugs do. They don't want me to do it. I, I think I wanna do it. Let me, I'm curious, right, because you put the big no on it.
So I think that what we have to do is start educating our young people and then build on that education into the teenage years. 'cause most teenagers really don't hear you when you're telling them to not do something they know better. So, you know, to me it's really about, 'cause you know, we know our kids are gonna get exposed to alcohol, tobacco, drug, you know, any kind of drug, substances, whatever, as they.
Go through school. And why, why, why wouldn't we wanna prepare them and give them the knowledge to make good decisions, right?
Tommy Truong: Yeah, well, it's getting in [00:34:00] front and being able to control the narrative because the narrative will be there and it's whether parents or teachers or you know, they can learn from somewhere else. So pick your poison thing.
Bonni Goldstein: That's right. And most of them are on the internet. And you know that you completely lose control of narrative that way. You don't know what they're looking at. Are they looking at something that implants like good decision making or something that, oh, that kind of looks cool.
I wanna try that. Right?
Tommy Truong: CB, D and THC get all the love and all the attention, and there are other can cannabinoids that the public don't really know about. Like
Bonni Goldstein: Yeah.
Tommy Truong: which is one calm down that I'm searching for because I'm a productivity nut. Can you shed light on other cannabinoids that people should look into and why?
Why should they pay attention to these?
Bonni Goldstein: sure. So CBG is now kind of considered not, and, and by the way, we call THC and CBD, the major [00:35:00] cannabinoids, and then we kind of call the rest of the minor. But CBG is kind of moved up from the minor leagues if you ask me. CBG stands for cannabigerol. It's come CBG, uh, is created when you heat the raw plant kind of in its more immature phase be just because CBGA is the kind of the mother compound to all plants, cannabigerol acid.
And when you heat that up, it becomes C, B, G the same way THCA when you heat it up becomes THC. So remember in the plant they're raw and when we, we humans apply heat. We convert them to the neutral, which we know is T-H-C-C-B-D and CBG and CBC as well. So, C, BG is a compound that, you know, it's crazy, it's available very few studies.
But there was a survey a number of years ago of 127 patients using, or people consumers using CBG. And what they found was that it helped with pain, [00:36:00] inflammation, anxiety, depression, and sleep. So it sounds familiar, right? So does THC do that? So does CBD do that? But people were highly uh, satisfied.
In fact when they asked the participants of this survey. How superior was, or, you know, compared to if you ever took a conventional medicine for, let's say anxiety, was CBG superior. And if so, like, you know how much so? Turns out something like 70, 80% of people found CB, G to be superior to their pharmaceuticals for these various indications like anxiety, depression, inflammation, pain and sleep.
And so I know it's a high number and even if it's a placebo effect, you know. That's okay because it's got less side effects and it has a much safer profile. I don't really see that much side effects with CBG. What I see with CBG is, um, occasionally if someone take, for some people it's alerting. So is CBD sometimes alerting and it's [00:37:00] almost like taking a quote sativa at nighttime right before bed, you are gonna stay up, right?
So CBG can sometimes be alerting for people. And when I tell people to try CBG, if I'm instructing them to do so, I usually tell 'em, just take it in the morning, see how you first see how it affects you. But a lot of people say that CBG helps with sleep because it's indirectly helping with pain, anxiety, right?
So if you lay down at night and your head isn't spinning and your back isn't hurting you, you can fall asleep. So it, it doesn't appear to be a direct pain, uh, I'm sorry, sleep initiator, like THC is, but. It, it, it likes CBD and a lot of people say CBD helps 'em sleep. Same thing. We doesn't appear based on the research to have a direct, uh, linked or a direct mechanism for sleep.
It's really more so it's helping with other things. Remember the kind of that calm brain putting you, not sending message of pain, not sending message of anxiety, you can like fall asleep. So CBG [00:38:00] also is really interesting because it's the only cannabinoid that targets something called the alpha two adrenergic receptor.
And that receptor is like your fight or flight receptor. And when you activate that receptor, it's very calming and that receptor is already a target of medicine. So they sometimes give children with autism, a medicine that hits that receptor. They also, that receptor is involved in your blood pressure as well.
There's a lot of people with PTSD now. You know, I read go online and I read Reddit and all kinds of things to see what people are saying in addition to just my patients. And many people report that CBG is really great for non impairing, so no high daytime anxiety without any sedating effects. So that's really nice.
Right. I did some research on children with autism where we collected, um, saliva and we looked at [00:39:00] various, what we call metabolites or biomarkers in the saliva. And then we collected those biomarkers before they took their medical cannabis in the morning and a couple hours after they took their medical can medical cannabis.
And what we were trying to do is to see. Do these metabolites, these little chemicals that exist in our brain and body, do they change in response to cannabis and does it correlate to the improvements reported by the parents? And basically the answer was yes. The parents are reporting, you know, like difficult behaviors in the morning.
They give them their cannabis, they report great better behaviors in the afternoon, but what's happening in the physiology, right? And that's what we were looking at. And what's really interesting is after we were kind of did all this research, we took the data and we put it through machine learning. And we found that CBG has its own slew of targets different [00:40:00] from CB, D and THC.
And when we created like this Venn diagram of the overlap CBG overlapped with CBD and CBG overlap with THC, but THC and CBD did not overlap with each other.
Tommy Truong: Oh, wow.
Bonni Goldstein: So C, B, G we concluded and there were a couple other reports in the literature of this, which were new at the time, is kind of very rewarding to f find something in your research that supports somebody else's kind of new hypothesis.
So basically what we figured out was C-B-C-B-G resides pharmacologically between C, B, D and between THC, so it's non impairing like C, B, D, but you don't need really high doses. Like you don't need all big doses of, unless you have huge tolerance for THC. Most medical patients are taking lower doses of THC, right?
They, because they don't, they don't overdo. But it's interesting because you can get away with lower doses of CBG. It, it, it acts similarly [00:41:00] to THC and CBD and overlaps a little bit with those. It's really interesting. CBDV is another one I mentioned. There's not a lot of research but's being looked at for autism and epilepsy.
Again, dialing down overexcited brain. Right? CBNI know you've heard of CBN cannabinol. So cannabinol is one that was everybody was claiming work, work great for sleep. And there was a report in 2021 that looked at the literature and we found nothing to support scientifically that it helped with sleep.
But then a report came out at the end of 2023 where they compared 20 milligrams of CBM with placebo and with combination various combinations of CBN with CBD, and it turns out that 20 milligrams of CBN and, and it, and they did compare to placebo. So it looks like this is, you know, that it's not, it's not by chance or a placebo effect that 20 milligrams of CBN [00:42:00] did have some meaningful benefits for sleep.
Tommy Truong: Oh, wow.
Bonni Goldstein: like reducing sleep disturbance and um, improving what was the other thing? So reduced, uh, just a meaningful effect on sleep, if I recall correctly. And so some people CBN is just the breakdown product of THC, right? So if you leave THC laying around it ages from heat light exposure to air oxygen.
And so it oxidizes and it changes to CBN. And so it's kind of like old, you know, I joke around old pot, right? But really it is, has very similar targets as THC, but it has about the quarter of the potency. So I just don't see people getting high off CBN in dispensaries. Here in California we see a lot of sleep products.
You know, they're, they're made to promote sleep specifically for sleep. That combo CBN and TH THC together. And [00:43:00] then, you know, on the hemp unregulated hemp market, you can get CBN without very much THC in it. And so it's available for people to try for sleep. It also targets, what's interesting about CBN is that it has a preference for the type two cannabinoid receptor, meaning that's why it doesn't cause so much high.
But that type two cannabinoid receptor remember, is involved a lot in inflammation. And so, CBN, all of these compounds are high anti-inflammatory, potential. Yeah. And then I guess there's CBDA, which is one that I love personally. It's the raw form of CBD. I'll tell you a funny story. Many, many years ago when I first, so I remember I started doing this in 2008, it must have been 2009 or 2010, this young guy came into my office.
He had torn his bicep. He had, uh, he was a bodybuilder. He had torn his bicep muscle and had to have surgery. And [00:44:00] he brought in all his paperwork to prove that he had chronic pain with his bicep. And it was really bothering him because he's a bodybuilder, you know, are you wanna be able to show your guns and all of that?
He, so he, I, so I, you know, in the conversation, have you, are you using cannabis? Oh, yeah, yeah. I use it all the time. I said, oh, okay. How do you take it? Remember, this is pre 2013. It's all THC on the market. There's really, he goes, oh, well I eat it. I go, oh, so you, you get edibles? He says, oh, no, no, no. I eat, I eat the raw flour.
And I said. Like, kind of looked at him like, what I eat the raw flour. I, I just hadn't heard of that. You know? And you know, I'm sure anybody listening who's like an OG is probably rolling their eyes, but I just had not heard of that at that point in my career or in my experience with cannabis. And so, not to mention, I couldn't imagine the taste, you know, I mean, ooh, raw, raw flour.
Uh, and he said, yeah. He goes, I don't get [00:45:00] high, but gosh, my pain goes away. So I'm like, what is this guy talking about? Like, I have not read that study. So I go delving into the research and there really isn't very much, but it appears that the acid forms, which are the unheated forms, so the raw plant T-H-C-A-C-B-D-A-C-B-G-A have potent anti-inflammatory effects.
Now I like CBDA because it has virtually no THC in it at all. 'cause remember, it's coming from a plant that's a dominant CBD. Genetics. It doesn't have much THC in it. And again, 'cause it's raw, so it's gonna have very little, so it's a nice option for people who either don't like THC, who can't access THC legally get drug tested.
Right. And you know, I have a family member who needs a knee replacement who couldn't walk up and down stairs, was just miserable. He is an avid athlete. He destroyed [00:46:00] his knee, now he needs a knee replacement. He's not very old. He's in his fifties and he doesn't wanna take opioids. So he's suffering.
And I put him on CBDA and here we are now, years later, probably three years later no knee replacement, playing tennis, able to walk up and down stairs, can go for a five mile hike. It's just an amazing response. I have an uncle, unfortunately he passed away this past year in his mid nineties, but he had terrible bone on bone, knee joints.
I mean, there his knees were so destroyed that he had malformations. He was really bow-legged 'cause the bones just, you know, everything's is just, um, falling apart basically. And I had him on CBDA, he's on a slew of heart meds, kidney meds, all kinds of medications. So you wanna be super careful. This man went from not being able to walk to being able to walk.
He got two good years of pain relief before he
Tommy Truong: Wow. So if he were to take CB, D and not [00:47:00] CBDA would've been the same results, just
Bonni Goldstein: So it really interesting. I can't answer that question without tri, without doing that trial in that person because we're all different in the way we respond. CBD is quite good for inflammatory pain. However, you know, and believe it or not, we don't have a lot of studies on arthritis and on CBD for in humans, there's hardly any, it's shocking, hardly any studies.
And that's also because remember, it's just hard to get a appro, get the funding, and get approval to do the study. I will share with you that before CBDA was available, I had lots of patients saying CBD worked well for joint. I, I remember this woman who came in with her adult daughter, she was probably in her late seventies, and she wanted to be able to play with her grandchildren.
And she had, I think for her it was a hip, she had terrible hip pain. She was trying not to have a hip [00:48:00] replacement. She was on medication. She just wasn't ready to have the hip replacement surgery yet because she was still function still. But she said getting on the floor and getting off the floor was like.
Very, very difficult. After watching her grandchildren for two hours, she's like, I gotta take some pain medicine and sit down. You know, you know how active kids are. You're running around, you're keeping your eye on, you're not sitting down. And she got very good pain relief with CBD for my uncle, he was on a, um, me, he was on medication for his heart that I didn't wanna mess with CBD in higher doses that are often needed for infl, not always higher doses, but for him, the, his, his, um, osteoarthritis was so severe.
So this is like where clinical decision making comes in, right? So I've got all these compounds, which do I think is gonna suit the bill, or, you know, fit him the best. And so for him, I didn't wanna do CBD 'cause I didn't wanna interfere with the metabolism of his other [00:49:00] drugs, even though it was low risk, you know, it's still something to consider.
And if I have something else.
Tommy Truong: Yeah.
Bonni Goldstein: You know, you can get away with. Now, one thing I didn't tell you is that for CBDA, CBDA is less what we call lipophilic fat loving. So we ab, it's more bioavailable. We can absorb more.
Tommy Truong: Oh, wow.
Bonni Goldstein: Okay? So you can, with CBD, you have to overcome this really poor absorption. So you have to take a higher dose Range of dosing for CBD is what we call very wide.
I've got patients at like 20 milligrams, 10, 20, 30 milligrams a day, and I've got other patients at 600 plus milligrams a day.
Tommy Truong: Wow.
Bonni Goldstein: Now usually those are sicker people who kind of haven't found anything else to work and they're willing to pay for that high dose of CBD. But if I can get away with a lower. Dose less costly.
'cause remember, all of this is out of pocket for people. So, you know, over the years as these compounds became available, I [00:50:00] kind of switched up my first line. You know, CBDA moves up 'cause now it's available and I'm gonna try that first. Some
Tommy Truong: what I was gonna ask you, but like, when would you not go with CBDA versus
Bonni Goldstein: It, it's, yeah. So like in older people, you know, CBD can be in higher doses can be somewhat sedating. So you don't wanna sedate somebody who might be at a risk for a fall if they have to get up to pee in the middle of the night. Even if, you know, you just kinda learn. That's kind of the art of the practice of medicine is you kinda learn which scenarios to use, which compounds.
But the reality is it's still a bit of trial and error. You know, my, the research I did with the biomarkers is, the future of that research is to be able to test, collect saliva and test people to see if they're even a candidate, right? Is there, are there biomarkers? All are the biomarkers that respond to cannabis abnormal?
And can we correct them? [00:51:00] Kind of like having a high cholesterol. Can I bring it down with medicine? Right? And then the biomarker, if you have a baseline and then you treat somebody, you, it's great to get feedback from the patient, but I'd love to see, you know, love to get a test to see exactly what we're targeting and then to see if there's something, maybe CBG targets this pathway and I only have the patient on CBD.
And when I get those test results back, it shows that, you know, pathway X, Y, and Z that respond to C, BG are still a little bit off, then I know what's next. It will help us. 'cause remember we make clinical decisions, but it's also nice to have some objective data, which there does not exist right now.
Tommy Truong: Well, hopefully with this.
Bonni Goldstein: Yeah. No, and it's so easy 'cause you know the way to do it. And the company's called Cam Formatics. I'm gonna give 'em a little shout out. They tracked, they, they I heard about them, they heard about me. We got together and did the research. And the research is applicable beyond autism. It's for dementia [00:52:00] chronic pain endometriosis, like we can actually help patients find their cannabis regimen sooner rather than later and take out some of the trial and error, if that makes any sense.
It's just, and that's kind of what I do, is I help patients find that cannabis regimen that gives them the best results without side effects. That is the goal.
Tommy Truong: What do you know about THCV?
Bonni Goldstein: So, yep. Terah Hydro Variant. So the Varin is a, like a little subgroup of cannabinoids. And they have a shorter tail. That's the, the little propyl tail. I, I think that's what they call it. The propyl tail is instead of five carbons, it's three carbons, which completely changes the activity. But THCV, there's not a lot of research.
But what are people, well, some of the research that has been done focuses on, um, metabolic issues, meaning like insulin [00:53:00] sensitivity and how your body handles calories and energy. And THCV in lower doses, blocks that receptor or kind of tells the, it doesn't trigger the receptor. It's not the key in the lock.
It's more like I'm putting cement over the, the, the keyhole. Okay. And so you don't get high with lower doses of THCV, but through other mechanisms, what we call non cannabinoid receptor mechanisms, it can tell your body to be a little bit more efficient. With managing glucose and energy. Okay. And it can help with what we call metabolic syndrome, which is when you have high blood pressure, obesity, you know, your lipid panel is off THCV in blocking that receptor helps you kind of shift into a, let's say a better metabolic picture, if that, [00:54:00] okay.
And there were, there's some studies that, that looked at that, and, but in higher doses, what's interesting about THCV is it has a different react, different effect, which is then it does bind to the receptor, so then it can, cause now THCV is hard to find on the market without THC in it.
Tommy Truong: yeah.
Bonni Goldstein: And so when somebody calls me and says, I have this product with THCV and THC, and I had this effect. It's like, well, are they canceling each other out? This is binding to the receptor. This is blocking the receptor. And one thing to be very careful with THCV is that and it's, it's different than a synthetic cannabinoid, um, inhibitor.
So, or endocannabinoids or cannabinoid receptor inhibitor. There was a drug in Europe that was on the market, I wanna say about 15 years ago. It was called Ramona Band, [00:55:00] and it was a weight loss drug. So think about THC. You take it, you get the munchies. Okay, well, if you block the receptor, it reduces your appetite.
So it was sold on the market as a weight loss drug and people lost weight. But guess what else happened? They became depressed and anxious and there was an increase in suicidal ideation. Now, I don't expect THCV to do that because it's natural. This was a pharmaceutical, so it's very different. But THCV really has not been well categorized.
There are people who say it, it lowers their anxiety and keeps them alert. That's probably what you're referring to when you first brought it up, right? That it can help with focus a lot of in the kind of, you know, the anecdotal world. People with PTSD says it's very, they say it's helpful for anxiety and always my question is, well, what are you taking exactly?
Is there some THC in there? 'cause [00:56:00] maybe that little bit of THC in there is doing the trick. So as a scientist, I kind of wanna understand,
Tommy Truong: Yeah, and I heard that you can't teach cv. It's really hard to find in the plant, and you can't really create it unless it's synthesized, which then. There's a lot of byproducts. I'm assuming that you're consuming with it,
Bonni Goldstein: Yeah. And, and you know you know, with all these synthetic cannabinoids that are out there now, you know the THOP and all the, you know, my husband calls it alphabet soup. It's I am a big proponent of natural
Tommy Truong: yeah,
Bonni Goldstein: mother. Nature gives us this great plant that has lots of compounds in it. And like I said, we're smart enough to understand how to use it as medicine.
We don't need to. And there are people that do well, what if we synthesize something new that can like, you know, save people's lives. I'm on board, but you better show me that that's safe, what you just synthesized. 'cause I know the compounds from the cannabis plant [00:57:00] are safe,
Tommy Truong: yeah.
Bonni Goldstein: right? They're not. In, in proper use, let's say.
Tommy Truong: Yeah, I had someone on the pod that really opened my eyes and he has a his business is he, he does testing, so he tests, you know, you get samples and he will test. And he said that a lot of synthetically derived can, can cannabinoids, you can extract the cannabinoid, but there's not a lot of control over the, the, the waste or what
Bonni Goldstein: And that's exactly when you think about it, right? So right now what's happening is we're seeing this backlash from the loophole in the Farm Bill where people are taking CBD that is legal and they're putting it through a chemical process to create delta nine and delta eight, THC and poor Delta eight is getting beat up.
It's a beautiful compound. It's in the plant, it's just in teeny tiny amounts in the natural plant. Um. Dr. Ulam actually in his [00:58:00] laboratory, took CBD and created Delta eight THC with it, but like 99% pure and gave it to children getting chemotherapy, and it stopped vomiting and nausea in a hundred percent of cases.
Tommy Truong: Oh wow.
Bonni Goldstein: is back in 1995, and nobody did anything with that. Like that would be great. But the problem is, is that you have people who are taking CBD and they're converting it, and they're getting some Delta eight and some Delta nine, and then there's this kind of unknown what's in there, and we are actually seeing reports in the literature of people having suicidal ideation.
It's like synthetic, it's like K two, like spice, you know, it's synthetics. And they're novel, which means that we've not seen them before. We have no toxicology on them, and we don't know. So we've got reports of people having difficult to treat depression suicidal ideation, excessive anxiety, psychosis.
And there's the one really scary report, if that's not scary enough [00:59:00] psychosis. A report of someone whose vision changed and they have something called visual snow, which, you know, looks like static. And they lost their vision and now they only have this static vision. And that came from a contaminated, um, synthetic vape.
Um, and what I'll tell people is like, prohibition doesn't work. We need to just legalize this across the country so that we don't have this need or this gap, this, um, gap to fill that, where people fill it with synthetics, right?
Tommy Truong: That's unfortunate and it puts such a bad name to the plant itself because the general public, they don't know.
Bonni Goldstein: That's right. People don't know. Is it, is it natural or is it synthetic? That's right. Nobody knows. And you know, we're getting to a point where hopefully things will be required to be labeled so that people will know, but at the same time, it absolutely has given [01:00:00] cannabis, natural cannabis a black eye.
Tommy Truong: Terrible. Dr. Bonni, I want to thank you so much for joining. You dropped so much knowledge. I've learned so much. This is one of the, the interviews, the podcast episodes that I was looking forward to the most.
Bonni Goldstein: Oh, well thank you.
Tommy Truong: Oh, thank you for coming on. I have to have you back. You have to come back, please. I picked up your book for you guys that are listening, cannabis is Medicine.
Pick up that book. I have to have you back after I read that book. I think I'll have so many more
Bonni Goldstein: Sure, sure. Well, and, and just be aware too, some of it, you know, because it was written. Five years, you know, closed five years ago, and then put out on the market. It's missing some of the more recent details. Um, and so if you see something in there and you say, Hmm, why isn't missing that information?
It's because it was written a number of years ago. And the information highway for cannabis is like being flooded with studies and research. And of course there's good research and there's bad research, but, um, one thing if I could, Tommy, I just wanna [01:01:00] plug something if I could, which is a new company I started called Goldstein Wellness.
So it's goldstein wellness.com, and basically what it is, is an educational program for clinicians because most clinicians do not get education on the endocannabinoid system or how to use cannabis as medicine in their patients. In fact, they're still telling their patients don't use cannabis, which I, I find really egregious, especially in a patient who's suffering.
Because I think once you learn. The medical side of it, there is no quote, other side, it's medical use. And so we have a free, uh, sign up and a free educational program. It's like everything I know I put into the videos. So there's something like 50 videos on the website for people to learn everything from the basics of the endocannabinoid system to drug interactions, safety and precautions, clinical pearls, all the various different cannabinoids.
Also, there's condition videos like autism, epilepsy, chronic pain. [01:02:00] And then the really nice thing that the, what I think is the best part is that if you are a patient looking for help, there are not very many cannabis clinicians around. A lot of clin doctors, nurses still don't wanna be involved with cannabis.
We have over, I think at this point, 300 clinicians. Who have signed up. And so if you're a patient and you're looking for help, we have clinicians from every state in the us. So if you go on and register, we don't use your email for anything other than to connect you with people in your who are licensed in your state to help you because it kind of does have to be state-based in a way because you know, you wanna know the laws in the state and also the products in those states.
Tommy Truong: That's amazing. That's, how can our listeners find you?
Bonni Goldstein: So just go. Um, so I have a Instagram, Bonni Goldstein, md and Bonni B-O-N-N-I. And then Goldstein md [01:03:00] goldstein wellness.com. You can just Google me, you'll find I also have YouTube channel with some videos. And um, I'm trying to think what else. Link. I'm on LinkedIn as well.
Tommy Truong: Dr. Bonni, thank you so much for joining me.
Bonni Goldstein: Thank you for having me and I hope to see you soon and come back and we can talk about some more stuff.
Tommy Truong: Definitely.
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