E42 - PTSD: getting to the Hart of the matter

Kirk and Trevor discuss PTSD with Dr. Mike Hart founder of ReadyToGo Clinic.  Dr. Hart talks about how PTSD, migraines, IBS and some other conditions are due at least in part to an endocannabinoid deficiency.  That means cannabis is an obvious treatment for PTSD.  Also hear how cannabis can also be used in sports medicine and about Kirk's Runners' High on the Columbia Ice Fields.


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Episode Transcript

Dr. Mike Hart:   Sure. Well, first of all, you know, thanks so much for having me on the podcast, there Trevor.  Really excited to share whatever knowledge I can today with your listeners. And so your listeners know who I am. My name is Dr. Mike Hart. I'm a family physician. I was born in St. John's, Newfoundland. I'm currently residing in London, Ontario. I have my own clinic called Ready to Go Clinic. And I mostly, you know, dispel a lot of cannabis education on social media and on doing podcasts like this. And, you know, I'm excited to share whatever knowledge I came with you guys today.

Trevor: Thank you very much. Now, I know you've got a wide range and breadth of knowledge. In fact, I was I was watching you were on the Joe Rogan experience. I'm a little bit jealous of that. But also, holy snot. Does he have long podcasts? Like I was almost three hours. I got about 35, 40 minutes into that. But you were really good on that. But but rather than do everything, I think I'd like to do PTSD today, because I think that's one of your specialties. You've even written a couple books on that. So can you start by just telling our listeners what PTSD is and sort of how we were treating it before cannabis? Then we'll sort of get into where cannabis fits into PTSD treatment.

Dr. Mike Hart:  Sure. So PTSD as your listeners probably know it's post-traumatic stress disorder is generally associated with a lot of, you know, military veterans who come back from combat. But, you know, the message is that I also want to share today is that, you know, there's a lot of people with PTSD who haven't been in the military. You know, there's people who have been, you know, rape victims as people have just been victims of, you know, human malevolence, you know, over and over again. And so, you know, it's not just military veterans who are struggling with PTSD. It's also, you know, regular people, everyday people, civilians that also struggle with PTSD. So, you know, I think that's a really important message for people to understand.

Trevor:  thank you. That's that's really good, because, you know, we've got lots of ambulance attendants and firefighters around here who have, you know, symptoms of PTSD and, you know, even members of my own family who have been sort of robbery victims. So, yeah, there's a whole bunch of people out there who have experienced traumatic things.

Dr. Mike Hart:   Yeah, and I mean, the thing is, is that those people, you know, it doesn't matter whether you're know, you mentioned a robbery victim or a rape victim or, you know, if you were, you know, a veteran who was engaged in military combat. All of these things are going to end up producing very, very similar symptoms. And the symptoms that a lot of these people have are hyper vigilant for the day. You know they're always on alert. So, you know, they think that just like a military person is trained to detect threats. So, you know, when they come back from the military, then they feel that they are threatened, you know, everywhere. So, you know that that's an issue for people who have, you know, who have a history with the combat and the military. And then, you know, you take someone who say who's been, you know, a rape victim by, you know, a certain type of man who works, who looked a certain way. You know, any time that person sees someone who looks particularly like that man, they're going to get triggered and then they're going to get the same symptoms. They're going to be hyper vigilant. They're going to be out on alert, you know. And so instead of, you know, the guys who are in the military who are really out on alert for sort of like threats and violence, you know, the same thing is going to happen to the girl who got, you know, raped by someone. When she sees other men outside, she's going to feel very, very threatened. And that's going to create a lot of hyper vigilance, a lot of anxiety. And then, you know, the worst part is when we get into a state of sort of like agoraphobia when people aren't leaving their home. And that does happen to people with PTSD. And then in the nighttime, you know, the worst symptom by far is that they can't sleep. They get a ton of nightmares and they're even afraid to go to sleep because they know that if they do go to sleep, they could encounter those very terrifying nightmares that they had, you know, the previous night. So, you know, those are sort of that's kind of the way I sort of try to approach PTSD is I look at the symptoms in the daytime and I look at symptoms and the nighttime and then I try to work on both of those.

Trevor:   Okay. And so pre when you were when you're dealing with people's PTSD before before we started using cannabis or before you start bringing cannabis in your practice, what what sort of treatment modalities were you? Well, what we're using for them.

Dr. Mike Hart:   So, you know, again, fantastic question. And, you know, in 2015, there is a meta-analysis done that actually stated that the drugs that we have for PTSD are actually largely ineffective.  It's a meta-analysis. And, you know, if someone is interested in that research, I can certainly send to you that link and be included in the bottom of this podcast somewhere.

Trevor:   Yeah, that'd be fantastic.

Dr. Mike Hart:   Sure. We could we can do that because I think your listeners are all about the research, the evidence, the science. And I am, too. So, you know, I certainly appreciate about that. About you and your podcast. But, you know, coming back to it, so, you know, there's never been a drug specifically made for PTSD. So, it's all the drugs that are being given to the people have a diagnosis of PTSD like these are for anxiety. They are for insomnia. They are for depression. So they're for some symptoms of PTSD. And, you know, I'm not saying that none of them have any beneficial effect at all. But, you know, as I did state in that meta-analysis that says that most of the drugs prescribed are largely ineffective. And then when you really look at, you know, the pathophysiology physiology behind PTSD, you know what's going on, you know, there's a study that you may be familiar with, I think the gentleman's name is Matthew Hill. Dr. Matthew Hill. This is probably four or five years ago. And this is another one that we can include in the links on bottom. But he had a study that showed that people who have PTSD have an over 50 percent reduction in something called anandamide. So, anandamide is a fatty acid neurotransmitter, also referred to as the bliss molecule. So, I mean that this is what, you know, a molecule that really makes us feel well. And in fact, when we exercise, it's a huge burst of anandamide. And that's part of what people call the runner's high. Now, coming back to PTSD and you know medications, you know, the way you would want to approach any anything you know is when you hear the best way, sorry to approach anything when you get the best results clinically. Doesn't matter whether it is cannabis or vitamin or hormone is when you're correcting a deficiency? So, you know, coming back to the study you just talked about, you know, and saying that these guys, the people who in the study get over 50 percent reduction in PTSD. They had a lower level of anandamide. So I'm using, you know, just basic logic, you would think. OK. So, you know, these guys are low in something called anandamide. We need to replace that. And when you replace it with cannabinoids, which can generate anandamide, then you're actually correcting a deficiency. So it's like the people who have PTSD may, in fact, be deficient in cannabinoids.

Trevor:   OK. I've got to stop you there. This is really interesting. I'm going to stop you here because I think this is important. Now, anandamide has come up in previous podcasts, but in case people missed it. So make sure I've got this right. Anandamide is one of the cannabinoids our body produces on its own. And so this this is the famous endo cannabinoid system that we keep hearing more about. So, yeah. So you're saying that PTSD actually causes a deficit in one of the endo cannabinoids that our body produces. So we've got an endo cannabinoid deficit. And so then it kind of makes sense to treat PTSD with cannabinoids.

Dr. Mike Hart:   Yes, exactly.  Because, you know, again, whether it's a vitamin, whether it's a hormone, you know, whenever someone has a deficiency in you, correct. A deficiency, you're generally going to get amazing clinical results because you know exactly what's going on. And, you know, I don't want to get too off of topic with PTSD we'll come back that in a sec. But it's just the exact same thing when we're talking about, you know, migraines, fibromyalgia and IBS, these are three conditions that Dr. Ethan Russo has stated have been associated with something called a clinical endo cannabinoid deficiency. So just like we can be deficient in vitamins and hormones, we can also be deficient in cannabinoids. Now, the other three conditions that I stated, they have PubMed studies and, you know, Dr. Ethan Russo I think put out the first one on those three conditions around 2004. So, you know, this is something that's been fairly well established with regards to PTSD. You know, I can only refer to a couple studies that, you know, Dr. Matthew Hill has done. And there are some other animal studies, animal models and things online.  Some studies that are there are excellent to showing that there is a deficiency amongst people who have PTSD with anandamide. So, you know, again, I really I really, truly believe that, you know, the best treatments are always when you provide someone with a correction in a deficiency so just coming back to the migraines part, you know, like nobody is deficient in Imitrex. You know one of the more common medications for migraines.

Trevor:   Right? That makes sense.

Dr. Mike Hart:   But, you know, some people when they when they use the cannabis and there's many of them, they say that like, you know, it doesn't take my migraines from a ten to a five. It takes it from like a 10 to a zero. And, you know, in those like subset of patients, I just really feel that when they're taking the cannabis, they're definitely deficient in some type of cannabinoids. And that replacement is just fixing it and fixing it immediately. And they're getting excellent clinical results.

Trevor:   So I'm gonna jump in one more time just because.  So comparing it to some other sort of conditions out there. So you're saying just like somebody who is hypo thyroid, their thyroid isn't working as well. We give them levothyroxine and we give them their thyroid hormone back or someone who has type 1 diabetic is insulin deficient. So we give them basically the hormone insulin back. So you're saying that things like migraines, PTSD, fibromyalgia, IBS might not be the whole kit and caboodle, but at least partially because they've got an endo cannabinoid deficiency.

Dr. Mike Hart:  Absolutely. Yes, that's exactly that's exactly what I'm saying. You worded it perfectly.

Trevor:   Wow.  I honestly hadn't hadn't heard that. That's I've learned my new thing for today.

Dr. Mike Hart:   Well I'm glad.

Trevor:  So back to the PTSD. So we've done our little bit of our our psychopharmacology and we think that they might be anandamide anandamide. Although I'll say endo cannabinoid deficient.

Trevor:   So how are you treating them? Like I'm because I'm a pharmacist and I obsess about this. How are you getting it into them? Are you. Are they vaporizing it? Are they taking it on oil? Are they taking it edible? What do you what do you do that way?

Dr. Mike Hart:   So, you know, again, really. Perfect, perfect question. And I just want to give you my whole approach, which will also answer your original question. So, you know, when I when I see people again, like I try and break up a lot of the symptoms to the daytime and to the nighttime and a lot of people who have PTSD, you know, as I was saying earlier, they're literally afraid to leave their house. You know, they're afraid to go to the grocery store. They're afraid to go to any place with crowds. And obviously, this was a learned behavior like nobody is born afraid to go to the grocery store. Nobody is born afraid to leave their house. I mean, for sure, you know, we all have certain genetic predispositions, some people might be more extrovert and introverted. But, you know, for the most part, when you're looking at PTSD, these are learned behaviors that these people weren't. So, giving someone like that CBD in the daytime can be incredibly effective because CBD has actually been shown to decrease learned fear and then it's actually been shown to decrease it in three different ways, which is incredible. So, you're providing CBD in the daytime with people with PTSD is usually an excellent therapeutic option because you really get rid of that underlying anxiety and that underlying fear that so many people with PTSD have.  Now when it comes to nighttime, you know, like I said, a lot of people have a lot of nightmares at night and they're afraid to go to bed. So, you know, how do you treat that? So, you know, CBD is not as effective as THC for sleep and for reducing nightmares. So, THC has been shown to be incredibly effective medicine for reducing nightmares. And because it's such a good medicine for reducing nightmares, then, you know, when you have the CBD and the day taking away that fear and the THC at night, taking away the nightmares, you know, overall you do get a really, really good result. And then with regards to the modes of administration, which is what your original question was, CBD in the daytime, you know, you want to use that in oil form for the most part because, you know, it's going to last throughout the day. You know, the half-life you'll see this generally varies from about four to eight hours depending what citation you read online. So let's just call around five or six, that's what you know generally about my patients tell me. So, you know, some patients will say they only need it once a day. Maybe you only have like a lower level of anxiety just to kind of get them going in the morning and then there. And then they, you know, they feel comfortable after that, but  there's a lot of people that do need it two, three, sometimes even up to four times a day. You know, they do feel that you after a few hours, the medicine wears off and they need another dose. So, you know, for those people, you know, I definitely encourage them to use more of their medicine. And, you know, the other thing, too, about that CBD. People always ask about the dose. You know, there's really no minimum or maximum to CBD. So basically, the amount that you take that makes you feel best. That's the dose for you. And if there's ever a time where you don't take your CBD in, say, the next day, you know, you don't feel as well. It's not that you're withdrawing from the CBD. It's just that you're not getting the benefit of the medicine anymore. So, it's never going to return anything, say, worse from baseline. Whereas, you know, when you look at something like THC, you know, you can develop a little bit of a tolerance to THC. So, you know, because of that, you do have to, you know, be a little bit more cognizant of your of your use of THC and how it is affecting you.  So hopefully that explained my approach for the most part,.

Trevor:  No that that that was really, really good. I'd love to do more on this, but we'll probably gonna run out of time if I keep going down that one too, just for something completely different.  I saw I think of I can't remember over on Twitter or linked in, but recently you were at a talk basically geared for athletes and you were talking about WADA, which the World Anti-Doping Agency and how you thought that they should be treating, we'll call it cannabis as sports medicine. Can you talk about that a little bit?

Dr. Mike Hart:   Sure. You know, I'd be happy to. So, you know, the way that I see WADA is that, you know, that, again, the World Anti-Doping Agency is that if you're using something that's, you know, giving you an edge beyond your genetic potential, then, yes, you know, that should be considered to be a performance enhancing drug. You know, like if you're giving someone like, you know, a testosterone or like a real steroid, like a winstrol or something like that, you know, like these guys are going to get major, major improvements in their athletic performance, like almost overnight.  I think it's you know, people take steroids because they work, you know. You know, when it comes to, you know, cannabis, I don't feel that cannabis is a performance enhancing drug. You know, like when people say that, oh, when I take my cannabis, I can do my workout. Yes. But you're doing your workout with your own genetic potential if you're not doing anything beyond what you weren't given. Meaning that if you didn't have the cannabis, you'd just be riddled in pain. Maybe it's riddled with anxiety or riddled with fear about doing the workout or whatever it is. But when you use cannabis, you is just treating your medical symptoms. Right. So anxiety before a fight or before, you know, a race or whatever it is. I mean, to me, that is that you're treating a medical symptom. You're not giving the person any extra performance like that's not going to make you run faster or run longer. You know, so because of that, I don't see it as a performance enhancing drug. And then even so, I mean, like the way I see this as well. Just ask the athletes, like, if you asked any athlete, hey, do you care if your opponent is using steroids? They're definitely going to say, yes, I'm not fighting that guy. He's clearly an unfair advantage against me. He's using a substance that's taken him way beyond his genetic potential means making them stronger, faster, more athletic overnight. You know, but I don't think any athlete would care if he if they told you that they're taking cannabis, you know, so I don't feel that cannabis is a performance enhancing drugs. You know, it doesn't take you beyond your genetic potential. It's just treating medical symptoms. And so it's basically just allowing you to reach your own potential. So it's not taking you'd beyond your genetic potential.

Trevor:  And I think I agree with 90 percent of that. But just so I can push back a little bit.

Dr. Mike Hart:   Sure.

Trevor: So. So I agree with that for, you know, you know, a hockey player, a soccer player, a weightlifter, a boxer, that all makes sense. But there are some more unusual drugs, performance enhancing drugs in like the shooting sports, like beta blockers, which we normally think of about as a heart medication is banned in shooting sports because it stops people from shaking when they've got either their bow or their rifle pointed at the target. What would you say to Cannabis, since it reduces anxiety being an unfair advantage in shooting sports, where anxiety is literally part of part of how you compete.

Dr. Mike Hart:  Yeah, I think that that, you know, an important consideration and, you know, I definitely appreciate that comment. You know, I guess what? One thing that we need to like decide is like is specifically for anxiety is anxiety and overcoming that part of the athletic performance. And, you know, some people would absolutely say that it is you know, if that's part of the competition, you gotta overcome your nerves. You know, that other people would say that, you know, the competition is just about, you know, whether or not you can hit, hit, hit the hit the target. And, you know, that's, you know, based upon just your performance and because, you know, you're not enhancing your performance. You're just reducing, you know, anxiety, which is, you know, a medical condition. Then in turn, you know, you wouldn't be, you know, using a performance enhancing drug. You'd just be using something to treat your medical condition. So really, it's you know, it's something that we need to decide, you know, collectively, you know, is the person who needs who has anxiety, you know, can they use something beforehand or can they not? And that's something that, you know, is I guess is a little bit of a subject to debate. But overall, you know, I feel that everyone wants just to see the best athletes perform. And, you know, I feel that and the best competition and the best results. And, you know, I think that the way to do that is to be able to allow the athletes to treat any medical condition that they may have, but not allow you any type of thing that would take them beyond their genetic potential. But, you know, coming back to your question and you know, specifically with regards to, you know, that the sport you had mentioned, I understand why there may be a banning, you know, in that particular area, you know, because, again, it's very, very tricky, you know. Are you going? Are you reducing someone's anxiety level just to baseline or are you reducing their anxiety level to sort of, you know, like a superhuman level where they don't have to deal with any anxiety that gives them an unfair advantage?  So, you know, I think,.

Trevor:   Frankly, I was just kind of nit picking on that when, like I said,  90 percent of what you said makes sense. The cannabis, if it helps the athlete, seems like a reasonable, reasonable option. You know, instead of at ibuprofen, or a, or a morphine or whatever else they were using before to treat pain, you know, if cannabis works to help their pain so they can recover faster, seems like a reasonable treatment to me. Now, before I completely run out of time, because you have such a length and breadth of knowledge on different cannabis subjects, any anything else you want our listeners to know or anything you've you thought I was going to ask or wish I was going to ask just before we let you go.

Dr. Mike Hart:  Sure, maybe just a couple quick things. So, you know, I did make a post the other day about THCV, but I haven't made like too many posts about other cannabinoids other than THC and CBD. And the reason is just because they're not that commercially available. So, you know, people are like, OK, that's great information. But, you know, I can't do anything with it. So, you know, that's why I've kind of chosen not to talk too much about the other cannabinoids. But just so people know, like THC and CBD are only two of 100 cannabinoids in cannabis and so many cannabinoids are going to be coming down the line that are going to, I think, provide so much medical benefit for so many people.  So, you know, that's something I think to really get, you know, excited about in the in the future.

Trevor:  Well, that's great. And we are we're always looking for for more an interesting cannabinoids. So. Dr. Hart, that was great. Thank you for talking with us. And we've very well might call on you again when something else comes up.

Dr. Mike Hart:   I'd love to be back on, I really enjoyed it, so thank you so much for giving me the opportunity for doing this.


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