E83 - Are the Cardiovascular Effects Worth the High - With Dr. Venkat Subramaniam

Most certainly, we have learned Cannabis has benefits but it is not benign. With all medications it is important to understand the risk and benefits. In this episode Trevor and Kirk discuss the cardiovascular effects of chronic cannabis inhalation with an accomplished student of medicine, Dr. Venkat Subramaniam. Although, he admits limited studies are available, his literature review suggests those who start smoking cannabis at a young age, making it a daily indulgence, are at risk of developing cardiovascular disease. He makes it easy by comparing cannabis to donuts; reminding us we must consume in moderation.

Thursday, 28 April 2022 13:07

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Episode Transcript

Kirk: Hey, Trevor, how's it going? 

Trevor: I'm doing well, Kirk. We're here out of love, Kirk. It's all about the love today. 

Kirk: Yes. Yes. 

Trevor: Ah, maybe. Ah, maybe just the heart. 

Kirk: Yes, the heart. It's all about the heart. You know, I did this interview about three or four weeks ago, and I can't remember how I stumbled on to the papers. But what grabbed me about where I found these two papers, one was called the Cardiovascular Effects of Marijuana are the Potential Adverse Effects Worth the High. And I was thinking, Gee, that's quite a dramatic, dramatic statement to make. Like, Oh my goodness. 

Trevor: Yeah, no, that's a good, catchy title. 

Kirk: It's a very good, catchy title. And there's a second paper, and both of these papers will be on our website. reefermed.ca. Reevaluating America's Latest Pharmaceutical Trend. The Cardiovascular Risks of Cannabis. I can't remember how I found these papers. I read them both. And I mean, we've often said that in this passion project, a Reefer Medness - The Podcast, we wanted to have a balanced program to look at the pros and cons and learn about cannabis. And every time we seem to find something about cannabis, it's sort of like, Oh, cannabis is good then. You know, and even when we, you know, we did the addictions on cannabis, it's like, OK, there's a problem with addictions with cannabis, but well, when you compare it to other medications and drugs, it's kind of a lower issue. But So, I'm always looking for something that we can put on our page that says, You know what? Cannabis has adverse effects for you, and you should be aware. So, this title, this title grabbed me. 

Trevor: Well, and I'll throw it there because we talk about everybody else's health concern, So, I might as well just So, I am a person with... I have atrial fibrillation. It's technically I don't right now because of a procedure done. But let's call me somebody who has recently in the recent past had atrial fibrillation. So, I am a I am a person with a heart condition. So, the whole does cannabis have anything to do with cardiology? Obviously piqued my interest as well. 

Kirk: Yeah, and that's where I wanted to get this voice in our in our library. I reached out to both authors. I found the author of the 2019 paper, and therefore I spent a lot of time with this paper and I'll speak when we come out of the interview, I'll speak more about what I found in sources. But I wanted to bring Dr. Subramaniam as he calls himself Sub. I would completely ruin his last name, and I apologize for that. Venkat is his first name. He introduces himself, So, let that happen. But I wanted his voice because I think it's important that we understand that cannabis is not benign. It does have effects, and this paper really focuses on the adverse effects of cannabis specifically to the cardiac system. So, I wanted that voice. Is there anything you wanted to say, upfront, before we get into the interview? 

Trevor: Just that the things to listen to, he sort of listed sort of four, four big things. So, I'm just going to list them here So, people can be listening for them along the way. So. So, when you're talking about cardiovascular effects, there's a bazillion. But I OK, Trevor: grouped them as four. So, kind of electrical effects on the heart that that's my thing. That's atrial fibrillation, that's arrhythmias. Vascular. So, they talk about, you know, the blood vessels doing weird things. Platelets, that's the clotting thing. And then they threw it, and I broadly clumped it into illegal market slash adulterants. So, I think those were sort of his four big, big things that he was looking for. So, it just, have a listen for those. 

Kirk: Yeah, peripheral arterial itis, coronary vessel spasms, platelets, aggregation. And he does he does speak a little bit about additives. Now one thing I want to say straight out is that in some of his assertions in his paper, I did challenge him on it and he does explain well. For example, his assertion about additives comes from a 1976 paper. So, I challenge him on that. So, and I like the way he answered that. One thing I I don't know if I've ever have felt older talking to one of our guests. Yes. I really, 

Trevor: so, Kirk, because I wrote this down. Yeah. Kirk, how does someone of your generation feel about this interview? 

Kirk: Yeah, yeah. Yeah, he made me blush. 

Trevor: I giggle going, I'm pretty sure that Dr. Sub thinks he's talking to a fossil. Well, you know, maybe he's not wrong.

Kirk: It's has to be the silver beard, I guess. But no, there's definitely a generational gap here. And what I like about his paper is his discussion with me. He does come out in the sense of he acknowledges that he's a very knowledgeable man. I mean, gee whiz Trevor. 

Trevor: a lot of school. 

Kirk: A lot of specialty. Is this this guy is not only an internist and you call an internist a doctor's doctor. Yeah, he is. He's a pediatrician. He's an internist. He's going to be a fellow cardiologist, this guy 

Trevor: and before all that he just did a master's in pharmacology. 

Kirk: Yeah, yeah. Yeah, just So, he's a perpetual student, So, he's got a lot of book knowledge. But again, we'll come out of this, the papers, the papers a weak paper, and I challenge him on that and we'll get what came out of it. But he's good with how he addresses it in the sense that he has book knowledge. He doesn't have a lot of practical knowledge. His practice is not exclusively cannabis. He hasn't had a lot of clinical expression within cannabis. And I found it interesting that he and again were walking through the conversation that ultimately his major concern with cannabis is chronic use of it, which is which gets into the paper, and also, that the biggest issues he's seen clinically has to psychological, not necessarily cardiovascular. 

Trevor: So, it was an interesting comment coming from someone who specializes in the heart. 

Kirk: Yeah, yeah. So, let's get let's get into the conversation and then we'll come out of it and then we can sort of really scrutinize what we are learning from him. 

Dr. Venkat Subramanian: Absolutely. Yeah. So, my name is Dr. Venkat Subramaniam. Everyone does calls me Dr. Sub and I am a cardiology fellow at the Ochsner Clinic Foundation in New Orleans, Louisiana and United States. I was born and raised in New Orleans, Louisiana. I went to college and did biomedical engineering and ball, and then graduated and worked in pulmonary biodynamics for a little while. And then I got a Masters in Pharmacology and Experimental Therapeutics from Louisiana State University Health Sciences Center in New Orleans, Louisiana. And then I eventually after that went to medical school in Louisiana, in New Orleans, and then I did my internal medicine and pediatrics residency at Phoenix University of Arizona in Phoenix, working with Banner Health and with Phoenix Children's Hospital. And just last year, I moved here to start Cardiology Fellowship, and that's where I am currently. 

Kirk: Wow. So, do you ever you have a pharmacy background or did you work? 

Dr. Venkat Subramanian: Pharmacology background? Yes, sir. 

Kirk: All right. And OK, So, the paper you wrote, there are two papers that I had and it looks like you're one of your colleagues. I was in was involved with both of them. Your paper was written in 2019. What motivated you to write that paper? 

Dr. Venkat Subramanian: You know, I think that what motivated me was that I was kind of seeing in this country that there is almost a growing push to legalize marijuana. And it kind of reminded me of what happened with your generation in the tobacco industry almost. And that, you know, tobacco was being pushed as, you know, something to legalize, then we should use and there's not that big of a deal to it. And I saw that happening with marijuana, and it made me kind of say, you know, what exactly are the risks for it? What are the benefits for it? We look at it as something that is a commonplace thing. Everyone gets quote unquote caught smoking marijuana at some point in their life. So, I wanted to see that dive and delve into the research behind it and see, is there anything that is bad about it? 

Kirk: OK, and you certainly discovered lots of stuff. I'm going to get into the meats and potatoes, I just want to just do in sort of an overview. Now, the second paper, which was also, coauthored by your coauthor, was that an update of the material

Dr. Venkat Subramanian: that I think Dr. O'Keefe is a different physician. I don't know him too well. I know that he is associated with Dr. Levie, both Dr. Levie are our mentors and is very well known in the research arena. But he I think he just kind of extrapolated and moved further on my kind of start of the topic. 

Kirk: Mm-Hmm. OK. And are you as a cardiologist fellow? I explain that to me. Are you still doing your training or are you now a full fledged cardiac? 

Dr. Venkat Subramanian: no sir, I'm still doing my training. So, for I am board certified in internal medicine and I finished my general pediatric residency, So, I finished both of those. And I can practice in those. But for cardiology, you have to do what's called specialty training or fellowship. So, it's three years for general cardiology, and I am at one of three. So, I'm at the low end of the totem pole, but it is a continued education afterwards. So, I'm not a board-certified cardiologist and I have not finished my training for cardiology. 

Kirk: So. So, you're an internist and a pediatrician? 

Dr. Venkat Subramanian: Yes, sir. 

Kirk: Are you going to specialize in cardiovascular for kids? 

Dr. Venkat Subramanian: Originally, that was the plan, you know, internal medicine residencies three years. If you do both internal medicine and general pediatrics, it's four years. I kind of do like more adult cardiology. Then I would say pediatric cardiology. Or there's a new field called congenital cardiology, where they look at adults who have cardiac birth defects. So, hindsight, I probably could have saved myself an extra year of education if I just did internal medicine, but truly do love kids, and I loved working with them, So, I'm happy I did the medicine in pediatric. 

Kirk: Well, you're a perpetual student. I think I think I could do a podcast just on your study. You know, let's get let's get into the bulk of why it why I contacted you. Cannabis. This was 2019, So, this was something that you obviously wanted to know about then. Are you still involved with cannabis patients who are on cannabis as a part of your history gathering? 

Dr. Venkat Subramanian: It is part of my history gathering. You know, I for all my patients, whether they're 10 years of age or they're 80 years of age in their social history, I asked: What's their occupation? Are they married? And I ask all my patients, do you drink alcohol? Do you smoke tobacco? Do you use illicit drug use? Now one thing I noticed is at the beginning of my education when I would say, Do you smoke tobacco? They knew that cigarettes, do you chew tobacco? They kind of knew that when I asked, Do you drink alcohol? Everyone knows we're drinking alcohol means. But interestingly, when I said, Do you do illicit drugs? They would say, Oh no, I don't do illicit drugs, you know? And if I pretty soon found out that illicit drugs was heroin and methamphetamines, cocaine, things like that, a lot of people don't view marijuana as an illicit drug. 

Kirk: Well, it's not in some states 

Dr. Venkat Subramanian: or in some state it's completely legal and it's not an illicit drug. And in some states, people are still having to smoke in their house or in their car because they can't do it outside. So, it's in that gray zone of, you know. It's not tobacco, it's not alcohol, but it's not cocaine, and it's not heroin. And it's more viewed as a tobacco and alcohol in terms of health risks in terms of legality. So, I've had to start saying: Do you use tobacco? Do you use alcohol? Do you use illicit drug use? And do you use marijuana? So, I've kind of put that as a different term in terms of my history take. 

Kirk: Interesting. That is interesting. And one of the things I found both papers start right out by saying that cannabis has replaced tobacco as the number one consumed product is I. That's incredible. I hadn't thought of that. 

Dr. Venkat Subramanian: And I think it's per generation to tell you the truth. I think that, you know, no offense. Your generation is a little older and I think that your generation was more the tobacco generation. Tobacco cigarettes and cigars; chewing tobacco generation. I think my generation and the teenage generation of this year is more into, I like to say, the technology of consuming these products. So, edibles, vaping these products. Tobacco and marijuana. And I think that there's been So, much media and research on the bad effects of tobacco that my generation has been pushed away from tobacco. There's not that much research on marijuana, So, they've moved into that realm. 

Kirk: It is funny, you say my generation, but it is funny. I have watched, you know, as a young lad, tobacco was smoked everywhere. Everyone just lit up in a house. And then in the last 10 years, 15 years, even people who smoke, don't smoke in their own homes. So, there's definitely been a behavior change in tobacco and society, too. So, it's interesting that you know you gave me your history. You're now a cardiologist, fellow learning to be a cardiologist. But you did this paper two years ago when you were probably in PEDs, your training to be a pediatrician. So, are you using it now? Like is like we can get into the bulk of your paper. Why don't we do that? Why don't we get into the bulk of your paper? What did you find in your studies? 

Dr. Venkat Subramanian: You know, very little. That's what I found. Very, very little. You know, there is no double-blind control. You know, randomized clinical trial is the number one strongest research tool we have. You know, there is nothing like that on marijuana. They're anecdotal case reports on marijuana. There are few studies here on marijuana. And what I wanted to know about marijuana as we view it as a very benign drug.  I'm willing to say a larger than 25 percent of the population. If you say, Oh, what would you do if you know if you could smoke marijuana, would you do it once? I think most people would say it's OK. It's not a big deal. My concern was the people who smoke marijuana daily; numerous times a day and the people who do it from a young age. My concern was those people and that population, and I wanted to know what the cardiovascular side effects were of this. I knew I was going to become a heart doctor. And this was something that I'm probably going to have to deal with in my generation of patients when they age. And what we found was we don't know too much, but there are a couple of different areas that are concerning when you have chronic heavy use of marijuana. One of those areas is what we call autonomic dysfunction, where you have confusion between both the sympathetic and the parasympathetic nervous systems. These are their electric wiring from your brain to your body that regulates your heart rate, your blood pressure, et cetera, et cetera. There is vascular effects with chronic heavy use of marijuana in the terms of basal spasms where you have the arteries in your heart can sometimes spasm, causing all a pseudo heart attack almost. It causes inflammation of the vessels. That's something that tobacco is known to do as well. And third, one that we kind of realized was that it it sometimes affects a certain blood cell in your blood called the platelets. The platelets are involved in the clotting cascade when you cut yourself. The reason why we all don't bleed out besides not having a bleeding deficiency is because platelets aggregate at area of trauma and they form a clot and you're you stop bleeding. Now, that's fine and dandy, but you don't want to form clots where you don't need them. And you know one of the areas is in your heart. One of the most important areas in your brain where you can have a stroke or a heart attack, respectively. And then the last thing is that most people, you know, especially in states where it's not legalized, they go and they buy their marijuana from someone who knows a friend who knows a friend who gets it from somebody else and stuff like this. We don't know what is on it. We don't know where it's been grown. What has been sprayed on it, etc. So, are you really just smoking marijuana or are there other things that you're smoking? And these are the four main things that I wanted to look into. 

Kirk: OK, fair enough. And you definitely found some studies that suggested cannabis is not benign, and that's what are the reasons why I wanted to talk to you. I always thought, you know, comparing cannabis to tobacco and the health things. Tobacco, we know the tobacco companies laced the tobacco with chemicals, chemicals to burn, chemicals, keep it free, antifungal, blah blah blah. My understanding of cannabis and now I did go through your bibliography, your references and some of the studies are old. They go back many years. And I think that was probably one of the limitations that you found is there's not a lot of information out there. But I'm wondering in today's marketplace where you do have access to legit grass cannabis marijuana that are we are we still concerned about marijuana having something more than just, say, the natural product? And I say this because we know that the tobacco companies laced tobacco is cannabis the same? Or are you suggesting maybe some of the legit cannabis? There's more in it and just cannabis? 

Dr. Venkat Subramanian: No, I don't. I think that it is. As it becomes legalized, there is more concentration on making a very pure product. And when a company or a private organization starts to sell marijuana, the last thing they want to do is to sell a product that's not good. And this is basically the economics of capitalism, right? And when something becomes legal or lots of companies start this for a profit-making corporation, they want to make the best product in the world. And that's step one for making a quote unquote healthier version of marijuana than, let's say, the previous generation had. I think that as time goes on and this product becomes more regulated, this product becomes more efficient to produce, you know, and more pure. I think a lot of those chemicals that I mentioned, arsenic, aflatoxin, anti-poor of this stuff will be pushed to the side, excuse me, will be pushed to the side. But my one concern I always have is the term preservatives. You know, marijuana at the end of the day is an organic plant. And you keep a plant long enough organic bacteria can grow on it. You know, it's just like having a hamburger just sit out the it'll go bad, you know? So. You know, there's always the McDonald's hamburger versus the natural hamburger, how the McDonald's hamburger never goes bad after days and the other one, you know, you know that, yeah, that anecdote that came out. So, is that going to happen with marijuana as well? I'm not too sure. Is that happening with marijuana as well? Maybe I would say that is something that is going to go by the wayside soon as this gets in in more of a process, I would say, compared to the previous generation where you would buy this from a friend of a friend. 

Kirk: Okay, fair enough. So, when you when you look at cannabis, then you wrote your paper, you've reviewed a whole bunch of documents and resources and you and in your practice, have you had have you stumbled to any of these adverse effects? Have you seen people come in with adverse effects in cannabis? 

Dr. Venkat Subramanian: No. So, no, I have not. I'll be. I'll be straight up with that. I think that. These are anecdotes, and are we I just have not had enough patience, I guess, that have used it enough chronically to see these effects, OK? I would say more than the cardiovascular effects of chronic marijuana use. I tend to see more psychological and neural manifestations of chronic marijuana use. You know, for example, um, why do people smoke cigarettes? It's a nicotine that people smoke cigarettes for, you know, they're not smoking cigarettes because, you know, maybe they like that, that sense of having a cigarette to their mouth and that kind of pathway. But at the end of the day, it's all based on reward. It's a reward pathway that releases dopamine in the brain and gives you that good feeling. Nicotine is known to increase dopamine levels in the brain, So, that's why people smoke and chew tobacco is because it releases that. Marijuana on the other hand, does have a euphoric feeling when you use it. You do have some impairment. Are there, and it is known to have both psychological dependence and physiologic dependence on it. You know what I mean? Physiologic dependence. When you when someone uses heroin, they can withdraw physiologically from it. There is a psychological component to it, but I find that what I see in the adolescents that I used to work with in the pediatric population is that they quit and they don't have a physical withdrawal whatsoever. Maybe they can't eat for a few days. Maybe they get nauseous when they eat. But it's that routine that's built up of I'm going to come home and I'm going to light up a marijuana cigarette and just relax at home. And that routine, that psychological routine and that ability to de-stress with marijuana is the whole, you know, psychological component to it. And I find that I see that more often in my practice. And when I was a pediatrician practicing in pediatric medicine, I see that more often than I do you know, the platelet aggregation, the arterial inflammation. And moreover, these are all microscopic in histological findings from the cardiovascular effects of marijuana, not something that we would be able to see on a physical exam, you know?  

Kirk: Mm-Hmm. So, again, going back to the motivation of writing the paper, it's almost did you write the paper as part of your academic work or did you write it? So, was it was part of academic work like it was an assignment? 

Dr. Venkat Subramanian: No it wasn't an assignment. It's one of those, you know, when you when you're in the medical field, you have to have research and you have to have research to, you know, improve your chances at moving your career forward. You know, So, that's one of the reasons why I wanted to do it is I wanted to do something different instead of just doing hypertension guidelines instead of just doing lipid management and stuff like this, I wanted to do something that affects the population as a whole, and that's new and novel. 

Kirk: Did you get lots of attention back in 2019? 

Dr. Venkat Subramanian: You guys are the first one that I feel like have emailed me wanting to talk to me about it. So, that's cool, but I've definitely had people cite my paper and continue research on it. 

Kirk: Yeah, and that's good. I like I said, I spent some time with the paper. I read the paper a couple of weeks back when I first discovered that I'm trying to remember as I was reading it, how did I get a hold of this paper in the first place? I remember what initiated it. But today I actually had time waiting for you. I went through the I went through the sources and like I said, some of the sources go back to 1975, 1976 or their old sources. And then I was looking at the second paper and I see that they've cited the paper up just as new citations. But yet they still come to the same conclusions that cannabis has these effects, and it's not that I'm a proponent of. Well, I guess I'm a proponent of Cannabis in a sense if you compare it to other medications or drugs. I mean, it's got a very low addictive force, too. It's got a low, low harm, harm risk to it. But when I read this paper, it's like, Oh my God, I mean, even the title is the risk worth it. And I was thinking, Oh my goodness, 

Dr. Venkat Subramanian: I think that. And that's not what I'm trying to do. I am not an anti-marijuana person whatsoever. I think that marijuana has its place for sure. You know, I think that since the dawn of the age of man, you know, alcohol and smoking have been there since we've since we've done this. And, you know, do I think the do I think that an adult smoking marijuana cigarette every now and then is going to be that big of a deal? No. I mean, you eat donuts, you know, like and they're not good for you, you know, but if you eat donuts every single day, numerous times a day, it's not good for you. You know, So, I think the biggest issue with marijuana and it stems from the tobacco is that not So, much the stuff that's in marijuana is the way it's consumed. Smoking anything is just not good for you. OK? And I think that we can all agree that smoking something is not good. When you inhale smoke, it causes inflammation in the lungs. It recruits white blood cells to lungs. And when you have an inflammatory process, it's when you have cell turnover and it just takes one cell to accidentally not replicate properly and become a cancer cell. OK. So, I think that, you know, and whether this is vaping, where the fallacy about the I vape So, it's safer than smoking? Not necessarily. You know what? So, smoking anything is not good for you. And what's unique about marijuana is that there's become So, many other modalities on intake for this. You have people who drink it, you have people that eat it, you have people that put it in food, their restaurants that serve marijuana, you know, in cities I've been to. So, it is a unique medication. I am always just afraid of and I think that it's equivalent to what in your generation smoking cigarettes in high school that how many people do we know that smoked cigarettes in high school that continue just to smoke them constantly throughout their whole lifetimes? And that is my concern is that the culture of marijuana is viewed as it's not that big of a deal. It's not that bad of a drug. It's OK if little Johnny got caught with it in high school. You know, I'm just afraid of how many little Johnny's are constantly smoking weed every single day from high school with the developing brain. And just like tobacco, has those effects now you kind of bring up, you know, other medications and stuff like this that are worse side effects. And the answer to that is a hundred percent true. You know? As a doctor, we're taught of the issues, what's something called polypharmacy, you know, adding one medication to deal with the side effects of another medication that are causing side effects from another medication, you know, and all these things. And pretty soon someone's taking 15 different pills and they're trying to combat the side effects of all these different things. That's polypharmacy. Marijuana is known to have beneficial effects in pediatrics. Epidiolex, that is a medication that is a synthetic form of marijuana that treats seizures. I've dealt with patients. I've admitted patients to children's hospitals that are on that medication. Dronabinol is another great example of a medication that we use in adults and with kids as well for chemotherapy-based nausea. And it has been shown to be much more effective than anything than the pharmacological industry has, such as Zofran. So, you know, it has its place in society. Don't get me wrong, I just want everyone just to know that you know it is. It's not good for you. Hey, you know, like it's not going to improve your exercise potential. It's not going to make you a genius. Does it combat stress? I'm sure it. Does distress have deleterious effects on the body? Absolutely. So, that's one side of the argument. But you know, everything in moderation just to go back to the donut analogy. 

Kirk: Fair enough. That's good. And I, you know, that's about it. We could easily go through every part of the paper, but I think you gave us a good summation. My motivation is more to just find out about the paper and who wrote it and why. Because I found it. It is. It's a dramatically it's a dramatic paper in the sense that I do a lot. I read a lot about cannabis and this one pretty much just comes out and says, What you just said. It's not great for you, for your, for your, for your cardiovascular system. There are effects. So, yeah, I guess I wanted that in the podcast. I wanted to have your voice in our library. Is there anything I didn't ask you about your paper that you thought I might know?

Dr. Venkat Subramanian: You know, and I just want to get across that I am not anti-marijuana establishment. And I think that for my generation, it has its place in society. If and I'll be straight up with you and maybe this is just me as a personal physician, if someone comes in and says that they smoked tobacco and drink alcohol and I'm slapping them on the wrist and I'm giving them lectures about stopping that, and I take a lot of time in my time with my patients to tell them to stop that. If someone tells me they smoke marijuana, I personally say, You need to stop doing that and I move forward very quickly, you know, So, even if I have that view of things as a physician. Is that appropriate? Who knows? We don't know at this time point, you know, but I just want everyone to know that everything should be done in moderation and that marijuana is good for you in some senses, but also, deleterious to your body, and that for anyone who's using anything, just knowing the risks, benefits of doing that is always the most important thing. 

Trevor: So, Kirk, how does someone of your generation feel about that paper? 

Kirk: All right. I liked reading this paper. It's probably I have probably spent more time on this paper than I have had in other papers recently. Like I got down in the 2019 paper, his paper, the one that the Cardiovascular Effects of Marijuana are the Potential Adverse Effects Worth the High. I love that. I love that title. I really went into his paper deeply, and a lot of his lot of his sources aren't strong, right? Did you find that? Did you? 

Trevor: Well, and let's back up even a step farther for people who don't read papers. I would call in my mind, I would call this a review article. So. So, he's not doing it. That doesn't make it bad, but he's not doing any of his own research. He didn't have, you know, a control group and a study group and did things to them. He's not. It's not even really a meta-analysis which takes a whole bunch of other studies and sort of glommed some together with some statistics. It didn't do that. This is this is what I would call a review article, and it doesn't make it bad. He sort of looked through the literature and said, OK, here's the question I want to answer. How many? How many papers can I find about it? And then can I kind of make that into a thesis? So, that's what he's doing. 

Kirk: Yes, exactly. And he explains that he wrote it. What motivated him was that he didn't just want to write a paper that everyone else writes 

Trevor: yet another cholesterol figure. 

Kirk: He wanted to write something that people would read, and he caught our attention. There is a second paper that I'll put on the website. I did not get a chance to interview that, that author. But there's a coauthor. They share coauthors, ship with another, another fellow. But again, in the 2021 paper, Reevaluating America's Latest Pharmaceutical Trend the Cardiovascular Risk of Cannabis. He gets in and reviews newer literature, but doesn't come up with any new conclusions. So, I think the jury is still out in regards to the The Mass Effect. Now, obviously, like any substance, individuals are going to have unique responses to it, right? I mean, we are always looking individuals have adverse effects to cannabis and other medications. So, this paper reviews papers that have reviewed adverse effects on cannabis, but the numbers are very small. There's not a lot of people out there having adverse effects, with cannabis cardiology. However, having said that, the science suggests that cannabis chronic use of cannabis, and that's another caveat I think we have to use. He said that a couple of times he's looking at those young people who are treating cannabis like cigarettes. Smoking continuously. Yeah. 

Trevor: And I want to jump in on that one because apparently not new information, but new to me. Now, not as a population as a whole. But he was saying the younger population. So, I don't know what cutoff you want to put, let's say 30 and under 

Kirk: the other generations, the other generation, yeah, 

Trevor: those other generations that are using cannabis more than tobacco and the cannabis use is is increasing and tobacco use is decreasing. So. So, this part, I think he probably nailed it on the head, which just didn't occur to me at all is, you know, cannabis smoking is is the cigarette smoking of the younger generation for for good or for ill. And I think that made a really valid point to his review that this is something that's happening. What's it going to do, especially to the heart? 

Kirk: Yes. And I think his paper, also, speaks to the whole issue of of contraindications. And there's a small on the second paper they talk about, they talk about the cytochrome P45 family metabolizing enzymes. And our listeners can get more in-depth on that in our episode. What is episode 80 where we talk about Contraindication

Trevor: Dr. Lindsay Anderson from the Lambert Initiative? 

Kirk: Yes. So, So, the second paper does cite that which we we've done a whole episode on. So. So, I guess I just wanted this this voice in our library in the sense that it's it's a paper, it's a paper that discusses cannabis is affecting the cardiovascular system, but it's not a paper that suggests this is happening to a lot of people. It's a paper that suggests that if you do have if you are a chronic smoker, if you are someone that young smoking cannabis every day, that there will be a buildup and there will be an effect down the road. So, be aware of that. And it's a paper that sort of says that, you know what? You know everything in moderation. And if you do decide to smoke a lot, then you might have cardiac problems. So, I like the fact, 

Trevor: yeah, no, no to two things, because one, you take a whole lot more history than I do, but I know I have definitely and as fun to listen to him. Talk about this to the. So, Mr. so-and-so, do you drink alcohol? Yes. No. Do you smoke tobacco? Yes. No. Do you use illicit drugs? Oh no. And I've asked that question too, because nobody does illegal drugs. And I, as soon as he said that I was one. Yeah, that is a it's a terrible question because nobody thinks what that whatever they're doing, like take your take your whatever drug you think is the scariest. If you think heroin is a scary drug, could I do? But if I was a regular heroin user, I'm not thinking of that as a bad thing. That's just part of my day. So, no one thinks that their illicit drug use is, in fact, during a whole smoking cessation year we are on a pilot project I asked that question a lot. Literally one guy. And this was way pro-legalization one guy admitted to using cannabis. Ask that can't be right? But yeah, I really like the fact that he eventually came to the conclusion, that asking people if they use illicit drugs didn't give them particularly good information. So, he changed that. Do you do you use marijuana? And then, you know, it's So, much less judgmental than illicit drugs? 

Kirk: Yes. Yeah, well, and in history gathering it, I've had to change my way of asking these questions to. I do come out and say, Are you a cannabis user? And So, I opposed to putting it under the global effect of drugs. But yeah, no. I also, just like talking to him, he's he was a nice guy. He was very informative, very open the chat with me and he was prepared for me to challenge him on some of the sources, and I think he answered it well. So, yeah, I think it's a good voice. Yeah, no, 

Trevor: we really appreciate that and thank you. And that wherever his next practice takes him, because it sounds like he's always looking for a new challenge. Keep cannabis in the back of your mind. You know, it's for good or ill. It is. It's part of the it's part of the community now. And if you have any other research papers that come up, give us a call with we'd love to talk to you about it. 

Kirk: Yeah. And I'll always remember to keep your health practitioners informed of your cannabis use and recognize the fact that if you are using cannabis every day and smoking it like cigarettes, you know everything in moderation and be aware that it can cause issues with your heart. 

Trevor: Donuts, right? Last thing because I think people can relate, I really liked his quotes or I wrote down, I forgot. I don't know if this is a perfect analogy, but I really liked what he said. Think about donuts. Are they good for you? No, of course not. But you know, moderation. They're probably fine. You know, a donut or two a month. Great. Five donuts a day. Bad? Where's that magic line? Who knows. But you know, now obviously not. Not a perfect correlation between a donut and cannabis, but think about the moderation and the dose, I guess, is what I'm doing a terrible way of trying to get around you. 

Kirk: Yeah. So, I'm glad to have him as part of our library. I'm Kirk: Nyquist. I'm the registered nurse. 

Trevor: I'm Trevor: Shewfelt, I'm pharmacist. 

Kirk: And we are Reefer Medness - The Podcast. 

Trevor: So, Kirk, if I'm remembering right when we were in Calgary, we were we are in a local cannabis shop and you ran into somebody handing out pamphlets I want to say, 

Kirk: Yeah, you know, I'm always searching for My Cannabis Stories and we in the in the hotel that we're staying at when we're doing the Calgary Expo just behind it, there was a Green Panda. Namedrop. Maybe Green Panda would support us anyways. Green Panda. So, we walked in to check out the prices and see what they had. And Bobby Jones was sitting there and he was doing some legwork for a company called Arbor Medics. And we started talking. I said, Hey buddy, give me a give me a cannabis story, and I recorded it and didn't think much of it, to be honest with you. It got buried into many other files of stories that we're going to be sharing in the next couple of months, I guess. And, you know, spend some time figuring out who Bobby Jones was and Bobby Jones has his own little business called Green Guidance that we follow on Instagram and LinkedIn. And this is his story. 

Bobby Jones: Yeah. All right. My name is Bobby Jones. I'm from Calgary, Alberta. I guess my story in cannabis starts in about 2015. He came out of university with a pretty serious drinking habit and really leaned on the healing power of cannabis. Got into the gray market, started my own education business. In 2017, got into cultivation, So, learned how to grow, learn how to trim, got into retail in 2018. Learned the ins and outs, and then started my own sales agency. My agency came out of the need for a more education focused representation option. Where you had a lot of Red Bull people. You had a lot of alcohol people that were just trying to stop their business model on the cannabis, which really started the creation of Green Guidance. And out of that need, I bumped heads with a client of ABBA medic's in Ontario. They're a veteran, founded veteran, first medicinal producer. They are my first client and now they've just been bought by MTL Cannabis. So, as fast as things seem to settle, they change that quickly in cannabis. And that's how I ended up where I am today. 

Kirk: Fantastic. See you. You grow for better. 

Bobby Jones: No, I started your sales agency, So, I represent producers in Alberta. I track their numbers. I make sure they get market penetration representation, and I basically just increase their presence in Alberta. 

Kirk: So, I like Parkland Flower, those kind of businesses?

Bobby Jones: Parkland.  Like ABBA is a producer, as I was saying, there are medicinal first, but they also, sold into the retail market. So, now they've been bought by MTL Cannabis, who's very successful company out of Quebec. They're more brand focused, So, now I may be moving in house with them. We're going to see if the future is under. 

Kirk: Your business is to help agencies go through the system and to. 

Bobby Jones: I work through AGLC because Alberta, it's a it's a twisted mess. Once you start dealing with how many regulations and the right people to talk to what you can, you can't do. It seems to change every week. Thank you. All right. Thanks a lot. 

Trevor: Kirk, let's say people wanted to do a little more reading and then sleep well afterwards. What? How could say our website helped them up with their reading in their sleep? 

Kirk: So, oh, you talk about, Oh OK, I thought, you're talking about how boring our website is. No, you're talking about no. Our website is exciting.

Trevor: get getting some education and then then having a good sleep. 

Kirk: Yeah, our website reefermed.ca is building all the time. Thank you for the push on this. I really ask our listeners to check out the web page. The transcripts are all there. All the research that we discuss with our guests is there. The links are there. You can search the web page. You can search the web page using key terms, topic, affiliations, guests. I mean, you look at the long list of guests we've had there, there's some impressive names on there, some of the some of the most noted cannabis people in the country and and North America and including Australia. So, we've got some really good 

Trevor: because North America, Australia is the same

Kirk: that's only, you know, 18 hour flight. But but So, I think that would keep people excited. Now the sleepy part is you're talking about the hoppy dreams. 

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