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Your Health Checkup: Marijuana and Your Health

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.

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When I wrote about marijuana (cannabis) previously, I emphasized that its legalization in multiple states as well as increased recreational use, especially among young people, have heightened the need to better understand its potential benefits and harm. Because multiple formulations exist, including edibles, transdermal formulations, combustible smoking, and vaping, assessment is difficult since each can impact health differently.

In general, marijuana exposure impairs thinking, psychomotor skills, and driving ability, and can inflame bronchial airways, leading to bronchitis. While the adverse cardiovascular effects are less certain, multiple reports have noted heart rhythm problems such as atrial fibrillation, ventricular tachycardia (rapid heart rates from the bottom heart chamber), and acute coronary syndromes such as heart attacks, cardiac arrests, and strokes.

The most definitive report on medical and recreational use and cardiovascular health has just been published as a scientific statement from the American Heart Association. They note its beneficial effects on pain, cachexia (wasting), nausea, vomiting and spasticity, but that there are no well documented beneficial effects on the heart and blood vessels.

Multiple compounds, particularly tetrahydrocannabinol (THC) and cannabidiol (CBD), determine the impact of cannabis products that can contain pure THC or CBD or their combination. The two compounds exert profoundly different actions on the heart and blood vessels. THC exerts generally negative actions by stimulating the system of nerves (sympathetic nervous system) that increases heart rate, need for oxygen by the heart muscle, blood pressure, and platelet stickiness, and makes the inner lining of blood vessels function abnormally. The increase in oxygen demand by the heart and decreases in heart muscle oxygen supply can trigger angina or even heart attacks in people with preexisting coronary artery disease, particularly when cannabis is smoked.

CBD appears more beneficial than THC and may reduce heart rate and blood pressure, improve blood vessel function, and reduce inflammation. CBD is non-psychoactive, is found in cannabis plants like marijuana and hemp, and has no recreational application. The only investigations of CBD subjected to rigorous study are those for epilepsy and schizophrenia, so claims of benefits for a host of other illnesses remain unsubstantiated.

Cannabis can have addictive qualities with long term exposure, and users may experience withdrawal symptoms such as anger, anxiety, restlessness, irritability, depressed mood, disturbed sleep, strange dreams, decreased appetite, weight loss, headache, and night sweats if cannabis is suddenly stopped, the dose is reduced, or formulation changed. In addition, tolerance occurs with chronic use.

Except for nicotine, adolescents abuse cannabis more than any other drug. Because the brain continues developing until approximately 21 years, adolescent exposure to marijuana can be particularly harmful. Use before age 16 or 18 has been associated with poorer sustained attention and reduced verbal IQ, along with abnormal structural changes in the brain. Pregnant women or those considering becoming pregnant should refrain from using cannabis because of potential damaging effects on the fetus.

Before using cannabis, consider potential risks and benefits for the various forms of drug and administration. Cannabis obtained from the black market, especially synthetic illicit cannabinoids, should be avoided because of possible adulteration, contamination, and questionable dosages. Smoked or vaporized cannabis in general should be shunned, especially in patients with respiratory diseases. Cannabis should not be used in combination with alcohol or drugs that affect mental activity. People with psychiatric conditions should avoid compounds containing primarily THC with little or no CBD.

Many rumors and fallacious claims about the health benefits of cannabis products exist, and users should be wary. If something sounds too good to be true, it usually is.

Featured image: Cannabis plants (Tatevosian Yana / Shutterstock)

Your Health Checkup: Is CBD Too Good to Be True?

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Cannabidiol, or CBD for short, is a non-psychoactive compound found in cannabis plants like marijuana and hemp. CBD contains only trace amounts of tetrahydrocannabinol (THC), quantities too small to make one high. Because of this, it has no recreational application and there appear to be no public health related problems.

Sales have been increasing. Estimates indicate that the CBD-product market grew 40 percent to $367 million in 2017. By 2022, economists estimate sales for hemp-based CBD products will about double.

CBD is available in many forms, including oils, tinctures, creams, gels, and vapors. It has been touted for health benefits such as treating autism, anxiety, pain, sleeplessness, depression, and eczema. Scientific studies have shown it to reduce the frequency of drug-resistant seizures in some forms of epilepsy and to reduce symptoms in patients with schizophrenia. The FDA has approved CBD for treating epilepsy. It has also been considered as an interesting possible curative drug for some forms of cancer, diabetes, inflammation and neurodegenerative disorders. The major application appears to be for patients seeking alternatives to prescription medications to treat anxiety, insomnia, and chronic pain.

Because much is still unknown about side effects, adverse reactions, proper dosages and interaction with other medications, first-time users should be cautious. In addition, with the exception of treatment for epilepsy, CBD is considered a dietary supplement in the U.S., not a drug regulated by the FDA. (It is regulated as a drug in the United Kingdom.) Consumers should seek out reputable distributors.

As I have detailed previously, dietary supplements are a category of food not subject to the usual premarket safety and effectiveness testing required by the FDA for drugs. These supplements may not be carefully regulated and may contain contaminants. Some off-the-shelf products have been found to contain little to no CBD. The lack of regulation raises issues about the quality of the product, the effective dosage of CBD that is fundamental for its therapeutic effectiveness, the purity, and the absence of chemical or microbiological contaminations.

The legal status of CBD is subject to interpretation. Under federal law, it’s technically illegal, although a 2014 amendment permitted the cultivation of hemp in some cases, as well as the marketing of its products. Hemp-based CBD oil, however, is widely available across the country. A few states ban it outright.

When something sounds too good to be true, it usually is. I would interject a bit of caution before accepting all these claims about the wonders of CBD. The only investigations subjected to rigorous study were those for epilepsy and schizophrenia, so claims of benefits for the host of other illnesses remain unsubstantiated. Future research — carefully performed by skilled researchers, as in the seizure and schizophrenia studies — will determine the rightful place for CBD among our therapeutic choices.