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Living Well Interview Series with Dr. Michelle Sexton on Cannabis Research - Blog Puriya

May 27, 2019

Recorded Live, listen to this educational interview with Dr. Michelle Sexton, a pioneer in Cannabinoid Research. Learn about the may uses and research behind medical cannabis, understand exactly what is the endocannabinoid system and how it affects your body, and hear about ways that Dr. Sexton integrates these treatments in her own medical practice.

Read the transcribed version below…

00:00 Dr. Michele Burklund: Okay, and we’re live right now. Hello, everyone, my name is Dr. Michele Burklund, I’m the Chief Science Officer here at Puriya, and this is our Living Well series, where we meet with amazing people and change makers in the health and wellness area. And today, we have Dr. Michelle Sexton with us, and I’m very excited to have her.

00:24 Dr. Michelle Sexton: Thanks so much for inviting me. Two Michelles.

00:29 DB: I know, I know, I keep wanting to spell your name the way I spell mine, and I have to remember, it’s with two Ls this time. So for all of those who are joining in live, feel free to write in the comments where you’re watching from and if you have any questions. And I’m going to start off reading your biography, so feel free to jump in at any time. Okay, so Dr. Sexton is an Assistant Adjunct Professor in the Department of Anesthesia at the University of California, San Diego. Her role at UCSD is to engage in cannabinoid… Cannapoid… Cannabinoid…

01:09 DS: That’s it.

01:11 DB: Research, and to bring cannabinoid medicine into clinical medical curriculum. Dr. Sexton is a physician/scientist, meaning that she has both extensive clinical expertise, but has also spent time engaged in basic science, translational and clinical research. In clinical practice, she specializes in mind/body healing. The body and mind are deeply connected and cannot be separated when treating illness. This healing process is facilitated by balancing the evidence-base of research with unearthing the root cause of disease. Dr. Sexton has been helping her patients fine-tune their endocannabinoid systems since 2008. Her approach is backed by six years of formal study of cannabinoid pharmacology at the University of Washington, in addition to her naturopathic doctoral degree awarded from a four-year credited institution, Bastyr University.

02:10 DB: Dr. Sexton sees patients for education on utilizing medical cannabis for chronic conditions. Guidance is based on the latest peer-reviewed science-based research on the topic of medical cannabis. This education is woven into a complete naturopathic approach, recognizing that each system in the body is interconnected. Her overall approach to treatment may include herbs, nutrition, lifestyle changes, self-discovery, care, and feeding of the soul. Her philosophy is that personal empowerment, renewing connection to nature, and teamwork with her patients are all central to enhancing quality of life. Dr. Sexton enjoys surfing, swimming, gardening, guitar playing and grandkids, while generally engaging in life-giving outdoor activities in her spare time.

03:00 DB: Dr. Sexton graduated from Bastyr University in 2008. She completed an NIH-funded pre-doctoral and post-doctoral fellowships at the University of Washington in the Department of Pharmacology and Psychiatry and Behavioral Sciences. This is where she examined the effects of cannabis on immune parameters in patients with multiple sclerosis. She is an internationally recognized scientist with research published in peer-reviewed journals. Recent projects include documenting the natural history of cannabis administration to pediatric patients and a Cannabis Use survey. Well, that’s a lot. That’s a lot to get in, definitely. And do you have anything to add to this at all?

03:49 DS: I mean, the only part of my history left out of that, I would say that I got involved in healthcare first from being a midwife. So I was a midwife for 10 years in Texas, and I also became an herbalist. So that was my foundation of how I wanted to come to healthcare, was that model of midwifery and being close to patients and spending a lot of time with them to help facilitate change.

04:20 DB: Yeah, yeah, I think that’s great. So how long were you a midwife before you decided to go to Bastyr?

04:26 DS: That was 10 years.

04:28 DB: Okay, okay, so a long time.

04:29 DS: Yeah.

04:33 DB: Okay, well, I will jump into the first question. And before we get into a lot of the research of the endocannabinoid system, I wanna discuss some basic things that I think that there can be a confusion about for some of the patients.

04:47 DS: Okay.

04:47 DB: And could you explain what the difference between THC and CBD is in terms of the constituents and the therapeutic uses for them.

05:00 DS: Yeah, so that is a very confusing topic. I was just reading something where somebody said they use CBD as an acronym for cannabinoids, which makes it even more confusing. Because CBD is actually an acronym for one single chemical compound, cannabidiol. And so it’s not CBDs. There’s only one CBD in the plant. And it’s a chemical structure that looks almost identical to THC. They have the same molecular weight. Just a difference in the structure of non-CBD, and that little, tiny difference really distinguishes the pharmacology of these two compounds, which they don’t share much pharmacology at all. And so I think there’s a lot of misconception on behalf of the public that, for instance, they could use CBD and have all of the same benefit of medical cannabis that contains THC, but that’s really not possible when you’re leaving out a big piece of the pharmacology.

06:23 DS: So when you come to their action in the body, what happens with the biological interaction in our systems, THC was the compound that was, it was finally arrived upon that CBD was the active ingredient of Cannabis. And this was in 1964 when that compound finally got isolated. So it’s kind of interesting because cannabis was being used therapeutically, but the active ingredient in opium poppies had been discovered a century earlier. And so that allowed for opium to be quantified, and we could dose it accurately and know how to use it as a medicine, but with cannabis and the cannabinoids, CBD had been isolated in 1940, but it didn’t do anything. They were administering it to dogs or animals and they weren’t getting high. And so CBD really just kind of got shelved. Oh, that’s not the ingredient we were looking for that causes these profound effects. And so once THC was discovered, that really opened the door to the discovery of this entire biological system or biochemical system in the human body. And so when I say a complete biochemical system, it means we discovered there are protein receptors that bind to these compounds.

07:52 DS: There are enzymes that our bodies is to make our own endogenous compounds to bind those receptors just like we learned with endogenous opioid compounds. We make opioids. We also make cannabinoids but they don’t look like the plant cannabinoids in terms of their chemical structure. And so THC was found to be primarily binding this cannabinoid 1 receptor and that’s what produces what we call the psychoactivity or intoxication, or there’s any number of terms that people might use to describe what THC can do. Whereas if you take CBD even at a really high dose, there is no drug effect whatsoever. And that’s because CBD doesn’t hit that receptor and trigger the transduction mechanism that CBD does. So while THC is really directly modulating the endocannabinoid system, CBD does not do that. It has its own set of targets. And even though we know a lot about it pharmacologically, we still have a pretty small amount of human research done on cannabidiol.

09:08 DB: Interesting. So I guess that kind of brings us into the next question of what would you say would be conditions that cannabis could be helpful for both THC? And if there is anything, what would you say about CBD as well?

09:29 DS: So when I’m describing cannabis to patients because many of the patients that come to me, they come with a certain amount of stigma about cannabis from years of propaganda on the evils and… But now a doctor has said, “Well, we think that this is the next thing for you to try. We’ve sort of exhausted drugs for you or procedures and now it’s cannabis.” And so I like to ask people, “Do you like peppers?” And a lot of people do like peppers, but a lot of people may not like hot peppers. So we have a huge spectrum of peppers with bell peppers being thought of as really sweet and not having any of the spice component, whereas we’ve got something, maybe like a ghost pepper or a habanero pepper that’s so hot that most people can’t even tolerate it. And so I think we really see that as a metaphor for cannabis that it’s a species, depending on it’s environment and it’s genetics, it’s gonna produce anywhere on the spectrum of almost no THC to high amounts of THC.

10:47 DS: And so there may be utility across the spectrum, but typically starting out, I just tell people we’re starting down here on the bell pepper end. And so if you’re on the bell pepper end of cannabis, that typically means that the plant has genetics for the enzyme that’s gonna make a lot of CBD while the enzyme for making the THC is relatively low. So it’s this ratio of the cannabinoids that may differ across the spectrum. And so hemp by definition can have a THC component. It’s typically not enough in there, depending on what the extract is to create a feeling of being high at all. And so this is where it’s a good place to start with a lot of people. And I think people feel comfortable with that too. They feel more comfortable with CBD. And so if they’re getting something that’s a lot of CBD and a little bit of THC then it’s just more… They feel it’s more accessible.

11:53 DS: So in clinical practice, we’ve been using this type of low-dose THC for facilitating the tapering off of opioid medications, and so we have epidemic across the globe of people in chronic pain, for a great variety of reasons, and then we’ve got this epidemic of the overuse of opioids occurring. And there’s really interesting data showing that if you take opioids over a long period of time, it can actually exacerbate pain. There’s been a couple of papers published on what’s known as opioid-induced hyperalgesia. And so we actually sometimes see people once they get off of their opioids, that they would have very little pain any more. And of course, this really varies. But in general we are seeing a really good trend of people being able to lower their opioids by adding the cannabis to that. And again, THC can be analgesic at a really low dose. So people don’t have to have a full blown high effect. So chronic pain, tapering of opioids, along with that are anxiety and depression, sleep disturbances. We have a central sleep apnea that can occur with administration of opioids chronically, and THC has the potential to benefit all of those things.

13:27 DS: And then looking at sort of outside of the population dealing with chronic pain, we have cancer patients who are dealing with chemotherapy, appetite suppression, loss of taste, nausea, chronic pain associated with cancer treatment or their cancer. People with seizure disorder, and that’s really where I think CBD plays the biggest role is that CBD has been shown to have utility for seizure control in pediatric populations, with intractable epilepsy. So intractable, meaning that they may already be on a handful of anti-epileptic drugs and yet they’re still having seizure. There’s a lot of probably some benefit for autoimmune disease, although our understanding of the role of this endocannabinoid system in immunity, it’s more complex and we don’t really know exactly. There’s not been as much study in autoimmunity, but these are all conditions that people may be inquiring about cannabis for.

14:44 DB: Yeah, yeah, it definitely seems like it’s across the board, when you can help with seizures or pain issues and well as psychiatric conditions too. I think that’s very interesting with that as well. Okay, I’ll go on to the next question because I think it has a lot to do with this, and I think it’s a very interesting one. The endocannabinoid system, in which you mentioned in that is receiving a lot of attention and I think it’s a great time for people to learn and understand more about it. And on your website, you described it as the one that produces messages, modulates activity such as pain, hunger and metabolism, sleep, adapting to stress, the ability to store and recall memories or to abolish negative ones, and to protect the body from chronic infection or inflammation. There are many strategies for addressing this in which could be considered an endocannabinoid deficiency or excess which is very interesting. I wanted to hear more about that and how you explain the endocannabinoid system.

15:53 DS: Well, I mean I just think the… What you just read, this ability of the system to modulate and if you kinda drill it down, I use eat, sleep, relax, forget and protect. And this was something that a researcher Vincenzo Di Marzo came up with because in naturopathic medicine we really… One of the foundations of our medicine is to treat the whole person. And so we have to think of the whole person and a means of systems biology. We’ve got a lot of different systems with crosstalk going on between them, and so this day and age of specialization where we compartmentalize the kidneys over here and the lungs over here and the heart. And everything’s separate, and you see a separate doctor for all of it. The endocannabinoid system is expressed in every tissue in the body and it’s playing a role in homeostasis across systems. And so a really easy way to just sort of go through the endocannabinoid system with a patient is to review eat, sleep, relax, forget, protect. And so that’s what I do in the context of the patient visit. I would say probably the biggest harbinger of something being really awry with the endocannabinoid system is assessing the patient for their stress resilience.

17:32 DS: So we know that chronic stress is bad, produces inflammation, affects our adrenal function, can disturb sleep, etcetera, etcetera. And so chronic stress impairs the endocannabinoid system. In the endocannabinoid system, if you have genetics where maybe the function is down regulated, you may be a person who doesn’t adapt well to stress. And so when I was doing my post-doctoral fellowship, my study was specifically in multiple sclerosis. But our hypothesis was that people may be using cannabis to supplement their endocannabinoid system, which may not be optimally functioning. So looking at the stress resilience can be a really good key as to how the overall endocannabinoid system maybe functioning.

18:27 DB: Yeah. Yeah. I think that’s a very… It’s interesting but it’s also very hard to assess that system in any one ’cause it’s always subjective and their responses to everything, but so overall, the whole goal of endocannabinoid system is balance. Is balance between all body systems, and so something’s off with the excess or deficiency. So what would you do if there was an excess in that case?

19:00 DS: So we don’t have as much data on conditions that could be associated with excess. Excessive function has been related to obesity and metabolism. And then the other major one is schizophrenia and so we don’t have as much human data on modulating the system in those conditions, but probably everyone has a lot more experience with the things that could be associated with endocannabinoid dysfunction or under-function. So chronic pain conditions being one, or like fibromyalgia.

19:35 DS: Chronic migraine headache, eating disorders, so that’s smattering of things where you could have reduced function. And then, of course, this inability to work with even just like normal daily stressors, where people can’t even function to do normal life things. And so then there’s a lot of things that we can do to stimulate our bodies endocannabinoid system or to tone it. It’s a system that… Because it’s homeostatic, I don’t know if you remember in school in immunology, but I remember where we’re learning all these negative feedback loops, you know, how things work. And then we got to immunology and it’s like, “Well, yeah, so the immune system, they have a reaction and there’s some inflammation,” and if that inflammation doesn’t get turned off, then it leads to chronic inflammation. But there was sort of this black hole of, so what turn… What’s supposed turn the inflammation down, what’s supposed to be turning the knob down on that? And it turns out, it’s likely the endogamy.

20:48 DS: So we talked about the CB1 receptor in the brain modulating pain, our perception of pain, sensory perception in general, and the psychoactive effects. But the cannabinoid 2 receptor is mainly on immune cells, and so, we know that when that receptor is bound, it’s a knob to turn down inflammation. So, if you have a down regulation of these receptors or your body is not making the endogenous compounds, that’s when you’re gonna see this dysfunction. And so, there’s a lot of things that we already do in naturopathic medicine that will modulate the endocannabinoid system and stress reduction technique is probably being prime. So that’s a question I’m always asking patients, what is in your tool kit for dealing with stress. And then we move into what’s going on with their sleep? Are they falling asleep, are they staying asleep, how many times are they waking, are they staying in awake, how do they feel in the morning? Diet, so probiotics, fish oil, eliminating alcohol, because that can suppress the endocannabinoid system.

22:05 DS: And what’s happening with exercise? We know that exercise stimulates our endogenous opioid compounds and our endogenous cannabinoids. And it doesn’t have to be hard exercise, it’s been shown to be just moderate exercise will do that. And then there’s other herbs that we know have compounds that can also bind either the cannabinoid 1 or 2 receptors. So there’s a whole lot of other things besides cannabis to sort of get at this building up of health through this potential system.

22:37 DB: Yeah, yeah, definitely. And I think that’s what’s so great about being a naturopathic doctor is having all these great tools and all these great herbs that we can work with as well. And there’s so much focus right now on cannabis that… Yeah, I think a lot of other great amazing botanicals out there getting pushed to the side right now, but we do have a lot, and cannabis has a lot of potential, we’re just… We’re learning more about it definitely as we go too. And hold on, let me grab the next question, because I think it has to do with your research, which I think it would be perfect to talk about right now too. Yeah, I thought it was interesting that I was reading a project you were doing, and it said that people are substituting cannabis in place of pain medication, anti-anxiety medication, antidepressant drugs, and it’s a project you were doing and interestingly, which is another question too, I wanna talk about is that women are substituting four times more than men as well. Now, I’m interested to hear part of that project and how it’s going with the substitution of those medicines, and also, how you found that women are doing it a lot more too?

23:56 DS: So, this… That project has been an ongoing survey that’s been in collaboration with my collaborator Dr. Laurie Mischley at Bastyr University.

24:05 DB: Oh, yeah, yeah, okay.

24:07 DS: So we created the survey in 2012. It’s been an ongoing survey, we’ve translated it into four other languages, and so, it’s a big data set. It’s just called Cannabis Use Survey. So anybody who had used cannabis in the previous 90 days was eligible to participate and just answer our questions. So, we published different data sets taken from that. And this one was related to the question about, are you actively substituting cannabis for other drugs, if so what are those drugs? And so, pain medications were number one, and then interestingly anti-anxiety and antidepressant drugs were number two and three. And you mentioned psychiatric conditions. We have very little data on psychiatric conditions. There is a bit of evidence showing that CBD may be anxiolytic or treating anxiety. It’s also known that THC at low dose can treat anxiety. Both of the major cannabinoids along with a lot of other natural compounds that we may be familiar with, even caffeine have what are called biphasic effects, so like with caffeine at a low dose it may treat headache, whereas at a high dose it may cause a headache. And so with THC, we know that’s true at low dose, it can treat anxiety and at high dose it can cause anxiety. So these are just people that were reporting that they are doing it. So.

25:42 DS: That’s what that project was. I don’t know if we’ll publish anymore, but the intention of collecting that kind of data is to give us preliminary data for future research and so, that’s really where we are now especially with the opioids. I think the antianxiety and antidepressant one is a little more touchy, because the psychiatric community isn’t quite sold, you know, that THC isn’t addictive or potentially harmful. I think you’ll find individual psychiatrists that are seeing patients and they know patients are doing okay, and they’re not as afraid of it. But we’re currently doing a retrospective chart review at UCSD where we’ve got 2000 patients and then we’ll be able to separate out which ones were given an authorization to use medical cannabis and which ones were not and compare their opioid prescriptions over time. But we’re also gonna look at antidepressants, anti-anxiety medications and sleep medications to see if people are indeed substituting cannabis for multiple medications. It’s known pretty well anecdotally that people are doing this, but the hard data from research isn’t there yet.

27:03 DB: Right, yeah, I mean, I’ve definitely heard of that too, but to see some solid science or to show that this can be more effective than this or this has helped somebody get off this, I think there’s a lot of potential there too, and especially, if people are doing it on their own then there’s starting to be a demand for that too to go into trials.

27:27 DS: Yeah, and probably because you’re out of the country you may not have seen it, but a study was just published the other day where they used Cannabidiol isolate, which is a drug that’s been FDA approved called Epidiolex in the United States. I think it was 400 and 800 milligram doses in people addicted to opioids, showing that it reduces drug craving, and so, that’s really promising preliminary data as well. I just wanted to bring up the topic about women, because you said you thought it was interesting women were substituting more…

28:05 DB: Yeah.

28:07 DS: Four times more than men, I think that could probably be explained by the fact that women get healthcare more than men, we seek it more.

28:15 DB: That’s true. Yeah.

28:16 DS: We probably have more health problems just related to our monthly cycles, reproductive issues and then there’s this long history of treating women for hysteria, we have mood swings associated with our hormonal changes. The term hysterectomy was derived from… We’re gonna treat this woman’s hysteria, we’re gonna remove her uterus and that’s how hysterectomy got its name, and then, in the current pharmaceutical revolution we now just put women on drugs. And so, you know, if a woman is going through a stressful event in life, maybe she’s already not very stress-resilient and she’s got hormonal swings, maybe genetic factors, everything coming together in a perfect storm, where maybe she really needs drugs in a short-term, but they’re not used in a short-term.

29:15 DB: Right.

29:15 DS: Women are put on these drugs, I see women that have been on these drugs for 25 or 30 years and now they’re slowly tapering off of them and the first thing that happens is a resurfacing of all this emotion that’s just been silenced. And so, it’s a lot of work to… I consider it like being a midwife, you know, to midwife these women through… Back through these emotions that they really need to process, now they’re 70 years old and they don’t know why life is passing them by and their life is so unhappy and they’re sometimes just a basket case. So I think that that’s why women are more highly represented in this drug substitution data, because they’re on more drugs.

30:05 DB: Yeah, that makes sense, that makes sense the way you put it there for many reasons. Yeah. I think definitely women are more out to get help in situations and they are more out to be treated and take the medicine too. So, what other studies are you involved in now, what other research are you doing? I’m interested in all of this.

30:29 DS: Well, so we got the… We have the chart review that’s in process, it’s been a little tricky, because we’ve been trying to get access to prescription data through the Department of Justice in the State of California, and that’s taken almost a year, because they had no process for research purposes of sharing that data. And then it turns out it’s de-identified data, so I can’t even go into the database for specific patients and get their prescription data. So now we’re gonna have to go individually into each patient’s chart, so we’re just getting ready to start that. We have a medical student and a resident that are gonna help with the chart review, but eventually we’ll publish that and I think it’s gonna be really strong and really good data. We have another sort of a pilot study going on, where we just had people coming in for a one-time blood draw [unintelligible] and got a blood draw. We’re gonna be looking [unintelligible].

31:31 DS: And we’re looking for people that are healthy who have no pain, people who are healthy that are cannabis users and then people… Three classes of patients who live with chronic pain, either those who respond to opioids, those who respond to cannabis or those who may respond to neither opioids or cannabis. And so, we’re gonna map their endocannabinoid system and the genetics, individual genetics. There’s been interesting data on the enzymes that breaks down an anandamide in a case report showing the mutation where it allows a lot of anandamide to be in this particular woman’s body and she’s really never felt pain in her lifetime.

32:21 DB: That’s interesting, yeah.

32:23 DS: Yeah, that’s been a strategy for drug development, but unfortunately there was a FAAH inhibitor that was used in a phase one study that was done in Portugal and there were, I think there was a death that occurred. So the first in human dosing is really tricky, so the FAAH inhibition research kind of got a temporarily shelved. So we’re doing this now. It’s called a network analysis where we’re gonna be looking at genetics and looking for potential biomarkers in genetics for chronic pain. We have a project in process to do inhale, cannabis for acute migraine attacks. So that’s one of my…

33:05 DB: Interesting.

33:06 DS: Collaborators as UCSD who’s a neurologist, and a migraine specialist got that funding from the migraine foundation, and I’m participating in that. And then the Center for medical cannabis research at UCSD is just getting their first infusion of money from adult use sales, in California. So I have a proposal, that’ll be submitted this week and hopefully… That’s the hard part about research is you have to have money. So, getting…

33:35 DB: Raising the money.

33:36 DS: Is the hardest part. So yeah. And that’s to develop an oral… We’ve studied inhaling cannabis for pain. Dr. Wallace at the pain… Center for Pain Medicine, at UCSD is published a couple of papers, one was a pain model, and the second one was in people with diabetic neuropathy. But we think cannabis is particularly good for neuropathy or neuropathic pain. But oral cannabis hasn’t really been studied for that because we don’t have access to an oral product. So, at UCSD we’re gonna develop our own oral product and it’s gonna be a cannabis brownie. So, that’s the next project that I hope I’ll be doing.

34:21 DB: Very nice. Yeah, there’s a lot of projects going on, and I think that’s so exciting too, especially in this area where we need a lot more information. So lots of different… I’m surprised you can remember all the different studies and everything that’s going on right now.

34:40 DS: It’s a lot.

34:44 DB: Yeah, and I think it’s gonna keep giving us a lot of great information for different things. So what do you… So when they talk about pain relief. Do you focus on topical instead of oral or is it intravenous, which ways have you been studying it?

35:03 DS: So, inhaled cannabis has really been the primary means we’ve had to study cannabis in the United States because there’s no other product. Well we have there’s THC in a pill form is called Marinal and it’s pretty expensive. Dr. Wallace doesn’t like to use it because patients don’t tend to like it. So this is an example of an isolated compound having a different effect when it’s given all by itself, as opposed to with the whole synergistic effect of the entire plant. So we’ve really been using the entire plant but inhalation is the primary means because the National Institutes on Drugs of Abuse, they have a cannabis supply program, but they’ve only had plant material and no… They don’t have any capsules or topicals or anything else for us to use. So a lot of our experience is just coming from patients who are using products that they’re accessing in the real world. And in California, those are regulated, they have to be labeled accurately for their potency. And so, you know, we can drill down the dose pretty well.

36:15 DB: Right. I see.

36:18 DS: Yeah, I forgot what your question.

36:21 DB: Yeah, just the different kinds because yeah when inhalation.

36:25 DS: Oh you were asking… I wanted to talk about topical. So THC and all… The whole class of cannabinoid compounds are thought to be extremely fat loving compounds. And so for that reason they wouldn’t make a good IV drug. You need something that’s more water soluble, to go into an IV. It has been administered IV and certain research for certain purposes. I asked Dr Wallace about that ’cause you know they do spinal injections for pain as a treatment modality. And I said, “What about… Would you ever use THC in an injection?” And he said, No, no it’s too lipophilic we couldn’t do that.” And so that same concept could apply to topical application because underneath our skin, we have subcutaneous fat and while there may be cannabinoid receptors on nerve endings or in blood vessels, the chance of THC or CBD just getting trapped in that fatty layer is really high.

37:33 DS: And so it’s unlikely that it’s ever gonna get into systemic circulation or maybe not even reach the nerve where the pain is. And that’s my personal experience, clinically because the people that I deal with, and the type of pain I just, I call it complex pain because it could be through several different mechanisms that they’re having pain. It could be bone on bone, it could be bone smashing a nerve, and a topical application just isn’t gonna treat that, so it really does need to be systemic.

38:08 DB: Yeah, that’s interesting with the barrier and how to penetrate. Have you studied anything about penetration to get that further down, and over the subcutaneous?

38:18 DS: No, yeah, it’s just like I said, it’s so hard to get research done. And I’ll see people will bring their topicals in. And a lot of times there will be peppermint in the topical or like the popular topical called Tiger Balm that’s got camphor and menthol and we know that those two compounds are hitting channels that may modulate pain. And so it’ll be cannabis that has menthol and camphor and so it’s like, how do you know it’s not just the menthol in the camphor or the peppermint that’s providing the pain benefit. But those other compounds in plants, particularly the terpene class may help to drive it into the tissue, but we just… We don’t have any data on what’s the dose that would be effective topically or what’s the best transdermal way to get it through the skin.

39:14 DB: Right, right, interesting, yeah, I’m sure that’s definitely something to be studied later on too with all the new products coming out in that area.

39:26 DS: Yeah.

39:27 DB: So one of the questions I love to ask is about philosophy. Naturopathic medicine to teach our viewers what it is and how to look at medicine differently. So I read on your website that you wrote “The intention of naturopathic medicine is to shift the focus to body, mind, and spirit wellness instead of just treating the symptoms. The shift is achieved by using natural substances to balance the biochemistry and stimulate the body’s ability to heal. Further using this approach helps minimize or eliminate pharmaceutical medications. You may also order laboratory analysis to enhance diagnosis and treatment of medical conditions.” So I just… I love this question and asking each person about what is your philosophy? How do you integrate it into your practice? Just to educate our viewers on looking at medicine differently and giving them kind of the whole picture, so tell us more about that.

40:33 DS: Well, I think one of the values of being a naturopathic doctor and one thing I really value about it is like I said earlier, it really allowed me to just sort of extend the midwifery model. I remember one of my early midwifery patients, she had had a doctor hospital experience with her first baby. She came to me to see if we felt compatible for her to pursue a home birth. So she said, “Yeah, I wanna do this. I’d like to use you as a midwife,” and I said “Okay, well, you’ll probably wanna find a babysitter for your son because our appointments will be an hour,” and she was like, “An hour? What are we gonna do for an hour?” She was used to like a 10-minute in-and-out visit. What all or most people are used to. And so as a naturopathic doctor, I still schedule my appointments for 45 minutes, we usually go over. Because I think for patients to have this opportunity to feel like they’re being heard, they just need time, you know? They need time to more… Say more than my shoulder hurts, you know?

41:42 DB: Right.

41:42 DS: And so again, if you go through them systematically and I use eat, sleep, relax, forget, protect, and you go through all of these systems, you can really get this complete picture. And then, even interesting psychological things start coming into play. And that’s part of our training is in psychotherapeutic counseling of our patients. And so our mind plays a huge role in our overall health and people are largely unaware of this. So that’s what I like about the philosophy of naturopathic medicine, is time and that patients get heard, and we get to really see them more, and who they are as a person, and then especially as they come back for visits. So one of the things that I’m consciously and always integrating into the treatment plan is asking them, what do you do for play? Are you having fun, leisure activity? Sometimes I’ll even have them do fake laughing to try to stimulate neurotransmitters, vagal nerve toning. And people don’t even realize they have heart rate variability, so I’ll have them listen to their own heartbeat and then have them do long, slow exhalations and how that changes their heart rate and their heart rate variability.

43:09 DS: We’re all still creatures of rhythmicity. So dancing or anything rhythmic activity is really things that could be good for entrainment of the brain, just exercise in general. I have a patient I’ve been working with for a while who’s been… She’s one of these women in her 70s, who’s been on benzodiazepines and opioids for several decades, and she wants her life back. But she came to me with decades of this suppression and over time I learned more of her history, there’s abuse in her history. It takes time for patients to open up about these things. And so she’s now identified that when she starts having a reaction that it starts in her throat for her. Well, she doesn’t have a thyroid anymore. She was abused by her mother, abused by her husband and she doesn’t feel like she has a voice. So I have her singing, she goes outside and she sings or yoga exercises to open up the chakra. So that’s I guess, that’s how I integrate this philosophy about we’re not separate beings. The mind is not separate from the body and the endocannabinoid system is one of those systems that integrates the two.

44:28 DB: I think those are great examples to just how much the mind and the body are affected, and just looking at the whole person and bringing people back into their body, having that intuition again.

44:38 DS: Yeah, yeah, it’s amazing how people are out of touch with their bodies. And I think that… I was talking with a psychiatrist, the other day, that’s gonna do a study in… Might be veterans that are addicts and she wants to use CBD. So we were talking about, there’s this term called interoception. And so, this is something that we have to teach children like starting early with toilet training them. They have to learn to recognize the sensation in their body and what it means and what they need to do about it. And we have grown ups that can’t recognize when they’re hungry, you know? And have enough sense to go eat something. Or in this instance, this woman getting this feeling in her throat, but she doesn’t know what it is or what to do with it. So just that interoception first of even just feeling the sensation and then learning how to interpret it and work with it. And so I think that low-dose THC enhances this ability to become more in tune with the physical body.

45:46 DB: Yeah, yeah, that sounds very interesting. I think it’s great that you’re integrating that into your practice too and seeing really amazing results in that. So tell our viewers here, how that we can get a hold of you, whether you have a website, where you’re practicing?

46:07 DS: So I live in San Diego, and this is where I practice in Pacific Beach. So I ride by bike three blocks to my office and see patients there three afternoons a week. And I do at a distance meetings, teleconference, telehealth medicine. And you can find me out of a website, it’s just msextonnd.com. That’s spelled S-E-X-T-O-N, and then ND for naturopathic doctor. And there’s a place you can click on there if you wanna schedule an appointment or just read through the website and see if you have any questions. And I do brief 10-minute consults if people wanna know more for their specific condition, whether it’s a good fit to meet with me or not?

47:00 DB: That’s excellent. Well, thank you so much. I think that you’ve educated me and I hope you’ve educated a lot of other people just on some things that I’ve been confused about, and also a lot of the research of what’s going on and what we definitely still need to work on or what we have ahead of everything as well. Is there anything else you would like to share with our readers today?

47:30 DS: Just go have some fun. Life should be fun, and I hope that all of the viewers are taking a day. It’s a holiday today in the US and just taking time for yourself and doing some deep breathing and energizing yourself.

47:49 DB: Excellent, perfect. Well, great information for all of our viewers today too. I hope they go out and relax. I hope you take some time for yourself too today. You emphasized this.

47:58 DS: Yeah, I have a massage in an hour.

48:00 DB: Very nice, it’s a perfect way. Okay, well, thank you so much, Dr. Sexton for meeting with me and everyone today. I really appreciate it and I loved learning all of your knowledge as well.

48:16 DS: Thank you for inviting me.

48:18 DB: Thank you. Well, have a great day, and have a great massage too. 

48:22 DS: Alright, thanks.

48:23 DB: Take care.

48:24 DS: Bye-bye.

Want to connect with Dr. Sexton?  Click here

We named our interview series ‘Living Well’ based on the Ancient Greek term “Eudaimonia” translating to doing and living well. The Greek Philosopher, Aristotle uses this term in relation to balance in all areas of life. At Puriya, we believe that living well encompasses much more than health but all aspects of life.

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