THE NEXT CHAPTER IN AMERICAN HEALTH
Before she goes for a run every morning, Sarah Daniels decides whether or not she needs to take CBD. She thinks about how her body is feeling and whether her mind is at ease. As a long-distance runner, she knows that if she’s not in the right frame of mind, she won’t be able to get through that last mile. She also understands that, at the end of the road, every runner faces the kind of inflammation and pain that CBD can calm almost immediately.
“Cannabis can increase your ability to be present with your body and to let go of the cognitive stress that’s hard to get away from, so that you can exercise more successfully,” she says. “I’m not talking about a high, I’m talking about finding a minimum effective dose level to help shift our mindsets and transition out of our hectic lives in Western society.”
But Daniels isn’t just any fitness buff with good habits. She’s a graduate research clinician at the Zach Walsh Lab in Canada, studying what she calls the super-additive effects of cannabis to exercise, stress and our overall health management. She bases all of her personal and professional decisions around the use of cannabis on evidence-based research. Daniels practices mindfulness meditation and yoga in addition to her running, and she’s been certified in the art and science of ganja yoga, which has been aligned with thousands of years of yoga practice in India.1 Daniels not only has industry sponsorship for her research, but she’s secured matching funding from the government of Canada to see how health practices can be enhanced with the use of CBD and THC.
“Yoga has health benefits, but there are significant barriers to access including existing health issues, joint pain, attentional difficulties such as ADHD, or just busy minds, and overall pain management that can get in the way,” Daniels shares. “Cannabis medicines can enable people to participate in exercises like yoga in the first place, which can then allow them to build the capacity to reduce pain long term.”
Not only does CBD and THC help people get into healthy habits, but Daniels says that the research around exercise has actually changed since we’ve discovered the endocannabinoid system and that endocannabinoid deficiencies exist. We used to think that exercise led to the release of endorphins, as she explains, but we’re now looking at the endocannabinoid system as a deep part of that process. When we have an endocannabinoid deficiency, we may not be able to gain the mental strength to begin a life change that can result in health. “Adding exogenous cannabinoids can give people a boost when they’re starting out lower than they should be,” Daniels says.
The transtheoretical model of health
We need that boost.
In the United States, we have some of the highest levels of what is called metabolic syndrome in the world. Metabolic syndrome is just that: the way that we live drives down the ability of our metabolism to cope, and we end up with obesity, diabetes, symptoms of cardiovascular disease and respiratory disease, as well as behavior-related illnesses such as HIV. Among people with literally any kind of mental illness, the risk of physical disease increases by at least two times, and HIV prevalence may be increased by as much as eight times.2
The less happy we are, the more likely that we will spiral into poor health.
All of these issues are linked to self-care. When we don’t care for our bodies, we are exposed to hyperglycemia, elevated triglyceride levels, cholesterol and hypertension, which, over time, can result in exposure to disease.3 When we have poor health, we also get depressed. There is a difficulty in coming to terms with the level of powerlessness that many people with mental illness feel in managing their own care. What this means is that the first step toward self-care is not necessarily putting a mental or physical health plan into action, but rather supporting the development of self-efficacy among those who are vulnerable to metabolic syndrome. This is because many Americans see their physical health or the quality of their medical care as beyond their control and in the hands of others.4
All of this means that there is a reciprocal relationship between metabolic syndrome and mental illness. The higher the level of physical distress, the more likely that there will be a mental health impact. In addition, the incidence of a mental health issue is likely to lead to a lack of self-care, which can result in metabolic syndrome over the long term. Self-efficacy requires that people have options and choices, rather than direct instructions, so that they will be able to succeed on their own by learning what works best for them. If people do not engage in self-care chronically for years on end, however, they will keep their bodies in a state of subconscious fear, which will break down into a disease condition linked to a lower-functioning immune system and inflammation response.
Let’s face facts. There are a number of underlying reasons why individuals continue to practice poor health habits. There could be a lack of knowledge about self-care, but the reality is that many individuals continue to engage in harmful habits because it is inconvenient to change, or because it is easier to continue on the same path without challenging oneself to pursue a better future and positive health outcomes. Health education programs, doctor recommendations or even friends and family can help to influence the way in which people consider their health habits and can shift them toward a new way of managing their health, but only if people choose to participate.
The transtheoretical model of change is what most health professionals use to help people shift their own health status quo and engage those in poor health to move toward self-care. This process includes five stages of health behavioral change, which are precontemplation, contemplation, preparation, action and maintenance. Individuals must embark upon each stage so that they will build the foundation for self-care over the long term, rather than just start and stop.5 This is important so that the process does not have to be repeated, and so that individuals in need of health habit changes feel confident and secure in making these shifts.
Health advocates know that this model must be individualized for each person. The stages of change identified by the transtheoretical model suggest that different interventions should be targeted to people at different stages of readiness, for example, to exercise.6 In other words, not everyone is ready to begin to make a change.
Let’s take what Daniels suggests about the use of cannabis for exercise and apply it here. If someone is in the precontemplation stage, the initial psychological hurdle to change may be significant. If someone is already in the contemplation stage, which means that they have begun to think about shifting their behaviors to protect their own health, then using CBD might provide the tipping point to the preparation stage by breaking down a few of the barriers. The movement toward a positive health plan is often a slow one. This does not mean that it will be unsuccessful. It is important to recognize that health is not only a matter of action but also of psychological readiness and self-belief. Therefore, in finding a solution to this problem, an individual may benefit from the support that cannabis medicine has to offer them. A barrier to both the use of cannabis and to exercise, however, is each individual’s social context.
Let’s take exercise first.
People who are vulnerable to metabolic syndrome are likely to be more effective at self-care when they have access to social groups that provide long-term support.7 Social support networks can help the individual in coming to terms with the stress and strain of their physical health conditions, help them achieve their goals and alleviate the isolation of mental health issues as well.8 By finding a pathway to social support, those with mental illnesses can address some of their most substantive issues related to self-care.
We know that cannabis also engenders social barriers. “Using cannabis is not a socially encouraged behavior,” Daniels explains. “For a lot of people, cognitively they may be able to understand that there are medical benefits, but there’s such a strong pervasive message that it’s not a helpful thing. But you don’t have to use cannabis to the point of impairment. The opposite is actually true. The point is to bring yourself into balance.”
This return to the idea of homeostasis is at the heart of health, and we have to shift our social context about the use of plant medicines like CBD, so that we can support a change toward wellness as a nation.
Changing our health and wealth
I believe that we can create a positive cycle of personal growth, rather than stress, with the help of CBD and other plant medicines, and by shifting how we think about self-care.
There’s a cyclical effect, which goes back to our discussion about the economy in the last chapter. If you can achieve physical and mental health, you will have the stamina to work harder and work smarter, and you will be able to manage your money better than ever before. If you can manage your money, you’ll decrease your stress levels and increase your resistance to disease and daily strain.
As the United Nations reported in 2013, good nutrition and exercise can be the foundation for health and well-being, physical and cognitive development, as well as economic productivity.9 If you can take stock of what causes you stress, states the APA (as we discussed in the first few chapters of this book), you’ll be on your way to changing your life for the better. But how do we alleviate that stress?
Cannabis medicines, specifically CBD, can be one pathway toward our health as a nation.
Dr. Reggie Gaudino thinks that our social context is already changing in that direction. “I think a hundred years from now,” Gaudino states, “we will have returned to plant-based medicines in general. I think we are going to see an increasing number of people who start to take responsibility for their own health and become present in their own well-being. Cannabis helps with well-being because of its ability to lead us toward physical and mental homeostasis. When you’re in balance, your entire body is better. The evidence is coming out. We already know that, in those states where legal cannabis exists, there is less drinking, less opioid addiction and fewer suicides. It’s just a matter of time before we begin to associate cannabis with reductions in a bunch of other things as well. You can’t argue with data.”
The data is there, not only for cannabis medicines but for many other kinds of plants that can work in our favor. These alternate therapies are still grounded in evidence-based medicine in the same way that psychopharmacology is; the difference is that they may simply be less known or popular because of the social context of care that privileges Big Pharma.10 As noted by the Royal College of Psychiatrists in the UK, vitamins, minerals and animal and plant products, such as cod liver oil, can have a positive effect on the body and the mind.11 What’s missing in the equation, however, is that while the impact of these CAM approaches may be beneficial to people in need of health care solutions, patients are often not provided with the right alternatives that will make an impact on their lives.12
The data is there, and it’s significant, but people are simply not hearing about it on a daily basis. There are even more cannabinoids that are coming to light in research every day along those anandamide chains, like CBG, CBN and many others. As Andrew DeAngelo posits, something has to shift and soon. We have to make significant changes, not only in terms of our own lives but in how we organize our nation and how we define ourselves as Americans, so that we can understand how to find these medicines and put them to work.
“We’re all in this rat race right now trying to chase all this wealth, all this individual materialistic greed,” DeAngelo suggests. “Greed is the organizing principle on the planet Earth right now. It’s an important part of the human experience—it motivates us to create things and innovate—but we’re out of balance.”
Gaudino agrees. “All of these cannabinoids have a medical efficacy that we have been missing for the last eighty years,” he says. “But there are so many cannabinoids and plant medicines that we haven’t even begun to scratch the surface. Chances are there are other plants, other than cannabis itself, with other cannabinoids as well. CBD is only one. We found something, but we’re on the verge of finding even more.”
What is that something more?
Recent research has revealed that there may be deep connections between the practice of mindfulness, positive brain function and immunity from disease that creates new ways of moving toward self-care. Studies have indicated that brain electrical activity before and after an eight-week mindfulness meditation program can cause both brain function and immune levels in the body to change. The type of mindfulness program is not relevant, according to these studies. In fact, the same results have been found within the brain activity of both Buddhist meditators and Christian nuns.13
This is similar to Daniels’s ganja yoga and cannabis exercise practice research. “There are a lot of yoga purists who say that it’s inappropriate to use ganja on a spiritual yogic path, as using an external product isn’t true enlightenment,” Daniels says. “But let’s face reality. Most yoga today is more physically based. There’s a workout focus. A cannabis yoga approach to practice is very slow, feeling into your body and connecting. It uses small micromovements that act to counteract the sitting that we do all day long, and adjustments to bring us back to balance.”
Daniels suggests that an intrinsic spirituality could be a part of our lives, but in a different way than in the past. We need to move away from the idea of looking for a higher power to solve our problems as we did at the beginning of the American experience, and toward a contemporary definition of spirituality that brings together four components: a connection to self, others, nature and the universe in which we live. We need to honor who we are and the world in which we play a role. In this way, we can move toward a positive self-care psychology, subjective happiness and meaning in life.
Daniels may be onto something. A number of different experimental studies in the United States have indicated that the daily practice of mindfulness and the awareness of our role in the universe may also help improve memory and cognition, mood and overall mental health. A study at Wake Forest University School of Medicine found that even brief mindfulness training over a span of four days can significantly improve visuo-spatial processing, working memory and executive functioning.14
Why does this happen? Dr. Andrew Newberg, MD, is the director of research at the Jefferson-Myrna Brind Center for Integrative Medicine at Thomas Jefferson University in Philadelphia. He explains that the reason that these results occur with such consistency is that mindfulness may contribute to neural plasticity.115Neuroplasticity, as we’ve talked about earlier in the book, is the ability of the brain to adapt to new stresses over time. Newberg suggests that the brain activity of people who practice mindfulness may be positively affected by greater blood flow, which can clear plaque from neural arteries, allowing the brain to function better. This, in turn, positively affects the entire body and its functions.
While Newberg stresses that more research is necessary, he states that findings from the last five years demonstrate that the practice of mindfulness is likely to have a significant impact on our ability to remain healthy. For this reason, he recommends the practice of mindfulness as a component of a healthy life plan.
The first tenet of the Yoga Sutra, Daniels explains, is that we need to diminish the chatter, or vrttis, of the mind in order to witness our true self. Anyone who has tried to meditate knows this is much easier said than done, but the reality is that CBD can help to bridge that gap. We may be closer to self-realization and finding harmony than we think.
“I think that the key to longevity, to living a long and happy life,” Andrew DeAngelo says, “is having a community of people that you connect to, that you care about. That you love and who love you and who accept you for who you are. I think that cannabis can play a big part in bringing that sense of connection and community to the world again, so that we can create a sustainable planet and sustainable economy from which everyone can benefit. As more of us get our endocannabinoid system in line, the more we’ll create community together. The more we get together, the more we’ll be able to overcome our differences with each other and love our planet, love our home and create a sustainable way of being with each other. That’s the real promise of CBD.”
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