Missouri officially legalized medical cannabis in November 2018, with the passing of Amendment 2. The state first started accepting applications from qualifying patients and caregivers for medical cannabis cards on June 28th, 2019. Since then, the state’s list of registered medical patients has quickly grown into the tens of thousands, with the approval of qualified recommending physicians, like Missouri’s own, Dr. Lisa Roark. Her clinic, Roark Family Medicine, was the first in the state to offer telehealth options, where patients could meet with her office remotely. Because of this, Lisa quickly became one of Missouri’s leading recommending physicians.
“We were the first clinic to offer telehealth in Missouri, so we became very busy, very fast. I already had a full patient panel, so I had to do a lot of scheduling adjustments, work more hours, and adjust as needed.” It was during this exciting time of growth and expansion when Lisa was officially diagnosed with multiple sclerosis, which she first shared publicly on social media in October of last year. “For my birthday, I got a diagnosis. I have multiple sclerosis. I’ll follow up at Barnes next week to discuss options to help with my vision. Sucky birthday present, but better than not knowing.”
She may have MS, but she’s not letting it stop her, and she’s grateful for the incredible support she continues to receive. Lisa is a local doctor, with local values. Raised in Exeter, MO, she graduated from Exeter High School before moving to Kansas City, MO, where she completed her medical training at the University of Missouri-Kansas City School of Medicine. Afterwards, she completed her medical residency at Cox Family Medicine Residency in Springfield, MO, where she trained in all areas of primary care, including obstetrics, pediatrics, chronic illness management, women’s health, geriatrics, and many outpatient procedures.
Don’t buy into the ‘there isn’t enough research’ crap.
Now she lives on a small farm with her husband and four children in Cassville, MO, where Lisa tells us they “Enjoy spending time outside tending to the animals, gardening, hunting, playing and making memories. We are fortunate to have a large number of family members in the Cassville area.” This is also where her practice is located, which she loves for many reasons. “I love taking care of entire families, from babies to great-grandparents. It is very fulfilling to not just know a single patient, but to also understand their home and family dynamics. Family practice allows me to know my patient as a person, not just a body. I also love that I actually have time for my family and community. I worked several years for a large health system, got paid well, but missed my kid’s parties at school. I didn’t get to take them to school or pick them up, and had absolutely no community involvement. Now my office is one block from the school. I can walk up the street and have lunch with my kids, or they can even walk to the clinic after school. I also enjoy how much time I get to spend with my patients. As a Direct Primary Care practice, I have no billing/insurance/coding and can spend significantly more time with my patients.”
Lisa was inspired to become a physician by her role as a middle child and problem solver in her family. “This led me to medicine in general. I view most medical cases as a jigsaw puzzle, and I just have to figure out how to put it back together.” This passion for helping solve medical problems for her patients lead to her becoming a recommending physician in Missouri’s new medical program. “Prior to Amendment 2 making it on the ballot in Missouri, I had a patient ask me to help treat her child’s seizure disorder with CBD. I had to admit, I had absolutely no knowledge regarding cannabis or hemp, so I agreed to do research. The more I read, the more I realized physicians have been duped. I found significant research showing the medical benefits of cannabis and many therapeutic uses for this safe, effective plant. The more I learned, the more I wanted to know. I attended several conferences, met Dr. Sue Sisley on several occasions, did medical education credits related to cannabis, and joined several physician groups who have helped educate me, so that I can help educate patients. I became a recommending physician because I believe that all people should have the right to utilize cannabis as medicine.”
“The process of choosing to do physician certifications was easy, the implementation not so much. With this being a new program in Missouri, I’ve had to spend more time educating patients than doing the actual certification. I try to educate them regarding the law, medical uses, as well as the process of getting their medical card. There have been A LOT of changes in our clinic in the last year.”
Lisa’s advice for other physicians in states who have yet to legalize, and those who now find themselves in newly legalized states is, “Get educated. Don’t accept what you’ve been taught or told to influence your opinion. Don’t buy into the ‘there isn’t enough research’ crap. There is a lot of research (much from Israel), you just have to read it.” She tells medical students interested in medical cannabis to “Talk to patients. Learn how this plant has helped people for millions of years. Learn everything you can about it, and don’t forget to ask why. Why was it taken away from patients in the 1930’s? Why was it replaced with expensive, dangerous, opiate medications? And why can’t patients pick it up in a pharmacy?”
As far as her MS goes, she was reluctant to share any updates since first making the announcement last year. “Mostly because I didn’t have anything nice to say. I was formally diagnosed with multiple sclerosis in October, 2019. Since then, I’ve been on Tecfidera (crazy expensive MS med) with the hopes of keeping my disease in remission. Unfortunately, I haven’t seen any slowing in the progression (just fantastic side effects like hives, hot flashes, and heat intolerance). I’ve had steroid shots in my eye sockets, also in my eyeball, IV steroids, by mouth steroids for Trigeminal neuralgia (crazy painful). Physical therapy for weakness in my left leg, a muscle stimulator to try to keep my muscles working. I’ve only been working part time and sleeping excessively. I’ve cut out wheat, dairy, sugar and go to yoga as much as possible. I’ve been exhausted constantly, depressed, tearful and have felt hopeless,” she bravely shared, “for accountability. I choose to no longer be miserable or fearful. I have scheduled a stem cell transplant for March in Mexico. I will go through chemo, lose my hair, and Griff will have to go with me to care for me the entire month. I am hopeful this will put this monster in remission, and I will again be a functional mother, doctor, and wife. I am thankful to have a supportive family to help care for my babies, coworkers who will take care of my patients for the month, and a husband that will hold me up when I’m ready to fall.”
In the meantime, she is including cannabis as part of her treatment plan. “I am currently using cannabis as medicine. I make a cannabis smoothie for breakfast every morning, (no THC, so no concerns about working under the influence) and then treat myself before bed. It has been immensely helpful with my pain (especially trigeminal neuralgia), muscle spasms, nausea, insomnia and anxiety. It hasn’t cured my MS but it has given me reprieve.”
In her plan to help patients by becoming a recommending physician, Lisa never imagined also becoming a patient. “I didn’t plan to get my card, due to the risk of losing my medical license, until my MS diagnosis. There isn’t really a law that physicians can’t use cannabis in Missouri. It’s really up to the state licensing board. I took a huge risk, got my card, and have been very verbal about it. I believe it takes risks, as well as people questioning the system, to make change.”
GRAM couldn’t agree more with taking risks and asking tough questions to change the system. We also believe in the power of sharing personal stories to normalize cannabis and those who consume it, and we want to give a special thank you to Dr. Lisa Roark for choosing to share her powerful story with us. From everyone at GRAM, we wish you the quickest and most healing journey.
Turmeric is a root vegetable commonly used as a spice in various Indian and other cultures’ dishes. Turmeric is in the zingiberaceae family, as is ginger. The turmeric plant is native to the southeastern region of Asia and commonly harvested in places like India, Sri Lanka, China, Indonesia, and Taiwan. It is responsible for curry’s signature orange color, and its vibrant pigment will give essentially any meal an orange hue.
Turmeric contains a substance called curcumin, and curcumin has been shown through research to offer anti-inflammatory and other therapeutic benefits. The scientific name for the turmeric plant is Curcuma Longa, and likely where the name curcumin comes from. When people are talking about the health benefits of turmeric, they are referencing curcumin so you may hear the two names used interchangeably. Curcumin is part of a group called curcuminoids, with curcumin being the most active and the most beneficial for health. Flavonoids are another substance found in various plants and give these plants their color. Curcumin is a flavonoid and is responsible for providing that bright orange color to turmeric. In addition to providing aesthetic value, flavonoids are also strong antioxidants with anti-inflammatory and immune-boosting properties.
The Journal of Biological Chemistry published a study done by Sanjaya Singh and Bharat B. Aggarwal of the Cytokine Research Laboratory at the world-renowned cancer hospital, M.D. Anderson. The study found that curcumin suppressed NF-κB, a protein complex responsible for controlling inflammatory responses. In other words, turmeric shuts off the body’s inflammatory response. Anti-inflammatories can be beneficial for many different ailments, including chronic pain and digestive disorders. A lot of CBD companies even put curcumin in their products because of its benefits. It is believed to be a synergistic pair with complementary therapeutic properties. The thought is that the two plant medicines are powerful on their own; as a combination, they can deliver even more anti-inflammatory and medicinal benefits.
Many people simply add turmeric to their dishes as a way to easily incorporate it into their daily routine. It is pretty mild in flavor and can be added to many dishes without changing the overall taste too drastically. Some say that turmeric isn’t strong enough on its own to receive the anti-inflammatory properties that curcumin provides, and therefore recommend a curcumin supplement. Research varies on that, so in the end it is just up to personal preference and your doctor’s approval. Curcumin supplements come most available in capsules. Pregnant women can safely use turmeric as an addition to their food, but should avoid taking high-dosage supplements. Those who are interested in supplementing with curcumin products should talk with their doctor first.
M.D. Anderson Cancer Center did another study in 2007 exploring curcumin for cancer treatment. The study found that curcumin inhibits ovarian cancer growth and angiogenesis (the development of new blood vessels). It does this by targeting and manipulating the NF-κB pathway, the same protein complex responsible for controlling inflammatory response. According to a report published by the National Center for Biotechnology Information, “The nuclear factor NF-κB pathway has long been considered a prototypical proinflammatory signaling pathway, largely based on the role of NF-κB in the expression of proinflammatory genes including cytokines, chemokines, and adhesion molecules.”
The trend with curcumin seems to be it’s ability to control inflammatory responses in the body. It does this by multiple pathways, but a commonly researched one is the NF-κB protein complex. Because this pathway is able to be manipulated by curcumin to encourage anti-inflammatory expressions, its potential for successfully treating various ailments is there.
Psilocybin + Magic Mushrooms
When many think of plant medicine, specifically those plants with psychoactive effects, they think of “magic mushrooms,” or fungi containing psilocybin and psilocin that can cause hallucinations depending on the dosage consumed. In many states, there are active efforts to decriminalize these otherwise scheduled substances, lowering penalties for their use and possession. But what value do psilocybin-containing mushrooms offer? New research suggests a range of therapeutic and psychological value ranging from the treatment of substance abuse to anxiety and depression management.
What are Magic Mushrooms?
Magic Mushroom use dates back to 10,000 BCE and references continue throughout the era. Their modern popularity began when the term “magic mushroom” was coined by two etnomycologists who learned of a Harvard study on local doctors in Mexico using these substances, noting the substance’s ability to affect the nervous system. These findings were eventually published in Life magazine in 1957, and the term became the universal reference for psychoactive fungi and truffles, specifically those containing high concentrations of psilocybin and psilocin.
Psilocybin & Psilocin: The “Magic” in Magic Mushrooms
Psilocybin and psilocin are part of a family of psychedelic compounds found in magic mushrooms. Psilocin is pharmacologically active, and psilocybin is converted into psilocin when consumed or activated. Similar in structure to serotonin, there are more than 50 species of mushrooms and a variety of truffles that produce both the precursor, psilocybin, and the psychoactive compound, psilocin. Unlike LSD, magic mushrooms do not affect dopamine receptors, solely targeting serotonin sites.
How are Magic Mushrooms used?
Magic mushrooms are often used for recreational, therapeutic and medicinal reasons. “Effects range from mild feelings of relaxation, giddiness, euphoria, visual enhancement (seeing colors brighter), visual disturbances (moving surfaces, waves), to delusions, altered perception of real events, images and faces, or real hallucinations.” Recreationally, this is often known as “tripping.” As an alternative health option, these fungi are being used for anxiety, depression, PTSD, and trauma, as well as psychological disorders such as substance abuse disorders, and science is beginning to back the potential for these applications.
Research on Mushrooms
Evaluations of currently available scientific studies suggest a growing number of therapeutic benefits and treatment options. “In the past few years, a growing number of studies using human volunteers have begun to explore the possible therapeutic benefits of drugs such as psilocybin…looking at psilocybin and other hallucinogens to treat a number of otherwise intractable psychiatric disorders, including chronic depression, post-traumatic stress disorder, and drug or alcohol dependency.”
Magic mushrooms have been respected as a “safe & natural healing sacrament for millennia throughout Mexico, Central America and the world,” and are known to be beneficial for depression, recidivism (the tendency to repeat past transgressions), and encourages openness, creativity, as well as personal and spiritual growth. UCLA and NYC have done studies on the applications of magic mushrooms in the treatment of end-of-life anxiety and other studies have backed up the use of psilocybin and psilocin in the treatment of substance use disorders, depression (especially in cases of terminal conditions like cancer as well as treatment-resistant depression), and reducing depression and anxiety overall.
Best way for people to consume?
When it comes to the consumption of mushrooms, advice on dosage is about as specific as it was with cannabis under prohibition. Consumers must purchase on the black market and are subject to whatever may be available.
“Recreational doses range from 1–5 grams of dry mushrooms depending on the species and individual strength of the specimens… After ingestion, the psilocybin is enzymatically converted to psilocin. Absorbed from the gastro-intestinal tract, hallucinogenic effects usually occur within 30 minutes of ingestion with a duration of effect of 4–6 hours.”
My recommendation as someone who has used magic mushrooms both for recreational and therapeutic purposes, is to grind the mushrooms into a fine powder and either encapsulate them in small increments and/or combine with lemon juice. Capsules will allow you to titrate your dosage as needed with a recognizable increment, while lemon juice will expedite onset time.
The Legality of Magic Mushrooms
In the United States, psilocybin is a Schedule I controlled substance, with no accepted medicinal value and a high potential for abuse. In contrast, the Drug Policy Alliance states that “Physically, psilocybin mushrooms are considered to be one of the least toxic drugs known.” With that being said, local efforts such as Decriminalize Nature – Oakland and Decriminalize Denver have pushed for and successfully passed initiatives and legislation to reduce penalties and make enforcement a low priority, as was done in the early days of cannabis activism. This has spurred multiple local and international efforts to “Decriminalize Nature,” efforts that we learn more about in this month’s feature.
Ginkgo biloba is an ancient tree; its roots originate in China. The ginkgo biloba tree is also sometimes known as the maidenhair tree or the Japanese silver apricot, and it produces a foul-smelling fruit commonly harvested for its seeds known as “ginkgo nuts”. Ginkgo nuts are popularly used in Asian cuisine.
The ginkgo biloba tree’s fan-shaped leaves are used to make ginkgo biloba extract, a supplement traditionally used in Chinese medicine, but has since garnered the attention of cultures worldwide. The supplement comes in liquid extracts, capsules, and tablets. The leaves can also be dried to make tea. The type of ginkgo biloba extract supplement someone takes is all a matter of personal preference, and depends on the user’s already existing regimen. If you do not already drink tea, a ginkgo biloba tea may not implement easily into your lifestyle, thus a greater chance for inconsistency or erratic results. But if you take vitamins or other supplements regularly, after a doctor’s approval you can easily incorporate an additional capsule or tablet into your daily routine.
The 16th-century Compendium of Materia Medica or Ben Cao Gang Mu is revered as the most comprehensive text ever written in the history of traditional Chinese medicine. This text reveals that ginkgo biloba seeds were used as a topical extract for antimicrobial purposes on the skin. Traditional Chinese Medicine also uses the leaves for tea and attributes it to soothing coughs and activating blood circulation, as well as other benefits like respiratory and digestive ailments.
A common use for ginkgo biloba is to preserve memory and prevent cognitive decline. Dr. Hiroko Dodge of Oregon State University at Corvallis and his research team followed 118 people for three years aged 85 years and older, in good health, and showing no signs of dementia or memory loss at the beginning of the study. Half took ginkgo biloba and half took a placebo over three years. The patients taking it regularly had a 70% lower risk of developing dementia. According to the study, the other variables included considered “basic demographic variables including age, sex, years of education, and living arrangement (living alone vs living with someone).”
The National Center for Biotechnology and Information published a study exploring ginkgo as a potential remedy for anxiety and, “The authors reported a significant improvement in psychopathological symptoms. Response rates were 44% in the high-dose group, 31% in the low-dose group, and 22% with placebo. Additionally, the percentages of clinically significant responses were 81%, 67%, and 38% for the high-dose, the low-dose, and the placebo groups, respectively.”2
A 2008 study reinforced the idea behind Traditional Chinese Medicine that ginkgo biloba improves blood circulation. The study shows ginkgo biloba extract to improve coronary artery circulation in patients with coronary artery disease. The study notes, “GBE (ginkgo biloba extract) treatment demonstrated a significant improvement in maximal diastolic peak velocity (MDPV), maximal systolic peak velocity (MSPV) and diastolic time velocity integral (DTVI) compared with controls.”3 In other words, ginkgo biloba extract is a great contender as a treatment to improve blood flow.
Like cannabis and other medicinal plants, ginkgo has terpenes and flavonoids. Both of these compounds have therapeutic properties, and can provide anti-inflammatory benefits as well as being packed with antioxidants. Anti-inflammatory effects can serve many different ailments, especially relieving pain of various kinds. Antioxidants are thought to protect our bodies from free radicals, which are unstable molecules that can cause harm to the body. Terpenes are also responsible for giving plants their unique and flavorful smell. Flavonoids are the compounds that give plants their vibrant and diverse colors, and are the largest group of phytonutrients. There are approximately 6,00 different types of flavonoids.
A few years back, the National Toxicology Program released a detailed report on ginkgo biloba extract. It dissects the toxicity and carcinogenic properties of ginkgo biloba using rodent test subjects. The report made its rounds as proof that ginkgo biloba causes cancer, because the rodents developed cancer at high-rates over two year periods. Per the American Botanical Council, “Adjusted for bodyweight, dosage levels given to the animals were up to 55 to 108 times higher than levels of ginkgo normally ingested by human beings taking ginkgo supplements.” Many people have been using this report to warn against the supplement, but Bill J. Gurley, Ph.D., a professor of pharmaceutical sciences at the University of Arkansas School for Medical Sciences, Little Rock said, “Almost anything will create cancer in rats and mice when it’s fed to them at high doses for two years.” The American Botanical Council also claims the ginkgo biloba extract used in the rodent experiment was of lesser quality, and not meeting European standards.
Though this seemingly negative research on ginkgo can be explained, it is still important to discuss any kind of supplement addition with your doctor, especially if you are on other supplements or pharmaceutical prescriptions.
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