Reviewing the Endocannabinoid System

Transcript:

– Thank you everybody for being here. We really appreciate your time. I’m Dr. Jen Palmer. I’m a Naturopath, Education Director for Charlotte’s Web and we are distributed through the ECS Distributors. And I want to thank them for hosting this. And we have Brian Grosso here from our sales department who Brian if you want to jump in at any time just put a note there and I’ll let you in. And I just want to thank you all for joining us today. Hang on, I’m checking notes. Yeah, there we go. All right, so today I’m going to cover a little bit about the company, just really briefly, what is CBD basics just for anybody who might be brand new to this industry. And doesn’t have a lot of information about it. We’ll cover that really quickly. Talk about quality and mostly talk about the endocannabinoid system, and what is CBD and how does that work? And then Dr. Nevius is going to jump in and talk about clinical experience, and therapy more therapeutics. Now I’m a naturopathic doctor, but I’ve been in the dietary supplement industry for about 20 years now. And so I’m not a practicing clinician. And that’s why I asked Dr. Nevius to join me, to share his clinical experiences because I just read the research and that’s not always the same thing. So, we can get started right now. And please, if you have any questions, feel free to type that in the chat feature, and we will review those at the end. So, first of all, let’s talk about what is the difference between hemp and marijuana. This is a really confusing topic, and it’s very common to be a question because literally these are the same plants. They’re cannabis sativa, that’s their Latin nomenclature. But the thing is because they’re plants, they create different compounds and the marijuana plants create a lot of THC versus hemp, which is really high in CBD. So, in the 2018 Farm Bill is when we decided that there was a difference between hemp and marijuana, and because both were really scheduled like controlled substances at that time. And so the new definition for hemp is that it has less than 0.3% THC. Marijuana on the other hand, is anything over that, but typically marijuana is bred to have 15, 20 maybe even 30% THC. And as we know, marijuana as medical cannabis is legal in 33 States, and recreationally it’s legal in 11 States. And hemp, because of this 2018 Farm Act, is now legal in all 50 States. So, when we’re talking about CBD. You may have heard this term, The full-spectrum hemp extract, and that’s what Charlotte’s Web is. And what this means is that we are extracting all of the compounds from the hemp plant, and keeping them into this formula. So, with the full-spectrum hemp extract, the hemp plant offers up to 500 different kinds of compounds. And that includes terpenes and essential fatty acids and phytosterols and flavonoids. It also, the hemp plant is capable of producing a variety of up to a hundred phytocannabinoids. And so that includes THC, and CBC, and CBG, and CBN. Now one plant doesn’t produce all of these, but these are all them we know of and have researched. And all of these compounds work together in a full-spectrum hemp extract, to create the Entourage Effect. And that’s the synergy where these different compounds support the CBD and help it be more active. And research has shown that this full spectrum entourage effect is superior to just using a CBD isolate. Now the definitions for full-spectrum hemp extract and CBD isolate, and broad-spectrum hemp extract, which you may have heard of, were recently defined by the US Hemp Authority. And Charlotte’s Web is certified by US Hemp Authority which really gives you a guarantee for quality. Now, the full-spectrum hemp extract I just explained, and a CBD isolate is exactly what it sounds like. It’s purely CBD. It’s isolated as no other supporting vital compounds, and it has no THC. So, there’s that benefit. If somebody is worried about a drug test, however, as I said, the full-spectrum entourage effect is superior. And so by taking the same amount of a CBD isolate you’re going to get a bigger effect from that. Now this middle term broad-spectrum is kind of a confusing one and still a little vague in the industry. And not it doesn’t always follow this definition but technically what they’re saying is a broad spectrum only needs to have two cannabinoids and one terpene. Those can be a mix and match situation and it may or may not have THC. So when you see broad-spectrum on the label you really have to do some digging and you can’t really assume it is exactly what this definition says. Now, back to this concept of the Entourage Effect I really like in this to, what the benefits we get from eating an orange. Now we know through science that eating the whole food is superior to getting just like the isolated pill of a nutrient, so an isolated vitamin C. You have to take a lot more of that to get the same benefits as you would from vitamin C from an orange, that’s because the orange provides a lot of other beneficial compounds like flavonoids, and anthocyanins and polyphenols and hesperidin. These are all really powerful antioxidants, and they enhance the absorption and the activity of the vitamin C. And there are studies that show this. So, the effect that you get from vitamin C, in this full spectrum orange, is superior to taking a CBD isolate. And that’s very similar to the story of hemp. So, in case you’re not super familiar with what CBD is. This is the most prominent compound that the hemp plant produces. So, it’s short for cannabidiol. And so among all those other phytocannabinoids you are usually going to see much higher levels of CBD than anything else. And it is one of the more active compounds and be more researched compound probably because it’s found in more significant quantities. So, this entourage effect is this concept of synergy, that all the compounds work better together. And the endocannabinoid system is what the CBD works on. So, the endocannabinoid system is a system of receptors. It was recently discovered in the 1990s actually, and what this is are receptors that found throughout our body. Now our body makes endocannabinoids, and these are very similar in chemical structure to the compounds that the hemp plant makes. So, the endocannabinoids, for example, is anadamide and 2ag. And these work on the endocannabinoid receptors. And for example anadamide, is also known as the bliss molecule. And this hemp gives you a very calming feeling, not unlike THC, but these endocannabinoids are very short-lived and they don’t last in your body very long. But you get their body makes these in response to things like yoga or exercise or meditation. And that anadamide is that feeling that we get of contentment after doing those kinds of activities. So, these endocannabinoid system, so these are receptors that are found throughout the body everywhere, and they interact with all different systems of the body. So, think of the immune system, the cardiovascular system, the endocrine system, all of these intersect with the endocannabinoid system, and it helps bring balance throughout. And so I like to call it the master switchboard, because it’s really helping regulate all of these systems in our body and helping them become more moderate. So if they’re excessive or deficient, it helps bring them back to balance. So the CB1 and CB2 receptors are the primary receptors of the endocannabinoid system, and these are both found all over the body but you’re going to see a lot more concentration of CB1 receptors in the central nervous system and the brain, the spinal cord and the cerebellum. And then you’re going to see a lot more of these CB2 receptors found in the peripheral area. So the peripheral nervous system, the immune system, the digestive tract, the eyes, the heart, the lungs, the organs. Now what this endocannabinoid system does, is it helps regulate the system. So it helps moderate inflammation. It helps regulate neurotransmitter production can be neuroprotective, and it can support the gastrointestinal and the immune systems. And the fact that these receptors exist, and they receive the endocannabinoids or phytocannabinoids from hemp, to me is a sign that our body was actually made by nature to accept the compounds made in the cannabis plant. Now on top of those CB1 and CB2 receptors which are the most well-researched, we also know that the endocannabinoids interact with these other receptors in the body. So they bind to things like the 5-HT receptors to make serotonin. They work with the TRPV receptors to regulate pain. They work with the PPAR receptors for insulin sensitivity and they interact with the GABA receptors for calming. So this is just an example of how these endocannabinoids are so pervasive and how they interact with all these other systems of the body, which are really, these are more like neuro-transmitter receptors. And just briefly a little bit more detail about the gastrointestinal endocannabinoid system, it’s very prevalent. And it’s a really interesting topic to study. We find that these endocannabinoid receptors are in the gut and they help bring balance to the GI immune system, to gut mortality, to gut pain, and to secretion. So, when this ECS and the gut is out of balance you’re going to experience potentially things like IBS and IBD and gastro other gastrointestinal diseases. Now this gut inflammation is related to conditions like intestinal bowel disease, and leaky gut or damaged microbiome. And so, this triggers the endocannabinoid system to produce endocannabinoids and help create balance in the gut and help reduce inflammation or decrease abdominal pain or decrease motility in the situation of diarrhea. So, this endocannabinoid system modulates the intestinal inflammation, and that’s happens by reducing these inflammatory cytokines. And there seems to be a reciprocal relationship between the gut microbiome. So the probiotics there and the GI endocannabinoid system. And so by enhancing the microbiome, and making sure it’s optimal, by using probiotics and prebiotics, that can really help support the endocannabinoid system functioning really properly. So, together endocannabinoids and a healthy microbiome will help keep that gut inflammation in check. And it can work on things like IBS, cannabinoids can help reduce diarrhea because they trigger the CB1 receptors which are anti propulsive. And so that’s going to decrease the acetylcholine levels and help reduce loose stools basically. And then in the skin, the skin also has its own endocannabinoid system. There are receptors of the CB1 and CB2 receptors, in the skin cells in the epidermis. So you’ll see those in the sensory nerves the hair follicles, sweat glands, and the skin also makes its own endocannabinoids. So, this all helps regulate hair growth and sweating, and oil production. Now, you can use CBD topically on the skin, and that is only going to affect that area of epidermis where you’ve applied it. It’s not going to get absorbed systemically. So there’s no concern about THC getting into the body, if there’s any kind of drug testing situation and topical CBD is just a really good place for people to experience the benefits of CBD without taking it orally. And it’s kind of a nice entry level for people who are new to that. So just super briefly, this concept of our body makes endocannabinoids, there also could be endocannabinoid deficiency. And this is probably why so many people are benefiting from taking CBD. So, this is a theory developed by Ethan Russo, who is one of the premier cannabis researchers. And it’s also been supported through other research but still it’s in its infancy, but he shows us that endocannabinoid deficiency may be linked to Alzheimer’s, Parkinson’s, depression, chronic pain or IBS. That’s a note article cited there the first one, and also there’s been evidence that low and the cannabinoid levels, have been found in chronic things like migraines, PTSD, and fibromyalgia. So very interesting that they’re finding correlations between the presence of these diseases and low endocannabinoid levels. And also there’s been some preliminary evidence that using phytocannabinoids for these conditions can be beneficial. And really briefly, these are some really great review articles I highly recommend if anybody wants copies of them you can email me, but basically this one over a review article on the GI diseases says, “An impairment of ECS signaling has been suggested “to play a key role in several GI diseases “like functional gastrointestinal diseases “and intestinal bowel disease and liver diseases. “And even if conflicting results have been produced “in vivo, convincing evidence suggests “that pharmacological manipulation “like using cannabis products of this multifaceted system “might provide new therapeutic options “in treating GI diseases.” And I believe that that is going to be a really big in our future of understanding this better. And this other review article and the cannabinoids in dermatology was really interesting. And essentially it’s saying “When the skin ECS is out of balance “we can have acne, allergic dermatitis, psoriasis, eczema, “excessive hair growth “and potentially even auto-immune skin disorder.” So there’s a lot of interesting things to explore there using a topical CBD product. And this one in a nutshell is basically when people ask how much do you take? I know that Dr. Nevius will address this, but basically it’s very customized for each person and we always recommend start low and go slow. There’s a great reference here, this project CBD how to CBD drug interactions. If you go to project cbd.org and go to CBD drug interactions, they provide an excellent resource. It’s a downloadable ebook that really thoroughly explains how CBD can interrupt CYP enzymes and therefore explains how it could interact with specific pharmaceutical medications. And also it explains how you can actually adjust the pharmaceutical medications to accommodate that reaction. And therefore a person can take CBD along with their medications as long as you are overseeing that and knowledgeable about your recommendations. Also, I just wanted to let you know that we are participating in a industry-wide study right now. And we are going to be testing enzyme levels in consumers who are regularly taking CBD over the long-term. And we expect that the results of that will show that liver enzymes really don’t increase at regular dosages that our average users, our consumers are using. So that is just starting next month. And we hope to get some information by this fall and we will keep you updated on that. So I’m going to have Kyle takeover now. Sorry, I went a little bit over. Kyle, why don’t you try to share your screen there? And again, please feel free to type in any questions you have along the way and we’ll address those at the end. All right, you there Kyle?  

– [Kyle] Okay, so, my job is to talk about the clinical effects that I’ve experienced over the last four or five years with Charlotte’s Web. But before we get started, Dr. Jen, I’m not able to see the screen that I’m sharing or the slide that I’m sharing. Do you have any advice? 

– [Jen] No 

– [Kyle] I can see your lovely picture. 

– [Jen] You don’t see your own computer screen? 

– [Kyle] I do not. 

– [Jen] Okay, so stop sharing and start over again. ‘Cause I see it.

– [Kyle] Okay, when I share it has your picture. 

– [Jen] Well, you can’t see your PowerPoint. 

– [Kyle] I cannot see the PowerPoint. 

– [Jen] I can see it, but I can’t control it. So, did you unsharing and then resharing? 

– [Kyle] Yes, I did, I can certainly do that again. 

– [Jen] All right, well, why don’t you just instead of showing your slides, just talk? 

– [Kyle] Okay, I can do that. 

– [Jen] Okay. So Kyle, if you want to go through your PowerPoint you can just stop sharing the screen and then just look at the PowerPoint yourself and just talk to us. 

– [Kyle] All right, so I’m assuming you can see the screen. 

– [Jen] Yeah we can see it. 

– [Kyle] Okay, so what the industry what has struggled with for, well since its inception is clinical data to support. Many physicians are hesitant to start utilization or even recommended, recommend CBD to their patients unless they know it’s safe. And unless they know that there’s a reputable brand out there that is going to be consistent and safe with the dosing. And that’s where Charlotte’s Web comes in. I could talk all afternoon on why I recommend Charlotte’s Web and Charlotte’s Web only, that’s a separate conversation but for those of you that may get that question feel free to email me or call me. Or we can discuss that later on in the Q&A, but there are many, many reasons. The first of which is the average CBD company in the United States is only about two years old. And Charlotte’s Web is approaching, I believe 10 or 11 years old. And then we can talk about federal guidelines, participation, outcome measures, endorsement by the Realm of Caring, and so on and so on. But as a physician, Dr. Palmer touched on some really great and promising areas for GI skin… In my wheel house, I deal with a lot of musculoskeletal and neurologic issues. So, I was very interested in the national pain foundation research that showed that CBD was actually mortified. 

– [Jen] Kyle, we lost you. Kyle? 

– [Kyle] Can you hear me? 

– [Jen] Okay, you’re back. 

– [Kyle] Okay, so we as physicians have an additional tool in our tool belt when we are dealing with patients that have chronic pain. And that’s really important especially with the challenges of opioids. So when patients come to you and say, “I’m having chronic pain “but I cannot or will not considered opioid addiction,” this is something you can discuss with your patients. There are other clinical issues that we’ll talk about but I’d like to start off by saying anything in medicine and in science has started off with anecdotal responses. Anecdotal response or success is always followed by a scientific confirmation, okay? So we all know that CBD is in the anecdotal phase right now because we don’t have all the research and the double blind studies that we’d like to have to support. That is not the majority of the public opinion of physicians looking forward. Because many physicians like myself have already seen significant impressive outcomes, and understand that CBD is a safe, relatively safe, especially if you choose your product wisely. And so that’s where Charlotte’s Web comes in. We want as physicians a product that we know is going to have 6,000 milligrams in that bottle if it says 6,000 milligrams, we want it to be consistent. We know that it’s going to be the same consistency and therefore, hopefully, same outcome, each and every time. I have patients that have been on this now for five years and they buy another bottle every month, like clockwork. And I think that’s important because for people to spend their hard earned money on a product day in and day out, I think is probably one of the highest votes of confidence that we can ever expect. Now, a lot of us already know this and Dr. Jen touched base on this, but years ago cannabis made up half of the medicine from 1842 to 1900 Prada to aspirin. And then it was outlawed until 1939. Well, what happened in 1939? It’s called the Second World War. And all of a sudden we changed her mind, Oh, we need hemp now, because hemp is great for rope for the Navy’s ships. It’s great for the material that we make our soldiers uniforms from, and there were many advantages so it was legalized. Now, from the clinical side, I know Dr. Palmer wanted me to touch base on the clinical side. So I’ll try to stay focused on the clinical side. We all know that Charlotte’s Web became famous because of little Charlotte, and the way it controlled her seizures unlike any medication on the face of the earth. And she’s not the only child to benefit. What we don’t know is why some children or adults respond very well and others have an equivocal response. So ongoing research has been going on for a while, that this particular research was actually approved by the FDA if a couple of years ago. And it was part of the Epidiolex research. I know most of you already know that Epidiolex is the pharmaceutical approved brand but I’m here to tell you as a physician that not everybody responds well to Epidiolex. And I think part of that is due to the way it is processed the way it’s extracted and the fact that it may not be full spectrum. But that’s a whole another talk on a whole another day. Okay, so when you’re talking to physicians or pharmacists, one of their most important questions is how do I achieve the best outcomes? Well, first of all, you have to pick a superior product. And when I speak to physicians at these conferences I try to lower the learning curve and say, “Look don’t take my word for it. “Go to places like Realm of Caring.” Realm of Caring is co-managed by Johns Hopkins. It has input from Harvard medical and many other institutions. They publish white papers on their research library website. That’s easy for you to digest, go there doing your own research. Don’t take my word for it. But the Realm of Caring only endorses a handful of products a handful of CBD companies. And I think Charlotte’s Web was one of the first. So, you can narrow the field from 3,500 to about a half a dozen products that are approved by the Realm of Caring when you are asked that question. And it’s not just your opinion when you share that information, it’s information from well-respected medical entities. So when we talk to physicians, we say, look don’t waste your time with lower milligram dose. The minimum bottle should have 1500 milligrams and should go at, or higher 5,000 for your neurologic and chronic pain disorders. This question comes across the desk a lot. You know, why are the bottles or the droppers not regulated? Well, it has a lot to do with the dropper sitting in the product itself and the material that’s used to regulate that. So, we provide either regulated droppers or three millimeter three milliliter, or three CC syringes to our patients so they can accurately dose themselves. And of course, we give that to them when they purchase the product, but that’s why the droppers do not have the calibration in the bottle. Obviously we want it to be organic non-GMO whenever possible. And we also need to realize if you’re a treating physician, the majority of the products that you’re going to use are going to be critical CO2 extracted, but I have come across merely from an anecdotal standpoint and experience in the field with patients that do not respond as well to the critical CO2. And what we did is we turned around and gave them a brief trial of the original formula. And most of you know, that the original formula of Charlotte’s Web is alcohol extracted and many of those patients did respond favorably. So, I recommend that you start with the critical CO2 but if you don’t have the outcomes you want, or no response, I would encourage the patient to at least try one brief trial or one bottle of the original formula which is the alcohol extraction and that’s 5,000 milligrams. So you’ll have to adjust your dosing a little bit. And we’ll talk about dosing a little later. Forbes Magazine published about tag article in 2017 by the Brightfield Group and HelloMD. At the time they had 175,000 members. It was the largest survey today. Now they’re well close to 350 400,000 members. And the information that they extracted from these people was very interesting. And it talked about the fact that women are more likely to use initially, but later on, men will use the product long-term. At that time, the diagnoses that seem to respond the best, were insomnia, depression, anxiety, and joint pain. And I think that’s consistent with what a lot of us have found in practice. The chief medical officer Dr. Perry Antelman has said 80% found the product to be extremely effective. And that’s a really good percentage for any pharmaceutical, let alone a CBD product. I’m not going to talk about drug test, and we can address that individually, if you have the questions during q&a but there are some considerations for those of you that are dealing with patients that may be in a drug testing program. There are other references for dosing. So I don’t want you to just go by the information I am going to provide today. Realm of Caring has, or did have a great dosing recommendation or a place to start. Pediatric doses were also recommended and utilized on that website for your pediatric patients. And of course, there’s a difference in adults. And a lot of it has to do with metabolism and course body weight and saturation. I like to tell people that we divide patients into two primary groups when they walk in our office for a consult. Half are going to complain about anxiety, stress, sleep, disruption. Those patients will typically respond to the lower dosing envelope. They don’t need high dosing and they can respond quickly typically within 72 hours. And so when someone walks in my office and says, “Geez, I’m stressed, I have anxiety. “I have sleep disruption.” I have a very high level of confidence that we’re going to help this patient. And we’re going to help them very quickly. When we talk about pain, the other half, we divide pain into three categories, musculoskeletal inflammatory which involves mostly arthritic and neurologic. And those patients typically require higher doses and require more time to reach therapeutic levels or in other words, to get the relief. So, the musculoskeletal patients, the strains, sprains, the muscle tears, contusions, they respond a little quicker, with little lower dose. We found that the inflammatory or arthritic patients take a little more and a little longer. And our biggest challenge, are our neurologic patients. Spinal cord, chronic pain, chronic spinal pain patients, postoperative discopathy is things like this where there is a spinal cord or neurologic compression. Also the neurologic disease category the and eating disorders, things like that. Those also, and we call it the 21 day rule. In other words, it may take up to three weeks for these people to reach therapeutic levels. And so you have to coach them, you have to encourage them and you have to realize that’s why a lot of patients that walk into your office will say, “I’ve tried CBD and it just doesn’t work.” Well, A, you probably didn’t try a reputable company. B, you probably bought a little 30 ML bottle that was 50 milligrams, and C you didn’t take it long enough. So, the outcome is going to be directly related to the patient compliance and the physician or pharmacist knowledge about how to start these patients. We want patients to have a great response right off the bat and that’s not always possible, but that’s our goal. But I like to say sometimes we have one chance to get it right the first time because you may lose those patients afterwards. But we try to encourage them to hang in there. I’ve had patients that have stayed with their CBD integration over 30 days, some 45 days before they actually turn the corner, but they did respond and they responded very well. AEDs I’m going to say this about any anti-epileptic medication. CBD has the effect to increase decreased and in rare cases, to have a neutral effect on these medicines. So when you’re working with patients that have seizures they’re already on one of maybe 30 different medications. And so you need to understand that if they’re on phenobarb, Topamax, Keppra, Depakote it’s going to increase that effect. Now, at first that sounds a little unnerving, but the reality is it’s going to allow their neurologist to decrease that dose. And hopefully decrease those horrific side effects that accompany those medications. If it’s something like tegretol there’s no effect whatsoever. But look at klonopin, klonopin will have to have an increased dose with CBD to have the same therapeutic outcomes. So, that’s why it’s important that you work with the patient’s primary care or neurologist to make sure they’re up to speed. I get referrals from neurologists in Naples, where I practice. So, after a while they start to learn and they develop some confidence. They realize that CBD is not a risk. It actually lowers their risk as a physician because they’re able to reduce the amount of medications some of which are harmful for their patients. And so over a period of time we’ve seen a shift from our physician community but it’s still is going to be heavily weighted on when we can provide more extensive research. TSA restrictions, I’m not going to touch on, but we can talk about those, if someone has that important outcome. Now, originally, if you recall glaucoma was supposed to be improved, but a recent study, I think it was University of Indiana, said that CBD blocked the THC effect. And so at least in mice, it was not successful. It reduced the effects or the improvement of glaucoma. In fact, it could aggravate glaucoma in mice. So, if you’re a veterinary and you’re treating mice for glaucoma, I wouldn’t recommend it. But as a physician, I have to at least make our patients aware that the data is inconclusive and that CBD alone may not be the way to go. These patients in fact, may ultimately end up responding to a higher THC product, such as a marijuana product. Brandon Korman is a gentleman I met and I won’t go into detail but he is on the forefront of research and outcomes. He’s been involved with Epidiolex. He’s part of the research program at Miami Children’s Hospital but I’ve been able to meet a lot of great people and very important places on the front if you will, on the battleground of CBD research. All right, loading dose. Let’s talk about dosing briefly. If you have a pen and a piece of paper this will be the time to pull it out. I have based this on about four or five years of experience and cross-reference that with the initial loading dose approach that Mayo Clinic provided and that Johns Hopkins endorsed through the Realm of Caring. So, when I’m dealing with patients, I try to divide them into weight categories for the initial dose unless there’s another variability to the equation. Zero to a hundred pounds, I like to start them on 15 milligrams BID, or twice a day. If they’re 100 to 150 pounds, I like to start them on a minimum of 30 milligrams twice a day. If they weigh between 150 and 200 milligrams, 45 milligrams, I’m sorry if it’s 150 to 200 pounds, I like to start them on 45 milligrams, twice a day. And any patients over 200 pounds, we like to start them on 60 milligrams BID or twice a day. Now, if they are being seen for stress, anxiety, sleep interruption, I’m going to go on the lower end of that envelope when I start them. If they come in with a horrific chronic neurologic spinal issue, I’m going to start them on the higher end of that envelope. And I’m going to coach them, and I’m going to tell them to call me every three days let me know how they’re doing. And I’m also going to tell them not to expect any miracles right up front. In fact, I talk to them about the fact that most of our neurologic patients require about three weeks or 21 days. We call it the 21 day rule. But your sleep, your stress, your anxiety patients should respond very well, very quickly, to low dosing, but that’s a great place to start. Obviously, everyone does not respond in the same way or manner, but it gives you a baseline. Now, resources, in addition to Realm of Caring, I like Google Scholar, CBD project has some great stuff. Of course, PubMed, National Institute of Health and Department Health and Human Services, our government entities and they’re a little lethargic in their response to publish. So, I really like Realm of Caring as my first place to go. And I’m sure that most of you are familiar with that. If not, it’s theroc.us.  Center for Cannabis Research has recently published some great articles on autism, anorexia, and essential tremor. And I know Dr. Palmer also mentioned a few minutes ago about the research within the GI tract. Alright, so, like I said, we have one chance to get it right the first time, contact me, if you have any questions, or Dr. Palmer, and Dr. Palmer, I’m going to hand it over to you. 

– [Jen] All right, thank you, Dr. Nevius. That was great information. Everyone is welcome to, can you mute yourself please, Kyle? 

– [Kyle] I’m trying to get there. 

– [Jen] Everyone’s welcome to email me, Jen, jen.palmer@charlotte’sweb.com. I have access to thousands of research papers. If there’s any topic that you’re looking for, some kind of substantiation on, I’ll be happy to pull that for you. Also with Realm of Caring. There are other website as realmofcaring.org. You can pull research papers from there, and also they have free education and consultations for clinicians who want some information or more specifics including pharmacists or any other kind of any other practitioner. Thank you everybody for being here. I don’t see any other new questions, and we look forward to talking to you again in July and have a happy 4th of July and a wonderful week. Thank you, bye-bye.