Understanding Cannabinoid Hyperemesis Syndrome (CHS) with Dr. Codi Peterson, & Megan Mbengue

Dr. Riley Kirk  0:03  
All right, today's topic is actually an adverse effect that some people develop from cannabis use over time called cannabinoid hyperemesis syndrome, or chs. CHS is a condition characterized by reoccurring episodes of severe nausea, vomiting and abdominal pain and individuals who use cannabis regularly over an extended period of time, it's quite paradoxical, because cannabis is often used for antinausea or antiemetic properties, yet from CHS, these symptoms could actually arise from chronic cannabis use. Patients with CHS may find temporarily from hot showers or baths or from rubbing capsaicin or hot pepper cream on their stomachs. This is a distinguishing feature of this syndrome compared to other syndromes that may cause other types of vomiting. There is very likely a genetic component to CHS, so not everyone who uses cannabis is equally as likely to develop it, and we will discuss that, as well as some other theories on CHS throughout this episode. We are releasing this episode today because we are running a study on CHS right now at this very moment when this episode drops in october 2024 this study is being run through the University of California, Irvine, with myself today's two guests, Dr Cody Peterson and Megan bang, as well as three other amazing researchers who will mention this episode. CHS is very real, stigmatized and often misdiagnosed. The goal of this study is to learn more about the signs and symptoms of CHS and what may be contributing to its triggers. The links to part one and to part two of the study are going to be linked in the show notes, three people from part one and three people from Part Two are going to have the opportunity to win a total of $600 if you sign up for the raffle after completing the study. We really, really, really appreciate you taking the time to contribute to science. So we wanted to give back in any way we could, which is from raffle prizes. So during this episode, stretch your legs, check on your plants, grab a glass of water and just Chill with us for the next hour or so. You

all right, welcome back to the bioactive podcast. I'm your host, Dr Riley Kirk, today we have two guests with us, Dr Cody Peterson, also renamed Dr Cody wederson On the last pod that you were on here, and Megan bang, who has also been here a lot, or a couple times, I should say, who is a cannabis nurse. And the topic of today's discussion is CHS, or cannabinoid hyperemesis syndrome. And this is a serious topic. It is a serious podcast, because there's not a ton of information out about chs. It sometimes question the validity of it, which I think is kind of egregious. It's absolutely real. It's absolutely happening. So we'll start there, but let's start with talking about what CHS is. So Cody, can you just kind of start from just 30,000 foot view, what is chs?

Codi Peterson  3:17  
And I would just stress that this is very much real, and in the hospital where I work every not every night, thankfully, but where I work full time, is we saw a patient that fits this mold perfectly, just last night, within the last 12 hours, and this is a patient who's experiencing repeated bouts of nausea and vomiting that is uncontrolled, with normal anti emetics, and that individual has been consuming cannabis, most likely high THC cannabis, for an extended period of time. So it's an unexplainable vomiting that is refractory or resistant to our normal medicines. That is in someone who's been smoking a lot of cannabis, and, interestingly, hot baths and showers. They patients often find relief or have a tendency to start taking hot baths and showers. So that's sort of like the Hallmark classic case of something known as CHS

Dr. Riley Kirk  4:15  
love that can we also discuss? Like, how much vomiting is this like, Oh, I hit the bong and I puked after is this like, like, a lot of vomiting?

Codi Peterson  4:23  
Megan, you're welcome to chime in at any point. I don't want to cut you off, but the answer is,

Dr. Riley Kirk  4:28  
Oh, yeah. Honestly, anyone answer at any time, I feel like we all kind of vibe all the time. So like, just go for it.

Megan Mbengue  4:33  
Yeah. I think there's it is important to differentiate between, like, vomiting caused by acute intoxication versus chs. You know, somebody who had their edible story. You know, they just had too many edibles and then vomited after. This is not chs. This is somebody who's been using cannabis for a long period of time, depending on the type of cannabis, and that amount of time, and then they there. There's a series of events. That happen before they even get to the vomiting phase, and we can cover that. But the vomiting, I think it's like for some people, it's a couple of days that it lasts. A lot of people end up in the hospital and with severe dehydration, and we've seen severe organ damage, and even people dying of this. It's

Codi Peterson  5:19  
an unfortunate truth, but I think that Megan makes a really good point. I'd love to talk about what leads up to this. But the intensity of the vomiting is remarkable, or remarkable. Often people are described as screaming and vomiting at the same time. There is an immense amount of GI distress, pain, uncomfortability, sort of cramping, as opposed to say, when you've smoked too much cannabis and maybe you were drinking with your buddies before, you're likely to get more of that typical like light headed vomit acutely feel a little bit better, lay down and sort of shake it off. That is not what's going to happen here. In fact, it's likely you're going to have continued episodes for over the period of hours or even days where you can't keep anything down, you can't think of food, you can't you can't tolerate anything by mouth. Yeah,

Dr. Riley Kirk  6:10  
and this is really important for the cannabis community, because at least for me, if I'm feeling nauseous, if I'm feeling sick, if I have GI issues, I might smoke more weed, you know, I might be like, Oh, my stomach hurts, or something's happening with GI issues. I'm gonna hit the bong to make sure that, you know, my stomach can calm down. And this is where a lot of people's thought process goes, and they end up using more cannabis, and it perpetuates the issue further and further, because a lot of people don't know about CHS, so it's hard to tell those, those signs of when it's starting. So I think we were kind of getting into the conversation. Of the prodrome phase, or what's happening, you know, before someone gets really, really sick. So I think you're starting to say that, Megan, would you want to? Yeah,

Megan Mbengue  6:51  
yeah. So prodrome is technically like phase one of CHS, and this can last for weeks, months or even years prior to the first vomiting phase, and typical symptoms we see are people wake up with nausea, they start having heartburn, alcohol intolerance is surprisingly a big one that a nurse friend of ours sees in a lot of her patients. Cody, what else do we see in like

Codi Peterson  7:19  
a morning heartburn, particularly pain above the belly button, we see individuals who are waking up very sweaty or anxious in the mornings, who don't feel good in that especially that early morning time. And once again, these individuals are typically consuming cannabis for long periods. And when they consume cannabis, say, on a day they feed, wake up feeling icky. It might help a little, a little marginally right during that, that acute phase, but that's actually the, you know, what we believe to be, what's setting them down this path in the first place, and it can be a really challenging condition to better understand. Wait,

Dr. Riley Kirk  8:00  
I think this is a really good point right here to plug the study that we're doing. You might notice a lot of what we're saying is like, Oh, we see these trends, or we think this is happening, you know, a lot of hypotheses, but we are starting a study. When this podcast is released, this study will be out, and it'll be linked in the show notes of this episode, as well as our social media channels and the links in our bio and all of these different places, but we are running a study that's a two part study, and it's quite long. I will warn you about that it is long, but it's long because it's incredibly in depth, and we're trying to get to the bottom of some of these questions that we have about chs. So this right now, I'll plug this a few times. But if you, or somebody you know, suffers from CHS, please fill out the survey the study linked in the bio, and you have the opportunity to win $600 so $300 for completing three people can win $300 for part one, and then three people can win $300 for completing part two. So we wanted to give some sort of incentivization to finish these studies. And we really appreciate the people who are willing to take their time and contribute to science. It really, really is going to change the way that we understand and think about ch.

Codi Peterson  9:12  
I've learned the most about this condition by asking my patients directly, hey, is this happening to you? And I see cannabinoid hyperemesis, you know, probably once a week or once every other week at the hospital. This is not some immense wave of patients coming in. But keep in mind, I work with kids, right under 18 year old individuals, and you know it's happening, and it's it's very clear. It happens in a very um stereotypical pattern of not feeling well for an extended period of time, starting to have a bout of vomiting. Typically, they go to the hospital, they check all the things, and they don't see anything. They go home and they're still vomiting. They come back to the hospital. This is exactly what happened to my patient today. She was at the emergency department on Wednesday. Their family is in town. Down from Canada going to Disneyland. You know, she knew we had a spicy fatty burrito at Disneyland that set us off into this, this vomiting episode, which we also see with chs. Another funny thing, what that we see is it seems to be some food intolerances and sensitivities

Dr. Riley Kirk  10:21  
and spicy foods, are we? Are we kind of alluding towards the TRPV receptors? TRPV one, maybe,

Codi Peterson  10:27  
maybe, I think that good reason to scientifically go that way. But I also think we don't understand this condition very much, and we're really trying to reach for what might be an intolerance. So that's why we need your help, and you or your friend, make sure you send them this flyer so that we can better understand what intolerances you might be experiencing, so we can get this into the literature and get it into the hands of doctors, so that when they're treating you or your friend or your cousin in the hospital, they don't go down the, you know, the wrong rabbit hole, or they don't miss this very clear evidentiary thing, or they don't get it wrong, right? That happens sometimes, too, is they don't get, they don't jump to that conclusion just because you're a cannabis user and you dealt with nausea and vomiting. Yeah, right,

Dr. Riley Kirk  11:12  
that's a really good point to make. I remember when I was last in the hospital, when I almost, you know, cut off my thumb with that whole incident. You know, I was, I was there getting stitches, and I was talking to the person who was or the doctor that was stitching me up. And she's like, What do you do for work? And I'm like, I work with cannabis. And she's like, Oh, we see CHS all the time here. First thing, she's like, the only thing that helped, Oh, yeah. And the only thing that helps are cold showers. And I'm like, wrong. Oh. But like, really, I mean, that is a problem because she was not educated on the subject. She knew that, like, what CHS was, but she was saying that cold showers helped. And I'm like, that's just, that's just not true. So part of the reason we're doing this study is to essentially provide a infographic for people in hospitals, for people work in hospitals, to quickly identify CHS and to not prescribe them the wrong drugs and to not send them home just because they're cannabis users and we're, you know, putting off their experience as not real. So I want to just put that in there is like there's a lot of people who don't know about this, who are uneducated about this, whether you're a healthcare professional or a cannabis consumer, and we all need to know about this so we can spot it in our community, and we can kind of help in that way too, or just share information about it.

Codi Peterson  12:30  
This isn't a condition that's easily diagnosed, right? If you had the flu, you come into the hospital, I take a little swab, I stick it up your nose. I send it to the lab, it comes back, but, um, but um, all these symptoms you're having are because of the flu. Congratulations. Here's your diagnosis. We've got a plan. We've got we know what to do with chs. We have, we have to exclude everything. When you come in with this intense vomiting, I need to make sure you don't have appendicitis. I need to make sure you don't have an ulcer. I need to make sure you don't have, you know, some uh, bowel obstruction and so many other things like a dozen or more, and it's expensive, it's it's costly, it's invasive. There's a lot of problems associated with it. So we have a long way to go to making things easier. As it stands right now, the only way to diagnose CHS with the poor diagnostic criteria that's technically agreed upon is to quit smoking cannabis for six months to know if it's actually chs. That is the only definitive way to technically diagnose chs. So we have a long way to go, but we have to get the help of the people who are afflicted with this condition. We need better data

Megan Mbengue  13:37  
right, and I think that the symptoms are also so nuanced. You know, I used to think that, like, Okay, people smoke a lot, and then, like, it causes vomiting and but what we see is people, like, use the cannabis and it helps with their symptoms a little bit, and then, you know, and then it perpetuates episodes. And sometimes the withdrawal phase triggers episodes and triggers the symptoms. So when people, when you

Dr. Riley Kirk  14:05  
start abstaining from cannabis, then it's triggered, okay, right?

Megan Mbengue  14:08  
Like I had a 17 year old here who he didn't go into a into a hypermedic phase. He was only in like prodrome, but would wake up with morning nausea, anxiety. He went on a school trip, and then he wasn't consuming during that school trip, and then he started having, like, all of these, like terrible symptoms that very closely resembled CHS in that withdrawal period, the two to three days. So it's a really fascinating like, is that withdrawal or is that chs? We've

Codi Peterson  14:39  
talked about this before, right? So like this, this group of us meets together, meets and where we've been working on the survey that we're gonna launch and everything. So we've kind of chatted about this before, but Megan and there's no consensus on whether this is happening and where withdrawal falls in abstaining from cannabis falls into the CHS episode. But I would point out that my pay. Today was on vacation and was not consuming cannabis for the last six or five or six days. And, you know, here we are. So it was just a funny you know, you've been talking about this on the last meeting. There could be something here. You know, one thing that's not known, and I think this is probably a good time to jump into this. Riley is what's causing CHS, yeah, 100%

Dr. Riley Kirk  15:22  
let's get into and and this is going to be theories, by the way, we don't have an answer for this. No one has an answer causes CHS, yeah. It doesn't exist. We don't have Yeah. But I think it's good to talk about, because I think people are worried, specifically people who dab, people who dab, are very worried, because we often are attributing high doses of cannabinoids to CHS, being a cause of CHS that might be related in some way. And I'm just going to say, from my perspective, I think CHS is kind of your endocannabinoid system being off kilter, being off balance, like we've we've exposed it to too many cannabinoids. And you know, typical situation say you have inflammatory gut, or say you have chronic pain, and you're using cannabis to balance out your body and to help with those symptoms. Well, like anything on earth and nature, it can go into balance and it can go out of balance. And if we throw these systems out of balance. We know that the ECS is controlling everything in our body, including things like nausea and appetite, and I do believe that CHS is a product of your ECS being thrown off balance and causing some of these adverse effects from from this whole system being off kilter and exposing it to too many cannabinoids. But we should talk about other theory, the theory

Codi Peterson  16:45  
of imbalance, you know, opens us up to a lot of potential problems. But look, we know this is highly correlated. You can't even argue it. Individuals smoking high, THC, cannabis are far more likely to develop this condition than anyone else, right? That is the correlation. Now the question then becomes, what is in that high THC, cannabis product that could set us off? Now you could, and like the Internet has, you could reach for perhaps it's something that's been sprayed on that product. Perhaps it's a pesticide. You know, neem oil is frequently cited online as the causative agent, and it's true that acute exposure to neem oil can cause acute vomiting, but there's no evidence that neem oil presents in this cyclical fashion with patients presenting with a prodrome, repeated bouts of emesis or a hot shower. So that really doesn't explain any of that withdrawal

Megan Mbengue  17:39  
piece, too. Okay,

Codi Peterson  17:41  
you're totally right. It was the toxicity of an acute exposure. And this is what physicians that I've talked to in this space, because I'll take the theories from the internet, I'll be like, Hey, Doc, you know you're a toxicologist. What do you think of this? And the problem becomes, is these patients do not fit a classical, what's known as toxidrome, a syndrome, kind of like a prodrome, the pre symptoms, the syndrome of toxicity. Toxidrome almost always continues to present itself in a very consistent way, and almost exclusively that toxicity is seen when drug levels are highest in the body, which means right after you would consume the cannabis. And that's not what we're seeing relief, and then we're seeing them get CHS or an episode two to three days later or months later. So that doesn't make a whole lot of sense to me. You would then have to look back at the Cannabis, what is abundant in this thing that we're smoking, okay? And if you get down to it, if we're talking about concentrates, 80 to 85% of that concentrate is THC, if you get if you're talking about modern flour, 25 to 30% of that flour, by dry weight, is THC. It's certainly not that much pesticide. It's not that much terpene of any of the varieties. So the most guilty looking party is THC. Now I know that's bad news. He's my favorite, too, and like, that's not great, but it's it's also this master key to this, this regulatory system that we discovered. It helped us discover the system that actually explains quite well all of the symptoms we're dealing with, the prodrome, waking up with difficulty, balancing your temperature, feeling hot, feeling cold, sweating, feeling anxious, your heart racing up and down. These are all correlated to the endocannabinoid system without even a stretch. Like we know that's what the ECS does. And I could keep going, but, you know, I'm gonna let someone else talk.

Dr. Riley Kirk  19:36  
Megan. You wanna talk about any theories? I love talking about the theories. Like, honestly, whenever I post something about CHS, I mean, the the comments are always an absolute pleasure to look through, because honestly, we don't know so it is. It is very interesting to get community theories, because people do care about this a lot, and they want to know for our community what's causing it and how to avoid it,

Codi Peterson  19:58  
right? We love this play. And we'd hate to see it. Yeah, you know, be a bad girl.

Dr. Riley Kirk  20:02  
Yeah. We're not making this episode to, like, fear monger people away from THC. I mean, I've already used THC today, and I'm going to use it later too, but the point is just having a resource for people to know what those signs and symptoms are and to participate in the study if you have suffered from chs. Yes, yeah.

Megan Mbengue  20:19  
I think what's interesting too is, you know, people are like, well, you know, we didn't know about CHS up until 20 years ago, true. So why is it just now? Now we've like commercialized cannabis, and so it's got to be like the growing conditions and this mass production, but also concentrates before it concentrates a thing prior to the 2000s you know, that we've really seen this explosion in concentrates in the last 10 years, and this like explosion in CHS at the same time. And what I've seen in people coming to me with CHS is they've, you know, somebody was just using that 17 was using concentrates for only a couple of months, like two to three months, I think, and then in his withdrawal of it, he started experiencing these symptoms, GIS. And I think what we see is people using flour are 10, tend to be like, Oh, I used for like, six to 10 plus years, and then they start developing symptoms. Concentrates are much, much shorter, oftentimes less than a year of using COVID and Cody. What do you see? Yeah,

Codi Peterson  21:25  
that's an interesting correlation. So once again, I work with pediatrics, and you know, it doesn't take very much reasoning to see what kind of products are kids gonna be most likely to be consuming. It's not rolling up flour and smoking a fatty outside the gymnasium, right? It's, it ain't that. It's like the humble, you know, mixed light, no, it is a vape cart, and that's what they can get. That's what's concealable. That's what's all of the things. So they're almost always exclusive smoking vapes. But again, if you looked at statistically what my patient population is smoking, they would be vapes anyway, like, whether they get CHS or not. So I don't have an answer. I want to know. We ask about it in the survey. We want to know more. We want to know about your use patterns, what you've been consuming, what changed recently. But we do know definitively that concentrates do produce in in like sort of that one puff per shot, a higher blood concentration than you will achieve with smoking. There's evidence to say this. The the van out of Colorado did some drug and they saw when people titrate with concentrates, they shoot a little higher than when if they titrate with smoking and and

Dr. Riley Kirk  22:37  
that's why a lot of people love concentrate, right? Need that higher dose. You know, it feels better to them, yeah. But this is important to talk about anyway. But it doesn't mean all concentrates are bad. It just means that some people do have an ad that

Codi Peterson  22:50  
part I wanted to get to that. So Ethan Russo, who, by the you know, he's like one of the the demigods of the the cannabis industry. We all love his paper. We're really fans of the entourage effect, which is what you think are so postulated. So if you're a big on THC and CBD, work better together, and limonene helps this. And thank Dr Russo. Now, Dr Russo also has an opinion about cannabinoid hyperemesis syndrome, which is a, this is not pesticide contamination and B, it's likely endocannabinoid system imbalance due at least in part to genetic abnormalities. So he did an evaluation of, unfortunately small, but still found it to be statistically significant, group of people who, if you had CHS compared to non CHS, pot smoker controls, right? And they looked and they said, who smokes cannabis and doesn't get CHS, who smokes cannabis and did what genetic differences they had? They found six, and some of that has to do with the hot chili oil. TRPV we talked about earlier, but not just that. It's just like a lot of brain enzyme stuff that goes on. So we think there are people who are genetically predisposed. And to Megan's point, we've never had this much THC available to this many people at all. You know, it's so easy now.

Dr. Riley Kirk  24:07  
So we have a larger genetic where more and more people are actually using cannabis, using THC. So we are seeing the rates go up because more and more people are using and I do think the genetic thing is really, really important, because I've seen, I've seen comments too, of like, you know, my brother got CHS, and I have CHS too, and I think that's kind of, I'm not saying it's like comparable to schizophrenia, but in my opinion, if somebody in my family had CHS me, I would, that's when I would start being worried about using concentrates at at high doses and stuff. Because, you know that you very well might have that same genetic change that would make you more likely to get chs. So I think that's an important point to make, that we've seen that within the community, and we have Dr Russo's evidence that there likely is a genetic component to CHS, so everyone's not equally susceptible to. This condition, I

Codi Peterson  25:00  
think it helps break the stigma a little too. This is one of the biggest problems with this condition. We have ostracized people who've come out and say they developed this because they're talking negative about the plant, right? Look, I love this plant, but it's not perfect. Nothing in this world is and if you're willing to die on the cross that something's perfect, I promise you, that's where you'll stay. Because this is not that's not the way the world works. And cannabis is an amazing medicine for so many people, it's even amazing medicine. Oftentimes, for the people who develop CHS, it can still be both. It can have a side effect profile and be medicine. I got so into my point that I don't remember where I was starting up.

Dr. Riley Kirk  25:38  
Wait, let's talk about that point, though, because this is a common question of of people who get CHS asking if they can still use cannabis at any point in their life, or hemp CBD products. Do we know the answer to that?

Megan Mbengue  25:51  
So Katie, our nurse friend who treats does a well part of our team for this study, as well part of our team, and she has been like pivotal in this study, because she deals with hundreds of people directly with chs. So her mantra is, you can never use without some degree of symptoms. So for some people like I think that perhaps they can go back to using a small amount of low, low low percentage flower sporadically. I don't, you know, using, going back to using heavy concentrates, I don't think is realistic for a lot of people. And

Dr. Riley Kirk  26:30  
what about CBD products? Could you like smoke a hemp joint? I

Megan Mbengue  26:35  
think some I've heard that. I mean, this is what we're gonna find out in the study. I've heard that that can often trigger a lot of people also, because it's still activating our ECS,

Codi Peterson  26:46  
there's definitely anecdotal evidence that CBD can be a problem. We haven't really well evaluated, maybe like a CBG or CBGa or CBDa or THC like so there's a lot of therapeutics out there, but generally for both THC and CBD, it's pretty well agreed that this can trigger a problem. However, I have literally seen the entire spectrum of patients reporting it. Some people they had CBD. It made the condition so bad that, you know, they went to the hospital. Other individuals say they switched to hemp cigarettes, and that's all they smoke, and they've gone about their lives. So this disease is occurring on a spectrum, and we won't be able to put everyone in there, but there is something about this disease that isn't a spectrum, which is the set of conditions leading the prodrome, which we can talk about one more time before we're done, and then the the hyperemesis, these vomiting episodes that are unlike the other vomiting that we typically have in our lives. You'll feel that it's different almost.

Dr. Riley Kirk  27:41  
One other thing that we included in the study that I think is important to talk about, because I've been making content on this recently, is the synthetic cannabinoids, these hemp derived compounds, whether it's Delta eight, HHC, Delta 10, thco, thcp, whatever it is these, these other ones, these other cannabinoids that are not being extracted from the plant, but are being synthesized in a laboratory. I've seen so many comments that people had no symptoms of CHS, started using these types of products, and now are experiencing some adverse effects. So I think that's an important thing for us to study too, as they become more available and more popular, to just understand if this is triggering people or if it's not because they are acting in a similar way.

Codi Peterson  28:29  
Yeah, it's confusing. I've had, I've had a couple examples where one patient had developed CHS she was she had been to the hospital five times over the course of six months, and this individual decided to stop vaping, so they went to the hemp store, right the CBD shop, and what did they pick up? A replacement, a hemp vape, also known as a Delta eight vape. Now, when I talked to this family, where do you think we were again in the emergency department, because the patient was still, regrettably having it and it, guess what? They said the hemp was helping, right? They got the hemp and it worked for a few days. Because, again, like this, maybe it's less potent than the THC or the Delta nine THC. Somehow it floated them over a few days, and then you get the impression that it is better. And so it's a really complicated thing out there, but there are case reports so documented scientific evidence of a patient developing CHS from not hemp derived, but from fully synthetic pharmaceutical cannabinoids, k2 spice, so to speak, okay and okay. There's no reason to believe that anyone is spraying that product with insecticide, because it's typically like an incense that's dried and then sprayed with the drug. There wouldn't be a place for much pesticide, although, you know, I'm open minded to the way the world works. But the point is, is it doesn't really line up with the pesticide case and all. So interestingly, there was one one off case report with a little boy who had a chronic and complex seizure disorder. He was not, you know, a normal little boy. He was, he was quite sick, and he was on a ketogenic diet for his seizures, and they started him on Epidiolex. I might have just switched anyway, the combination of both high dose CBD, which is prescription strength, CBD, extracted from the plant and the ketogenic diet, ended up leading to him developing CHS, like symptoms, uncontrollable vomiting that doesn't respond to medicine from just the Epidiolex, which is CBD, almost isolate. There's like, point one milligrams in a dose, or point one milligram maximum, but like tiny, tiny amount of THC, almost all CBD, and therefore, like, what are we dealing with here? It's not totally clear. Oh,

Dr. Riley Kirk  30:55  
man, it's not clear at all. I don't think so. Yeah, I think back to theories one more time, because I do think it does make sense if you're adding so many cannabinoids to your body, like, maybe it's possible that your body adapts by producing less, you know, like less endocannabinoids. And then when somebody takes a break from cannabis, whether they're on vacation or whatever, their body's not able to produce enough of those endocannabinoids, and that might lead to them feeling like they need the vomit or like, that's kind of where my Yeah, that sounds

Codi Peterson  31:29  
like dysregulation, down regulation. It's pretty well established. Yeah, yeah. I was in the literature doing my weekly posts, and I stumbled across nausea, the stress, nausea, stress and the ECS and kind of like it linked everything together, and it very much showed that this increase in nausea could be from a down regulation. If the ECS is helpful to your nausea, and you can take THC and it helps your nausea even more chronic exposure to THC sucks that receptor inside of the cells. Now there's less satellite dishes to receive the signal. You have less anti emetic or anti nausea, let's call it bandwidth or range.

Dr. Riley Kirk  32:05  
I like that. Yeah, it's possible. Can we talk about, can we talk about what helps people with their CHS symptoms, and maybe why? If we have any thoughts on that,

Megan Mbengue  32:16  
yeah, I'll jump in what, what I have learned and seen. And you know, of course, it's different for everybody. Um, I'll let Cody you talk on the medications, but supplements that we have seen help people are like, magnesium glycinate to help, kind of like, calm and regulate the nervous system, to help with that anxiety, uh, digest, taken

Dr. Riley Kirk  32:37  
orally, right? Yeah, because you can add magnesium topically as well, right?

Megan Mbengue  32:41  
And I'm, I'm curious if that would help. We had that in our study, that's a topical magnesium. It

Codi Peterson  32:48  
probably won't hurt, that's for sure,

Megan Mbengue  32:52  
right? Yeah, yeah, yeah, for sure. Um, like digestive enzymes to help people, because it like this can, like, wreak havoc on your GI system. Like, I know that Katie, our nurse teammate, she gets pictures of people's stuff all the time, and it's not like normal poop, so digest. Oh, god,

Dr. Riley Kirk  33:11  
that's what you mean by people's stuff. I'm like, Oh, they're like, their charts or what? No, okay,

Megan Mbengue  33:17  
no no. And I have, like, gotten photos as well from CHS patients. And, like, you know, loose stools, constipation, like, can be cabots. So she suggests digestive enzymes, coding and what medications do you see in the EV Wait,

Dr. Riley Kirk  33:34  
can we talk about, can we talk about caps? Yeah, yeah. Let's talk about medications. Okay, cool, cool, hot

Codi Peterson  33:40  
baths. Like, that's the thing is, like, patients often report this. I would say, well, over half of patients that I talked to do report significant relief. The only time they feel okay is in a scalding hot bath, or shower, as you might imagine, this company to the point of

Megan Mbengue  33:56  
burning their Yeah, we have seen them. They'll post photos oils

Codi Peterson  33:59  
over their skin? Yeah, I mean, it's anything. If hot water is good, like, the brain pretty quickly goes well, scalding is gonna be better, and they're in so such immense pain in their stomach, any even distraction from that, I think can be a lot, but very hot water, not doesn't have to burn them. But certainly, we've seen that in occasion, and it's really only short lived, they're only feeling better whilst that water is actually hot, while the hot water is, like, honestly hard for patients, because they get light headed and you can't stand in the shower all day, and how much you're already dehydrated. Yeah, there's no there's no bath in the hospital. But I do have patients sometimes go to the hot shower. So that is one thing that patients definitely do to get to feel better, and because of that, the heating pad has become a regular recommendation as well. So not bathing and showering all day, but putting the warmth around the primary point of our issue that helps people a lot. Megan mentioned the. The digestive enzyme to help with food, and maybe magnesium to help calm the nervous system. You know, other things people have reported, again, we're asking you guys, like, what has worked for you? But this is what we've heard, and so we ask you about these things. Sometimes Benadryl or antihistamines can be helpful for individuals to just take the edge off or break it and then, like, avoiding certain foods, you know, like people. There's not a lot of evidence to support what's called the the trigger list of foods, but there's certainly something to it. Patients are very sensitive to food, and spicy food, in particular, while they have this condition alcohol, alcohol is a really good example. I see this with some regularity as well. Oh, was that with my friends last night, and here I am today with MSS, okay,

Dr. Riley Kirk  35:50  
wow. And one more thing about the hot showers too, capsaicin cream on the stomach, because Capsaicin is the active ingredient or compound in hot peppers. So putting that as a cream on your stomach activates the same receptors as a hot shower does so hot pepper and hot showers activate those TRP one receptors which can, which have been shown to help people with these symptoms. Do we know why that is, why these TRP one or a theory of potentially, why this receptor is involved with CHS at all.

Codi Peterson  36:28  
So I'm doing a talk on on this basically coming up. But TRP, v1 the capsaicin receptor is now it's basically been lumped in with the ECS. It's a CB one, CB two, type of receptor. The new definitions are strong in this direction, and a lot of receptors, like that one that are sensory or thermo regulatory receptors also appear to have a lot of crossover with the ECS. So it's probably our growing knowledge of the system and its masterful complexity that is really driving us to consider these other options. And I would say it's that maybe TRP one is not the only answer, right? Like mustard oil interacts with a receptor, and, you know, menthol interacts with TRP receptor. Maybe there's something more here that is totally un yet explored around topicals. We just sort of through the and

Megan Mbengue  37:20  
this the arthritis cream. This receptor has been, this receptor has been largely implicated in the driving cause of chs. Also, that's one theories down regulation of these trip receptors, right? That one thing?

Codi Peterson  37:34  
Yeah, I think that. I'm not sure which came first, the the benefit from capsaicin because of the hot showers, or the theories around T R, P, v1, receptors, but definitely one of the leading theories is T r p dysregulation, and so this, this secondary signaling system. What other theories are out there? There's one related to the the cortisol system, that the cortisol system becomes out of whack, and that's what's contributing to this imbalance. Again, all of these are mostly hypothetical based on what we've seen in patients, and

Dr. Riley Kirk  38:08  
all are linked to the UCs, because the ECS is just intertwined with everything. So it's definitely involving the ECS in some way, but the exact mechanism remains a mystery, but honestly, from the data we get from this study, it's going to help us think of better, more accurate hypotheses and theories to then pursue further with laboratory tests and analysis and maybe even genetic tests as well. So you know, this study is really like step one, and then it'll allow us to continue, continue getting information about this Cody, can you talk about what pharmaceuticals in a hospital setting that are prescribed to people who are suffering from chs? I know you said that the classic anti medics aren't working well. So is there anything that is other than abstaining from cannabis? So

Codi Peterson  38:56  
typically, we use a medication for almost all types of nausea, vomiting. It's typically called ondansetron, or what's also known as a serotonin three, a blocker, okay, so we're specifically targeting serotonin, and that typically blocks the average nausea and vomiting, even nausea from chemo, you know, gastroenteritis. It really helps to block the serotonin, which stops the trigger the induction of vomiting. So that should work for most vomiting. However, in the case of CHS, it doesn't do much of anything. Most, I mean, the vast majority, patients find no effect. There been multiple reviews. Everybody gets it because it's the go to in the emergency department. Yeah, and it just doesn't seem to work. So scientists have thrown darts, and doctors have thrown darts, and they've tried to review what darts, and there really haven't been very many that stick the tip. The typical next line agent that's used is typically something known as meta clubramide or proclarzine. Both of them are anti medics, nausea medicines. That, instead of blocking just serotonin, they act on dopamine. So they're going to block the d2 receptor, and hopefully that helps cut up take, you know, take the edge off the nausea, vomiting. We'll give these medicines frequently for, like, a headache that's accompanied by nausea, vomiting. We'll give it for for GI distress, unrelated, once again, it doesn't seem to work. They've tried a bunch of stuff. They've tried prometheine, which you've probably heard of, the primary ingredient in scissor, you know, we they've tried all sorts of anti medics, but really, what they've only found to be working is is sort of a throwback drug, one, one or two medicines that are fall into the original anti psychotic category, and instead of just blocking some serotonin or some dopamine, they kind of indiscriminately go and block a bunch of receptors in the brain. Okay, and that's why they're old and sort of what we would call dirty, but they also work for a lot of conditions, and are still in use today, despite being developed in the 1950s now this is called haloperidol, or droperidol. These medications can be extremely Haldol. Haldol is the brand name typically that you'll hear these medications are usually what we get to after Zofran and chili oil. Don't seem to help you, and if we get you there, we are going to give it to you IV, and it is a very sedating medicine that can make people feel a little different. It's changing your neuro your brain chemistry, pretty profoundly when you get it. However it freaking works. And patients come back, they're like, please just help me with the hallow peridol. Don't mess no. You can take that chili oil and shove it up your ass, like, I need the Halo peridol. Don't do that. That would burn because you have TRP channels.

Dr. Riley Kirk  41:57  
I was literally just thinking that because Meg and I were talking about suppositories, and I'm like, Oh, that would be, like, the most painful suppository ever.

Codi Peterson  42:05  
Chili Oil, yeah? Well, this how I teach it. I'm like, you know, and you have all these sensory receptors in your mouth and throughout your GI tract, right? Because the next day, you know, you also had something spicy.

Dr. Riley Kirk  42:15  
I was gonna say, I think a lot of people know from their lived experience about I love

Codi Peterson  42:21  
spicy food, but I don't always love the day after spicy food.

Dr. Riley Kirk  42:26  
Great anatomy lesson. Yeah,

Codi Peterson  42:29  
channels, part of the endocannabinoid system, are distributed throughout all of your mucus membranes on your eyes and your mouth and, you know, all sorts of places. And we got off topic, I think

Dr. Riley Kirk  42:42  
no, but that was a that was a great answer, that was about pharmaceutical drugs that are prescribed for people suffering from chs. And now for both of you question, because I know, Cody, you've been mentioning that you work with people 18 and younger. Megan, you mentioned a 17 year old. Is this something that's, do we know anything about the age distribution? Is it happening with younger people more than older people? Is it just a product of younger people using more concentrates? Do we know anything about like, who's suffering from this the most?

Megan Mbengue  43:13  
I think that it's happening faster in younger people, either because, meaning like, they're using cannabis for a shorter amount of time than a cohort that's in the older age. And either that's because their ECS is like, still developing and sensitive, or they're just using concentrates at a higher rate, and people our age and older, what I see is, I've been using I've been smoking flour for 10 years and then develop symptoms. Or, you know, I've been using concentrates for five years and then develop symptoms. You have

Codi Peterson  43:45  
patients who've smoked for 3040, years on these Facebook groups, 40 years, but has been feeling unwell for 20, right? And didn't like didn't know what was going on, never heard of this crap, and as soon as they learn about it, light bulb moment. Oh, my God, that's what's been afflicting me this whole time. And sometimes those people are growing their own weight, right? And so their pesticide is like, sometimes they're going to the store, sometimes they're still in the illicit market, but we've seen it kind of happen all around. I do agree with Megan, that is the trend on what I've seen, maybe what I feel. If we look at the data, if we look at what's been published, we see the highest rate appears to be that 18 to 25 year old. And I believe male is what the data is. But my experience has been that's

Dr. Riley Kirk  44:27  
also the main people consuming cannabis, right? Like that is, like the most

Codi Peterson  44:31  
cannabis, because maybe they don't have a job, they're just in college, or, you know, there's a lot of, I think, reasons why that might be. I personally have not seen a strong male correlation. I see a pretty, pretty even distribution in my patient population. But again, as a whole, men tend to smoke more cannabis than women, or at least the number of men smoking cannabis regularly is higher than the number of women smoking cannabis highly. So for that reason, I think that there's probably some correlation there. Sure, but i Hard to say. Who, what we know is it can take everybody. We've seen 80 year olds, and we've seen, you know, this crazy case I told you, with the CBD, which is not the same thing, but he was like, eight, so like, it's not like it can occur in this whole spectrum of problems,

Dr. Riley Kirk  45:21  
right? Okay, yeah, I'm gonna ask the Patreon question. We've kind of covered this, but I think it's good to explicitly answer this, because it is a big question a lot of people have. So this is from Neil Devine. He asks, Is this related only to certain potencies, or how often somebody uses cannabis? Would mixing in CBD help? And I think that means, would it help not develop CHS or trigger it? Like, would it help in a preventative way? And I would say yes, like always mixing in CBD and reducing the actual potency of the amount of THC you're putting in your body. We talked about the entourage effect, if we can just produce other chemistry with our products, and touch on more receptors than just absolutely slamming the CB one receptor. I think that's a great way, like a preventative mechanism, but we don't have the data to back that up. But what would you guys say about that

Megan Mbengue  46:15  
in treating patients with cannabis or educating patients about cannabis, my goal is to achieve their goals with the lowest amount of THC, possible. So if it only takes them, like, five to 10 milligrams to achieve, like, pain relief or help with sleep, like we want to stay there. Even for cancer patients, I'm hitting them with like, high concentrated CBD and CBG, we aren't going with the, you know, the Rick Simpson protocol of 90 grams and 60 days, or crazy, whatever that is, that are very, yeah, high Constance a THC, and I've heard stories of cancer patients doing that protocol and then developing chs. And if you're a cancer patient, you know, C, H, s, and you can't use cannabis.

Codi Peterson  47:03  
Not ideal. That's terrible. A really useful one. You've lost.

Megan Mbengue  47:08  
You've lost a tool. So, yeah, my goal is to always stick with the lowest amount of THC, what else can we use to manage your symptoms? There are 100 other cannabinoids that can do amazing things for us to help manage symptoms. Yeah, I

Codi Peterson  47:21  
love that. So I would say for the person who has not yet developed CHS, it may be reasonable to integrate mixed varieties, type twos reduce overall THC exposure. And, you know, try to still derive the same benefit, and maybe get some of those benefits from CBD, as far as those people who've developed CHS this, this idea of like, oh, just switch to CBD or reduce your THC with CBD. This is, this would be a mostly failing effort. I believe that's opinion, not fact, right? We haven't done these experiments. No one's making people smoke. And so I just we've seen too many people react to CBD, especially with, like a one to one, or even even a mix with some THC. I think once you've gotten that out of whack, we need to reset the scales, so kind of bringing it back to, like a period of abstinence, and then reconsidering where the calibration is, and if you're someone who can tolerate THC versus not. And this is what I tell all of my patients, I need six solid months from your young person, and you're gonna feel way better. In six months, you're gonna feel like a new person, and then with that renewed self confidence, you can go experiment with THC. But you need to know you're never gonna smoke like you did, and this can come back at any point. You need to be thoughtful. You need to be conscious and thoughtfully, mindfully consuming your cannabis. And that's not the worst lesson, even for somebody who doesn't have CHS,

Dr. Riley Kirk  48:51  
I would agree, everything and everything in moderation. And I think that I want to revisit Cody, you were talking about stigma. And I think this is a we're getting towards the end of this episode, I think it's really important we touch back on this, because people do use CHS to fear monger. People do use CHS to say that, you know, cannabis is harmful to so many people, and it really like I think we do need to shape the conversation a little better around CHS, because cannabis is so safe for most people. But as we were talking about before, you know, it's not safer than water. It has hundreds of bioactive compounds, and they are acting on your body, and too much of anything is bad for you. So I just wanted to reiterate the stigma point, because we're not trying to perpetuate any stigmas with cannabis here. As we mentioned, we're all cannabis consumers. We want to make make sure that people aren't developing CHS and they're using in a responsible way. But CHS is very real, and people are suffering from it, so it is worth giving them the validity, but also not taking away from, you know, people thinking that everybody's going to get CHS if you rip a dab like that, right? That's

Codi Peterson  49:57  
hyperbole. I've had people reach out to me. I'm so scared. Of developing CHS, and I tell that individual, I need you to breathe, okay? And there's no reason. Like, if anything, you're setting yourself up for this by putting it in your head and wishing it into existence, yeah? Like, I mean, I take that with you know, some I joke a little, but like, we shouldn't be stressed about things that are out of our control and in the future that haven't happened yet. That is just not a great way to live. That's just life advice, take it and carry it with you. Audience, but like from a from a stigma perspective, we have a few different angles in this, and I want to address all of them. Number one, healthcare provider stigma, okay, our doctors need to lay off. They need to not think, oh, this person's some addict. Therefore they develop chs. There's a genetic component that person probably is deriving benefit. Get a life. Don't jump to a conclusion. Ask them questions. How long have you used? How long you know? How long have these symptoms? Has it ever happened before? Have you ever thought about it? Have you ever had prodrome symptoms? Ask those questions. Don't just throw a diagnosis. So doctors drop the stigma and the bias. Second person needs to drop the stigma is the damn industry, this is a real condition that's affecting real people, and unfortunately, has taken the lives of certain individuals, because there's not acceptance, there's not awareness, et cetera. So the industry needs to be willing to accept that people can get sick, especially if we're not taking the right care or doing the right education, and that we need to do a better job as an industry. The last person that needs to to, I think drop the stigma, would be us when we're talking about it, or check our stigma is like, Yes, this is a concern, but we need to talk about it in a tempered way. We don't need fear mongering. We don't and we don't need to claim like we know everything like we maybe it's some we don't know. Maybe it's a cannabinoid we've never even heard of showing up in these to check that. And that's the healthcare professionals too. Is like, what are we going to do and what is the actual solution? We got to work as a community to get there.

Dr. Riley Kirk  51:58  
I love that. COVID. Thank you for including that that's so important, I would reiterate the thing about the industry, like we are not doing ourselves a service when, when we are pretending like CHS is not real. As the industry, we are the experts on cannabis, and we need to treat this as a real thing, especially like this is community medicine. It's always been community medicine, and we need to look out for our community. If somebody tells you that they're experiencing these vomiting episodes, you need to share information with them. You need to tell them that it might be CHS and that they should stop using cannabis. So that's important too. But thank you so much for that. I think we should repeat just one more time the different like phases of of CHS from prodrome to hyperemetic to recovery, say our survey one more time, and then we can be on our merry way. Yeah, okay,

Megan Mbengue  52:49  
I'll cover projo prodrome can happen weeks to months to even years before the first vomiting episode, and oftentimes prodrome symptoms include waking up with morning nausea and anxiety. People can develop an alcohol intolerance. They just don't feel well. Sometimes this happens, like when people have gone hours without cannabis and they're kind of like dipping into like the abstinence or withdrawal effects of cannabis, they start to feel these symptoms. Is GI upset, heartburn is really common. You know that one of the most common medications people are put on right away are, is it ppi? I'm not supposed to be on PPI for long periods of time, and so then that, yeah, people can just feel like shit for a number of months or years, or even decades, prior to developing the first hyper medic.

Dr. Riley Kirk  53:41  
So pro prodrome can last decades. It can last a really long time. It's not like it's you get one week of prodrome, immediately go into hyperamesis, and then from there, it can be, like, a varying amount of time.

Codi Peterson  53:54  
I think, yeah, definitely. And it's not set, and it's not clear which of these symptoms you're going to have. And so everyone has a bit of a different and it's not always abundantly clear that people are in programs they often don't recognize it, but this is why awareness is so key. We can educate people that if you're a daily or near daily cannabis consumer, and you're waking up with this heartburn, this indigestion, diarrhea, anxiety, hot and sweat colds regularly, and you're consuming cannabis, probably from vape pen, not necessarily, but like you probably need to consider, could this be a thing, and how can I how can I approach this? Can I temper my use? So I think that there that's really important on the prodromal side, then, for whatever reason, a trigger, maybe a food, maybe alcohol, patients go from a prodrome, which is sort of the pre symptoms, into the hyperemetic phase, or the vomiting phase. And the vomiting phase we already talked about, it is characterized by intense nausea and vomiting. It's not like, Oh, I just. Burke up my lunch and everything I feel better now. No, it is hacking up everything, dry heaving, just wanting to curl up into a ball and cry, sometimes also associated with similar like hot and cold sweats that we talked about, shivering like we said, screaming while they're vomiting, just a lot of uncomfortability. And this can last kind of regardless of how long you'd been smoking, but can last from anywhere for a couple hours to a few days, as long as a week in severe cases, what does typically happen is it gets longer and more severe over time. But that's also, what are you doing on the backside, right? Are you continuing to consume? Are you reducing consumption, etc. So it's not that straightforward, but just know that it's likely that this is like a almost like a relapse, remitting disease that comes back a little bit worse each time. And it's what we see in the majority of patients,

Dr. Riley Kirk  55:57  
okay. And then there's the recovery aspect, where you're not using any cannabis products, and you're just trying to get your body back to normal as you're abstaining,

Codi Peterson  56:05  
yeah, and that one's kind of complicated too, because it's gonna depend on, did I stop consuming? But most of the time, people are so unwell during their hyperemetic phase, they're not touching cannabis, right? Like, they can't even, like, get to that point, even though it's in helping them for so long, maybe even they don't even believe it's the cannabis. They just feel so unwell that smoking doesn't even doesn't even sound appealing. And so those individuals often are already sort of abstaining and potentially on that path. But if they don't believe it, or aren't aware that it might be cannabis, then they're probably going to fall back into the pattern of consuming, then the prodrome, and then the hyperemetic phase again, and it kind of runs in a circle that way.

Dr. Riley Kirk  56:48  
Yeah, thank you. Yeah. So, as we mentioned, the study, the survey, it is quite long, but it is you contributing directly to cannabis science. It is anonymous, so it's not like we're going to be, you know, pasting your name all over the place, but if you do want to win the the money, you will have to enter your name at the end. But that's not like we're not using your name for anything else, as I mentioned, though it is. It's going to take you a little while. So grab a blankie, grab a cup of tea, sit on the couch, get comfortable, and we really, really appreciate anyone taking the time to complete the study. It means a lot to us as researchers, and we just appreciate your time a lot. So if you guys have anything else to say on CHS or the study, or what people should be prepared for, yeah,

Codi Peterson  57:33  
just, just on the study, this has been my baby. This is I really appreciate Riley and Megan, first off, having this podcast and be my friends, but also for their help on this project, I also really want to and the rest of the team, that's Jackie, Katie and Jill. Thank you so much for your contributions as well. Thank you. Thank you. With respect to the study, just a reminder, we are trying to incentivize your participation. We know that taking 20 or 30 minutes out of your day times two is going to be a significant task. We also hope that you're passionate about this enough to share, but to try to help make it better, we've got two raffles, one for the part one of the survey, one for part two. Three people who take the survey will win $100 gift card. I don't know what the odds are, but it's guaranteed to be better than one in 1000 which isn't too bad and so, but it's gonna be way better than that, unless we get hella good participation, because this podcast blows up and everybody signs up. But please share this with your friends. We're looking specifically for people who have been diagnosed with CHS, or who believe they have chs. Okay, so if you have a friend, please send them the flyer that will probably be linked in the show notes, or at least the link, there'll be a quick description form and then a bunch of questions. Really, we cannot do this without you, and I really appreciate every minute that you spend helping us help other people and help improve

Dr. Riley Kirk  58:57  
diagnosis. I also want to say, Cody, you've done a fantastic job as your first time being the principal investigator on a study. So you know, clap for you. It's not an easy thing to do, and you've done a great job organizing the team, getting everything together, and we will be writing this into a peer reviewed publication after we get all of this data collected, so we will be sharing that as well. But just pat yourself on the back, Cody, because I know it's been stressful, but you've done an amazing job. Yeah.

Megan Mbengue  59:26  
Okay, I have one question from Facebook, then we can yay, live engagement. Yes. Alright, so my 15 year old GI doctor is saying that my child is suffering from this. They have been vomiting for two years. They didn't smoke then. So we are stuck. The doc has pretty much wrote us off. We don't know what to do anymore.

Codi Peterson  59:44  
Oh, I love that. This is such a good example question. This is something I'm always counseling my doctors on. When did this start? Right? Because, especially with my patients, because I'm dealing with 15, 1617, year olds, when did this nausea, vomiting thing start? I had a had one. Doc. Or thought it might be. CHS had called me over come to find out the patient benefits tremendously from smoking THC, and has had this problem preceding His adoption of that plant medicine. And so it was a no brainer, not chs. So in the case of what you're describing, it sounds much more similar if your 15 year old developed this vomiting, cyclic, cyclic vomiting disorder before starting. THC, sounds much more like cyclic vomiting disorder, which is a similar sort of like broader category of vomiting disorders. And that's the stigma that I'm talking about. Is like, Oh, this kid smokes weed.

Dr. Riley Kirk  1:00:40  
Do we know what causes that disorder, the cyclical vomiting versus chs? Like, do we know what could be causing that?

Codi Peterson  1:00:47  
We don't. It's not, it's not a well understood

Megan Mbengue  1:00:49  
well, okay, so I had to do this for a school project, and like, the cause of CVS is, or it's oftentimes, like, correlated with childhood stressful events, maybe childhood trauma, kind of like this. This psychosomatic thing that happens with kids that like that's their manifest of stressful events, is CVS. And cannabis oftentimes helps those with CVS, whereas in CHS, it will make things worse in the long run.

Codi Peterson  1:01:19  
It is interesting because I think immediately to like PTSD and changes to the endocannabinoid system, and then, so then I'm thinking, Wait, is then cyclic vomiting potentially like ECS regulation, just like the other direction,

Dr. Riley Kirk  1:01:36  
very well, COVID.

Codi Peterson  1:01:37  
So cyclic vomiting syndrome is a larger category. CHS is technically a sub sect of cyclic vomiting syndrome. You know, I'm not medical advice, and I'm shooting from the hip here, but it sounds a lot more like cyclic vomiting than it does cannabis. To me. Is CVS.

Dr. Riley Kirk  1:01:54  
Do people experience the vomiting? Well, sorry, let me back up with chs. A lot of the symptoms are in the morning. Is that the same with CVS, where a lot of those symptoms are in the morning as well? I've never

Codi Peterson  1:02:06  
seen that data. I've never seen that correlation, so I'm gonna guess probably not. One thing that is definitely different is the occurrence of in childhood. People develop CVS as kids, usually and often, if their emesis, their prodrome, is characterized by a headache, which is much less common in our population that we're discussing today. Not to say it couldn't happen, and that's the definitive The other thing is, and I've seen mixed results, is the hot baths and showers seem to be more strongly correlated with cannabinoid hyperemesis, as opposed to traditional cyclic vomiting. So think those are some differentiator points for our medicine. Friends.

Dr. Riley Kirk  1:02:44  
Man, five questions. Yeah.

Megan Mbengue  1:02:46  
Somebody asked, Is it permanent? We kind of covered this a little

Dr. Riley Kirk  1:02:50  
bit Great question. Well,

Codi Peterson  1:02:52  
we think it's partially genetic, so in some ways, definitely, but we also think it's like, sort of like, dose and exposure related, so in that way. So

Dr. Riley Kirk  1:03:03  
some, sometimes, definitely, sometimes,

Codi Peterson  1:03:05  
definitely, always, 35% of the time, half the time, every time,

Dr. Riley Kirk  1:03:13  
yeah, so likely. It seems like a component of it would last your entire life, because you are genetically susceptible, and you're clearly reactive to THC,

Codi Peterson  1:03:26  
yeah, but that dysregulation does not appear to stay sustained, and we do have patients reporting and no evidence and not recommending this, that they can continue to consume cannabis with moderation or with thoughtfulness. Some individuals have just switched from indica or sativa, and that's it works for them.

Dr. Riley Kirk  1:03:47  
I've heard a lot of people to switch from concentrates to flower, like the flower doesn't bother them, the same way the concentrates do. Again, this is not life advice. I'm not telling you if you have CHS to switch from concentrates to flower. This is just anecdotally from comment sections and from direct messages that I've heard people

Codi Peterson  1:04:05  
are talking about this, and we need to create a safe space to talk about it and understand it better, and then we need to teach our doctors about it.

Dr. Riley Kirk  1:04:12  
All right. Any other questions from your end? Megan, on Facebook Live,

Megan Mbengue  1:04:18  
we don't tell our live friends, thank you.

Dr. Riley Kirk  1:04:22  
Yeah, thank you for great questions. Thank you people. Yeah. All right, well, I think we've covered everything that I needed to cover in this episode. I really, really hope that people are sharing the study with people. Anyone you know who has suffered for or is suffering from. CHS, please share this. Please share the study link, and feel free to just continue asking us questions. All three of us create content about CHS, about the medical applications of cannabis and cannabinoids. We, all three of us, are great resources in this community, and we will not judge you. We will not treat you in any negative. Way from communicating with us. So we want to be we want to be resources for you. So please don't hesitate to reach out. And I hope this episode is helpful for anyone suffering out there, and hopefully we can get to the bottom of this eventually, through research and and your participation, again, is helping immensely, helping us understand this condition better and helping us treat people faster in the future. So thank you all so much. Mad Love, and we will see you in a couple weeks. Thank you, Dr Cody and Thank you Megan,

Megan Mbengue  1:05:30  
thank you. Thank you Riley. You