In the fickle world of life fashion statements, racial justice, gender equality, same-sex marriage, pay equity, rambunctious viruses, fighting global warming, and civil rights movements regularly come full circle.
In 2020, Green Revolution doesn’t only refer to veganism or watching our carbon footprint. It also points to a long term fight for cannabis legalization on a global scale. Paving this road has come a long way, from being part of Traditional Chinese Medicine in ancient times to sliding under authoritarianism in the modern days. Though this phenomenon seems to require myriad energy, we are convinced that by arming ourselves with the right knowledge and tools, a paradigm shift will eventually be co-created.
In this issue, we bring you The Insights from a cutting-edge family of doctors - The Knox Docs, also known as Endocannabinologists who help patients incorporate cannabis for medical use adequately. Their fortitude leads them as one of the known innovative pioneers to bring hippie counterculture to the mainstream medical table, to demystify the verity of this versatile plant to medical colleagues as well as the general public around the world.
The Knox Docs are here to recalibrate our lens from sick care to health care by sharing how inextricably medicine and cannabis are now braided together. They share the safety of cannabis use for pregnant ladies, parents of kids who have special needs, behind the scenes of the cannabis industry, cannabis substitution if inaccessible, and their healing lifestyle choices as well as perspectives on living that keep them stay vibrant.
(Spoiler alert : Baby Shark is mentioned on the list).
C O N V E R S A T I O N
NL | Nicole Lui @ NOIRSTONE
DK | Dr. Knox Family
| P A R T 1 : C A N N A B I S L I V I N G & S A F E T Y |
- NL | As a family of conventional medical doctors, what was the one thing that brought you into the cannabis space?
DK | Individually and collectively, we knew there was a better way to promote health and wellness amongst patients than our conventional medical system offers. The conventional medical system has its place - namely, acute care, surgical care, and even some preventive care - but over the past century, it has invaded the realm of healthcare, which it doesn’t do well at all. Even though most of us have been trained to believe that the medical system should make us healthy, that is not what it’s designed to do.
Health is predicated on good nutrition, a clean and safe environment, fulfilling relationships with self and others, a connection to nature, and a number of other things that the medical system does not and cannot deliver. For us, cannabis is a bridge to health - not just another medical tool in the bag, but a gateway to understanding the endocannabinoid system and all it can teach us about being healthy and well.
- NL | Could you share how cannabis benefits people who face Autoimmune, Mental, and Neurocognitive challenges on a daily basis?
DK | There is so much to unpack here! But in short, cannabis works on the endocannabinoid system and endocannabinoidome (the network of ligands and receptors beyond the ECS that interacts with the ECS and cannabinoids) to promote balance in the body. We have a lot of information regarding the anti-inflammatory effects of THC and CBD, both of which work to quell hyperimmune responses and otherwise balance the immune system.
THC is a suitable replacement for our endocannabinoid anandamide, “the bliss molecule,” and CBD is known to bind serotonin receptors - receptors, by the way, that commonly pair up (dimerize) with cannabinoid receptors. And both THC and CBD are neuroprotective and antioxidant (as recognized by the US government in their patent on cannabinoids). In a world that is constantly assaulting the endocannabinoid system and our general health, cannabis offers myriad benefits in the way of toning our ECS to adapt and respond more effectively to protect and promote our health.
- NL | Is it safe for women to incorporate cannabis pre, during, and post pregnancy?
DK | We believe it is possible for women to safely use cannabis around pregnancy, but informed and intentional use is essential. Though government agencies and medical societies will frame it otherwise, we have no evidence that cannabis use is harmful to a pregnancy or developing fetus.
Indeed, women of certain cultures have used cannabis regularly throughout their childbearing years and pregnancies for centuries without ill effect on their offspring. That said, it is still advisable to heed certain precautions. TheECS is always finely tuned, and this is particularly true when it comes to conception.
Anandamide levels must be low for successful conception, so for women struggling to become pregnant, it might be advisable to take a break from THC-dominant products or from substantial THC dosing before and while trying to conceive.
- Anandamide levels must be low for successful conception, so for women struggling to become pregnant, it might be advisable to take a break from THC-dominant products or from substantial THC dosing before and while trying to conceive. Like tobacco smoking, cannabis smoking has been associated with low birth weight, so a non-inhaled method of cannabis use is advisable for pregnant women. Cannabinoids can cross the placenta and also enter breast milk but research has yet to determine what effects this might have on the fetus or nursing infant.
At the end of the day, pregnant and postpartum women often experience a number of uncomfortable or troubling symptoms, including but not limited to nausea, pain, and anxiety or low/depressed mood. Many women are offered, and use, prescription pharmaceuticals to manage these symptoms with varying levels of effectiveness, side effects, and risk to themselves and their babies. Comparatively, we feel the appropriate use of cannabis is a much safer alternative for mothers to manage these symptoms.
- NL | Any experience of seeing adverse symptoms from cannabis patients who have chronic pain, mental, and / or neurocognitive challenges?
DK | We haven’t witnessed any true adverse symptoms in our patients using cannabis. What we do see is either lack of effect or transient unwanted effects of THC, both of which simply reflect a cannabis regimen that isn’t yet optimized. Especially with CBD, folks tend to underdose, perhaps never reaching the dose that would be effective for them before deciding CBD “doesn’t work” and giving up. On the other hand, having too much THC may cause unwanted effects like anxiety, paranoia, palpitations, dizziness, etc. Fortunately, these effects last only as long as the duration of activity of the method used to consume THC (e.g., up to 4 hours if inhaled or 8 hours if ingested).
We prefer to talk about “time and titration” rather than “trial and error,” but however you put it, most patients must make a sustained effort (often weeks to months) to find the optimum chemical profile and dosing for their needs. Informed use guided by a knowledgeable cannabis clinician may help patients avoid some of the “trial and error” pitfalls and reduce the “time and titration” period.
- NL | Cannabis remains mysterious or has been labeled as a bad influencer for a long time. Asa result, a lot of parents are hesitant to try it with their children who are on spectrums.What is the first step that they can take to help alleviate some of these fears?
DK | The first step to alleviate fear or stigma surrounding cannabis is to learn about the history of cannabis and the science of the endocannabinoid system. Most people begin to think differently about cannabis when they learn it was one of the most commonly-used medicines across many civilizations throughout history, including by American physicians until the early 1900s. People think about the plant differently when they understand it was demonized and outlawed not due to medical or scientific concerns, but due to the political and economic interests of a few. Another key piece of historical context is that scientific study of cannabis in the United States has been functionally prohibited since the mid-1900s unless it was research designed to identify the negative effects of cannabis. Even so, much American research has inadvertently revealed that cannabis isn’t nearly as harmful as popularly claimed.
If the history of cannabis isn’t compelling enough, the science of the endocannabinoid system should be. When someone learns of the existence and even just the basic function of the endocannabinoid system, it becomes self-evident that cannabis is medicine. Looking specifically at the Autism Spectrum Disorders, research suggests these are clinical endocannabinoid deficiencies and therefore therapeutically amenable to phytocannabinoid (cannabis) supplementation.
Parents should also feel reassured that cannabis is a medicine with an unparalleled safety profile, devoid of the scary laundry list of adverse effects that accompanies most(all?) neuropsychiatric pharmaceuticals. And when used medicinally, we have no evidence whatsoever that cannabis harms the developing brain.
- NL | Let’s go behind the scenes of cannabis. Pharmaceuticals have recently jumped on the cannabis wagon. How do you see the impacts that have been made (or will be made) in the industry and the consumer world?
DK | Over the past 100 years, we’ve seen the ins and outs of pharma’s playbook. The pharmaceutical industry is interested in isolating single molecules that can be patented and highly controlled, dominating the market to maximize their profit for decades on end. The problem with this model is it doesn’t work - at least not for patients, and definitely not for cannabis. When it comes to cannabis, we know conclusively the whole plant is superior in efficacy, safety, and tolerability compared to isolated cannabinoids. But whole plant medicine isn’t a clean fit for pharma’s model of chemical isolates available only in a handful of discrete doses - cannabis dosing is more nuanced (each plant contains 400+pharmacologically active compounds) and very personalized, and the plant comes in countless chemical varieties, all of which have potential therapeutic application.
Even so, we know pharma is waiting in the wings for federal cannabis legalization, or at least descheduling. The open question is whether their market of cannabinoid isolates, which are more likely than whole plant cannabis products to be covered by insurance, will undermine the whole plant market, which is likely to remain out-of-pocket. We hope not. That’s why we’re in an epic race right now to educate our healthcare colleagues, the general public, and lawmakers about the superiority of whole plant medicine and the importance of creating and maintaining a robust and accessible whole plant market.
- NL | When we talk about the plant, not only where it’s grown, but the quality of soil, terpenes profile, consistency, or price range, we tend to leave out that a lot of research on cannabis relies on studies from Israel or exclude the history of cannabis farming with low cost / unpaid labor. Can you give us a little more insight into the cannabis industry that consumers or patients should be aware of?
DK | There is so much to say here but for the sake of time and space, we’ll limit ourselves to a couple issues: (1) a PSA about hemp CBD, and (2) a call to support equity in and through cannabis.
Though made federally legal by the 2018 Farm Bill, the hemp CBD market remains unregulated, which means the veracity, quality, and safety of CBD products available online or on local store shelves are not guaranteed. When shopping for hemp CBD, look for products that come with certificates of analysis (COAs) to verify the products’ contents. Also look for products that are made from US-grown, organic (ideally USDA certified) hemp and free from fillers and junk ingredients.
On a much different note... Cannabis has long been (and still is) used as a weapon against black and brown people, families, and communities in the United States. And now, with the spreading legalization of cannabis, the very people most targeted and harmed by the war on drugs are also the most likely to be excluded from the boons of the legal cannabis industry, both medically and economically. As many of us casually reach for CBD or cannabis to help us feel better, have fun, or unwind, we must not forget that not everyone is yet able to reach for these substances so casually. We must not overlook the fact that many CBD and cannabis companies are following the lead of the big industries that preceded this one, largely boxing out minorities and women from ownership, leadership, and meaningful participation. If cannabis is an essential wellness commodity as most legal states agreed it was at the outset of COVID-19 stay-at-home orders, it means that we all should have equitable and affordable access to it. If any one is to benefit economically from what promises to be a tens of billions of dollars industry(at least), the first to do so should be the communities most blighted by the war on drugs.As consumers and patients, always remember that we have the purchasing power to hold the hemp and cannabis industry to the standards we all deserve. Let’s use our money wisely.
We must not overlook the fact that many CBD and cannabis companies are following the lead of the big industries that preceded this one, largely boxing out minorities and women from ownership, leadership, and meaningful participation.
- NL | There are a lot of families who are unable to access medical cannabis or hemp CBD globally. Are there any methods or alternatives that they can incorporate in order to support their endocannabinoid system holistically?
DK | Absolutely, and this is one of our favorite things about the ECS! Cannabis is just one tool we can use to support the ECS. Our first and most important tool is nutrition. As Dr.Rachel puts it, we wouldn’t put diesel in our gasoline-powered car and expect it to run smoothly, so why would we put fake, processed foods in our natural, whole bodies and expect them to run smoothly? The food we eat provides the building blocks for a healthy ECS, including the endocannabinoids themselves, so it’s critical we’re feeding our bodies real, whole, natural foods.
We also love to teach people about cannabimimetics - these are substances and practices that mimic and stimulate the healthy function of the ECS. Cannabimimetic substances include herbs and spices, many of which are already in folks’ cabinets and refrigerators - things like black pepper (which contains the terpene-cannabinoid beta-caryophyllene), ginger, turmeric, basil, lavender, etc. Essential oils, which are the most concentrated sources of terpenes available, are another of our favorite cannabimimetic substances and can be diffused, used topically, and in some cases ingested (just make sure to follow usage instructions for safe topical or internal use). Cannabimimetic practices include activities such as deep breathing, meditation, grounding, yoga, moderate exercise, acupuncture, and massage. Even simple feel-good activities like smiling and hugging have been shown to increase anandamide levels. Incorporating a variety of these cannabimimetic substances and practices into your daily routine goes a long way toward restoring and maintaining ECS health, with or without cannabis.
| P A R T 2 : P E R S O N A L G R O W T H & P E R S P E C T I V E S |
- NS | What was the most invaluable lesson you’ve learned?
DK | Dr. Jess: People will take as much from you as you let them, so it’s critical for you to define and enforce the boundaries that will protect your physical, mental, spiritual, and financial health. Don’t allow others to set those boundaries for you because the ones they set will likely be at your expense. Boundaries don’t mean you shut your self off from the world; instead, they set the parameters for how you can engage with the world in a way that honors yourself.
Dr. David: Life is never done in revealing more surprises, not just in learning new discoveries in the world, but in what I as an individual can accomplish.
Dr. Janice: Life holds more wonder than what we can see, touch, taste or smell. In my studies on the pharmacology of cannabis and physiology of the endocannabinoidome have led me to see a fuller, more spiritual aspect of the“entourage” of life. That is to say, reconnecting to what the earth has provided to us for sustainability and abiding by the laws of the universe.
Dr. Rachel: Prosperity is both a mindset and a state of being. Like the Kingdom of God, it is at hand. Let go, let God, and you will walk faithfully into the prosperous life God designed through you and for you.
- NS | How do you see our society changing a decade from now?
DK | Dr. Jess: In 2030, we will measure our governments and our businesses by the health of the people they serve. 2020 has thrown into stark relief the effects of political and economic models that prioritize profit over people and self over the collective. These are models we’ve accepted and allowed to persist for far too long. Our collective work over the next decade is to develop a conscious and compassionate society that holds ourselves and our institutions accountable for contributing to an ecosystem that supports the total health of all of us.
Dr. David: I am pessimistic that our society will become more just and inclusive for all, as we will be harshly battered by the ecological effects of climate change, as well as the viruses of pandemic and racism and selfishness. The money power still pits us all against each other, and keeps a majority of us distracted from what really matters to make a change in the world. The opportunities are there, and I plan to do what I can to support this industry that has so much potential to help make the changes in society that we need to see happen.
Dr. Janice: That the global population realizes that we are all one, belonging to humankind. Borders are arbitrary, the laws of nature will be recognized and obeyed. Our governments will no longer be run by a patriarchal model that now subsides on power, greed and the control of others. Health will not be defined as we know it today, but as health that pertains to physical, spiritual, economic, and community health.
Dr. Rachel: How do I see our society changing? I don’t think society can change until people individually and collectively do. So I’d spin that question back to people as individuals - how do you see yourself changing a decade from now? What life do you want? When we want others to have the amazing lives we envision for ourselves, we’ll finally get somewhere.
- NS | What does #selfcare mean to you?
DK | Dr. Jess: Self care is health care. I realized early in my medical career that there was very little I could do as a doctor to “make” my patients healthy. Vastly more important and impactful for their health was what they did every day at home, school, or work, when they weren’t patients, but just people living their daily lives. To me then, selfcare is the real health care. The choices we make every day to nourish ourselves with good food, clean water, exercise, mind-body therapies, healthy relationships, and connection to nature are the best health care we can get. Of course, these choices are not options for everyone in 2020, which is why we have a lot of work to do as a society to make these choices available and accessible to all people.
Dr. David: Self care means taking on the responsibility of keeping oneself healthy, by making the right choices in food and nutrition, exercise and activities, work and relationships, etc. Feed this responsibility with learning and education about how best to accomplish the end goal.
Dr. Janice: Self care means being well. Self care means not needing a physician to get one well. Self care is doing everything possible to maintain wellness, assuring a quality of life that allows one to live to ripe old ages. Finally self care is the right to use every tool the earth has provided us such as botanicals, good earth, clean water and clean air.
Dr. Rachel: Self care is a reflection of self love. Have you ever heard the instruction,“love your neighbor as you love yourself”? If you don’t know how to love yourself, how in the world can you love others? In this way, self care is one of the most selfless, loving things one can do. When you really love yourself - for who you are and who you are not - you not only care for yourself tenderly and forgivingly, but you challenge yourself to grow. And not for only your benefit, but for the benefit of others. When we fill up with love, we pour out. For many, however, self care by the name “wellness” has been relegated to a privilege, inaccessible to many for all the ways the systems of today’s world make so many too busy and too sick. Self care (or selflove) becomes inconvenient or a distant priority. We have to dig deep and fight this illusion. This is why self love is such a radical, revolutionary act today.
- NS | If you were to meet your younger selves, what advice would you give them?
DK | Dr. Jess: There’s no rush. Take your time to explore the world, learn across a diversity of subjects, and try on a variety of (figurative) hats so you can find what really makes your soul soar.
Dr. David: Take more time to do what you really enjoy.
Dr. Janice: I believe that I did this, but self actualize first, then build your dream.
Dr. Rachel: I wouldn’t change a thing. I am who I am today for all that I experienced, both the ups and the downs. I would probably just remind my younger self that she is lovely, loveable, and loved; and to know and trust that God’s plan is perfect.
- NS | What’s that one question you’d like to ask our NS Insiders so that they can take time to reflect?
DK | Dr. Jess: Have you set boundaries in your professional and personal life that honor yourself?
Dr. David: What have I done to expand my own horizons today?
Dr. Janice: Do you recognize that you are a spiritual being and what does that mean to you?
Dr. Rachel: Do you love yourself unconditionally?
T H E D O C K N O X' S C H O I C E
| Snack(s) |
Dr. Jess: Hard boiled eggs, Cheese (fresh or moon cheese), Any fresh fruit
Dr. David: Cheese, nuts, berries
Dr. Janice: I don’t have a favorite snack
Dr. Rachel: Dark berries, pistachios and cashews, and sharp cheddar; green apples with almond butter; egg and avocado toast (with the works)
| Drink(s) |
Dr. Jess: Water (usually flat, sometimes sparkling), anything mezcal-based if we’re doing happy hour
Dr. David: Coffee, wine
Dr. Janice: Sparkling water or tonic water (hate the calories but love the quinine)
Dr. Rachel : Water, sparkling water (+/- flavor), or kombucha. Did Dr. Jess say happy hour? Then anything with ginger beer and lime
| Song Of The Month |
Dr. Jess: “Don’t Kill My Vibe” - by Sigrid (Jack Garratt Remix)
Dr. David: Haven’t a clue (other than Baby Shark, but that was months ago). I just turn on the radio while driving.
Dr. Janice: Take me to the Throne (I love spirituals)
Dr. Rachel: “Out of Your League” - by Blood Orange.
| Book(s) |
Dr. Jess: So many but I’ll try to contain myself to a handful of recent favorites. Fiction: Americanah, The Fifth Season (sci-fi trilogy written by a kickass Black female author) Non-Fiction: Tiny Beautiful Things, Bottle of Lies, And The Band Played On, Why We Sleep, Boys + Sex, Girls + Sex ( I’m not a parent at this point, but I think the + Sex books are soooo important for parents and teens alike to read as an introduction and resource for critical health and wellness conversations they should have together.)
Dr. David: I can’t keep up with reading emails, news and research, so I haven’t read a real book in years.
Dr. Janice: Jess is so good, but I’m currently reading They Were Her Property by Stephanie E. Jones-Rogers.
Dr. Rachel: I’m in that Bible every day. Now, I’m not religious - I don’t believe in religion, and think religion was created as a tool of oppression and suppression. But I truly enjoy it. It has something for everybody: reality drama, suspense, comedy, mystery, romance...but the reason I read it is for the universal law. There are so many nuggets of wisdom in that book. What’s been really fascinating to me, though, is how much better I recognize the spiritual truths there in with my growing knowledge of endocannabinology, cannabis and plant medicine, and of the body’s inherent connection to earth, heaven, and other beings. Reading the Bible is definitely one of my daily habits of self care. Other than that,I just started reading a book I was gifted called Untamed, by Glennon Doyle. I’ve only read through Part 1, but so far it’s a book about living authentically; about self-actualizing (as my mom puts it); about loving yourself and living the life meant for you.
| Mentor(s) + Inspiration(s) |
Dr. Jess: My family! Mama Sue Taylor of Farmacy Berkeley - her energy and outlook on life are nothing short of inspiring; in the entertainment world, I have lady crushes on Issa Rae and Viola Davis, both of whom are powerful, creative, and unapologetically themselves, while making their space better for the people it typically excludes or marginalizes.
Dr. David: My wife (even though she refuses to be my IT expert). Dustin Sulak and Bonnie Goldstein are my inspirations in cannabis medicine
Dr. Janice: All of my children. I want to grow up to be like them.
Dr. Rachel: I recognize every person who has walked in and/or out of my life as a mentor. I’ve learned and keep learning from my experiences and observations with them all. My inspiration, however, is my destination - prosperity for myself and others. I am inspired daily by the abundant life and sustainable world I believe God wants for us.
| Stress reliever(s) |
Dr. Jess: Working out, Reading, Watching K-dramas！
Dr. David: Fishing, though I haven’t had the time for it in years. Yard work and building projects.
Dr. Janice: Singing (I sing all the time, I sang as I put my patients to sleep as an anesthesiologist) Like Jess, I love K-dramas.
Dr. Rachel: My dad is so good at building things! I like grounding; kicking off my socks and shoes and walking through the grass. And watching K-dramas. If I could watch K-dramas unrestricted and unbound by all my commitments and responsibilities, I’d be pretty stress-free.
| That 1 Thing You Keep Telling Yourself |
Dr. Jess: “You were made for this moment.”
Dr. David: I am smart, I am blessed, I can do anything!
Dr. Janice: “You can do it because I believe.”
Dr. Rachel: I wish I had that 1 thing to keep this answer simple, but the truth is that I tell myself all the things! On a daily basis I say words of encouragement to myself. I give myself grace, but remind myself to grow beyond my mistakes. I tell myself to listen more and champion others. I tell myself to keep going, especially when I am uncomfortable(which is often). But perhaps the most important things I tell myself are to breathe, and to remember that God’s got this.
| Daily (Shelter In Place) Routine |
Dr. Jess: Wake up usually around 7 am, read a chapter or two of my current book, make a cup of tea and work until about 12 or 1 pm (work is any combination of reading research/news, writing, preparing/delivering presentations, giving interviews, taking meetings/calls, speaking at conferences - webinars, these days, etc.), exercise for about an hour (I have a 6 days a week workout rotation that includes HIIT, barre, cardio, strength, pilates, and yoga), eat lunch (I’m an intermittent faster so lunch is my breakfast most of the time unless I’m on vacation), work again until about 6 pm, make dinner and eat with my husband while watching the show du jour ( yes, we eat dinner while watching TV, I know), then relax or work as needed until bedtime. I try to go to bed by 10 or 11 pm, and I always read another chapter or two of my current book before turning off the lights unless I’m too tired to keep my eyes open!
Dr. David: Sleeping in unless it’s a clinic day, when I get up around 7 am. Make coffee and eat my vitamins. Reading emails, meetings, research and writing if no clinic, otherwise working various hours depending on clinic schedules. Depending on what needs doing, house projects or yard work in the afternoons. I try to get some exercise, walking or swimming, if yard work isn’t enough of a workout. Dinner is often later 7-7:30.Work on the computer until bedtime. I get roped into watching K-dramas sometimes.
Dr. Janice: I’m up around 5:30 AM to do daily chores before starting my 9 am work schedule. I’m in meetings, answering emails, talking to patients, lunch break, back to work doing the same thing, then workout for 1 hour on my stationary bike before calling it an evening around 6 PM.
Dr. Rachel: I wake up and first give my gratitude to God. Next I heat water in the kettle for my and my partner’s morning ACV+lemon juice detox, read a few Bible chapters, and ground outside. After this I start work, breaking for noon “Fit Hour” with my partner whois my live-in trainer (praise God!). After this I resume work and break-fast with a delicious meal usually prepared by my partner. I almost always work until dinner, which is prepared by either my partner, me, or together, and then I relax.
C R A V E F O R M O R E
The Doctors Knox
American Cannabinoid Clinics
The Doc Knox Instagram
Rachel Knox | TEDxPortland| The endocannabinoid system and the revolution of one