If I have your number in my phone, you probably woke up last Thursday morning with a text from me that said something like, “The Dr. Goldstein podcast is finally out. Send it to everyone.”
You can now listen to the podcast below, watch it on YouTube, or read the following blog post and transcript if that fits your learning style.
In this long-awaited episode, we sat down with the highly experienced pediatric physician, researcher, and author Dr. Bonni Goldstein to discuss the use of cannabis as a therapeutic option for children with autism.
What transpired was a wealth of information, dosing insights, and a myriad of cannabinoid combinations that left us in awe.
Unfortunately, we had to keep you waiting for months due to a series of unexpected tech glitches and editing hurdles, and for that, we apologize.
The day finally arrived, and we released the episode after many late nights of editing. I was convinced that I’d never listen to it again.
But then, I decided to put myself in your shoes – the parents who seek answers and solutions for their children with autism.
I hit ‘play’ and started taking notes because the podcast was not just informative; it was so in-depth, it sounded like it was in code. If you don’t have experience with Cannabis science, there was a lot of information to sort through.
I knew I had to write this post to decode it all and share these invaluable insights with everyone.
Decoding Dr. Goldstein’s Insights on Dosing
Before we dive into Dr. Goldstein’s dosing recommendations and how she navigates using this botanical medicine with children, we must emphasize that the information provided here is not medical advice.
Always consult a medical professional before introducing cannabis or any cannabinoids, including CBD, to your child. Using cannabis or hemp without a physician’s recommendation can have serious legal consequences.
Please ensure you have a proper recommendation before embarking on this journey. If you’re looking for a cannabis clinician, you can go to the Society of Cannabis Clinicians. If one doesn’t live by you, you can use a service like Veriheal that connects patients to doctors licensed in their state.
Now, let’s distill what Dr. Goldstein shared in the podcast:
What is a good starting CBD dose for autism?
Dr. Goldstein typically initiates treatment with full-spectrum CBD oil, recognizing that, in approximately 50% of cases, THC or THCa supplementation may be necessary.
She usually starts with a dose of 1-2mg of CBD per kilogram per day (if you’re American, that translates to about 0.5-1mg of CBD per pound per day).
For example, for a 50-pound child, the starting dose would be in the range of 25-50mg of CBD per day.
Dr. Goldstein begins with the lowest possible dose, emphasizing that this is an out-of-pocket expense, and some children respond better to smaller doses.
However, it’s essential to understand that this doesn’t hold true for everyone. As Dr. Goldstein puts it, “If your child weighs 50 kilograms, they may end up needing 1000mg per day.”
It’s worth noting that even though Dr. Goldstein primarily focuses on CBD, her treatment often involves full spectrum products that contain small amounts of THC, typically at a ratio of 25 parts CBD to 1 part THC (25:1).
She rarely uses CBD isolate, stating that the small amount of THC helps stimulate receptors, and there’s a harmonious relationship between CBD and THC in modulating each other’s effects.
When to take more CBD?
Dr. Goldstein stresses the importance of patience when working with cannabis. It can take up to six days for any changes to reflect in the bloodstream. “You can’t make a change on Monday and then on Wednesday say ‘it’s not working.’
You have to give it time. This is a botanical medicine,” she explains.
She typically waits at least a week, or even two weeks, of observation before considering an increase in dose for her patients.
What If a CBD Dose Isn’t Working?
CBD exhibits biphasic effects, which means it can be overstimulating or alerting at low doses and more calming at higher doses.
Since half of all children won’t experience significant results with CBD alone, Dr. Goldstein will explore other options when reaching an upper limit of around 8-12mg per kilogram per day (4-6mg per pound per day).
For a 50-pound child, this upper limit for working with CBD alone is around 200-300mg of CBD per day.
Is CBD Safe for Kids? Is THC Safe for Kids?
These are vital questions, and the short answer is that it likely depends on how they’re used.
Ultimately, we don’t have the data to say that there aren’t negative long-term effects from using these plant compounds, but after a decade specializing in cannabis with pediatric patients, Dr. Goldstein has seen so many benefits for her patients that they outweigh any potential downsides. In her words:
“No matter what you figure out, if there is some benefit here, you’re going to have a natural medicine that is very unlikely to harm your child in the long run and can really make a difference.”
Keep in mind that the safety and efficacy of cannabinoid-based treatments for children with autism are still being studied.
Always consult with a knowledgeable physician who can assess your child’s specific needs and provide recommendations based on their medical history and current medications.
Dr. Goldstein talked further about the safety of THC and CBD for kids on the podcast, and holds the professional opinion that – when used at the minimum effective dose – these medicines are highly unlikely to cause long term harm.
Will using cannabis for my child with Autism mean my kid will be high?
“There’s this myth that these kids are all walking around stoned, and that is so not what is going on,” said Dr. Goldstein.
She uses a conservative and slow approach, especially when using THC, only increasing the dose of THC by .5-1mg each week. If the child exhibits any signs of a high from THC, she reduces the amount of THC to the prior dose.
Navigating cannabis dosing for kids is a painstaking process, so she cautions that parents and physicians be patient and observant.
When compared to the side effects of other medications recommended for kids, the side effects of cannabinoids are typically more mild.
Unfortunately we don’t have long term studies yet, so you’ll have to weigh your options and do what you and your doctor feel is the right course of action.
In conclusion, while the journey to understand the potential benefits of cannabis for kids with autism may seem like a complex puzzle, Dr. Goldstein’s insights shed light on the possibilities and dosing guidelines.
Remember to consult with a healthcare professional, ensure you have a recommendation, and approach this journey with patience, as results may take time to manifest. We’re here to provide guidance, share knowledge, and support you on this path towards improving the well-being of your child.
For more information, listen to the podcast or read the transcript below.
We hope it helps.
Corinne and Andrea
Ep 201 Transcript
Corinne Tobias: I wanted to start out by welcoming Dr. Bonni Goldstein to the wake and bake podcast and highlighting the fact that you’re a clinician that actually works with this population. You’re actually doing the work to help patients with autism can you tell us a little bit more about what you do? .
Dr. Bonni Goldstein: Yes. Thank you so much for having me. So I trained as a pediatrician and I went into pediatric emergency medicine, which, you know, adrenaline junkie, the whole thing. I loved it.. You actually Make a difference you’re saving lives and so on. I Was burned out and went into, a time in my life where I just like stepped back, which I think is a good thing when you’re struggling. And during that time, someone close to me asked me about cannabis medicine. I knew nothing.
Started reading about it and was intrigued. And since then I have been a cannabis clinician and initially started seeing adults cuz it was kind of very taboo to see children. And there, this was well before the whole story about Charlotte Figgy came out. And then, uh, right around the time that, that, uh, CNN documentary aired on tv, I ended up getting like, inundated with pediatric patients.
So that’s how I ended up, uh, basically being a cannabis specialist for children. .
Corinne Tobias: Thank You so much for sharing that that is such an incredible journey to get from, from where you started to here. So how did that turn into more of a specialization in autism ?
Dr. Bonni Goldstein: Initially it was just really mostly kids with epilepsy.
Some of them had a dual diagnosis of epilepsy and autism. And then the feedback you get is that, well, it’s not just helping with the seizures, but it’s helping with the autism symptoms as well. As you know, like moms who are struggling, dads, families that are struggling, they’re up at night, stressed out, and where are they?
They’re on the internet. They’re looking to see what other people are doing. The whole idea of cannabis spread like wildfire. I was just taking patients, taking patients, and when you are seeing patients and doing the work of what a doctor does all day, you learn about how the interventions that you’re suggesting affect the patients.
And these kids were seeing great results who had some autism as part of their multiple medical issues and on then it just started becoming more autism patients. So I would say right now that epilepsy and autism, either separately or together as a dual diagnosis is the top, uh, diagnosis I see in pediatrics.
Um, I do see kids with advanced cancers. I see kids with gastrointestinal issues like either Crohn’s, ulcerative colitis, I see teenagers with anxiety, depression, PTSD, um, but by far it’s epilepsy and autism. And by the way, the scientific research that we have definitely supports the use of cannabinoids for epilepsy.
that is really not disputable. Uh, the data that came out like over covid, I think everybody was sitting at home writing papers and doing research, which was great. Um, that all kind of coalesced, you know, if you think about CBD kind of getting into the epilepsy community of pediatrics 2013, 2014. Now we have almost 10 years of data that you can look at and put together and say, does this work? Is this safe? How effective is it? Who should take it? And that data’s there. And so that definitely supports that. I think for autism, because I know of the safety and potential efficacy, I have no problem helping a family who ha is struggling with a child with autism because I know the safety of the medicine and as kind of a neurotic physician, I am always kind of watching and I’m very, I’m very conservative with that whole start low dosing and only go to the dosing that, that, um, is helping the child.
You know, it’s never, ever trying to get the child intoxicated. I mean, I think that there’s this myth of, because you’re giving a child cannabis, well, what is cannabis? That’s a whole bunch of things, right? But there’s this myth that these kids are all walking around stoned, and that is so not what is going on.
The data supports the use of cannabis and autism because it looks like there are endocannabinoid system dysfunctions in autism. When you think about what issues do kids with autism have? Brain, gut immune system. Where’s the endocannabinoid system? Heavily populating brain, gut immune system and there’s so much overlap.
And then just the clinical experience of parents calling me saying that, you know, they get this school report and the parent actually says, I think you mixed up my child with somebody else cuz that’s not how my child behaves at home. In school you start to see achievement and following directions and engaging, and the parents are shocked by it.
Corinne Tobias: Yeah, thank you for sharing that. I’d love to talk a little bit more about that. So we know that autism exists on a spectrum, right? And it can include a variety of different symptoms. Like you said, it’s in the brain, the gut it’s repetitive behaviors, obsession, delayed, cognitive abilities, sleep issues, those kinds of things. There’s a lot of different stuff going on and it’s clearly not the same for every patient. So in your practice, what kinds of things specifically have you seen cannabis help with in the autism population?
Dr. Bonni Goldstein: That’s a great question cuz there are so many parts to autism. So, number one, it doesn’t always work, but sleep seems to get better.
I have families that have come to me and said, no one in this house has slept in seven years. Uh, we take turns sleeping. We hired a nanny to come to our house at night so we can sleep and function the next day. I mean, think about that. That’s crazy, right? Um, how about we send the other kids to grandma’s house to sleep?
Because here at home we’re up, you know, pretty much up all night cuz our child’s just pacing all night long. All night long. Um, so sleep is definitely number, number one or two. Aggression seems to respond to cannabis. Think about cannabis. What does it do? It’s very calming, right? For most people.
If you take the right dose now don’t overdose and get paranoid and anxious. THC can help with aggression. CBD can help with aggression. CBG can help with aggression. I’ve seen CBDA help with aggression, THCA. So there’s lots of cannabinoids and if one doesn’t work, that doesn’t mean you’re done.
You move on to something else. In my book I talk about ruling it in or ruling it out, right? You methodically go through the various cannabinoids to figure out what plant chemistry suits my child’s chemistry cuz there is no one size fits all right. Restlessness, irritability, lots of parents.
Oh, reporting my child just seems happier. Right? Less rigidity. Whether it comes to routine in like going, you know, even just driving in the car to school. If you go a different way, sometimes the these kids freak out, right? Or you make a left instead of a right or you stop at the drugstore after school and you know, the, your child flips cuz they’re expecting their routine to be the same.
How about food rigidity? You know, when I have parents saying my child has been eating the same three foods for the last five years and now they’re willing to try a slice of pizza. My child’s tried broccoli for the first time. These are very exciting milestones, right? Cuz it’s allowing different, basically different connections in the brain.
And it’s also calming a lot of that neuro excitation of the brain firing. Um, other things that I have seen is, um, and not in everybody, so not to make, you know, a big expectation, but improved speech going from non-verbal to verbal, or going from partially verbal to putting sentences together.
Many children with autism only respond if they do speak. They only respond to questions, right? They don’t have spontaneous speech. I had one mom say And brought me to tears. She said, every day when my son came outta school, how was school today?
And I never get a response. she said, one day I get, I had fun mom. And she said she almost like dropped to the ground in tears cuz she had that meaningful telling her what his experience was. Right. So, um, let’s see, what else? Um, tick behaviors, you know, if your child seems depressed, that can respond. Um, just so many things, you know, just kind of a global improvement. And I do think anxiety plays such a huge role.
If you talk to lots of families who have kids with autism, they’ll tell you their child has terrible social anxiety. They like being home. They don’t necessarily like being out, not all kids, but once they get used to a place they do better. So imagine starting a new school, going to a new therapist, right?
Going to a new doctor, um, going just any place new. That creates a lot of problems. um, in my office, there was a child who would get in the elevator. and the mom came up in tears and said, I have him sitting in the car with grandma cuz he just won’t get in the elevator. I mean, I just think about these little things we take for granted that these people are struggling with
Andrea Meharg: I Heard a whole bunch of little success stories in those. Do you Have a success story in your head? Do you have a child that you can think of that made a huge impact on you as far as when you saw them responding to cannabis?
Dr. Bonni Goldstein: Gosh, there’s so many. I mean there’s one particular patient who came to me. And now he’s a young adult. Um, he, his mom had kept notebooks of pretty much every seizure. She documented everything. She was meticulous. And she came with this stack of notebooks for his, and he has epilepsy and autism, and she had every seizure documented, every medication change.
He had been on multiple different medications. She’s racking her brain. And this is something I see as a thread in my patients cause and effect, well if I’m giving him this medicine, is it doing something? Is it making him worse? Is it not doing anything? And people, they get into this cycle of trying to figure this out.
I feel so badly because, you know, epilepsy, autism too, very unpredictable. And I, you know, say that my families Until they get some improvement. They have not post-traumatic stress disorder, they’ve ongoing traumatic stress disorder because it’s so unpredictable. Like, I’m going to the grocery store, is my kid gonna end up on the floor with a seizure?
Right? I mean, or am I in the car on the highway? Am my kid strapped into a, you know, but this particular, um, young man was having lots and lots of seizures just about daily. And he would go a co maybe a couple days, but he never went really a week without seizures and lots of different medications. And when they came to me, he, he was actually in the process of trying to figure out if brain surgery would help him.
So they were mapping his brain and we had our consultation, and this is very early on, like, I wanna say 2014. And we really just had, at the time, THC and CBD but it was available and I was finding it to be effective for many patients. So they leave my office and I don’t hear from them for the longest time.
And the next time I connect with the family, the mom says, no, we haven’t started it. And meanwhile she’s got another whole notebook full of seizures. And I just thought, what are you waiting for? So I kind of read her the riot act. Riot act a little bit. I said, I understand what the mapping, you didn’t wanna change what they found in the brain, cuz if brain surgery was going to be an option, I understand, but it looks like he’s not a candidate, so let’s just go for it.
And this child re teenager responded incredibly. He got, as we worked up on the dose, I think it took maybe four to six months to find his sweet spot. Which again, you know, it doesn’t, it’s not magic. Gotta find this, the product that works, the dosing that works, you’re trying. , to make sure you’re not causing lots of side effects with the drug interactions of the other medications. So again, I mentioned I’m conservative, I take my time. We get there. He was seizure free for over, for over three years and then unfortunately as we, his mom weaned some medication, I think there was, you know, she didn’t reach out to me, I would’ve advised going up on the CBD to give him a buffer. But anyway, he had a breakthrough and then we had a little bit of a rough time.
But meanwhile, let’s just say right now he has, his seizures are far and few between. He is on CBD in a fairly high dose. And that’s the other thing is you don’t just give some CBD you dose it milligram doses. There’s enough information to understand that. I, I if you ha if you’re not seeing a benefit or only a partial benefit, it may be that you haven’t gone high enough for, especially for epilepsy and autism as well.
Um, He’s on, so he’s on CBD he’s on THC and very recently, CBDV which has, knock on wood somewhere he, that he has not had a SE had a seizure since we started CBD VCBDVand no breakthroughs, nothing. Um, some, one of the things I’ll share about epilepsy, one more thing is that not only does it help decrease the frequency or reduction of the number of seizures, what we’re seeing too is less severe se seizures.
So less severity, um, shorter seizures, right? And then also a much quicker recovery. Parents will tell me, it used to be a day, my child after a seizure. It’s exhausting to have a seizure. Your brain is over firing and you have what’s called a postictal period. You fall asleep and really you lack energy, right?
Um, parents are telling me that the. Postic do or post or the recovery period is really short. Like almost like, you know, he seemed kind of mellow for 20 minutes now He is up, running around. That’s huge. You get your life back. You don’t lose a day, two days, three days of your child trying to recover from, from a bad seizure. , and in autism, it’s interesting. It’s, it’s not magic, it’s not perfect. But when you have, like for this patient, he has autism as well. And what the mom says is he’s just calmer. He doesn’t perseverate as much. Um, his social interest has grown. He’s very interested in being out and about. He was able to go to college and graduate, which is so exciting.
And, um, he was even his school’s mascot for their, um, teams. I mean, you know, he got to participate in his life and. When I think back over those, always think of those notebooks and kind of looking through them when the mom brought them and I thought, oh my gosh. Imagine living through this. Not just now looking back at it, but oh, what a difficult life and a plant made a difference and I don’t get why there’s so much resistance still
Andrea Meharg: You talked about a bunch of different cannabinoids and how if somebody doesn’t respond well to CBD maybe it’s the dose, or maybe you need to add a different cannabinoid or switch one out to the other. This is something that people coming into the cannabis world often don’t understand, and it’s so refreshing to hear from a doctor, Hey, I do not have the magic dose here for you.
But now after working with patients for so long, you must have kind of a roadmap that you follow. Can you talk to us about where you start with dosage and in ingestion methods and different cannabinoids? .
Dr. Bonni Goldstein: Yeah.
Thank you for asking that question cuz it is, uh, a challenging one.
I try very hard to not just have a roadmap that I follow for everyone cuz you have to take people’s circumstances into account. But ultimately it is trial and error because you never know what a particular human’s baseline chemistry is despite their, you know, your checkbox on the diagnosis.
That’s why, you know, I take a lot of history up front. I read their previous medical records to try to understand where they’re coming from and then try to start somewhere that would be more helpful rather than just picking a, you know, a protocol and going there. But for the most part, for children with epilepsy, I start with CBD. Um, for children with autism, in my experience, and I’ll say it correlates with some of the studies that have come out of Israel, about 50% of kids are gonna respond, uh, who have autism to CBD for either low, medium, or high dose. Um, and then the other half are going to need to have some THC, THCA in the mix.
Um, and that is because we know that children with autism, and this is documented in two very good studies, one from Stanford and one from Israel, that they have lower levels of their natural, what we call endocannabinoids, their inner cannabis like compounds. and remember, those compounds serve the role to maintain balance of messaging.
And if you have low levels of those, how are you balancing the messages in their in the brain? Those imbalanced messages are manifesting as seizures, manifesting as behaviors, manifesting as difficulties with basic things like eating and sleeping and interacting. so rather than kind of go the route of altering the neurotransmitters, we are trying to address the endocannabinoid system, which regulates the neurotransmitters, right?
So that’s the whole idea. And CBD works within that endocannabinoid system also at receptors outside the endocannabinoid system. And I go with CBD because it’s the one that we have the most data for for epilepsy and autism, but also knowing that for some of these patients, THC is going to need to play a role because it mimics the action of endocannabinoids.
And if you don’t have endocannabinoids how are you ever gonna get into balance? It’s like saying to somebody, you have a thyroid imbalance. Let me give you a antidepressant. Um, no, that’s not gonna work. You’re not hitting the target. You need to take something that’s going to help replace, um, the thyroid issue.
Right? And it’s the same idea as we, as you know, someone who has Parkinson’s, right? They are missing dopamine. You replace with dopamine. So CBD is where I go. You ask about dosing, I start very conservative. Around one milligram per kilo per day, two milligrams per kilo per day. Because there’s are children who are low dose responders and the idea is minimal effective dose. If I slap ’em on 10 milligram per kilo per day,
what if remember it’s out of pocket medicine? What if five milligram per kilo per day works for them? What if one milligram per kilo per day works for ‘ em? So I prepare the family by saying, we’re gonna start low and titrate up. You’re engaging me for a year of help. So it may take that long. So just, you know, get your expectations set.
There’s a handful of patients, I’m sure we’ve all heard, with the first dose, my child never had another seizure, or oh my gosh, this is man magic for my child. But that’s not the case for most. Okay? And you know, I’m so happy for those families who have that, but that’s not the case. . Most of it is we are titrating up.
We’re trying to balance with other medications. We’re trying to balance with, you know, timing. Is it before school? What if your child’s in school all day, you know, then can what if you need a dose in the afternoon? It’s all of that trying to work through. It’s a lot of work. CBDs the first. Now, what’s interesting about CBD, again, we have trials with a pharmaceutical CBD that tell us that for that product, the dosing range is 10 to 20 milligram per kilo of body weight.
So if your child weighs, let’s just say 50 kilos, potentially your child may need a thousand milligrams a day of CBD. Now, cost effective wise, that’s very difficult. Luckily there are companies that do give discounts to patients. In California, we have the, you know, the legal dispensaries. Most of my patients using high dose CBD are going through the hemp market through very vetted oils that have been around a while, who share their test results, whose products I buy and send to a lab to get tested so I know for sure that I, I’m not recommending something where someone messed with the test results. Um, and there’s a handful of companies that are quite good that have like basically shown us that they care about the end user and they don’t change their product.
It’s the same thing bottle to bottle to bottle so that it’s medicine, right? Um, and so with CBD I tend to titrate up. If I’m not really seeing great results by a reasonable amount, you know, eight to 12 milligram per kilo, you’re not seeing really anything or you’re seeing worsening. Uh, I’ll go in a different direction.
But it is important to understand that it can take up to six days for that change that you make. Let’s say you go up on the dose, it can take up to six days to that, for that to reflect in the bloodstream. So you can’t say, I changed the dose Monday and Wednesday it’s not working. You have to give it time.
This is a botanical medicine. it’s not a hammer like pharmaceuticals are. It nudges you in the right direction, so you have to give it a chance. So I usually don’t make changes with CBD. And again, no hard and fast rules depends on the situation, but at least a week or two weeks of observation to give it a chance to work.
I also tell families to prepare that CBD has what we call biphasic effects. So low dose can be overstimulating for some patients, or alerting. I have one mom I talked to, yesterday. She calls him her nighttime party boy, And she’s like, this is not working.
And then, as you go, higher dose with CBD it’s more calming. This, this is very typical with cannabinoids. Depending on the dose, they can have different effects. It’s a very complex, you know, it’s not a key in a lock only, we talk about that, but it’s much more complex than that.
If a child is, let’s say a, a child with autism is highly aggressive just from the word go, and that’s why they’re in my office. I will include THC from the beginning. So usually I’ll recommend a, uh, lower CBD to T HC ratio for someone who, where I’m saying I’m just gonna try C, B, D,CBDit’s usually like 25 parts CBD to one part THC.
I never really use CBD isolate. I don’t find it to be effective. That little bit of THC in there helps stimulate that receptor. Not to mention it works at other very important receptors. Mother nature packaged it a certain way for a reason. It’s not dangerous to take a little bit of THC when you’re taking this huge chunk of CBD along with it.
CBD helps dampen down theTHC, it modulates it, it lets it do its thing, but not as a full force binding to that receptor. I hope that makes sense. But there is this, um, really beautiful kind of relationship with CBD and THC working together, like we know in pain studies cBD by itself, not so great THC by itself, not so great.
Put ’em together. You’ve hit the jackpot. So this whole idea of CBD being the good cannabinoid and THC, the bad cannabinoid, absolutely not. THC is an amazing medicine when used medically. Really amazing. Uh, if those patients with aggression , like where that’s the main issue, I just sometimes start four to one ratio.
When THC plays a bigger role, you don’t need as much CBD cuz the THC is doing some of the heavy lifting. Right. If you’re asking CBD to be the big, you know, powerhouse, you’re gonna have to go higher dose. I’ve been using THCA and CBD CBDA. Remember raw cannabinoids? These are amazing anti-inflammatories. and remember, one of the underlying issues with epilepsy and autism both is neuroinflammation, gut inflammation.
These raw cannabinoids, although understudied and we don’t have enough data on them, we at least have the data to show that they are potent anti-inflammatories. They’re also absorbed better by the body. They’re a little less fat loving, and a little more what we call, um, uh, water soluble. So your body seems to absorb them better, so you don’t need as big of a dose, okay?
And they also are not intoxicating. So there’s that added benefit of somebody who might be sensitive to the intoxicating effects. These are not intoxicating or impairing. There’s also CBG on the market. CBG is cannabigerol.lots of good research on CBG, uh, Dr. Ethan Russo and a number of other people did a survey and published it on last year, the year before, and it was just a survey, but it’s meaningful, pain, anxiety, depression, sleep, it was rated very highly, was, basically non intoxicating, which I have not found it to be intoxicating in my, in my experience.
Lower doses than CBD can be used. It has a few different targets in the brain and body that than CBD. Some overlap, but some different targets. And, it was in this survey, very highly rated. In fact, people reported being able to get off pharmaceuticals by using CBG. Um, in my practice I find CBG to be helpful for anxiety, even in low doses, especially when comboed with other cannabinoids cuz you get this entourage effect where they kind of all assist each other.
Um, and a very interesting thing about CBG with autism is that for about 30% of patients it expands speech. And I can’t tell you, you know, when I’m trying it, I don’t know if it’s gonna work or not. There’s like, no test is or is, you know, your child has, you know, brown hair, so they’re gonna respond to CBG.
There’s no way to know. You just try it and see. And again, CBG can be sometimes overstimulating for some patients, and it’s counterintuitive. If it’s overstimulating at a low dose, why would I give more? They’re gonna be bouncing off the walls. No higher doses can be more calming. . That’s just the funny thing about cannabinoids.
And then just recently I started using CBDV cannabidivarin. It wasn’t available on the market and now it is probably since about, maybe summertime when it kind of became obvious to me that patients could now purchase this in the hemp market. And I am just kind of blown away by the results in, in just yesterday, which I was excited about cuz I’m gonna be talking to you today.
I had a parent email me in the morning saying, I, I am holding my breath because we got through a pretty serious, kind of difficulty that I know trigger seizures, in my child, and there were no seizures. And then I had another mom reach out. You know, the gut and the brain are so connected, right?
We all know this. Um, a lot of children who get constipated, it will aggravate seizures or aggravate behavior. And I don’t know if you’ve heard that before, but it’s a big problem. Um, and keeping their kids regular without a whole bunch of medicines is sometimes very difficult. And things sometimes too in kids with autism, just their diets not very varied, so they just don’t have a great microbiome and there’s dysfunctional bowel anyway, right?
And then a very limited diet is not gonna help. , but I have one patient with autism who, I’m thinking about this boy. CBG is what keeps him, believe it or not, just keeps his bowels regular. It’s kind of amazing. And then with CBDV, this one particular patient where the mom knows if she gets constipated, they’re gonna live through all these cluster seizure.
The mom said we saw one brief seizure and then she didn’t go into those clusters first time ever when she’s constipated. We haven’t seen that. Then the other thing about CBDV is I am adding it into an already existing regimen. I’m pretty sure that’s why I’m seeing the results that I’m seeing, but I am like a 10 year old little girl with Dravet’s syndrome.
Two and a half months the longest she’s gone without a seizure since she had her diagnosis. This is amazing, right? And again, it’s not magic. These compounds Work at receptors and enzymes and so on in the brain and body the same way pharmaceuticals do. It’s, it’s when a pharmaceutical company develops a drug, they have a target in mind.
Of course. These cannabinoids target certain receptors, cannabinoid receptors and others. And so this whole idea, like I bel believe or I don’t believe in cannabis is nonsense. It’s, this is science. . Um, I will say that I absolutely, I’m in favor of a zillion more human clinical trials, but we have enough data to show that it is safe.
And certainly if you are in a situation where there is nothing helping, my goodness, what have you got to lose, right? I didn’t really answer your question of the, the kind of protocol. it kind of depends because if I give a child CBD and I see a response, then we get a fork in the road.
Okay, should we continue with this or do we now add another cannabinoid? I try to not complicate with lots of variables all at once. Like I have parents that email me and say, can we just add in this? We have not explored the full dosing range, and I understand you’re struggling, but if we divert now to something else, then there’s still this big question mark over here.
So it, it can be rough though because it is a tedious process. Um, but what I always tell people is that, no matter what you figure out, if there is some benefit here, you’re going to have a natural medicine that is very unlikely to harm your child in the long run and can really make a difference. You know, I just wanna share with you, there was a, report that came out in 21, I think it was, that showed that the longer you’re on CBD for seizures, the better you do.
That’s amazing. I just tell people this is mother nature. Like, if I go vegan tomorrow or I hit the gym tomorrow, I am not healthier tomorrow night. It takes time. Like we always, you know, say that, you know, if you’re working out, no one’s really gonna notice for three months.
You gotta give a natural option a chance. We’ve all become so used to the idea that I’m gonna take a pill and be better in two days, and boy, do I wish it worked like that, but that’s not really how it works.
Corinne Tobias: Wow. Thank you so much for all of that. That’s incredible. Um, I do want to circle back around to something that you mentioned. We talked a little bit about THC and you mentioned that in 50% of cases it’s necessary. I would say that the biggest question that I got when we solicited questions about THC and autism is that many of those questions were really intertwined with a lot of fears and beliefs that people have about this particular cannabinoid.
One of the questions a parent specifically said was that she read THC will cause brain cells to go dormant. And she wanted to know if they could come back. She also mentioned that THC lowered IQ. So there’s obviously this very real fear that THC will do more harm than good if you incorporate it, especially for things like brain function for cognitive function. So can you speak to that? Is there any real reason to be concerned about using THC for children and long-term effects in the brain?
Dr. Bonni Goldstein: Yeah, this is something that I hear all the time. So think about where we’re getting the data from, right? So first there’s propaganda. Remember that commercial, this is your brain on drugs and your, the fried egg and the pan. Okay? So leaving that nonsense behind. When you look into the scientific literature about THC, who were the subjects of these studies where they report that it’s bad for you, right? Or that it damages your brain or it does this or that. Chronic, heavy THC non-medical use with no medical supervision in a 15 to 25 year old age group, mostly boys or men and just like all THC all the time. Well, if you inundate your endo cannabinoid system with all THC all the time, guess what happens to your receptors, which you rely on to maintain homeostasis.
They say, you know what? That’s too much THC. I am over inundated. And they go from sitting on the cell wall. And they hide inside the cell. And we call that downregulation of the cannabinoid receptors. When you down regulate, meaning you dial down how many cannabinoid receptors you have now, your inner cannabis, which controls your emotional state, your cognition, your memory, your learning,, your re reward and, and addiction, um, system, your sleep, your appetite, like everything basic to your being.
You just eliminated that receptor. Where’s your endocannabinoid gonna go? It just is like floating around looking like where’d they go? And what happens is with chronic heavy use, often, again, non-medical, cuz I would never recommend chronic heavy use in a patient. That’s just not in the realm of all the, I do a lot of things with cannabis, but I don’t do that.
It is not a good idea, especially if you’re a person suffering from anxiety. Especially if you’re a person suffering from pain, you’ve eliminated the target. That makes no sense. Right. So those studies are studies of not medical supervised or medically knowledgeable people. I would, and my analogy is if I saw a 15 year old in my office with pneumonia, I would not say, here’s the keys to the local drugstore.
Go pick your medicine and take as much as you want. That’s just so silly. And when people say, I self-medicate, medicate, I don’t mind that if you know what you’re doing, but I do mind that if you don’t know what you’re doing, so when we look at IQ points, it’s something like eight IQ points in this chronic heavy use, right? But the clear cut studies that show that when you take THC away and allow the endocannabinoid system to go back in, the system will this, um, down regulation of the receptors is not permanent. They pop right back up. And if you test people when they’re under the influence of chronic heavy THC versus when they’ve abstained, they go right back to their baseline.
And there’s now a handful of studies that have come out by people who have made this, their life’s work to look at the effects of THC on brain development and on, um, cognition and, uh, emotionality and executive functioning, impulsivity. All these things that we look at. And even they come out and say, this may be genetics, this may be environmental factors as they’re growing up.
This may be dietary, this might be, um, family issues, a social situation. Cuz really how do you tease out? Right. My son is in his early twenties now, but when he was 15, I, I knew where he was and what he was doing. I’m not saying that you’re a bad parent. If your child goes out and hangs out with his friends and gets stoned and come home, but you need to have a conversation about their mental health.
Why are they seeking out cannabis? You gotta have the conversation because if you allow them to continue to quote self-medicate in the teenage years when they don’t know what they’re doing, it’s like saying, here’s the keys to the pharmacy. Have at it. Just go take whatever you want and disregard the actual effect on you.
What I have found in my medically supervised patients using THC is nothing but benefits unless the child just doesn’t do well with THC, and then we just kind of take it out. There’s no reason to take something that doesn’t help you. But with THC, you have to be careful because if it’s the only compound you’re using for your medical condition, if you’re not careful in terms of being thoughtful about dosing, knowing how much you’re using, or just being thoughtful, kind of about use in general.
Like, do I really need it right now? You know what, my pain’s a 10 outta 10. I do need it. But you know what? Let’s say you come home from work and you’re like, well, I’m not so bad. I, I, maybe I’ll skip it. That kind of helps maintain your cannabinoid receptor system, right? Your endocannabinoid system, and allow those receptors to not necessarily, uh, build up tolerance.
There’s all different levels of tolerance. You know, there are people who have tolerance that’s just a little bit, and actually in a way that allows them to really get good results with THC because now they’re tolerant to the memory loss part. And tolerance builds. It’s very interesting. You get tolerance to THC, um, at different rates in different parts of the brain.
So like for instance, I had a patient who, um, she kept telling me, I feel like I just can’t remember anything with THC use. She had multiple sclerosis and THC was very helpful for her spasticity, for her pain, for her sleep, for her appetite, all of the kind of things that, that someone with chronic illness is dealing with.
But she was upset about the memory stuff and I said, okay, let’s be a little bit more thoughtful about our use, right? And see if we can either change the product. We did a bunch of changes, dosing, timing, product. And what’s interesting is that memory issue kind of went away. She was like, I feel like it’s not an issue anymore.
And I think what happened is that she just was able to find the sweet spot where, , she was still getting very good effects for the pain and the sleep and so on, but the memory wasn’t as affected. You have to pay attention to all this. My colleague Dr. Dustin Sulak, uh, Maine always says, you know, take an inventory before you use your cannabis.
Right? Take an internal inventory. How am I feeling? Am I content? Where am I at? Um, and I think that’s very useful. Now, of course, we don’t do that with children, right? We, we are trying to treat them. But if you are using THC and you are concerned about these potential downside, it’s really all about use patterns and you just have to be thoughtful about it.
And one of the ways around tolerance so that you can get, the benefits of THCs to add some CBD into the mix, let them both share the heavy lifting. You don’t need as much THC. Often you get a beneficial effect. And it appears that CBD helps minimize tolerance to THC. In the studies on Sativex which is a one-to-one ratio, CBD THC, that’s available in Europe for multiple sclerosis and advanced cancer pain.
It’s a pharmaceutical product not available in the United States. Um, they have, oh my gosh, tons of research on it. There’s no tolerance. Just adding that CBD in there helps minimize tolerance. And again, going back to medical use, what is the point of taking a medicine that you build tolerance to and you lose the medicinal effects?
That makes no sense whatsoever. In my practice on children using high-dose THC, along with other cannabinoids, we are seeing learning, we are seeing progression of milestones. We are seeing the opposite of what these chronic heavy use reports are are saying.
So just to be clear about it, there should be no fear with medically supervised THC use.
Corinne Tobias: Thank you. That is so, so helpful. Is there an upper limit of THC with children? Do you get to a point where you’re like, oh, this is too much to feel comfortable with administering to a child.
Dr. Bonni Goldstein: It’s not a specific dose, it’s the child’s response. In my book, I talk about what’s called the ceiling dose, so we will titrate up.
I am very careful with THC i in children. I use 0.5 milligram to one milligram increments. You go in teeny tiny increments because a little bit can make a big difference. Right. I always tell the parents, if you see red eyes giggling sedation, you know, any of the things that we know, that impairment or intoxicating, uh, looks like we, okay, you hit the ceiling dose.
Too much. Backup. What was the previous dose? Let’s assess what that did for your child. So if you tell me that when you do five milligrams, you’re seeing less aggression, better sleep, just overall less social anxiety, great. But at six milligrams, your child looks a little high and parents know. I mean, you can tell you’re around your kid all the time, you know?
Six isn’t the dose, five is the dose. And if five doesn’t do the trick, then we still have to support it with other cannabinoids. I had a, a child in my practice years ago. THC was the only compound that helped his seizures and his autism.
But we ran into trouble where we would have to take a break. And who wants to have to take a break to reset receptors in a child that’s having symptoms? Nothing else seemed to work. We tried everything and that was what worked for them. So we, we tried to make it work and built in what we call holidays where you take a couple days off and just pray that the seizures don’t work.
But ultimately, I don’t fi find it to be a really great way to medicate somebody. I would have liked to have other cannabinoids in there, but he just, it seemed to aggravate him. So there is no dose. What’s the highest dose of THC I’ve ever had a child on? 1500 milligrams a day for cancer.
Um, I have a pediatric, uh, autism patient who takes 300 milligrams of CBD a day and about 250 milligrams of THC a day. And people might say, why would he need so much? Well, when you give him less, you don’t see any e effect. It’s only at this high effect. And remember, you don’t absorb every milligram you take.
In fact, absorption is horrifically low. It has terrible, what we call bioavailability. It’s between like five and 20%. And I ventured to say that in someone who has gut issues, it’s lower than 5%. So in order to get some into the system, you may have to go higher. Now, there are ways around this for some people.
So some of my teenager patients have, um, we’ve educated families on how to use vaporizers so that they can get a little more efficient. It gets into the system a little more efficiently. Also, there are companies out there that kind of wrap the cannabinoids in a more water soluble package. There’s a lot of claims out there, but some of it is, I would think scientifically valid. Cuz I do have families that use some of those products and they not only getting quicker, but you get a better result with a lower dose. I don’t know if that’s gonna work for everybody.
I just haven’t used it that much. And when you think about how much people are paying for medicine, it seems kind of wasteful to think that you’re only absorbing a small portion of it. But you have to remember, we’re in the infancy of this. So we still have a lot of work to do to try to enhance the delivery methods.
But in the meanwhile, we’re seeing good results with this. And so in general, most people don’t need mega high doses of THC. And if a family calls me and says, my child got intoxicated, we now learned what that dose is, and we just don’t do that again.
And that one time is not gonna change anything for that child. I think, you know, fast food is worse for your child than that one little blast of THC.
Corinne Tobias: How legal is it to give THC or CBD to a child in the United States or in north America?
Dr. Bonni Goldstein: In the United States, it depends on your state. So that we have a lot of CBD only states, so you can get in trouble for giving your child THC here in California if you’re under the age of 21, you have to have a medical recommendation. You have to have seen a doctor. And I have had some cases where parents have been reported to Child Protective Services.
And because I’m involved, there’s non-issue, there’s a responsible physician following the child. Um, there have been cases of children being taken away. And it’s really unfortunate because, you know, we’re handing out the atypical antipsychotics to these kids with no problem. And here’s a plant medicine that’s very safe, um, especially under medical supervision.
And, and we don’t want families to have to go through the, that burden already on top of all the challenges. So it just depends on where you live. And it’s unfortunate that we don’t have enough doctors embracing this. There are doctors in just about every state in the United States.
I know there’s a wonderful pediatric, uh, cannabis doctor named Dr. Jennifer Anderson in, in Canada. And, here in the United States, I, I usually refer people to cannabisclinicians.org. It’s a, it’s a group called the Society of Cannabis Clinicians. And if you go on their website, they do have a list of physicians.
Um, and then, you know, sometimes word of mouth asking other parents, who’s helping you? Where are you going, what are you doing? And if you can’t find an md, there’s lots of nurses out there that are doing cannabis coaching. And I find actually that doctors are the least interested in learning.
And I’m seeing a whole slew of people who wanna be like nurse practitioners, nurses, other people who have healthcare backgrounds, who wanna be involved in helping patients use cannabis. So sometimes you may have to go a little bit outside. As long as someone’s being thoughtful is taking a good history and being thoughtful about, uh, what they’re doing, um, you’re pretty likely to find some success.
Corinne Tobias: So I have one more question. That’s a little bit more about the role of cannabis educators and cannabis health coaches. When it comes to getting the word out about things that cannabis can help with, like autism
Corinne Tobias: Obviously, we’re not medical providers, right? We’re cannabis educators, and we’re really passionate about this plant.
So how can we, and the students at the cannabis coaching Institute and others who are in a role where we’re not in the medical field. But people come to us with questions so how can we support this moving forward in terms of getting the word out and helping people understand how to use cannabis in this particular way?
Dr. Bonni Goldstein: Well, I think you just have to keep talking to every single person, anybody who reaches out. I’ll tell you from 2008, to now that’s my experience. In 2008, it was like taboo to even mention marijuana. Oh my god. What? You’re giving marijuana. You’re taking it. I mean, I didn’t tell anybody. What I was doing, cuz I knew I was gonna be judged.
Like, what did she, has she lost her mind. That’s what my colleagues in the medical world would probably say. We just have to keep talking about it. We have to stress the science every chance I get, and I even write in the book someone who doesn’t understand, I say, do you know about the endo cannabinoid system?
And this whole idea of everybody saying, there’s not enough research. Let’s stop saying that. As you guys know, I’m doing an educational program. I cannot get through all the research. It’s too much. It is 12 hours a day on the weekends. And my husband’s like, wow, you’re, are you just reading the same article over and over again?
Or what? I’m like, do you know how many articles there are on this? I said, I’m, I’m always blown away that there is this tremendous amount. . One of the things that makes me really sad is it takes 17 years for the scientific literature to get into a practitioner’s hands. That is unacceptable. We must constantly talk about this, push people towards articles that help us understand and just really move past the reefer madness crazy mentality because this is medicine when it is used as medicine.
Andrea Meharg: I can’t thank you enough for coming on here and like dropping all of these really poignant bombs on us. I have two kids, neither one of them have autism, but as you were speaking, I could feel my own shoulders relaxing for the parents who I hope are able to listen to this.
So I really appreciate everything that you’re doing in this space. We are so grateful to have been able to spend an hour with you. If you want to find Dr. Bonni Goldstein, where should they go?
Dr. Bonni Goldstein: So my website, it’s, it’s either Bonni Goldstein, md we’ll take you to my main website, which is called Canna Center.
So that’s the name of my medical practice here in Los Angeles. Um, and then I have a book out call. Cannabis Is Medicine. Um, I didn’t get a chance to talk about my autism research, but if you go to Google Scholar and you look up autism and put my name, you’ll find a couple of articles that we’ve published on some groundbreaking technology and videos.
I have a YouTube channel now, uh, Bonni Goldstein, MD with no E on Bonni. And just trying to get the word out. Like what is CBDV? How do you use cannabis for epilepsy? Why does it help epilepsy? What about cannabis for autism? So those videos are out there to educate people.
Andrea Meharg: Thank you so much. We will link to all of that below. All right. Thank you very much for all of this.
Corinne Tobias: We appreciate you
Dr. Bonni Goldstein: thank you guys.
I’m not going to lie, Andrea. I know we were very excited about recording this podcast. I know that right afterwards, we were both like on cloud nine. But looking back after all of these months, after recording it, I can honestly say that this podcast changed my life, right? It like, opened up the world of CBDV for me and I started growing CBDV plants.
Um, I started having. More eloquent conversations with my friends who had children with autism about cannabis. I really, I hope this podcast does for others what it did for me personally.
I had the same experience as you Corinne about talking to my friends who have kids with autism, and I started to think about how overwhelming it might be as a parent who is walking into this brand new.
So you and I thought that we could break it down into three like kind of easy steps that are probably harder to take on the ground. In order to see if cannabis is an option for your child. So step one and the most important step we can’t hammer this home enough is that you get a recommendation in the United States or a prescription in Canada for your child.
to keep everything above board and legal, your own family physician may be able to help you out. But if that’s not possible, there’s a great website called cannabisclinicians.Org where you can seek out doctors or a service like Veriheal. And we’ll put the links to those down below.
And just to be totally clear, this is even if you are using CBD with your child and you’re in a totally legal state. Now, Corinne, you called one of these services, Veriheal and pretended that you had a child with autism.
Can you tell me about that? Was it easy? It was a very easy process and so don’t skip it. Uh, if you can’t find the support that you need local to you, find a resource like very heel. We have no affiliation with them. It was just the 1 that we decided to call and test out. It was a very simple, straightforward process.
And not only can you get a recommendation, but you can also, they can link you up with someone who can help you and the next step, which is. Ruling it in and ruling it out, figuring out which cannabinoids will work.
It is always the tricky part when you’re working with cannabis to figure out exactly what cannabinoids, what dosages work. Now, Dr. Goldstein gave a lot of guidance around this, and she talked a lot about what has worked in the past throughout this podcast.
So please, if you’re on step two. Go back through, listen to what Dr. Goldstein has to say, buy her book, read her stuff. She has the experience of working with this particular population to help you navigate that if you can’t find the support from your physician or from someone who has been down this path before.
And then step three is to track, and we’re not trying to make this an anxiety inducing or an overwhelming task that you have to add to your load, but because we’re working with children who sometimes aren’t verbal or able to communicate well, it’s so important that we make sure that we know what we’re tracking and how we’re going to track it.
I was actually just talking Corinne to one of our cannabis coaches who works with children with autism, and we were talking about how what sorts of things it was going to be easy for that child’s parents to track because the child was nonverbal. So they decided to start tracking sleep because that one was the easiest one to track.
So this doesn’t need to be fancy. You don’t need spreadsheets. Um, there are some. Excellent apps that we’ll put down in the links below, but even just writing it down on a piece of paper will really help you as you go through this process. And you’ll be able to look back at what worked in previous days or even weeks.
So this is also a super important piece of the puzzle here. That is so helpful. Even if you’re not working with a child, tracking one thing is so helpful. People really want to track everything. They want a metric for absolutely everything, especially when they start using cannabis, they’re like, but I want it to help with my anxiety and my pain, and I want to sleep.
And I want to have a digestive system, glowing skin, all the things like, can you imagine the spreadsheet? You’d be so like out of your mind within three days. And that really is important in this. And I do love that idea of just tracking sleep, even if your child is verbal, because you can ask a child. You know, my seven year old, if I were to ask her how she was feeling in any certain way, I could get a variety of answers that may or may not have good data in them.
So sleep is a really good one. Thank you so much for that.
We hope you found this podcast so helpful. Thank you so much, Dr. Bonni Goldstein for being here today. If you have a story to share about using cannabis for a child who has autism we would love to hear it.
Please email us at [email protected] or comment below.