Episode 23 – Jacob

Jacob is standing in front of a shrub, wearing medical scrubs and looking at the camera.

Dr. Jacob Silverstone talks paroxysmal hemicrania, evidence-based medicine, and the many uses of CBD isolate.

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Hi, I’m Brianne Benness and this is No End In Sight, a podcast about life with chronic illness.

This week I’m talking to Jacob Silverstone about his experience with paroxysmal hemicrania. Jacob is a practicing MD who couldn’t find relief for his headaches within traditional medicine, and he talks a lot about how this experience shifted his perspective on natural remedies. It shifted so much that he actually went on to found a CBD company called Alia Science, which you’ll hear more about later in the interview.

While we’re talking, Jacob uses the term “allopathic medicine” a lot, so I wanted to make sure that it was clearly defined in case you hadn’t heard it before. Basically, allopathic medicine is synonymous with “western medicine,” and generally seen as the opposite of “naturopathic” or “holistic” medicine. I was already familiar with the term, but when I googled it I was surprised to see that Wikipedia says it’s pejorative. I had never interpreted it that way and I don’t think that Jacob is using it that way either, particularly because he describes himself as an allopathic practitioner! So, what I’m saying is that we should probably ignore wikipedia on this one.

Before we start, here’s my disclaimer:

This podcast is not intended as a substitute for professional medical advice, diagnosis or treatment. Make sure you talk to your practitioner about any questions or symptoms.

[guitar riff]

Brianne: So what I like to do, just to get a little background, is ask how was your health as a kid? Were you a healthy kid?

Jacob: That’s a great question. It’s a bit loaded. No, the answer is… Well, let me rephrase that. I was significantly overweight as a kid, so while my general health, I didn’t have any diagnosed illnesses, I do unfortunately reflect back on my dietary habits as a kid. And it has certainly contributed to my struggling with it as an adult. I’ve certainly grappled with the issue with the weight, I’m pretty much ahead of it at this point and I have successfully tackled it. But no, my health as a child, though I was extremely active and I was involved in sports and I was involved in athletics, my eating habits were horrendous. And you know, that was partially contributed to the fact that both my parents held two to three jobs and the food that we were being fed was just quick and easy food. It was a Kaiser roll was cream cheese and potato chips. It was nothing significant. So I was overweight as a child, more towards the obese.

Brianne: Yeah. And food access is really hard. I feel like that’s something that we’re seeing hopefully more and more light being shone on. But as you say, when you’re really busy and you’re working to survive, going to the farmer’s market and buying unwashed vegetables that take quite a while to prepare actually isn’t… it can’t be a priority

Jacob: Yeah. If it was packaged and it was quick and easy, that’s what was going into my lunchbox. So other than that, no, I was a relatively healthy child and I wasn’t born with any chronic illness. I wasn’t diagnosed, you know, I think a lot of children are diagnosed with some level of asthma, which we mostly grow out of. And that was the extent of my childhood… I guess challenges.

Brianne: Yeah. And it wasn’t, it sounds like something that you thought about much at the time. So then you get older, you grow up. And when did things start to change? Both when did you start to think more about your health and your care, and also when did you start to experience trouble?

Jacob: So the funny part about it is there was a defining moment when it happened and obviously I lost a tremendous amount of sleep while the symptoms were emerging. It initially happened in my final year of residency, so I was approximately 30 years old. So it was really more towards my adulthood. I was already a little bit more aware of my health at that point. I had lost all of the weight. I was very conscious about my eating habits, you know, I’m married and at that point when the headache started, we had my third child and my wife was pregnant with the fourth. So I was an adult by my all margins and I had a lot going on. And the headache started, it was actually just one headache and it was a chronic headache. And it just simply wasn’t going away. I was also having some olfactory type response where I kept smelling, it was just a continuous smell of something burning. And obviously my first thought when I had a headache that was keeping me up at night, wasn’t letting me function, was disturbing some of my sensory portions… it was a tumor. It was definitively a tumor and that’s what it was. That’s what it was going to be.

Brianne: Yeah, you had instantly…

Jacob: Instantly, this is it. I’m 30 years old. This is the way it’s going to go. That’s it. All right. I accepted it. I went to get my MRI and thank god everything came back negative. I then visited a neurologist, NCVs, EMGs, bloodwork, everything. He said it was a simple migraine. Put me on a number of medications, all of which did absolutely nothing for me other than the side effects, which were mostly sedation and it really didn’t do anything. What ended up kind of stopping the headache was just time. Within three to four weeks of first symptoms, it went away.

Brianne: So was it solid? Would you say, the amount of distress or was it intermittent at all?

Jacob: No, not at all. So it was contiguous. It was just contiguous pain the entire time. There was no lapse in the quality of pain, but there were periods where it was just excruciating. So the intermittent was just really more on the severity of the pain, but it was constant pain.

Brianne: So your ability to suppress it and ignore it maybe went up and down, but it didn’t go away.

Jacob: Yeah. Well said. And obviously after I got the… as a resident in the institution where I was getting my MRI, I was looking over the shoulder of the radiologist that was reading it and he looked at me, he goes, “There’s nothing there. You’re fine.” That was really for me, the defining moment of, “Okay, so if it’s pain, I’ll just live with it or I’ll deal with it. It’s not the end of the world.” And that’s really my approach to it. And then eventually it just stopped. It really was not one particular thing that I can remember that just ended it. I just woke up one morning and was like, “Oh good lord, it’s gone. Thank god. It’s gone.” And I did not experience it for about a year and a half.

We moved from New York down to Miami. And the reason I’m mentioning that is because it does contribute to the diagnosis of the class of headaches that I have. And I woke up with the same pain again about a year and a half later and I’m like, “I can’t do this. I don’t want to do this.” Fortunately I found a neurologist locally who as I was giving him my symptoms, was smiling and grinning at me and he said, “I don’t understand. This is textbook paroxysmal hemicrania. This is triggered by seasons.” And you know, in Miami we don’t have a lot of seasons, which is why there was a lapse between the next headache. And he treated me again with all sorts of different types of headache medications. None of them really did anything. I just know that the triggering is seasonal changes, which really is only once or twice a year here in Miami, and it’s long lasting and I just kind of dealt with it because none of the medications were really helpful.

During the headaches, it’s extremely distracting. I know it’s not in the sense where I’m unable to function. In my profession I’m able to function, but it is severely distracting. My paperwork is lagged after two to three weeks of having the headaches. I have a ton of catch up to do. I literally work the bare minimum to get through the day. And then once the headache clears, I play catch up. And again, fortunately it’s not more than two times a year at this point. But while it’s not impactful in the sense of committing me to the house, it definitely plays a role and it’s a struggle to have to remain focused and to be, you know, because much like parents, physicians are not able to get sick. We show up, we don’t take the day off, and we just commit to it. It’s just like parents at home. You’re sick? Too bad, you’ve got to get up, strap on and just be there So that’s kind of the issue that I have. And I am fortunate that I have an understanding wife who suffers with the classic migraines. She does have about three or four a month. So she was kind of comfortable having me somewhat debilitated at home because the moment that I got home, I just couldn’t keep my eyes open. It really… it does put you out.

Brianne: Yeah. Yeah, definitely. And so that’s been… Now it’s kind of ongoing and maybe not predictable exactly, but it has a pattern that you can more or less identify.

Jacob: So the funny part about it is during the experience and because of the failure of conservative medication, my neurologist here said, “Hey listen, there’s this great publication out of Germany. It’s an herbal supplement called butterbur. I want you to take a look at it.” As an allopathic type of physician, we are trained on evidence-based medicine. That means that just because somebody says it’s going to work doesn’t mean that it doesn’t carry side effects. Things in nature carry side effects. You know, you don’t eat all the berries that are growing on the bushes. You have to be keenly aware of which ones have the good reputations and which ones don’t. And even in the supplement world we have to make sure that what we’re taking is somewhat positive in terms of our general health.

There are things that we take for granted just because we say, “Hey, it’s natural.” Not all natural is going to be beneficial. So being in that type of a mindset, and I’m a little stubborn with that. He said, “Do me a favor. There’s this publication, it was out of Germany, I think the number was close to 500 participants and this supplement called butterbur in the treatment of migraines.” And I read it and it showed that there was a positive benefit to it. The only unfortunate negative to it is there are certain extract methods, which one of the final portions of the chain, I know I’m boring you with this, has some carcinogenic linking. So be careful if anyone is hearing this and they hear the term butterbur, just make sure you’re getting the right type of butterbur. And it was very effective. It was really, really effective.

Brianne: So what was that like?

Jacob: The first time that this happened was I get the sensation of when it’s coming. I just get extremely exhausted and all of a sudden my nose and my ear are clogged and running, and that’s kind of like the classic paroxysmal hemicrania symptoms. And I know it’s about to happen. I started loading up on the butterbur and the first time I did that, I was fine. Like I was totally fine. Like two or three days later I was expecting the headache and it never showed up. And you know, I laugh about it. I say, “Listen, if it was psychosomatic and it was 100% a placebo effect, I really don’t care. It worked.” So if it was a placebo, it worked. So I don’t know if I just believed in it because I read the literature or it really worked for me. It worked. And that kind of changed a little bit my approach to practice in general. So that was quite an eye-opening experience because for the first time I went in a totally natural way and it was beneficial for me.

Brianne: Yeah. Because while you were talking about the earlier stages, I was wondering, but you kind of covered it, is if there had been anything else that you’ve tried in addition to medication. Because I know people with different headaches and migraines, it’s like you get to a point where you don’t care if it’s the placebo effect, as you say.

Jacob: Yeah. You don’t care. It was fine for me and it worked very efficiently. And at that point, it really was somewhat of an eye opener in the sense where, I don’t know why we get fixated on philosophy. We sometimes get a little bit stubborn on the idea of, “Well I am only a naturopath. Well I am only an allopath.” Well, I mean, the reality is that each one of us is somewhat different in the sense of how we metabolize different elements. So it very well could be that allopathic works for some and homeopathic works for others, I don’t know why we get into this philosophy discussion of “Well, you should only try one method.” And that was the pivotal point for me to kind of really branch out and recognize that while I had this evidence-based allopathic ideology that perhaps homeopathy may have a place.

And that doesn’t mean that it’s a place for me in every element though. I don’t get stubborn anymore. I really don’t. I don’t hang my hat, so to speak, on that hook. I really don’t. I have it all the time where patients will come to me and they say, “So what do you think about acupuncture?” And I’ll say, “Try it. If it works, continue. If it didn’t work, then it wasn’t for you. Don’t do it anymore.” So it’s really a matter of, as long as you’re aware of the negative consequences or potential negative consequences, if the risks outweigh the benefits, don’t do it. If the benefits outweigh the risks, try it. Worst case scenario, you’re back where you started. And that was to me really kind of the pivotal point.

Brianne: Yeah. Yeah. I can imagine that would be really… Especially if you’re in practice and you’ve been through med school and all of this stuff, and I know all practitioners are different anyway. But it’s my impression that Germany specifically does a lot of research around this kind of stuff, around more integrative care. Like they’re one of the leaders where any good studies are coming out of, or most,

Jacob: You have a lot… And again, not to draw any politics into the conversation, but I have, a feeling that some of this has to do with access to care and in a sense somehow when you have more of a universal healthcare type of a system, sometimes getting to the specialists may be a little bit more challenging. Therefore there’s a significant amount of research, and that comes out of Israel as well. Like the two leading countries, and you are absolutely right that they put out a tremendous amount of publication in terms of more conservative care in terms of herbal medicine and homeopathic are coming from countries that have more of a social or universal healthcare system. And that’s not a bad thing in any stretch of the imagination. I think anytime you can avoid getting to the chemicals we should try.

But like I said before, if you didn’t get success, then don’t knock the advancements of science either. You know, that pendulum can swing too far to the left or too far to the right. There are people that are clawing and dying at the opportunity to get some western medicine. At the same rate in the West we’re clawing at the opportunity to get some of that traditional eastern medicine. So there’s, there is to me in my opinion, a definite middle where we shouldn’t be as stubborn as sometimes we tend to be, but I always find that going the natural way is probably the preferred initial step. But then again, if it doesn’t work… you know, I always use unfortunately Steve Jobs as my case study, he had a treatable cancer but he got stuck and he got really stubborn and he did not want to do traditional therapy and he hung his hat on just one type and unfortunately that was unsuccessful for him.

So for me it’s really, yes, Germany definitely puts out a lot of that publication. I think a lot of it is because it in part is the first step. And I think unfortunately in western medicine we kind of forgot it. We forgot it. We know, for instance, typically that motrin is going to help us, but there are other anti-inflammatories that don’t have the side effects that maybe we can try first if we can tolerate it. I did it in the reverse. I tried all the chemicals first and only once it failed did I then go to the natural path? And I think a lot of times we find that that’s the reason we see such a stronghold on those that no longer believe in western medicine because it didn’t work for them and then the natural did work for them. I think that we’re kind of viewing it in the wrong fashion. We should first try naturopathic and if it worked, great, but if it didn’t work, there are alternatives. So in a weird way, I think the way I view medicine now is really the chemical is the alternative medicine where we should first try the naturopathic. But again, that’s really born out of my experience.

Brianne: Yeah, no, I think you’re spot on. I mean with both people who write about it, things that I’ve read, and then people who I’ve talked to so far in my own experience, it’s like you can get stuck in between and it depends because there’s something like migraine or headaches where there are a few treatments that work for a few people and then if they don’t, everybody is just out there trying to do their own research and find their own things to experiment with. And it’s the same with anything that has a chronic fatigue component because fatigue is so difficult. If your blood work looks fine, you know that you don’t feel right, but there aren’t a lot of options. And now with the internet, of course, I think this is one of the reasons that it’s getting more siloed now is that with the internet, anybody can make a testimonial that something works and so we lose a lot of that evidence and there isn’t even that much to begin with for a lot of this stuff. Like right now people are really into celery juice and maybe that’s helping people. I don’t know much about celery juice, but I can tell you it is a very trendy thing right now without a lot of information behind it. But probably low risk as far as these things go.

Jacob: Yeah. And also that’s funny that you mentioned celery juice. When I either blend or juice, I use celery because it’s really, really cheap and very, very, very rich in juice. So I use that kind of as a foundation, as a base because I can get a lot of juice out of it.

Brianne: It’s very watery, yeah.

Jacob: Yeah. It’s predominantly fiber and water. That’s really what it is. That’s funny. I can tell you that the only reason was because it just filled up the cup of water. I didn’t even hear about the benefits ot it.

Brianne: Oh yeah. I mean it’s… So I am not super informed on this, I will tell you, but it came from a book called Medical Medium, which is also a person who is as described. So a medium who has written a book about healthcare kind of, I think? So anyway, one of their main recommendations is celery juice for everything. And it’s… I think it’s the kind of thing like I have a smoothie every day. I think nutrition is important, I don’t… Whatever. But it’s appealing to people who are totally lost in the healthcare system I think, which is one of the things that can be so frustrating. You see it like, “Well, either a specialist couldn’t help me or I can’t afford to find another specialist. And here is one thing that I can be doing.” And we all end up with these whole panels of rituals, I think, that are things that we’re trying to do to improve, to move the needle, you know?

Jacob: Right. So, so for me, again, I never really lost my foundation of evidence-based medicine. I think the approach for me has shifted in the sense where let’s try the more natural remedies before we jump to the chemicals. But we should always have some level of evidence-based medicine. And again, the reason we’re also seeing this a little bit more with universal health is because countries that have universal health, their profits for pharmaceuticals are not as robust. Therefore you don’t have a lot of research money going into chemicals. So they’re looking for government subsidized research and that tends to go into the more natural or healthy ways. So Germany and Israel are leading a lot of that type of research, I really do find that we are starting to see a lot more in that sense.

But again, I’m not going to jump into a trend unless I see it. And you know, the neurologist said, “Hey, take a look at this article.” I looked at it, great numbers. It was great. It showed an efficacy towards it. I said, “All right, I’m going to give it a whirl.” But had I not seen that article, I don’t know that I would’ve done it to be very honest with you. Because I don’t know what butterbur is, have no idea. I’ve never heard of it before. I don’t know what the side effects are and reading through the article I did note that there is an extraction method which can be linked to liver cancers. So we have to be aware that just because it comes out of the ground doesn’t mean it’s going to be good for you. It should be well studied and sometimes just because it comes out of the ground doesn’t mean it should substitute. Again, going to some of the chronic illnesses, I am certain that most people with chronic illness try anything natural, but it doesn’t always work for them and they shouldn’t be shamed to use doctors either. We’re in an era where unfortunately it’s in vogue to not trust physicians. It really has become very popular as if somehow or another physicians are uneducated, they don’t know what they’re talking about. They don’t read the blogs. They’re completely unaware.

Brianne: In another world.

Jacob: Yeah, yeah. And like you can’t trust a doctor. Well that’s too far. You can’t say that either, because I do believe ultimately that shames other people from publicly saying, “Hey, I tried the celery juice. It didn’t do it for me. I tried the goji berry. it didn’t give me energy like it promised it would.” “Well then what are you going to do?” “Well I’m going to go to a rheumatlogist.” “A rheumatologist? A doctor?” They’re going to pump you full of chemicals!” Well, yeah, that’s okay too. If it helps and it makes you function then for your metabolism and for your specific makeup and for your chemistry, it’s working, therefore go ahead and enjoy it. That’s what it’s there for. Don’t be so dismissive.

Brianne: Yeah. It’s an interesting landscape, I would say.

Jacob: Yeah, it really is. I don’t know why, and maybe it’s just the era that we live in. If you’re not… you’re either on team A or team B and team A doesn’t like team B and team B doesn’t like team A and there’s no middle ground or no more compromise in the sense of logic. I think that’s kind of where we’ve fallen into. And I think it’s more as a society, and I think that burroughs into all the different facets of our lives and health being one of them, at least in my experience.

Brianne: Yeah. Yeah. And I think the promise of say, health bloggers, so people who are making these recommendations without a lot of evidence. The promise of it is that if you just work hard enough, you’ll get better. And usually your doctor doesn’t tell you that. Your doctor will either say, “Let’s try this medication.” If you’re at that point or like, “I’m not finding anything right now, we need to go to someone else or whatever.” And you can feel like you’re stuck. And I think it’s appealing if not necessarily real to see this other way, like change your diet and everything will get better! But that’s not the whole picture.

Jacob: Oh right. No, it isn’t. And that’s an excellent segue into the fact that while chronic illness, there are autoimmune diseases, there are definite pathologies that exist in the sense where we just haven’t figured it out yet. We don’t know why the body wants to attack itself. At least in the United States, 60% – that’s beyond majority – of disease is preventable with one change. And that’s diet. Diet is responsible. I know that we do see a lot in the sense now, and it’s starting to… I don’t know if you watched the Superbowl or you fell asleep halfway through it, but Budweiser’s entire campaign during the Superbowl was “We don’t use corn syrup in our beverages.” And guess who does? The competitors, Coors uses corn syrup. So even Budweiser, which is alcohol, by no stretch of the imagination is beer good for you. I mean, one beer is not bad for you, but we wouldn’t consider it a superfood.

They are on board with getting rid of the sugar. We don’t need those unnecessary sugars. They’re recognizing it. Not even to the point where they’re putting 30 seconds, $5 million campaign ads on the Superbowl, but they’re gambling on the fact that America has now picked up on this because that’s what we’re going to stress during the Superbowl. We are not a sugar-based drink. And then that was pretty remarkable for me to see. The market has moved. America has woken up to the idea that refined sugar, corn syrup, these types of additives that have been enriching food for the better part of 30 years have been making us sick. So yeah, diet has a significant role in our general health. And the good news is, I think the landscape of the medical community has done a very good job in educating people.

If there’s one success that I can attribute to the medical community at large, it’s identifying the risks of disease secondary to high sugar intake. I think they’ve done a very good job. All of my colleagues identify that. They all have conversations. It’s probably the number one conversation when a patient comes in with underlying health conditions, hypertension, diabetes, obviously high cholesterol, anything of that nature is, “Hey, cut out the sugar. Stop with refined sugar.” Every physician has that conversation with their patient. And I think that that is a potential bridge between the two communities because I think both communities identify processed or refined sugar as toxic to the general health and wellbeing of people.

Brianne: Yeah. And that’s moving so fast. And that’s one of the things that, while I talk to people, I think a lot of people are finding their own treatment or their own protocols somewhere in the middle. Where they’ll experiment with paleo for example, or variants of paleo, at the same time as changing their exercise and sleep habits and trying to fine tune their medication, depending on their diagnosis of course. But it does, it makes a huge difference in a lot of people’s lives. And I’m sure it’s a harder sell for people who feel healthy, like it’s a big change to cut sugar out of your life, for example, when you don’t feel like you need it. But when people do, they notice a big difference. So I have one followup question about your own health that I realized that I don’t quite know for sure. So you were saying you started taking butterbur and it cut off a headache completely. Has that continued to be true since you started using it?

Jacob: Great question. So, the answer is it’s not a foolproof method. It hasn’t gotten rid of the headaches. But I haven’t had a headache as severe as the one that I had my first year in Miami where I was just completely debilitated. No, they still come. I’m still able to sense when they’re coming. Does it always curb it entirely? No, it doesn’t, but it certainly helps. Like I said, it certainly helps. I have found it therapeutic.

Brianne: Yeah. And then have you added anything in? So after learning that that could make a difference. What else shifted? So both in your own care and then your whole attitude, which is what we’ve been talking about the whole time. But I’m just thinking back to that moment.

Jacob: So, funny enough, the conversation sometimes gets brought up by patients where they’re going to be the first ones to inform me because they’re looking at me and they say, “Have you ever heard of…?” You know, “Do you believe in…?” Right. So I have a close friend and I’m not going to mention him by name, but he’s a pain management physician out of Hopkins, trained in Boston, very, very well educated guy. The guy’s super square, he hasn’t had a sip of scotch, doesn’t take tylenol, doesn’t do… nothing in his life. He’s just one of those really, really, really square type of individuals who is very, very much by the book. If it’s not in the literature, he doesn’t want to look at it. And he follows a kind of like an algorithm of treatment. And if you deviate from the algorithm, it kind of throws things off and he has to readjust.

And he started in Florida. We had the success of medicinal marijuana added into our armamentarium in terms of pain management. And he started prescribing marijuana as a treatment for chronic pain. And the best part about it is you would think that his average patient would be in their 30s or 40s. And it is not the case. His average patient is in their 70s. These are patients who have never even considered it in their life. Never tried it, never experimented in college as they used to say. They mostly have arthritic conditions that are debilitating them. And they started with it. So we started looking into a little bit more of the literature behind it. And CBD, which is a big buzzword nowadays, is something that was very alluring to me. And the reason why it’s alluring to me is obviously because it’s downside is minimal.

Brianne: Right. And it doesn’t get you high, compared to…

Jacob: Correct. There is no euphoric effect. Right, that’s the medical term, is there is no euphoria associated with CBD. And then I started looking for the literature regarding CBD and its efficacy. And unfortunately because of the “war on drugs” in the late 70s, there’s very limited CBD research in the United States. So we had to kind of look outside and there is a lot of literature coming out of both Europe, South America and Israel in regards to the efficacy of CBD with chronic pains, inflammations, right? So now we’re believers. We have tons of literature that says, “Hey, everything from ulcerative colitis to anxiety to rheumatoid arthritis to migraines to dermatological conditions like eczema, all sorts of inflammatory type reactions. We’re finding that CBD is effective.”

Okay, wonderful. Now the question becomes where do we get, how do we get, what do we do? So now we started looking into it. Really mostly me. I started looking into the issue with CBD, and then came the whole world of the internet: CBD isolate versus CBD full spectrum. What’s the benefit of full spectrum versus this? Okay, so now I start looking into it and say, “Okay, where do I get what?” And the problem is again, this kind of ties back to my philosophy, is nothing in evidence-based medicine discusses CBD full spectrum oil. The internet community says, “Hey, the full spectrum oil has all of these cannabid oils associated with it, they must be good for you as well.” And I’m saying it very well may have benefits, but I don’t know because we haven’t done any research on it. They’re not studied. So I’m not saying they are or they aren’t, but I can’t consciously go ahead and advocate for something that I haven’t seen proper research on and I’m not suggesting that we’re not going to see research on it. I’m saying at the present time, literature is really suggestive of CBD and not CBDa. It’s the decarboxylated active CBD. So now where do I get it? And that was the problem.

The problem is, I don’t know where to get it. Most online sellers are selling full spectrum CBD oil. So I got in touch with a friend of mine who runs a lab down here in Miami and I said, “Could you explain to me why I can’t find the isolate?” And he said, “Well, it’s very simple. Because the CBD oil, when you sell it as 1000 milligrams of CBD oil, they’re not telling you how much CBD is per actual serving because it’s diluted and it’s diluted down. Therefore they can put on the label 1000 milligrams of CBD oil and not specify. So CBD is the expensive ingredient in all of this. So you can kind of fabricate a much more appealing product to the masses based on really being creative with how you’re using math.” And that was very offensive to me.

Then I figured out, I realized that while there are some reputable companies out there, the large-scale CBD oil manufacturers are the same guys… And I mean, I can show you who they are. They’re the same exact guys that are doing the male enhancement pills at the gas station. They’re doing the as seen on TV illuminated flashlights. It’s a volume market for them. They don’t care. They’re not caring about it. So it really bothered me in a way that we finally have something that has good literature to support its efficacy. And I can attest to good CBD being helpful because my wife does very, very well with CBD with her migraines. I did very well with at least bringing down some of the severity of it. The duration was really the butterbur for me, but the severity was really brought down by CBD. And it really bothers me that the quality of goods, unfortunately is being overshadowed by the capitalist idea that it’s a buzzword. We’re going to get it out there and we’re going to mass sell it and mass produce it. And I don’t know, I think the number is in 2017 the medical CBD market was at 2.5 billion. And I think 2018 it’s at like 15 or 16. You have to fact check me.

Brianne: It’s exploded.

Jacob: But the numbers are astronomical. And it really is. And with the new farm bill, it really did open it up to a lot less pervasiveness with government not allowing it to go through. The DEA is totally cool as long as it’s coming out of the hemp plant and not the cannabis plant. So all of this is borrowing to the explosion in the market. But the problem is you’re not getting what’s well researched and you’re not getting the product being labeled accurately. So that’s how I ended up coming together with one of the chemists and a buddy of mine and we actually started putting together and piecemealing supplements that we felt had some level of literature behind it, and some good efficacy towards them. And that’s what bore out my new, I guess, startup, so to speak.

Brianne: Your CBD venture. And so I have, I mean, CBD is really interesting for sure because it’s one of those things that like you basically say, people are asking about it all the time. In all of the online communities that I’m in, it comes up regularly. You see it all over instagram and people have, I think, a lot of the questions that you had, which is like, how do I know what to buy and what is the dosage? And I think this is a really interesting thing as it relates to pharmaceuticals, is at least with pharmaceuticals, you do know. You know what it is and you know what’s being recommended. And I may have some things about the pharmaceutical industry that I don’t love and could probably rant about, but I trust that the dosage in a pill is what it says it is and that it is what it says it is. And when it’s not, something has gone very wrong and we’ll get figured out.

Jacob: So the problem that we have is distrust in the pharmaceutical companies as you were alluding to, and with without a doubt, you’re correct. However, the benefits as you were suggesting with the dosaging is also true, because I do participate in research, in the clinical trials. So I have now done, I’m in my fourth as a primary investigator for FDA. Now we’re at the third stage. So when we show the efficacy to the FDA, then the product gets launched and now it’s approved. And I can tell you the amount of paperwork that goes in and the amount of regulation that goes in and the amount of involvement before you submit to the FDA is, it’s absurd. Every patient file, every subject that is being tested, a file this thick. Every page has to be initialed. Every page has to be detailed, right? And this is the pharmaceutical company dumping millions of dollars to ensure that their product is safe. And then they submit that to the FDA. Then the FDA looks at it and says, “Okay, we accept the research that you’ve put in front of us, we’ll approve it and we’ll let it go into market.”

Brianne: And for this specific use.

Jacob: For this specific use. With the homeopathic market, that doesn’t exist. All you’ve got to do is a little asterisk, “These statements have not been endorsed or approved by the FDA. You’re at your own risk.” And then you’re good to go. So it’s an excellent question and unfortunately even I don’t have a direct answer for that, which again is why when we went into this venture that was part of our discussions. And what we ended up doing is we said, “Listen, we know CBD is effective. We know that it has an efficacy in inflammatory components, but we also know that there are other supplements that exist that are also helpful and beneficial that have literature and we have for those certain recommended dosages.”

For instance, we know that turmeric, we know that magnesium, we know that l-glutamine, these are all supplements that have been well published, well researched. And for us it was, “Well why are we ignoring other elements that exist?” So what we did is we actually created, based on evidence-based medicine, different formulations for different types of, we’ll call them pathologies, in order to help and assist. And then what we did is we embodied it with CBD, we said we’re also going to add CBD, but what we’re going to do is we’re going to add the CBD isolate because that’s the only thing I can show you literature on.

And in terms of dosages, we’re going to go to what the dosages of some of the literature suggested that they used. And that’s kind of how we played our hands. So what we’re trying to do… And the reason we did that was very, very specifically because of my experience. I said, “Listen, I want to go to physicians and say, ‘Recommend this to your patients.'” And the first thing any allopathic physician is going to say is, “How do I know it works?” And I’m going to say, “We’ll take a look at the ingredients and I’ll show you publications on every one of these ingredients on how it works.” You know, I didn’t run a clinical trial, but we did run a 25 patient sample size and you know, we have success with it. So it’s not a surprise because we know that the ingredients that we use are beneficial.

For instance, our headache formula, what we call our migraine formula, you could already kind of guess what supplement you’re going to find in there. You’re going to find butterbur, you’re going to find B12, you’re going to find feverfew, and you’re also going to find CBD. So my experience said, “Hey, let’s use what’s worked, what’s published, what’s in the market. And kind of try to expand on that type of idea.” And the reality is that we’re not suggesting drop your medication. We’re saying give it a whirl. If this didn’t work for you, don’t be embarrassed. Go to the doctor and try the chemical that’s also been tested. There’s also publication. You don’t go out to market unless you’ve run the gamut of testing. So what we’re trying to really do as a company is maybe the undertaking is a little bit greater than what we can handle. But we really are trying to bridge the two worlds together and educate both sides to say, “Hey, trust your doctor. They’re not evil people. They’re going to have something within their cabinet that is natural and the side effects are benign. But if it doesn’t work, trust the same doctor to lead you down the path of which pharmaceutical may work for you.”

Brianne: Yeah, and to inform yourself about the risks, basically the risk/benefit analysis. So what other formulations do you have? You just mentioned migraine. It sounds like there’s probably still a lot of moving pieces, but I’d love to know more about what have you learned? What are you working on? How does this all work?

Jacob: So we kind of approached what we felt were the most common ailments in the United States, right? So we have what we call the original formula. The original formula is a B12 B complex along with CBD. And that’s really just for general wellbeing. I actually take B12 every day. There was a publication in the New England Journal of Medicine in 2011 and it showed the efficacy of B12 along with B6 and the prevention of dementia and alzheimer’s. And I remember that year because I couldn’t find B12 injectables anymore. It was off the shelves. There was a backlog. I couldn’t find it. All right. Six months later, the trend is over. Nobody cares about it. The media is no longer talking about it. But B12 is just one of those essential vitamins that everyone should just be taking. It is a great way to just boost your energy to a certain degree and it is protective. It’s a protective vitamin.

So we said, “Hey, if this is going to be our daily take of CBD, let’s add the B12 to it.” So that’s kind of our original formula where we suggest that that’s just for general fatigue, general inflammatory issues. That’s your daily take. Then we created four additional formulas. The headache one which I discussed, which is the migraine one, which my biggest success is my wife. She does really great with it, really, really great with it, and I finetuned it.

The second one we have is sleep. Our sleep has, we obviously stripped it of the B6 and the B12 because we don’t want you all perky at night. But we did keep the naicin and the B5. But what we added was obviously melatonin and kava kava. So kava kava is a natural relaxant, and melatonin everybody has heard of and most of us have tried. The problem that we have with melatonin is vivid dreams. So a lot of people don’t have a restful sleep because they have these vivid dreams and it wakes them up. Many of them turn into frights or terrors, especially with children. And I don’t advocate my formulas for children, we have no testing on that. But a lot of that information is available on melatonin in the sense of night terrors and vivid dreams. So the CBD for some reason or another, and I don’t have any explanation, gets rid of that. And my chemist’s wife who has been taking chemicals and she’s chemically codependent to go to sleep every single night, no longer does. She uses our formula for sleep. So we realized that sleep is a big challenge. And I think a lot of that has to do with the anxiety. And if I had to guess why CBD is working with the vivid dreams, because melatonin, while it works in the receptors to lull you into sleep, it does nothing for the anxiety, which most people suffer, which doesn’t let them go to sleep. So I feel that perhaps with the CBD it does break some of that anxiety in the sense of allowing people to just kind of calm and naturally go into that sleep.

So we have the original, we have the headache, we have the sleep, we have the general anti-inflammatory one. And in that one we added turmeric and cumin and magnesium, which all three specifically for fibromyalgia have been well studied and very efficacious. And we added that with the B12 and the CBD. And then our final formula was also for me because part of my anxiety is I do have reflux and I refuse to take nexium. I do not want to take a PPI because I am a firm believer that part of your general immunity does come from the gut. I don’t believe in the whole leaky gut concept. I know that there are many people that do, but I do believe wholeheartedly that serotonin is, the initial production is in the gut. And I do believe that again, food consumption, it all plays a major role.

So I didn’t want to take a PPI to disturb anything. And I have a reflux or GI one, which has ginger in it and it has turmeric, again, an anti-inflammatory and l-glutamine, which has shown to be really good as a natural way to prevent reflux. And again, added the multivitamin Bs with the exception of B6, which by the way could kick up the reflux. So people who are taking multiple vitamins, again, this is where literature is important, right? It shows that it could actually trigger reflux. So we remove that one out of the entire cascade of ingredients. And again, CBD. CBD has shown for ulcerative colitis, for crohn’s, so forth and so on. So those are our five formulas. So what we’re really basically saying is, “Hey, before the motrin, try our pain and inflammation one. Before you go to the purple pill, try and use a reflux. Instead of going with imitrex and all the pharmaceuticals for your migraines, we know that this stuff kind of works. And if you have low energy and chronic fatigue, then even though one cup or two cups of coffee is actually good for you, there’s nothing wrong with it. If you’re finding yourself having to take six cups of coffees, maybe you should try our daily formula first.” So that’s kind of how it all came into part.

Brianne: And so how… It’s relatively new, but obviously not that new because you’ve got all of this stuff done already. How has it been for you as someone who is still practicing, or who still believes in, as you say, allopathic medicine and is also now leaning into something that looks much more alternative? Do you find that this impacts how you navigate medicine in general? I don’t know if that’s… Does that make sense?

Jacob: Yeah. I mean, for me it’s like I said, rather than having the idea that allopathic medicine is evil and that allopathic medicine is the first and then natural is the alternative, I have adjusted. I said, “Hey, try this first. And the alternative is the allopathic.” If it’s an over the counter pill, try this first, it’s most likely to work better. That’s my approach to it. This is probably gonna work better than motrin. This is probably going to work better than excedrin. This is probably going to work better than nexium. This is probably gonna work better than the next thing. And the truth is it does. It really does. It’s effective. And the reason is because we know all the ingredients that are in it. We have literature and the medical community has been extremely welcoming mostly because so many patients are coming and saying, “Hey, I don’t want to take this. What are my alternatives?” And now they say, “Well, we have a well studied alternative.” So the medical community, like I said, is actually very welcoming. They’re not, we thought that it’d be a stronger or a bigger fight, but it seems like that’s where we’re shifting. I think we’re heading in that direction anyways.

Brianne: Yeah, that makes… I mean that’s really interesting too to think of it in terms of what are patients asking for, because I’m sure a lot of patients over the last couple of years have shown up and said, “What can you tell me about CBD?” And a lot of doctors are going, “I don’t know yet, but I will learn.” Or hopefully that’s what they’re thinking. But it kind of is everywhere. And people are recommending it online of course. And if you’re someone who’s on a bunch of medication, you want to make sure that things don’t conflict or whatever. And also I’m interested, like you mentioned one anti-inflammatory relating to fibromyalgia. And a lot of the nerve medications like lyrica can have some pretty tough side effects or now I just blanked. But the other one…

Jacob: Gabapentin.

Brianne: Yeah, gabapentin. Which is a controlled substance in some places and also has some pretty tough side effects. But there’s nothing in between really if you…

Jacob: Right. They used to use amitriptyline, which is no better. So the problem with those medications is their side effect is sedation. And here we are, we’re saying, “We want you to be an active person.” But you can’t be active because of the pain. So we’re now going to get rid of the pain but not make you active. And we haven’t gotten anywhere. So now you’re pain free, but you’re inactive. That to me is really not a good alternative. And I can tell you within my practice, and this is 100% anecdotal, it really is anecdotal. This isn’t published literature in any stretch of the imagination.

I see neuropathic patients regularly, diabetic neuropathic patients, I probably see about 15 a day. And that’s not an exaggeration. And I can tell you, I can count on my hands how many patients I have on gabapentin. It’s really not that many. Almost all of them are taking B12 and B complex, which has been neuroprotective and exercise. And the ones that are compliant and the ones that really push themselves to it seem to be functioning well. And I’m not suggesting that they are cured by any stretch of the imagination, but they are certainly able to tolerate whatever manifestation of the neuropathy that they’re sensing, but more importantly they’ve become active again. So yes. I always, and I have done that since my experience tried B12, I’ll give them the B12 injections. I’ve said, “20 minutes brisk walking, three times a day.” And I almost always… Education is a big part of this. I tell them it’s not that much. It’s 10 songs, five songs away from your house at a brisk pace, turn around, five songs back to your house at a brisk pace. Just get that heart rate elevated. And they seem to be compliant.

And what helps them is realistic expectations. I always have the conversation with the patient, “Hey, this may not get rid of it entirely, but it’s going to be much better and don’t expect it to happen overnight. It’s going to take three to four weeks for us to start getting a turnaround in these symptoms. And don’t worry, if we don’t get to that point in four weeks, we haven’t burned any bridges. We can always start you on a very low dose of neurontin or gabapentin and then incrementally raise you to an effective dose.” And of the patients that I have, I can tell you almost all of them are taking 100 milligrams once a day at night. I mean, it’s really a minimalist dose when you can go up to 900 milligrams three times a day. So it’s really, even those that I have on the medication, it’s a low dose and the reason is they really do, they are compliant because they feel the effects.

Brianne: Right. And because it’s part of a larger plan. I think that’s something that can get lost both with some practitioners and also the attitudes of some patients, is if you don’t want to change anything else and you only want medication to fix it, it’s not realistic probably. But I feel like it’s a really common attitude on both sides.

Jacob: Yes. Yeah, yeah, yeah, yeah. The answer is yes on both sides, unfortunately.

Brianne: And that’s something that’s shifting, I think. To your point about having a lot of colleagues who now recommend diet, cutting sugar and stuff, it’s shifting. But we have the legacy of that.

Jacob: Yes, we are. We are starting to see a shift. That’s the fortunate part of healthcare. We are seeing a shift in a positive direction.

Brianne: Yeah. Okay. So we are getting in on the hour. Is there anything that we haven’t covered just while we’ve been… I know we’ve talked about a lot of stuff which is common for this. I think we covered all of my questions for sure, but if there’s anything in your brain that you want to make sure you get out.

Jacob: No, no. I think this was a great conversation and I enjoyed it. It’s good to have this kind of candid discussion about some of the ideas that keep bouncing around my head and to be able to express them in a public forum.

[guitar riff]

Thank you for listening to episode 23 of No End In Sight! You can find Jacob’s company on instagram @alia_science, you can find this show on instgram @no.end.in.sight.pod, and you can find me on both instagram and twitter @bennessb.

In the next episode I’ll be talking to a woman living with cystic fibrosis who has been through all sorts of diagnostic and insurance obstacles.

As usual, don’t forget that I have a small Facebook Group called Chronic Hustlers for people living with chronic conditions who are self employed. Now that I’m trying to get back on a more regular work-type schedule, I’ve got plans to get this group a little more active.

And finally:

This podcast is supported by my cross stitch company, Digital Artisanal. When I’m up for it, I make simple modern patterns that you’ll actually want to hang in your home. I love to cross stitch as a way to feel productive during flares when I’m stranded in front of the television. I’ve been working on winter patterns but it’s definitely spring now so I’ll probably switch tacks soon. Either way, I’d love it if you checked us out at digitalartisanal.com