Whole Plant Medicine and the Entourage Effect: Why Isolates May be a Disservice to Medical Patients

Traditional plant medicine rests on the belief that the whole is greater than the sum of its parts. Whole plan medicine operates on a different theory than allopathic medicine, which seeks to break down and categorize different chemical components and different body systems. Instead, these traditional medical practices, Traditional Chinese Medicine being one example among many, see the body as a whole, to which plant medicines are applied for supporting a return to balance. The goal is homeostasis, and when this is achieved, symptoms are alleviated.

In Western medicine, the presence of Condition A is treated with Substance B. However, there are often numerous complications and side effects because our bodies are not equipped to handle and process Substance B. Scientific studies do not investigate the full extent of all consequences that arise from the introduction of Substance B to the whole body system. Largely, the warnings you will receive when you fill a new prescription are based on reported side effects from previous users and clinical trials. But many effects go unreported; the connections are not seen. Patients and doctors cannot possibly be aware of the full fallout of chemical treatments when the system is not looked at as a whole. Treatments with individual chemicals do not look at the bigger long-term impacts of how these harsh chemicals may be creating further imbalance within the body as a whole.

Thinking of illness as a state of dis-ease is a holistic view of overall health. The body has become imbalanced; it is no longer in a state of ease. Symptoms are the signals that the body uses to communicate that there are issues in need of attention. Often symptoms arise in one area, but the origin may be due to miscommunication between bodily systems. Let’s look at depression as an example; Allopathic medicine views this as a lack of certain neurotransmitters being produced in the brain. However, a holistic method of treating depression would focus on the gut, as this is where the building blocks for neurotransmitters are produced. A person suffering with symptoms of depression needs to look at their diet, but beyond that, they may need to focus on gut repair. “Leaky Gut”, a term used to describe micro-perforations in the walls of the intestine, impacts adequate nutrient absorption, which can lead to symptoms of depression and anxiety. In addition, it allows proteins to escape into the blood, which can lead to food sensitivity and low-level inflammation in the body, which fuels many states of dis-ease including neurological symptoms. And what causes Leaky Gut? There are numerous environmental factors such as glyphosate on our food, but prescription medications such as antibiotics also damage the delicate gut lining. In an effort to alleviate Condition A, Substance B has resulted in Condition C. Treating states of dis-ease with chemically isolate compounds may feel more like an ever turning hamster wheel than a path to health.

Whole plant medicines offer an alternative. While there are still safety considerations when using plant medicines, overall, these whole beings can be powerful allies in our collective journey towards wellness. We have co-evolved with the plant kingdom, and our bodies are designed to make use of these medicines. Cannabis is a wonderful example; we have our own internal endocannabinoid system that responds to the use of this plant. The endocannabinoid system can become unbalanced when bodily trauma occurs, resulting in symptoms such as insomnia. The use of cannabis can help a patient get a good nights rest, and over the long term, as the endocannabinoid system is brought back into balance, insomnia can be alleviated altogether.

Many “infections” within the body, are in fact overgrowth of our own natural flora. These flora, which include bacteria, viruses and fungi, play a critical role in our health and immunity. However, this flora can also become unbalanced, resulting in overgrowth of “undesirables” such as yeast. Overgrowth of certain yeasts, in particular Candida albicans, results in unpleasant symptoms, however, complete eradication of yeast is not the solution; it is, after all, an essential part of our microbiome. Instead, the goal is to bring it back into harmony with the rest of the internal flora. The yeast itself is not the blame; it has merely taken advantage of an imbalanced state, which has allowed it to proliferate. When the body is supplied with the tools that will enable a return to homeostasis, the yeast will be brought back to normal healthy levels. Traditional herbal medicines seek to change the environment of the body, and provide the necessary ingredients to feed the body as it rediscovers its own innate sense of balance.

Cannabis research has focused primarily on the two main players, these being THC and CBD, and the markets are now flooded with products containing just one or the other of these two big stars. However, mounting evidence suggest that isolates may not offer the same medicinal benefits as full spectrum extracts. You have perhaps heard of the Entourage Effect, first coined by Shimon Ben-Shabat and Raphael Mechoulam in 1998. The Entourage Effect refers to the biological synergy that occurs between cannabinoids, terpenoids, flavonoids and the many other compounds in the cannabis plant. One example of the Entourage Effect is how CBD mitigates the psychoactive affects of THC by binding to the CB2 receptor. Another example is how the terpene Myrcene enhances the sedative effect of THC through its action on the GABA system. There are two examples among many that illustrate how different phytocannabinoids work synergistically and provide a fast array of medicinal benefits just from this one plant. The industry is starting to look more closely at terpenes and how these play into the psychoactive effects of cannabis, but marijuana is a veritable cornucopia of plant compounds, and research has barely scratched the surface. The vast majority of studies look only at individual compounds, which has led to the craze over isolates, but this is perhaps a disservice to patients that would benefit more from whole plant medicine.

Berberine provides an excellent example of how the use of a whole plant surpasses the capabilities of a single constituent. Berberine is a plant-derived alkaloid whose actions have been well researched and is commonly available as a supplement. Berberine is found in herbs such as Barberry, Oregon Grape and Goldenseal. Among many other benefits, Berberine is known for it antibacterial action, in particular against Staphylococcus aureus. Oregon Grape root has high levels of Berberine, however, the antimicrobial benefits are further potentiated when the leaves are used along with the root. The methyloxylated flavonoligans present in the leaves further reduce the resistance of S. aureus bacteria to the Berberine, thus increasing is effectiveness. This potentiation of antibacterial action is also observed in the Goldenseal plant. Berberine is found in greatest concentrations in the root, but the herb’s antibacterial capabilities are increased when the leaves are used in addition. This demonstrates that not only are these plants medicines better than a single extracted constituent, but the use of the full plant amplifies the healing benefits. In regards to full-spectrum Cannabis extracts, this begs the question: Are we missing something? Piperidine and Pyrrolidne are two cannabinoid alkaloids found in the roots, stems and seeds of the plant, but extracts are made from the flower, and the rest is discarded. Are we, in our ignorance, tossing the rest of the plant when further medical benefits could be harnessed from its use? Further research will be needed on the actions of whole plant use, but to date, almost all double blind clinical trails have examined the effects of individual cannabinoids. The studies have hardly looked at the use of the flower, let alone looking at the synergistic benefits that may be gained from combining different parts of the cannabis plant.

Quercetin is another well-studied phytonutrient that can be found in many plant sources including Cannabis. It is classified as a flavonoid, and is recognized as another participant in the Entourage Effect. It is known for its anti-oxidative properties, anti-inflammatory action as well as its anti-cancer benefits. It has been demonstrated to encourage cell apoptosis and reduce tumor cell proliferation. Research shows that the Cannabis plant has significant anti-cancer properties, but it would be short sighted to give credit to any one constituent. But if a medical Cannabis patient gravitates towards an isolated Cannabis constituent because is the available research, they may be shorting themselves of the full potential benefits that could be grain from the use of the whole flower or a full-spectrum extract. We simply do not yet know all the synergistic actions that occur with whole plant use. There is a complex bouquet of compounds in the Cannabis plant, and our research to date has barely scratched the surface. Nature is wise, and plants are far older than us; looking at individual parts rather than the whole is not seeing the forest through the trees.

Research needs funding, and Big Pharma has money. Synthetic THC compounds, such as Nabilone, sold under the brand name Cesamet (“Substance B”), have long been available on the market. This drug is used to manage the nausea and vomiting that can accompany chemotherapy for cancer patients. It is also prescribed for the management for chronic pain. However, Nabilone can cause severe rebound pain when doses are missed (“Condition C”). This withdrawal effect is comparable to the discontinuation of opioids. Fortunately, Cannabis isolates do not have these undesirable withdrawal effects, but they may be missing the full medical potential that the Cannabis plant is offering us. One study showed that the anti-inflammatory benefits of CBD-rich full plant extracts are greater than pure CBD isolates. But there are simply not enough of these studies; we’ve barely caught a fleeting glimpse of the whole picture. There is so much we have yet to learn from Cannabis. Marijuana is a veritable phytochemical factory, and all the parts are working together in harmony. We have co-evolved alongside this beautiful, wise and healing plant, and it is naïve of us to pick her apart, thinking we know what makes her tick. Nature got it right. We would do best to honor and respect that wisdom by using her healing gifts in their whole forms. And in turn, she will reward us with the holistic healing we so need.