Weed vs. wine: the health questions (A cannabis conundrum?)

With the number of states legalizing marijuana increasing, resemblances to the wine industry are emerging, but the parallels are not so tidy on the health question. While the use of medical marijuana is well established, the health effects of regular recreational use have not been thoroughly studied. With wine there are numerous studies defending the J-curve that describes the health benefits of moderate drinking, but it is much less clear whether similar benefits accrue for non-therapeutic use of weed. And as regular weed use is increasingly seen as normal, perhaps even more than a daily glass of wine with dinner, it becomes an important question.

Wine Spectator columnist James Laube highlighted the increasing similarities of wine and weed in his recent piece “The Creep of Cannabis.” According to Laube, connoisseurs of cannabis employ a similar vernacular in describing their preferences, going so far as to debate terroir, appellation, and varietal, even organizing dinners themed on weed & food pairings. We haven’t yet seen “weed country” tours being promoted, but it wouldn’t surprise me.

In terms of physiologic activity there is an interesting intersection of the wine vs. weed issue: both exert effects through what is called the endocannabinoid system (ECS.)[i] Though only discovered in the 1990’s the ECS has now been fairly well delineated. Plant-derived ECS modulators are called phytocannabinoids and include THC as well as some wine-derived compounds. There are some studies showing phytocannabinoids to have neuroprotective, anti-inflammatory, and immunomodulatory benefits.[ii] ECS receptors are present in the central nervous system and throughout the body, and are involved in a range of processes from skin health to blood pressure regulation and heart function.[iii] Fundamentally, the ECS as a whole is described as a homeostatic system, integrating eating behavior and energy storage with resistance to oxidative stress.[iv] All this would seem to imply a benefit to regular cannabinoid ingestion, but the ECS is complex and much remains to be learned.

Alcohol consumption independently affects endocannabinoid levels (the body’s natural cannabinoids), correlating with positive changes in mood.[v] Wine also contains notable phytocannabinoids including resveratrol and antioxidant polyphenols, possibly amplifying the effect (working jointly?) Resveratrol binds with high affinity to certain ECS receptors (specifically CB1).[vi] Interestingly, the resveratrol molecule has structural similarities to the anti-inflammatory and anti-oxidant micronutrient curcumin, and comparable ECS effects. Experimental administration of curcumin in animals produces weight loss at dietarily relevant amounts, though regular ingestion of cannabinoids is not known to do the same in human subjects. Contradictions like this remind us of the hazards of oversimplification in looking at studies on the ECS.

One thing the science is clear on is the risk of combining alcohol and cannabis, known as a “crossfade.”[vii] The cross-reactivity of ECS receptors gives and enhanced high (I am told), but THC levels can be unpredictable and affected by whether the alcohol or the cannabis was ingested first, in addition to how much. Too much alcohol before cannabis and you run the risk of “greening out,” a sort of amplified and accelerated hangover. But it’s the long term risk of polysubstance use that is truly sobering: One study[viii] documented significantly smaller gray matter volume in several areas of the brain. (This could have been pre-existing in those prone to this behavior, by why take the chance?)

Better understanding of the ECS has led to development of drugs for conditions such as addiction, obesity, and even cancer. Some of these are in very early stages, and those that have been clinically tested have had varying degrees of success and usually significant side-effects. In any case, users might be inclined to prefer the natural variety, just as wine aficionados may favor taking their medicine in liquid form. For now the difference is that daily wine in the right amounts helps prevent disease, while marijuana’s established role is primarily in treatment of certain medical conditions. If you are waiting for evidence of a “cannabis conundrum” mirroring wine’s French paradox, I suggest you don’t hold your breath.

[i] Feuerecker M, Hauer D, Gresset T, Lassas S, Kaufmann I, Vogeser M, Briegel J, Hornuss C, Choukèr A, Schelling G. Effect of an acute consumption of a moderate amount of ethanol on plasma endocannabinoid levels in humans. Alcohol Alcohol. 2012 May-Jun;47(3):226-32.

[ii] Maroon J, Bost J. Review of the neurological benefits of phytocannabinoids. Surg Neurol Int. 2018 Apr 26;9:91.

[iii] Ho WSV, Kelly MEM. Cannabinoids in the Cardiovascular System. Adv Pharmacol. 2017;80:329-366.

[iv] Nunn AV, Guy GW, Bell JD. Endocannabinoids, FOXO and the metabolic syndrome: Redox, function and tipping point – The view from two systems. Immunobiology. 2009 May 19.

[v] Schrieks IC, Ripken D, Stafleu A, Witkamp RF, Hendriks HF. Effects of mood inductions by meal ambiance and moderate alcohol consumption on endocannabinoids and N-acylethanolamines in humans: a randomized crossover trial. PLoS One. 2015 May 11;10(5):e0126421.

[vi] Seely KA, Levi MS, Prather PL. The dietary polyphenols trans-resveratrol and curcumin selectively bind human CB1 cannabinoid receptors with nanomolar affinities and function as antagonists/inverse agonists. J Pharmacol Exp Ther. 2009 Apr 9.

[vii] https://tonic.vice.com/en_us/article/aey385/what-mixing-weed-and-alcohol-does-to-your-mind

[viii] Noyan CO, Kose S, Nurmedov S, Metin B, Darcin AE, Dilbaz N. Volumetric brain abnormalities in polysubstance use disorder patients. Neuropsychiatr Dis Treat. 2016 Jun 13;12:1355-63.

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