Updated May, 17th 2022
By Janna Champagne, BSN, RN
Whole Plant Spectrum:
As a holistic nurse who specializes in application of medical cannabis therapy, knowing which formulations are optimal for targeting patient’s health goals comes with the territory. After years of working with thousands of clients using a variety of cannabis products, I began noticing a trend: that the various cannabis products are not created equal in achieving optimal therapeutic results. This prompted intensive research into different types of cannabis formulations, so I could objectively advise my clients to optimal products, which led to creation of the FLOW™ criteria.
Products concentrating the cannabis flower as nature intended, with little to no loss, are the best option for therapeutic cannabis use. Cannabis formulations extracted using food grade ethanol or infusion methods are preferred to meet these criteria. Whole plant spectrum formulations conserve and contain hundreds of flower-derived cannabis ingredients, most of all of which remain intact in the final product. In comparison, CO2 processing nets around a dozen compounds (isolate cannabinoids + terpenes), and isolate contains only one compound (one cannabinoid). These lesser methods are popular despite research and patients outcomes clearly supporting that the Gestalt theory applies: the whole cannabis flower is truly greater than the sum of its parts (2).
Cannabis is a very complex plant, containing over 140 cannabinoids, 200 terpenes (similar to essential oils), bioflavonoids, chlorophyll, essential fatty acids, and antioxidants (1). Research supports that synergy between all of the 500+ compounds enhances the "Entourage Effect" experienced by the consumer, defined as the ability of cannabis to promote homeostasis. Many of the new and popular cannabis extraction methods in today’s cannabis industry, such as CO2 extraction, isolation, or fractionation, remove many of these ingredients contributing to the Entourage Effect (8).
It’s the balancing effect (homeostasis) that we specifically seek when the patient's goal is improved health outcomes that reach beyond superficial symptom management (4). Research comparing the efficacy of whole plant spectrum vs isolate cannabis clearly reflects that isolates, even with added terpenes comparable to CO2 and "Full Spectrum" products, aren’t as effective for exerting the balance we seek for optimal health outcomes. Research reflects that whole plant spectrum works as well or better than isolate CBD at 20-25% of the dose of isolate (or co2), thereby improving health outcomes for far less cost to the patient. Research also reflects that isolate and co2 extractions exert a bell curve response, narrowing the therapeutic dosing range, and risking little to no benefit with intensive dosing as indicated for serious conditions like cancer. In comparison, whole plant spectrum exerted a more predictable response, increasing anti-inflammatory response with higher dosing (2, 3, 6).
Another emerging issue is the increased risk of using human-altered cannabis products. This insight follows a tragic event in February 2020, when a patient using CBD for two years switched to a human-altered liposomal formulation, and immediately suffered onset of Stevens-Johnson Syndrome, a known adverse effect of her long-time medication, Meloxicam. It’s important to note that this patient did not experience any interactions between meloxicam and the first CBD formulation, despite a shared metabolic pathway (CYP450). Upon switching to a liposomal CBD, that same medication was potentiated to such an extent that she died only two days later.
Now that CBD is freely available for purchase, and most consumers don’t understand that it may interact with pharmaceuticals, this situation could repeat. This is another reason to ensure your product's effects are predictable, since we don't yet understand how our tampering with whole spectrum changes bioavailability and metabolism of cannabis with concurrent pharmaceuticals. When it comes to optimal therapeutic quality, based on my experience and the research, whole plant spectrum cannabis is the frontrunner.
5. Echo (2017). Major and minor cannabinoids in cannabis. Retrieved from: https://echoconnection.org/a-look-at-the-major-and-minor-cannabinoids-found-in-cannabis/
6. Gallily (2015). Overcoming the Bell-Shaped Dose-Response of Cannabidiol by Using Cannabis Extract Enriched in Cannabidiol. Retrieved from: http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=53912#.VP4EIildXvY
8. Echo (2017). CBD Alcohol or CO2 Extraction. Retrieved at: http://www.cbd-hemp-oil-drops.com/articles/57-cbd-alcohol-or-co2-extraction