The Entourage Effect & the Power of Whole Plant Cannabis

Do you prefer a medicinal herb to a pharmaceutical drug? If you’re like me, when possible, you go for the most natural option – the “whole plant,” rather than isolated components or a mere portion of the plant. Yes, there’s a place for pharmaceutical drugs in some circumstances – and we’re grateful for them when we feel they are the best option. However, from my own personal experiences and when we take into account the list of scary potential side effects that are read ever-so-quickly at the end of TV and radio commercials, it is clear that pharmaceutical drugs can sometimes create more health problems than health answers. 

If we go back in time a hundred-plus years just about every doctor’s bag contained medical cannabis, as well as other medicinal herbs. You see, before the era of pharmaceutical drugs, doctors studied botany because plants were their medicines. But then, as the world became more industrialized, it was found that the chemicals in a plant could be isolated and manufactured in large, consistent quantities. However, the problem is that most of the chemical compounds in the plant were removed. The assumption is that the chemical that’s been isolated is the only one that’s important because it is the active chemical.  

In my book, The Medical Marijuana Handbook: A Patient’s Guide to Holistic Healing with Cannabis, I share the wisdom of leading-edge, Harvard-trained M.D., Andrew Weil about why all of the chemicals in the plant are important – and therefore, why the “whole plant” is important. 

     “The term entourage effect has been used to explain why all of the chemicals in cannabis are considered important—and why a synthetic version of the plant that includes some, but not all, of its chemical compounds is often found to be less efficacious. A story that Dr. Weil shares in Health and Healing explains why the entourage effect is considered important. Dr. Weil says he was very confused when the heart medication digitalis was taught in his medical school pharmacology class. Digitalis is a potent heart medication which is given in minute doses. It is such a potent drug that it must be precisely dosed for each patient and requires close medical supervision for safe use. The pharmaceutical text explained that there were three successive stages that were indicators of overdosing or drug toxicity. By carefully monitoring a patient and catching any problems at the early stages, the doctor could alter the dosage and keep the patient safe. The first indicator that the dosage was too high was gastrointestinal symptoms, usually nausea and vomiting. The second indicator was more serious and showed up as benign or atrial arrhythmias of the heart, which means that the upper chambers of the heart beat in abnormal rhythms. And the third stage, which can be fatal in minutes, is ventricular arrhythmia, in which the main or lower chambers of the heart beat irregularly. 

     “Even though these three successive stages were taught in the medical textbooks, pharmacological manuals, and classes, Dr. Weil and his fellow students got conflicting information from their medical school instructors, all of whom said that the first stage—nausea and vomiting—never occurs. Instead, the first indicator that patients were experiencing an overdose or toxicity to the drug was the much more serious arrhythmia of the heart, which is stage two. Then, if they weren’t treated in a timely fashion, they could quickly go into the life-threatening stage three. That didn’t make any sense. Dr. Weil asked why there is a stage one if it never happens? But no one had the answer. They taught it this way because they were taught it this way. And, even though the information was clearly not accurate, apparently no one had the audacity to change the wording in the textbook. 

     “Some years after medical school, as Dr. Weil was talking with an older doctor, they discussed their common belief that plant forms of drugs are relatively safe. Then, surprisingly, the older doctor provided the answer to the riddle of why students were taught about the phantom “stage one” indicator of a digitalis overdose. It seems the original form of digitalis was the herb foxglove. When foxglove was given to heart patients in its natural form, the dosage could be easily monitored because of a chemical compound in the plant that caused them to get sick to the stomach if they were taking too much. That’s where the nausea and vomiting came into the picture. But when digitalis, the main chemical compound in foxglove, was extracted and isolated and sold as a pharmaceutical drug, the chemical compounds in the plant that could cause the minor stomach upset were no longer present. So, unlike their predecessors who dispensed the herb itself, modern doctors who prescribe the pharmacological version, digitalis, do not have the advantage of the stage one “early warning” symptom. Rather, the first indication that a patient might be overdosing is much more serious and even potentially life-threatening. 

     “Back in the day when the foxglove plant was given to patients in its natural form, the synergistic compounds in the plant worked together and the patient’s own body would signal any dosing adjustments that were needed by causing nausea and vomiting. 

In their enthusiasm at isolating the active principles of drug plants, researchers of the last century made a serious mistake. They came to believe that all of a plant’s desirable properties could be accounted for by a single compound, that it would always be better to conduct research and treat disease with the purified compound than with the whole plant. In this belief, they forgot the plants once they had the active principles out of them, called the other principles “inactive,” and advanced the notion that prescribing refined white powders was more scientific and up-to-date than using crude green plants….

The erroneous idea that plants and isolated active principles are equivalent has become the dogma in pharmacology and medicine today. Drug plants are always complex mixtures of chemicals, all of which contribute to the effect of the whole. In general, isolated and refined drugs are much more toxic than their botanical sources. They also tend to produce effects of more rapid onset, greater intensity and shorter duration. Sometimes they fail to reproduce desirable actions of plants they come from, and sometimes they lack natural safeguards present in those plants. Our problems stem directly from the decision of scientific medicine to value the refined white powder over the green plant. 

The possibility that secondary compounds of medicinal plants may be valuable in their own right or may modify the effects of dominant compounds in good ways seems unremarkable to me. Nevertheless, I find I have to explain it to allopathic physicians and pharmacologists with great patience. I notice that I make many of these people uneasy when I impute any “wisdom” to nature. They seem to resent the suggestion that natural substances may be better than manmade ones. All that I can say is that, empirically, I have found such a difference, at least in the case of medicinal plants versus isolated drugs. Whenever I have had a chance to observe or experience firsthand treatment with a plant and treatment with a refined derivative of the plant, I have found the latter to be more dangerous and sometimes less useful.”*

*Weil, Andrew, MD, Health and Healing, Houghton Mifflin Company, 1988, pages 98-99 and 101.