Welcome to Paging Dr. Gupta. This is the place where I tackle the questions you send my way, and the show's really growing. We're getting a lot of questions about your health, your body, and what it really means to live well. So we try and get to as many of them as we can. Our producer, Jennifer, is back with us today. What do we have first?

Okay, first we have a great question from Jean calling in from Illinois.

I have a question about micro dosin, CBD and THC for inflammation. I have arthritis in my right hip and in my lower back and for some reason it seems to flare up at night when I go to bed, which keeps me from sleeping. And I'm wondering if microdosing CBD, and THC, which is supposed to reduce inflammation, will help and if it's safe.

'All right, Jean, great question. I've done a lot of reporting on cannabis, THC, CBD over the years. I have a lot things to say about this. Microdosing, first of all, that basically means taking very tiny doses of a substance. And the idea for many people is to get potential benefits without the noticeable high. And I think what Jean is wondering is whether or not microdosing, CBD, and THC those are well-known compounds in the cannabis plant. Could potentially give her some relief from arthritis and the pain that hits her at night. So there's a lot in that question. We're gonna get into it, what we actually know, whether it's worth trying in your case, Jean to get some relief, and much more, right after the break.

'First of all, I want to acknowledge just how tough arthritis can be. I have family members that deal with this. It can be awful. It messes with your day, your routines, especially your sleep. And we know that when your sleep is off, pain then feels even worse. There have been a lot of studies about disrupted sleep, making pain worse, but also the pain causing disrupted sleep. It's a bi-directional relationship. It's an awful cycle. So, no surprise then, people started looking to all sorts of different remedies, including cannabis and these compounds, THC and CBD, to help with things like arthritis and chronic pain, especially if other medications aren't quite giving them the relief they need. And we do know, from plenty of studies out there, that for a certain percentage of people, about a third of people THC, and CBD can be really effective when it comes to pain relief. It can decrease inflammation. And it can help with sleep. At the same time, we also know that it doesn't seem to work for everyone. And that is why people get into this sort of trial and error phase that Jean is talking about here.

So before we go any further, couple caveats. I should mention that cannabis has been legalized in some states, we know that, but at the same it is not legalized everywhere. And federally, it's still classified as a schedule one substance, though, the White House has indicated recently they are planning to reclassify it. But, when it comes to microdosing, this term that Jean used... That can be a fuzzy term.

It's important to understand what people mean when they use the term microdosing.

That's Dr. Staci Gruber. She has spent years studying how cannabis affects the brain and she runs the Marijuana Investigations for Neuroscientific Discovery Program at McLean Hospital in Massachusetts. I've spoken to her many times over the years and one of the things that she's always emphasized to me is just how complicated dosing can be.

For example, a standard dose of THC, the primary intoxicating compound of cannabis, is typically five milligrams. Some may consider anything less than that a microdose, but in fact, for many, even half of that may be too much.

So let me just emphasize that point.

What one person considers to be a, quote, micro dose might be way too much for someone else. In fact, even half of what someone might consider a micro dose might still be too much for someone, else. It's really tricky. So what Dr. Gruber says is to start low and go slow. And I'm talking about really low. Start with a really low dose. The general idea is this: You can always take more, but you can't take less. Once it's in your system, it's your system. I should also mention that there is a stacking effect that can happen, especially with edibles. You may take an edible, not think that it's doing anything, but the problem is that it is just taking a while to kick in, even hours. And a lot of people may take more edibles thinking that the first dose didn't really do anything. That's stacking. And in fact, you can get a second response after the first response. Something known as a biphasic response. So you get one peak and then you think, okay, it's over, it has worn off. And then a second peak arrives as your liver starts to metabolize it.

And one other thing I wanna throw in there Jean is that we do know that older adults have a slower metabolism. So age is also a factor that comes into play. The high may come later and it may come higher as a result of that change in metabolism. So with all that in mind, Dr. Gruber recommends starting with a quarter of a standard dose or even less to start. That may not sound like a lot, but again, you may be surprised. She also mentioned if you're thinking about trying cannabis, especially edibles like gummies or cookies or anything you take by mouth, there are a few things that you should also keep in mind. CBD and THC can interact with medications you might already be taking. Those interactions could inadvertently increase or decrease levels of the medications that you have in your bloodstream and that can be a problem. So for example, you wouldn't want to increase your level of a blood thinner, for example. So it's always a good idea to check for possible drug interactions ahead of time. But again, when it comes to arthritis, when comes to the impact this is having on you and your sleep, it is something that a lot of people have tried with all the caveats I've just mentioned. Again, it's not going to work for everybody. But from the studies we've seen, for some people, it seems to offer very significant relief. I think it's great that there are a lot of options out there for managing pain, but you want to be thoughtful and you really want to understand what you're taking, even if it's something that's not prescribed to you by a doctor.

So Jean, I hope that answers your question, or at least offers a little bit more clarity. Thanks for sending it in. We hope you get some relief soon. All right, let's take a quick break. When we come back, we got a question about reversing Alzheimer's disease.

And we are back with paging Dr. Gupta. Jennifer, what do we have next?

'Okay, Sanjay. Our next question comes from Heather. She's calling in from Columbus, Ohio. And she's wondering if you could give a little follow-up on your special on Alzheimer's, specifically on the study that showed how an all-vegan diet, socialization, meditation, and exercise were able to halt the disease. She's curious if there are any new developments.

All right, Heather, thank you very much. I love this topic. I think about this topic all the time. Thank you for watching the special on Alzheimer's and thank you for your question. As I've mentioned, maybe you remember in the past, Alzheimer's also runs in my family. So I think this a lot, both professionally and deeply personally. And I totally get wanting to stay up to date on any developments on these studies. They're often a beacon of hope for me as well, me personally. This idea that there is something we can do to change the course of the disease.

Now, before we talk about the latest developments, I just wanted to recap for a minute those of you who haven't seen the special yet. Back in 2024, we released a documentary called The Last Alzheimer's Patient where we followed people all over the country who had been diagnosed with or at least were high risk for Alzheimer's. And what we saw was really remarkable. I should point out, first of all, that the documentary was shot over five years. So we had a long time with some of these patients to see their improvements and see if those improvements were actually stable and durable. We saw cases where Alzheimer's was slowed, prevented, and yes, to Heather's point, sometimes even reversed. And what stood out to me was that it wasn't always about some new or experimental medication. What it came down to were fairly simple things, lifestyle changes, diet and exercise, how we move and how we nourish ourselves, good cardiovascular health, what is good for the heart is often good for brain, but also things like maintaining social connections and really diving into the hormones that are released when you spend time with other people. And even meditation, looking precisely at the impact of meditation on the brain. It was huge. I mean, think about it. There are more than 7 million Americans living with Alzheimer's. More and more folks out there are considered high risk. It could be someone you know. The fact that these fairly straightforward lifestyle interventions could make a very real and measurable impact on the progression of the disease, that was a beacon of hope.

'This is something that even a few years ago, many people would have said was impossible. Now I do wanna dig into the research a little bit deeper, that study by UCSF researcher, Dr. Dean Ornish, because that is what Heather is referring to. Now let me be very specific here. This was a 20-week randomized clinical trial, a really intensive program, basically designed to drastically change people's diet, exercise, stress levels, and social interactions. In the first group, around 24 people participated, while a similar number participated in a control group and did not receive any treatment at all. The treatment group, they ate a strictly vegan diet for that trial period, again, 20 weeks, focused on whole, unprocessed plant foods. We're talking about complex carbs like whole grains, veggies, fruits, tofu, nuts, seeds, and definitely no alcohol, no ultra-processed foods. Again, it was a vegan diet.

'They also received a suite of daily supplements. They took weekly hour-long nutrition classes about vegan nutrition from a dietician, and then exercise. That was a big part of the treatment as well, training led by a physical trainer. I should point out that a big chunk of the study was done during the pandemic. So all the things that I'm describing were done primarily remotely. They engaged in stress reduction techniques, meditation, deep breathing, and yoga, oftentimes participating in telehealth or remote classes. Therapists also led hour long support sessions three times a week encouraging connection and the sharing of feelings. So that's sort of an overview of how the study was conducted. And that study was the first randomized control clinical trial showing that some Alzheimer's patients could experience cognitive improvement in just 20 weeks, five months with these lifestyle changes alone. Again, no new medication, no knew intervention, just these lifestyle changes.

Now, it is important to point out not everyone showed improvement. And it's important to note that those who did not make any changes in the trial, the control group, they did worsen over that time period as well. So while the thinking skills of a majority of people in the intervention group stayed the same, most in the control groups declined. And get this: Ten people actually saw their cognition improve measurably, objectively. That was the reversal component that Dr. Ornish talks about.

Now, let me get back to your question, Heather, about whether there's been any new developments on the study, and I'm happy to say that yes, there are. Dr. Ornish did indeed continue the trial and followed his subjects for an additional 20 weeks. So that made it a total of 40 weeks that the treatment group had been on the intervention program. And though he said he's gonna be officially publishing those findings later this year, he did decide to share some of the findings with us when we gave him a call.

And in brief we found there was on average even more improvement after 40 weeks than after 20 weeks. And the control group, which got worse overall during that first 20 weeks, crossed over. We gave them the same lifestyle intervention and they started to get better.

That said, there are no guarantees, but at the same time, it seems like there's real reason to feel hopeful.

Nothing works all the time for everyone, but unlike, you know, the drugs which are expensive and have side effects, the only side effects of these lifestyle changes are good ones, and they have so many other benefits as well that we've proven over the last 47 years of doing these studies.

And Dr. Ornish also hopes that these findings give people the confidence to take action, including getting tested earlier to understand their risk.

There are a lot of new tests coming out that blood tests and looking at your retina or voice patterns or other things like that, where it can be possible to diagnose whether someone's likely to get Alzheimer's up to 10 years before it becomes clinically apparent. But a lot people say, why would I wanna know if I'm likely to get this horrible disease if I can't do anything about it, it's just gonna make me crazy. But now we can. So I'm hoping that people will use this to these study findings to find out if they're predisposed. And clearly, the earlier you begin making these lifestyle changes, the more effective they're likely to be at preventing it.

'Any sort of lifestyle change we can take to make our lives better and longer and healthier, I think you'd agree it's worth considering. And Heather, I hope this helps answer your question, offers a bit of clarity and maybe even some empowerment. Well that's a wrap for today's episode. Thanks again to all of you for sending in all these great health questions. Remember no question is too big or too small. Keep them coming, we might just answer it on our next program. Reach out to us. Record a voice memo. Email it to pagingdrgupta at cnn.com or give us a call at 470-396-0832 and leave a message. Thanks so much for listening.