40 | Swathi Varanasi, Integrative Health Pharmacist

“There is a lot of controversy when it comes to the entourage effect and whether a lot of the cannabinoids work together in your system and perhaps it’s better to have a broad spectrum or full spectrum rather than just an isolate. I think more research is needed when it comes to that.”

— Swathi Varanasi

Budtenders make recommendations based on personal experience, but what if you had a trained medical pro advising you on your cannabis medicine? Swathi Varanasi is an integrative health pharmacist, out on the leading edge of medical professionals who are helping people find the right cannabis medicine for their individual needs. We talk about contraindications, dosing, full- and broad-spectrum vs, isolates and much more.

Connect with Swathi on LinkedIn

Swathi’s website

Society of Cannabis Clinicians

Kannaboomers (00:00): Hi, it's Tom. Welcome back to the Kannaboomers podcast. It is March 23rd, 2020 in the midst of the coronavirus lockdown. I am sheltering in place, self quarantining, all that stuff as you probably are too. We're all doing our part to squelch this thing as it runs rampant. We're not going to claim that CBD can cure the coronavirus cause that's definitely not true and we would not ever go there, but we do have a pharmacist today, Dr. Swathi Varanasi and we're talking about wellness and how CBD can help you support your own wellness and do some self care, which is definitely a necessity in these times. So we talk about full spectrum and broad spectrum and isolate CBD about the farm bill and how that is going to affect us going forward. But many different aspects of this plant, all the cannabinoids that we're just learning about now and how it can help you live a better, more healthy life. So it's a great conversation. I hope you enjoy it. Thank you to Danny in Milwaukee for making a sound good. Glad to be back. And we'll have another episode again soon. Thanks for listening.

Kannaboomers (01:03): This is, Let's Talk About Weed, the Kannaboomers podcast, CBD micro dosing, and all things related to medical cannabis, for baby boomers. From San Diego, here's your host, Thomas J.

Kannaboomers (01:15): It's Tom. We're back with the Kannaboomers podcast. Today we have Swathi Varanasi, Dr. Swathi Varanasi is a pharmacist in Los Angeles. How are you today Swathi?

Swathi Varanasi (01:24): I'm great. How are you?

Kannaboomers (01:25): Very good, thank you. I'll mention that it's March 23rd, 2020 so we are in the woods of the coronavirus epidemic. I don't know if we're going to be out of the woods soon, we may be just getting into them. But you're a professional who helps people take care of themselves. So I wanted to ask you, how are you taking care of yourself? Right now?

Swathi Varanasi (01:44): I'm trying to drink as many fluids as possible, trying to get an adequate amount of rest, trying to eat healthy, and also just social distancing. So I haven't left the house in quite a few days.

Kannaboomers (01:55): Right. Well a lot of people out here seem to have a problem with that concept right now. So thank you for doing that and thank everyone who's listening for taking care of themselves as well. So we're here to talk about CBD. You know, as a pharmacist, you're in between the doctor and the patients, kind of a unique place to be to help educate consumers. When you talk with people about CBD, what sort of misunderstandings are you hearing?

Swathi Varanasi (02:20): I think a lot of people think that it's 100% something that they don't need to worry about interacting with other medications. And also I think that because it's just so easily accessible and readily available, I think a lot of people can just use it for any sort of ailment. And so I think that's maybe one of the biggest misconceptions.

Kannaboomers (02:41): Yeah. I mean we sort of have this mythology in Western medicine that you just, you take a pill and it solves everything. And maybe some people have attributed CBD that way, but let's talk about some of the complications. What, what are some of the things we should watch out for with CBD?

Swathi Varanasi (02:57): Sure. I think so there are some drugs in particular that you would not recommend someone to take CBD if they were on those medications. A lot of the studies that have been done, the amount of the CBD that the participant has been taking is a lot higher than a lot of the than the average person would be taking for a certain disease state. But that being said, I do think it's still important to extrapolate from that. And even though they might not be taking that much, that perhaps that's still not the best choice for them if they're, you know, taking something like a Warfarin or specific anticonvulsant agents.

Kannaboomers (03:37): Warfarin is a blood thinner.

Swathi Varanasi (03:40): Yeah, it's an anticoagulant.

Kannaboomers (03:41): So just to be clear, I mean a lot of pharmaceuticals have toxicity levels, right? And CBD, we're not really talking about that.

Swathi Varanasi (03:49): Not in this particular case, I think a lot of research still remains to be seen when it comes to toxicity levels with CBD.

Kannaboomers (03:56): But we are talking about contraindications and combinations and, and it could create a negative effect with, with blood thinners and other things.

Swathi Varanasi (04:05): It could create a negative effect or even it could completely stop the, not completely stop but nearly eliminate the other drug from working that's a possibility or vice versa. Maybe that drug can influence CBD to not work in the system. So it's kind of their interactions within the body, not necessarily negative, but just depends on the medication and the way it's metabolized.

Kannaboomers (04:28): That's probably true for, for a lot of medications. Right. And that's something we don't often hear, but that's why you consult with your pharmacist and your physician is to kind of understand how this may affect you because it doesn't affect everybody in the same way. Right.

Swathi Varanasi (04:46): Exactly. And that's when genomics comes into it. Just like a personal interest of mine that even if we all have the same enzymes, for example, like the CYP450 system is the most well known when it comes to the metabolism of CBD and other constituents of or other cannabinoids as well. And yeah, when it comes to that, we just don't know a lot of the genomics if maybe someone is a poor metabolizer or an ultra metabolizer meaning that they metabolize it very, very quickly. So we just don't know a lot of that yet. And I think once we know a lot more about genomics and we can tie that in with cannabis, that will be like the prime personalized medicine for cannabis.

Kannaboomers (05:30): That sounds terrific. Do you see that day coming? Is that, is that like a matter of taking your 23 and Me results and having them analyzed or how do we get to that point?

Swathi Varanasi (05:40): I do see that day coming, I'm actually working with a company that is doing that exact thing where they're taking 23 and Me results and ancestry.com results and other modalities or other platforms as well that can analyze your genetic your biome and then go from there and look at how that can influence taking cannabis and specific dosages and things like that.

Kannaboomers (06:05): Well, and then the other side of that is cannabis is so multifaceted. I mean there's 113 cannabinoids, there's...

Swathi Varanasi (06:12): Or more maybe. Yeah.

Kannaboomers (06:14): Who knows. There's a lot of different actions you're going to get from cannabinoids. So it's like a giant matrix. Right?

Swathi Varanasi (06:19): It is. Definitely, that's a great way of thinking about it.

Kannaboomers (06:22): So there's a lot of potential that's, we've hardly scratched the surface of it seems like.

Swathi Varanasi (06:27): Yeah, definitely. I would agree. And then, I mean we haven't even talked about terpenes or anything either. And like terpenes can have incredible therapeutic potential as well. So there are just so many aspects of things like even past cannabinoids, other things in the plant. So,

Kannaboomers (06:42): And you're pretty much ahead of the curve on this, right? Are there a lot of people in the pharmaceutical realm who are dialed in like you are?

Swathi Varanasi (06:49): There are more and more like with each passing day, there are a few organizations that either there is one that's specifically for pharmacists that are in cannabis and, but there's also the Society of Cannabis Clinicians and they have a growing population of pharmacists as well. And quite a few of us are actually coming together within the pharmacist. And that organization to put together a CE program for pharmacists. And so hopefully we can help spread the knowledge of cannabinoids and the education behind it so that more and more pharmacists can learn more. Because I hear from so many of my colleagues that work in the community, like the retail setting of pharmacy and they just get so many questions about CBD and they don't really know where to even turn. So if we could, if we could provide that CE education or something like that, I think that would be very helpful. But yes, definitely the interest is growing.

Kannaboomers (07:43): And when you say CE, is that continuing education?

Swathi Varanasi (07:46): Oh yes. Sorry, it's continuing education.

Kannaboomers (07:48): Just to be clear, it's not really taught in schools yet. So it's something that pharmacists will pick up later through the sorts of programs you're talking about.

Swathi Varanasi (07:57): Exactly, yes. So I'm hoping that that will be one of the steps that we'll be moving forward is including the endocannabinoid system and just the talk of cannabinoids overall within all of the medical professional curriculum. So pharmacy, medicine, dental, nursing and everything beyond that too. So I'm hoping that that is soon. I know there are some universities that are starting to include electives or even included in their core curriculum, which is really exciting.

Kannaboomers (08:26): Did you say that you will be guest lecturing on this at UC San Diego?

Swathi Varanasi (08:32): Yes.

Kannaboomers (08:33): That's great. You mentioned the endocannabinoids system. Do you see that becoming a specialty at some point?

Swathi Varanasi (08:39): That's a great question. I haven't been asked that before. I think that that's definitely a possibility. That someone could go into that. I think that calling it someone who is going to be a specialist in the end of cannabinoid system makes a lot more sense to me than like someone's specifically only going in to be like a cannabis specialist just because so many other agents called cannaba-memetics also work on the endocannabinoid system. So I think if we can look at all those agents to best enhance endocannabinoid tone and enhance the way that the endocannabinoid system works, that would be like the most optimal.

Kannaboomers (09:15): Because it is so far reaching, right? I mean we're, we're talking about a system that regulates appetite and pain and sleep and all sorts of things. Right?

Swathi Varanasi (09:24): Then it interacts with so many other organ systems and influences them too.

Kannaboomers (09:28): And it is involved with your immune system as well, right?

Swathi Varanasi (09:32): Yeah, definitely. So the CB two receptor is the one that I think is the most well known when it comes to immunity and immune function.

Kannaboomers (09:39): So we want to be careful not to overstate anything here, but like right now we're in the midst of this pandemic and you know, I saw somewhere someone online claimed, ‘Oh CBD can cure coronavirus,’ which we know is not true, but can it help you as you say, kind of tone up your immune system and be more healthy?

Swathi Varanasi (10:00): I think potentially could. I think in terms of looking at risk versus benefit, I think the benefit could outweigh the risk. Again, it depends on the patient and their disease states and what other medications they're taking and everything. But overall I think just for health and wellness, I think it would be great for immune support.

Kannaboomers (10:19): And like you said earlier, there are complications sometimes where it interacts with something you're taking. So you know, as a pharmacist you're, you're in partnership with your patients and helping them understand those things. But definitely people need to listen to their bodies and pay attention.

Swathi Varanasi (10:37): Yup, exactly.

Kannaboomers (10:39): How much pushback do you get from sort of the traditional side of your profession? Are there, are there a lot of skeptics still?

Swathi Varanasi (10:46): Definitely. And I think part of that is just because it used to be, I mean it still is a schedule one substance. So the highest abuse potential in that same category with LSD and all the other illicit drugs. So I think just because it still has that status, a lot of clinicians are still very wary of it as having therapeutic potential because it's put in that schedule one status because it's quote unquote not supposed to have any therapeutic benefits. So I think that that's probably the biggest hurdle. And I think also just because as we kind of mentioned before, it's not taught in the curriculum. So I think if people knew more about the system then they would understand that enhancing the system could be beneficial for someone.

Kannaboomers (11:30): Right. It's still so newfangled and when you're in a profession that is first do no harm, people have to have the confidence that it's going to be safe.

Swathi Varanasi (11:41): And it's fascinating that it's, I'm like, I would, I would definitely call it newfangled right now just because it's fascinating just because it's been around for so many years and so many different groups around the world who used it. And so it's just interesting that now it's finally getting, it's a, it's light in the U.S.

Kannaboomers (11:59): Well, right? I mean, people have been consuming cannabis for thousands of years, right? I mean, I've heard it said that it's the biggest clinical trial in human history. It's not clinical, but people have been consuming it and as we often say, no one's ever died from it, but there can be contraindications. So you need to listen to your body. Once again, last summer we saw this vaping crisis kind of rear its head where a lot of people were trying to reduce harm, the harm of smoking by vaping. And for for a good 10 years it seemed like, 'Hey, this is a good alternative.' A lot of people picked it up, but then people started getting really sick. So there is a bias against some of these things still. So what do you tell consumers? How do you protect yourself against any kind of medicine that might not be proven yet?

Swathi Varanasi (12:50): I think the best is just to have a really great relationship between you and your practitioner. So that practitioner-patient relationship and having that, that shared decision making between the two I think is just so important. And so I did mention shared decision making as like the patient and the practitioner sitting down and weighing all the benefits and talking about it as a discussion rather than the practitioner just telling them this is what you should do, one, two, three and then just expect the patient to be on board with it.

Kannaboomers (13:19): So you need to have a sort of a cannabis enlightened physician or pharmacist.

Swathi Varanasi (13:23): Definitely. I think that that's really important to have someone who has taken it upon themselves to do more research and look into it after they have graduated and been in the field for however many years. Definitely.

Kannaboomers (13:37): Well, it's not that easy to find a physician and a pharmacist. I think you're sort of a diamond in the rough. I don't, I don't think there are too many pharmacists who are this enlightened yet.

Swathi Varanasi (13:48): As I said, the number is growing, but I mean there are like with the Society of Cannabis Clinicians, time mentioned there, there is a directory. So if you're looking for someone, I think that would be a great way for a patient to find someone. And I think apart from that, a lot of it is word of mouth too.

Kannaboomers (14:03): Okay. We'll definitely get that organization in the show notes. So people, you know, the Farm Bill was passed in 2018 and that has had an impact on, we can grow hemp now CBD seems to really have exploded. Where do you see it going from here?

Swathi Varanasi (14:20): Yeah, that's a great question. I mean, I think that there will be an overall decriminalization around the U.S. Eventually, I think a lot of states are finally seeing that it could be potentially beneficial for so many different patient populations in different disease states. So I do think that that is in the future. I'm not really sure exactly when, but hopefully soon. And then apart from that, I do think that a lot of the states in the Northeast for example, that are requiring a pharmacist to be on premises and to be on staff of a dispensary I think is just brilliant. So they can have the opportunity to speak with the patient and the patient can get that like specialized treatment too.

Kannaboomers (15:04): I didn't know that, but that is a great idea. I mean, I'm here in California, sometimes you ask your budtender, they really don't know. I mean they'll tell you their favorite strain, but in my experience it's not easy to find somebody who can really give you a good perspective on the medicine itself.

Swathi Varanasi (15:22): Yeah, definitely. And I, I don't want to say that budtenders don't know anything, but like they don't have the medical background on like that clinicians lens. So I think that that's what's missing.

Kannaboomers (15:33): Well, and again, as we talk about, it's sort of a matrix of, of different medicinal possibilities. So, I mean, there's a lot to know about this plant with all those terpenes and cannabinoids. Very complex, one piece of that complexity. If you can help us understand the difference between full-spectrum, broad-spectrum and isolate products and, and which people should look for when they're, when they're shopping for CBD.

Swathi Varanasi (15:59): Yeah, definitely. So CBD isolate is when they've actually isolated only CBD, so that one constituent of the whole plant. And so when you're buying a CBD isolate product, that's the only thing that's going to be in the product. When we're talking about broad spectrum, that means that it includes other minor cannabinoids to some of the other ones like CBG, CBN, for example. So those will also be in that product along with CBD. And then if we're talking about full spectrum, full spectrum is really to me like what goes with the Farm Bill. So that's that less than 0.3% of THC. So it will have CBD. The other minor cannabinoids that I just mentioned, CBD, CBN, but also, oh, sorry, CBG, CBN and other ones as well. And then it will also have less than 0.3% of THC in it.

Swathi Varanasi (16:51): So I think that's the, the main distinction between the three. There is a lot of controversy when it comes to the entourage effect and whether a lot of the cannabinoids like whether the cannabinoids work together in your system and perhaps it's better to have a broad spectrum or full spectrum rather than just an isolate. I think more research is needed when it comes to that. But in terms of recommendations, I'm inclined to say that perhaps a broader full spectrum is better just because of the different possibilities of, of benefits that come from different constituents of the plant.

Kannaboomers (17:26): That's good to know. I know some people are vehemently opposed to isolates because of what you mentioned, the, the entourage effect, which is a real thing. So that 0.3%, do you know, is there a scientific basis for that or is it more or less arbitrary? Can you address that?

Swathi Varanasi (17:45): So I don't know specifics about it. However, I have had conversations with other clinicians and other colleagues about it and my understanding is that an actually is a pretty arbitrary number that a clinician decided years ago when they were doing a lot of trials and then it's kind of just stuck since then. So I don't think that the, I don't, I'm not aware of any specific rationale or reason as to why it's 0.3. I just think that's how research and everything has been done for a long time. So it just kind of remained .

Kannaboomers (18:18): Because in general, it's not enough to have an intoxicating effect. Right?

Swathi Varanasi (18:22): As far as I'm aware, no, it could depend on the person, but I would say on average probably not.

Kannaboomers (18:28): Some people are concerned about triggering a positive result on a drug test. Do you think that 0.3% would do that?

Swathi Varanasi (18:35): I think if people are worried about, you know, taking drug tests at work and if they do have a positive result that their job could be in jeopardy, then maybe just staying away from full spectrum just to be safe. I don't think that it's going to show up probably just simply because of how little it is. I guess it depends on how much they're consuming, but overall if, if they are worried, I would just say go for the broad spectrum then.

Kannaboomers (19:02): For the believers in an isolate, the argument for that is it's the pure molecule, unadulterated. And if you, if you're confident that it's has a specific effect, there's, there's nothing else getting in the way of that.

Swathi Varanasi (19:17): Right. And I think that like when it comes to isolate, a lot of research has been done, for example, in epilepsy and that's the only FDA approved medication of cannabidiol right now in the U.S. Is the Epidiolex that's a CBD isolate. So I think that there is, there can be a benefit for an isolate I just don't think it necessarily is appropriate for everything.

Kannaboomers (19:41): Some people are taking CBD for anxiety and the other thing we hear is, well it doesn't have a psychoactive effect, but if it reduces anxiety, that is sort of psychoactive.

Swathi Varanasi (19:51): I completely agree. I think the term 'psychoactive' is a little bit of a misnomer. I think that like all the constituents as far as I'm aware of, I would describe them as psychoactive, but I liked how you used 'intoxicating' for THC. I've heard that term used quite a lot when we're talking about THC versus CBD.

Kannaboomers (20:10): Let's talk about dosing. You know, often these things come and tinctures and there could be, could be wildly different in, in the amount of CBD they have in them. So I guess we have to look closely at the labels and try to do a little math and figure out basically how many milligrams we're getting per dose. Right?

Swathi Varanasi (20:27): Definitely. And I think that a specialist can very much help with that, especially with starting with a tincture. Tinctures are great, I think because you can take as little or as much of it as you need so you can start low and titrate up or out a little more very slowly. So I like that as an option. I know that oil like sublingually and things like that, it's not something that we're really used to in our diets. I think that that's a little difficult for some patients to integrate into their lifestyle. So I think that's why they look to other things like capsules and other formulations that suit them better. But yeah, I think overall tinctures can be a great place to start.

Kannaboomers (21:08): You know, I guess it helps if the manufacturer puts a line on the eye, drop her so he can see if it's a quarter full or a half full. And then how do you equate that to milligrams? Well, I've seen studies where the amount of CBD can vary wildly. I mean, some products have more than stated, some have less. What's your best advice for finding a brand that is accurately labeled?

Swathi Varanasi (21:31): Yeah, I mean that's the, the big I don't want to say controversy, but a lot of people have been talking about that quite a bit, about all the different possibilities of what could be in the product or what isn't in the product just because there's no standardization when it comes to regulations. Right now. I do think that there are some regulation standards, like some companies, some third parties that are doing a good job. So, I think it really just depends. And then I think speaking with a specialist could help is maybe they have some insight and they have some relationships with certain brands. Perhaps that could be helpful. But I do know that the U.S. Hemp Authority does a pretty good job. I like how they have an emphasis on education. So they really want to teach the growers and manufacturers and everyone that they're working with about like GP. So like Good Agricultural Practices, GMP manufacturing practices and labeling and a lot of that stuff. So I like how they have an emphasis on that as well as the fact they have very rigorous standards. So that's a good example. I'm sure there are other great ones out there as well, but it is difficult to know at this time.

Kannaboomers (22:42): Yeah. We're doing something where we point listeners and readers to the U.S. Hemp Authority approved brands, certified brands. And I know you've been working with one of them. Vitagenne is one of the relatively few brands that's been certified by the U.S. Hemp Authority.

Swathi Varanasi (22:57): Yeah, I have actually met them. They were their offices a few doors down from the pharmacy, the independent natural pharmacy where I am most of the week. And so that's actually how I met them. But they've been so great to work with and every time we have a discussion about anything that we're doing, whether it's a video, I just recorded a video for them about immunity actually. And if I'm writing an article or something like that, I think that they do a really great job of always thinking about the patient and the consumer. And they also really want to be involved in the community. I know they're looking into nonprofit work and trying to like have a voice in that space too. So I think they're doing a great job with trying to actually benefit their consumer.

Kannaboomers (23:42): So you're pretty confident in telling consumers that if they look for a brand that's been certified by the U.S. Hemp Authority, they can be confident in that brand.

Swathi Varanasi (23:52): Yeah, I think that's a great way of thinking about, I think there are other good standards too, but I do think that the U.S. Hemp Authority is doing a great job.

Kannaboomers (23:59): I think we might've mentioned some of the minor cannabinoids. Can you talk about that? I mean, again, there's 113 known cannabinoids, maybe some more, have we just scratched the surface of our knowledge of these? And what sort of other efficacies might there be in this just long list of cannabinoids?

Swathi Varanasi (24:18): Yeah, I mean there's so many possibilities. I think when it comes to CBN, I've heard a lot about it helping with appetite stimulation. So that in tandem with THC for example, something like that, I think it'd be great. I've also heard a lot about it being used with Oh, what is it? Oh, like antibacterial potentially. There's been some studies about that as well. I do think there's just so much research that remains to be seen that I don't want to be necessarily concretely saying it should be used for X, Y, Z yet. But I do think that there's so much potential and overall when it comes to like a lot of the cannabinoids that I know about, they just are so great when it comes to their antiinflammatory properties and so many disease states can be considered inflammatory. And so if we look at it from that standpoint, I think cannabinoids can be useful in a lot of different disease states. We just don't know the specifics yet.

Kannaboomers (25:15): Just the fact that it's anti-inflammatory is a good reason to take it. Do you, do you take CBD as a supplement?

Swathi Varanasi (25:22): I do.

Kannaboomers (25:23): How many milligrams per day do you take?

Swathi Varanasi (25:26): I generally take around 20. I take a broad spectrum or full spectrum depending, but yeah.

Kannaboomers (25:31): Is there anything else that we haven't covered that, that is important to our listeners from your perspective?

Swathi Varanasi (25:37): No. I think I'm really glad we talked. We got to talk about the Farm Bill and we got to talk about the you got to talk about Vitagenne as well as the endocannabinoid system and the isolate versus full spectrum and broad spectrum. I get a lot of questions about that. So no, I think we covered a lot of the big things that I think are important to consumers.

Kannaboomers (25:57): Where can our listeners find you online?

Swathi Varanasi (25:59): Sure. Yeah. So my website is drswathi.com, so D O C T O R S W A T H I dotcom. So feel free to look at my website. I have like all of my recent podcasts and a lot of the articles I've written and content that I've created for various companies and brands. So I have that on there and please connect with me on LinkedIn as well.

Kannaboomers (26:21): Thank you for taking the time, Dr. Swathi, we really appreciate your expertise and helping us find our way in, in the CBD jungle here.

Swathi Varanasi (26:30): Oh, thank you so much for having me. I appreciate it.

Kannaboomers (26:32): All right. You've been listening to. Let's Talk About Weed, the Kannaboomers podcast with Thomas J for more on medicinal cannabis for baby boomers. Visit us Kannaboomers dot com.