African Americans and other people of color throughout the United States are suffering disproportionately from Covid-19. In this interview, Udaya Thomas, MSN, MPH, APRN, CYT, talks about how integrative practitioners can better serve the health needs of underserved populations during this pandemic. Thomas is an integrative primary care nurse practitioner and the board president of Integrative Medicine for the Underserved, a nonprofit organization of multidisciplinary practitioners committed to affordable, accessible integrative healthcare for all.
About the Expert
A. Udaya Thomas, MSN, MPH, APRN, CYT, is a board-certified nurse practitioner in primary care and practices integrative medicine in a Safety-Net hospital system for the underserved in Southeast Florida at Memorial Primary Care. She is also pursuing her PhD in nursing at Walden University’s interdisciplinary health track, focusing on the integration of behavioral health in primary care. Udaya is also the board president of the non-profit organization Integrative Medicine for the Underserved (IM4US).
Disclosure: Thomas is partially funded by Grant #5T06SM060559-07 of Substance Abuse Mental Health Service Association (SAMHSA) American Nursing Association (ANA) Minority Fellowship Program (MFP). SAMHSA is a government resource for practitioners and the ANA MFP is currently accepting applications for more minority fellows.
Transcript
Karolyn Gazella: Today, our topic is serving the healthcare needs of underserved populations. We'll also discuss the fact that African Americans and other people of color are suffering disproportionately from Covid-19. Hello, I'm Karolyn Gazella, your host and the publisher of the Natural Medicine Journal. My guest is integrative primary care nurse practitioner Udaya Thomas. Udaya presently works in a safety net hospital system for the underserved in Southeast Florida at Memorial Primary Care and she is also pursuing her PhD in nursing. Udaya, thank you so much for joining me.
Udaya Thomas: Thanks for having me Karolyn. It's great to be with you and thanks also to my colleague Priscilla Abercrombie, Past President of IM4US for connecting us.
Gazella: Yes, that's great. Yeah. Now before we jump into our topic, tell us a little bit about your present clinical work at Memorial Primary Care.
Thomas: Well, I work as a primary care nurse practitioner in a patient-centered medical home, and actually for the past 5 weeks instead of person care, we've had to go virtual with Covid-19 pandemic, but our administration led us into a quick change and we're doing 100 percent telehealth encounters. Patients can also message me directly to give them access to me whenever they need it.
Gazella: That's great. Now, where does your interest in healthcare disparity spring from?
Thomas: I would say from growing up as a first-generation Indian immigrant in a low-resource rural community, I've always actually been interested in integrative approaches. So I chose nursing and public health as my path to work for the underserved in this country.
Gazella: That's great. So you're the president of Integrative Medicine for the Underserved, also known as IM4US. Tell us a little bit about that organization.
Thomas: IM4US is a nonprofit organization of multidisciplinary practitioners who are committed to affordable, accessible, integrative health for the underserved. IM4US is the only integrative health organization focused solely on the underserved, which makes us fairly unique. We support practitioners that serve underserved populations to outreach, education, research, and advocacy. We also have equity, diversity, and inclusion principles for all the work that we do. And while we typically have an in-person annual conference, due to the coronavirus precautions, we've moved our 10th annual conference to a virtual conference.
Our underserved communities have been specifically affected by the crisis, not only because they're more likely to be susceptible to getting ill, but being out of work for this long really puts them at risk by not having an income, leading to less resources and poor health outcomes.
Gazella: Yeah, and I want to talk about that in a little bit more detail because right now, given the data that we've received presently more African Americans and other people of color throughout the United States are dying of Covid-19 compared to Whites. Now this crisis is really shining a bright light on existing healthcare disparity. So from your perspective, what is the present Covid-19 crisis telling us about this huge healthcare gap that exists in this country?
Thomas: There's so many factors. As Dr. Zwickey mentioned and at the end of your last podcast with her, the coronavirus pandemic has really turned on a loudspeaker to how many disparities there really are. Studies have shown that social determinants of health are responsible for on average 50% of people's health outcomes. For example, The Hill published last week that African Americans are 6 times more likely to die than their white counterparts in Chicago. Yesterday morning, Governor Cuomo commented on CNN, the new rise in Latino cases and deaths in New York. Suffice it to say that comparative to their percentage in the population, minorities are greatly affected and dying at a much higher rate. Current estimates as you might know, are up to 70% areas with concentrated low-income minorities. So is it their racial background or ethnicity that puts them at risk? Well, in the case of coronavirus and most illnesses, actually no.
Rather, it's poor social determinants of health, the lack of employment, safe and stable housing, literacy level, and access to healthy food options that determine health outcomes. These determinants are responsible for most health inequities, as well as lack of access to equitable care. For example, Karolyn, a New York hospital was recently highlighted in the lower-income part of town that is struggling with fewer resources compared to wealthier areas. It's a systemic issue. Because of all the challenges and sometimes trust issues, minorities may delay seeking care too. At IM4US we help practitioners attempt to level the playing field by offering low-cost solutions and increase access to integrative modalities and care and to increase trust. We also provide members opportunities to get involved with educational and policy initiatives to support the underserved.
Gazella: Yeah, I love that about your organization and it's going to be especially interesting for our listeners and readers because they already practice integrative medicine. So the fact that they can take their medicine and now serve the underserved, I think it's really a cool thing. And you know, you mentioned that 70% of deaths that studies showed that even though 70% of the deaths were in African Americans, African Americans only represented 32% of the population. So that is a really big healthcare disparity issue that we have. Now, as you mentioned, it is a systemic issue and it's clear that it needs to be addressed systemically. But what can integrative practitioners do to help ensure that they're not contributing to the problem or perpetuating healthcare disparity issues in their clinical practice?
Thomas: Mm-hmm (affirmative) Great question, Karolyn. While there are many things that practitioners and specifically integrative practitioners can do, but just to mention a few really important things that could make a great impact. One, they can do implicit bias training. This is a free training and it's online and it allows practitioners to find out their own biases as we all have them, whether we work for the underserved or not. Secondly, practices if they don't already have one, can try to secure a legal aid attorney to offer low-income patients legal advice and representation when facing issues like discrimination or eviction for example, and third, they can join our movement. IM4US promotes groups as a way to build trust and increase access to integrative care. In light of the current crisis, we're recommending telehealth groups whether in the time of Covid-19 or not, we can also offer medical group visits via telehealth. It's a great way to connect patients, HIPAA-compliant consent of course together with care team members to increase social connection, reduce loneliness, anxiety and fear that the public is currently living with.
Gazella: Yeah, that's true. What about people who may not have internet access? Does the telehealth visits still work?
Thomas: Great question. Actually we are putting together some continuing education for our upcoming conference and on that specific topic because we want to address access to everybody. I know actually that even when I do telehealth visits just with family members together, hearing multiple voices together and knowing that they're connected to their practitioner and their care team, whether through telephone or through video really makes their spirits lift and a sense of relief that they had contact with you. And you're right, many don't have high internet speed or access to join by video, but making group chats available is also helpful and just knowing someone is on the other line can save a life.
Gazella: Yeah. Like when you mentioned in the very beginning that your patients actually have access to you and they can message you. That's huge. And I would think that that would be a big part of their healing and a part of their care. Now, where can people find more information about IAM4US?
Thomas: Well, we have a website and I'll give you the address. It's www.im4us.org.
Gazella: Perfect. We'll also put a link to that website on our Natural Medicine Journal site so people can just click over and find access. It's a great organization, lots of resources, and really doing some good work to help underserved populations. So Udaya, thank you so much for joining me today.
Thomas: You're welcome, Karolyn. We've been around for about 12 years, so we're still considered somewhat young, but like I said, we're having our 10th anniversary this year and we're really excited to have more of the community join us.
Gazella: Yeah, absolutely. Well, happy anniversary-
Thomas: Thank you.
Gazella: … and this is a conversation that we're going to keep going. I think it's such an important one. You know we provided some good information, but let's just keep talking about it. I think this is very, very important. I also want to remind listeners that you can find all of our past podcasts at naturalmedicinejournal.com. Today I mentioned the ones that I've done with Dr. Zwickey on Covid-19. But we have lots of information at naturalmedicinejournal.com and our podcasts are also available on Pandora, Spotify, iHeartRadio, iTunes, and many other podcast outlets. So thanks for listening everyone and stay safe.
This episode was recorded on May 4, 2020.
On this episode immunologist and integrative health expert Heather Zwickey, PhD, tackles tough questions about antibody testing concerns, why more men die than women, and what the risk is regarding animal transmission. Zwickey is executive program chair and a professor at National University of Natural Medicine in Portland, OR.
About the Expert
Heather Zwickey, PhD, earned a PhD in Immunology and Microbiology from the University of Colorado Health Sciences Center with a focus on infectious disease. Zwickey went on to complete a postdoctoral fellowship and teach medical school at Yale University. At the National University of Natural Medicine in Portland, OR, Zwickey launched the Helfgott Research Institute and established the School of Graduate Studies, developing programs in research, nutrition, and global health, among others. She currently leads an NIH funded clinical research training program. She teaches at many universities and speaks at conferences worldwide. At Helfgott Research Institute, Zwickey applies her immunology expertise to natural medicine, with specific interest in the gut-brain axis in neuroinflammation.
Caring for a patient who is critically ill and dying poses communication challenges for everyone involved—patient, practitioners, and loved ones. How we communicate during this profound time in a person’s life can significantly impact end of life care. In this interview, health communications expert and researcher Carey Candrian, PhD, talks about the power of language and explains why it’s time to evaluate equity in hospice and palliative care. Candrian is an Assistant Professor with the University of Colorado School of Medicine and the author of the book Communicating Care at the End of Life.
About the Expert
Carey Candrian, PhD, is an assistant professor in the Division of General Internal Medicine at the University of Colorado School of Medicine and a Cambia Health Foundation Sojourns Scholar. A social scientist with a postdoctoral degree in communication, Candrian explores how communication shapes—and is shaped by—perceptions, attitudes, and biases in the community. She earned her PhD in organizational and health communication from the University of Colorado at Boulder, where she also was a researcher and instructor for 6 years.
This update features information about recovery from Covid-19, antibody testing, how long the virus lives on surfaces, healthcare disparity that increases risk of death, and new information about air pollution and Covid-19. Heather Zwickey, PhD, is executive program chair and a professor at National University of Natural Medicine in Portland, OR. She also has previous training and experience with infectious diseases.
Approximate listening time: 15 minutes
About the Expert
Heather Zwickey, PhD, earned a PhD in Immunology and Microbiology from the University of Colorado Health Sciences Center with a focus on infectious disease. Zwickey went on to complete a postdoctoral fellowship and teach medical school at Yale University. At the National University of Natural Medicine in Portland, OR, Zwickey launched the Helfgott Research Institute and established the School of Graduate Studies, developing programs in research, nutrition, and global health, among others. She currently leads an NIH funded clinical research training program. She teaches at many universities and speaks at conferences worldwide. At Helfgott Research Institute, Zwickey applies her immunology expertise to natural medicine, with specific interest in the gut-brain axis in neuroinflammation.
This interview was recorded on April 4, 2020.
This podcast addresses new information regarding the loss of smell and taste as symptoms, as well as airborne spread of the virus. In addition to being editor-in-chief of the Natural Medicine Journal, Tina Kaczor, ND, FABNO, has been seeing patients since earning her doctorate from the National University of Natural Medicine in 2000.
About the Expert
Tina Kaczor, ND, FABNO, is editor-in-chief of Natural Medicine Journal and a naturopathic physician, board certified in naturopathic oncology. She received her naturopathic doctorate from National University of Natural Medicine, and completed her residency in naturopathic oncology at Cancer Treatment Centers of America, Tulsa, Oklahoma. Kaczor received undergraduate degrees from the State University of New York at Buffalo. She is the past president and treasurer of the Oncology Association of Naturopathic Physicians and secretary of the American Board of Naturopathic Oncology. She has been published in several peer-reviewed journals. Kaczor is based in Portland, Oregon.
According to the National Osteoporosis Foundation, about 10 million Americans have osteoporosis and another 44 million have low bone density which places them at risk of developing osteoporosis. As Baby Boomers age, that number is expected to climb as 10,000 people turning 65 every day. In this interview, bone health expert John Neustadt, ND, explains why bone density scan is not the most clinically important endpoint and how to identify fracture risk in clinical practice. Neustadt details his whole-person approach to reducing fracture risk that includes medications, diet, lifestyle, environmental, and dietary supplements.
About the Author
John Neustadt, ND, received his naturopathic doctorate from Bastyr University. He was founder and medical director of Montana Integrative Medicine and founder and president of Nutritional Biochemistry, Inc. (NBI) and NBI Pharmaceuticals. Neustadt is a medical expert for TAP Integrative, a nonprofit organization educating doctors about integrative medicine. He has published more than 100 research reviews and was recognized by Elsevier as a Top Ten Cited Author for his work. Neustadt’s continuing-education podcast on Insomnia: An Integrative Approach is available for free through the Natural Medicine Journal.
About the Sponsor
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In this interview Heather Zwickey, PhD, provides an important update about Covid-19 for healthcare professionals. She discusses the concerning fact that people can be asymptomatic for a longer period of time than previously expected and that the viral shedding may take longer as well. She also discusses the connection between pollen allergies and Covid-19, as well as GI symptoms, conjunctivitis, and supporting the gut microbiome. Zwickey is executive program chair and a professor at National University of Natural Medicine in Portland, OR, and also has previous training and experience with infectious diseases.
About the Expert
Heather Zwickey, PhD, earned a PhD in Immunology and Microbiology from the University of Colorado Health Sciences Center with a focus on infectious disease. Zwickey went on to complete a postdoctoral fellowship and teach medical school at Yale University. At the National University of Natural Medicine in Portland, OR, Zwickey launched the Helfgott Research Institute and established the School of Graduate Studies, developing programs in research, nutrition, and global health, among others. She currently leads an NIH funded clinical research training program. She teaches at many universities and speaks at conferences worldwide. At Helfgott Research Institute, Zwickey applies her immunology expertise to natural medicine, with specific interest in the gut-brain axis in neuroinflammation.
Transcript
Karolyn Gazella: There is no question that the Covid-19 crisis continues to be a rapidly moving target. Hello, I'm Karolyn Gazella, your host and the publisher of the Natural Medicine Journal, an online peer-reviewed journal for integrative healthcare professionals. Yes, things are moving fast when it comes to Covid-19, but we at the Natural Medicine Journal remain committed to keeping abreast as best we can. Today we're going to be tackling the ever-changing picture of Covid-19 symptoms, as well as new research on pollen counts and Covid-19 and protecting the gut microbiome. My go to expert on this topic continues to be highly respected integrative health researcher and immunologist, Dr Heather Zwickey. If this is your first time listening to Dr Zwickey, she is executive program chair and a professor at National University of Natural Medicine in Portland, Oregon. Dr Zwickey also has previous training and experience with infectious diseases. Dr Zwickey, thank you once again for joining me to talk about this very complex topic.
Heather Zwickey, PhD: Thanks for having me.
Gazella: So let's start by having you give us an update since we last spoke 2 weeks ago. Anything new from your perspective?
Zwickey: Yes, there's a couple of things that are coming out I think that are worth noting for physicians. First, as we're finally hearing, young people also get this virus. They may not die, but many are being hospitalized. And I think as we talked about last time we chatted, the average age was 44 in China, it was not in the 80s. So keep in mind that younger people are still susceptible. And I think one of the biggest updates is the time of exposure to symptoms. We originally thought it was 2 to 3 days, but now we're seeing that it can be anywhere from 2 to 11 days. That's a huge time span. And we don't know why. It could be the number of viral particles that people are exposed to, or it could be various health factors related to the health of the patient. We just don't know. But during that entire time span, people could be asymptomatic and yet be shedding virus.
Gazella: Yeah. That is really important. And it's a good reminder as to why we're focusing on social distancing so aggressively right now. So that's great. And I do want to talk about the symptom profile, but first I want to discuss a brand new study that just came out in the journal Allergy that looked at pollen counts and Covid-19. Now obviously this can affect a lot of patients this time of year who are dealing with allergies. So what's the connection and what should practitioners consider telling their allergy patients about this new information?
Zwickey: So few things to think about with respect to this. The first thing is that people start worrying when they start having symptoms of allergies because many of the symptoms are shared with upper respiratory viral infections. So the stress isn't good. Secondly, we already know that there's a shortage of tests, and if people start worrying that their allergies are Covid-19 they're going to start using tests that we actually need for people who have Covid-19. So that's not good. But from an immunological perspective, the way that we think about this is allergies are a TH2 response. So when you start mounting an allergy response to birch, or ragweed, or any sort of pollen, you need a TH2 response for the allergy response. But what you need to fight the infection is a TH1 response, not TH2.
In some respiratory infections we're seeing that allergies are reducing the proinflammatory response, including the type 1 and type 3 interferons, and that's usually what we see starting to launch the anti-infection response. So if you have allergies, specifically allergies to birch pollen is what was reported in the journal Allergy, you may have less type 1 and type 3 interferons and mount less of an immune response to any upper respiratory infection. So the data that they used actually came from rhinovirus. We don't know exactly what allergies are going to do to a SARS-CoV-2 infection. In young people it could actually minimize their symptoms even more, even though they're infectious. And in older people and higher-risk populations, people who have comorbidities, it could reduce their ability to fight an infection.
Gazella: That's fascinating. Is there any advice that we should be giving patients who have allergies during this crisis?
Zwickey: Yeah, it's interesting. If you just get online and you Google allergies versus Covid-19, one of the things you'll find are symptom comparisons. So if you have allergies, you're probably not going to have a fever. That's the biggest thing. And if you don't have a fever, it's more likely the allergy and not the Covid-19. If you have a fever, then I would start thinking, well, this could be something different. And then if you get the cough that goes with the fever, now is when you start thinking, well, this could be Covid-19. So just get online and look at those symptom pictures and see where you're at. A headache is not a sign of Covid-19, a headache alone. But a headache, a sinus headache especially, may come with your allergies.
Gazella: That's great advice. Should people with allergies stay indoors more on windy days, or is there any lifestyle-based advice?
Zwickey: It's all the same things we've been telling people with allergies for a long time. Yes, you should stay indoor on windy days, you shouldn't open your car windows. Or if you're driving, put the air on recirculate instead of fresh air so that you're not exposed to more and more of that pollen. The other thing you may consider is using a local honey, which usually contains pollen. And we know if you eat the allergen you are less likely to have that TH2 response to it. So, all of those things are true in these cases.
Gazella: Great. Great advice. So let's dig a little bit more deeply into the topic of symptoms. Now, I have to say, I've been fascinated by the fact that Covid-19 has a growing list of really diverse symptoms, in addition to the typical fever and dry cough that you mentioned. For example, I've been reading articles that GI issues can be a symptom. Now, while it's not a primary symptom, patients with a fever and GI issues may have Covid-19. What's this connection all about?
Zwickey: So the same ACE-2 receptors that we've already talked about that are in the lungs and the kidneys are also in the gut. So if you happen to swallow the virus instead of breathe it, it'll infect the gut instead of the lungs. And when you mount an immune response, one of the cytokines that's made in the gut is TNF alpha, and we know that TNF alpha alone can cause diarrhea. Importantly, many people who have GI symptoms can also be shedding virus in stool. And that brings up something else I wanted to mention, the data from the Chinese that are coming out right now are showing that viral shedding is 20 days. It's not 2 weeks, it's 3 weeks.
So think about the fact that we've had people in quarantine for 2 weeks and then we let them go, and they can actually be shedding for another full week. In fact, Chinese scientists said that some patients actually shed up to 37 days. So that's why there's a continued focus on physical distancing. And I'm trying to change the vernacular from social distancing to physical distancing because people need to be social. It's such a good coping skill and I really hope people are communicating with their friends and family.
Gazella: That is a great point. Physical distancing. I'm going to make sure to use that in the future as well. Now, another symptom that's been discussed in mainstream media is pink eye or red eyes. Now this totally makes sense because people touch their eyes pretty frequently, and if they have the virus on their hands, they can infect the eyes. What do we need to know about this symptom when it comes to Covid-19?
Zwickey: So first of all, it's true. There is a conjunctivitis that can be associated with Covid-19, although it's relatively rare. Data coming out of China and Italy suggest it's about 1 in 1,000 will develop conjunctivitis. So the first thing remember as a doc is to treat these patients as Covid-19 patients. They are infectious, they're shedding virus. And a lot of times when we see the red eye we think that it's limited to the eye. It's not. Also remember that this isn't bacterial, so the antibacterial drops that you drop in people's eyes aren't going to work. You're to treat this like you would treat any other Covid-19 infection, and it can be severe. People can develop a lot of inflammation in their eye from this particular virus. So treating inflammation the way you would as a physician is the way to go.
Gazella: Okay, great advice. Now, is it common for a virus to expand its symptom profile like this? Does this tell us anything about the severity or the uniqueness of this particular virus?
Zwickey: Well, it's not so much an expansion of symptoms. These symptoms have been happening all along, they were just happening in much lower numbers, which meant that doctors didn't know if they were unique to individuals or part of the SARS-CoV-2 infection. So until the numbers became really high we weren't seeing them in high enough numbers to report them. So this is kind of a lesson in epidemiology. If there's low numbers, they could be random. When the numbers get higher, now we can form correlations. Now there's another piece of this. Viruses can infect any tissue for which there is a receptor, and for SARS-CoV-2 the receptor, ACE-2, is distributed among many different tissues. And because the receptor's widespread, there's widespread symptoms. We call this tissue tropism, that the virus is attracted to the tissues that express the receptor. Another virus that does stuff like this is measles. Measles binds to 3 different receptors in 3 different tissues, and as a result you see measles in the lungs and the gut, and in immune cells as well. So, it's true for other viruses, it's just that until you get the law of large numbers, we don't see the symptoms appear in high enough quantity to associate it with this particular infection.
Gazella: Okay, great. That was a great explanation. So I want to end our conversation with the gut microbiome, kind of going back to our conversation about GI symptoms. Now, there's a significant connection between the gut, the immune system, and our ability to fight viruses. What steps can we take to help protect and enhance the gut microbiome?
Zwickey: Yeah, this is so true. We know that if you disrupt the gut microbiome, you make anyone, animal, human or insect susceptible to infections. So the A number 1 thing you can do for the microbiome, of course, is eat vegetables, especially vegetables with good prebiotic fibers. I'm thinking onions, Jerusalem artichoke, sunchokes, leeks, garlic. Potatoes are a vegetable, but they're not the best for feeding the microbiome. Although I'd much rather have you eat a potato than a cookie, but I'd rather have you eat asparagus or greens than a potato. The other thing that most of us forget get is spices are prebiotic. So cooking with spices, rosemary, thyme, basil, oregano, cinnamon, all of those things are going to help feed the bacteria in your gut, your gut microbiome. The next thing that many people would think of is probiotics, and I go probiotic first with food. So thinking about keifer, kombucha, sauerkraut, and yogurt. And usually people are going to gravitate towards the yogurt because they like the sweet taste, but remember the sugar isn't good. So if you're going to go for yogurt, you're going to go for the low-sugar versions.
And then probiotic supplements, of course, could be helping the gut for some people. And while it's true that we have shown that probiotics can improve gut health, we don't actually know which probiotics work best with each individual. And remember, each person's microbiome is different, we all have our own ecosystem. So it'll be great when we can individualize them, but in the meantime, I would consider it self-experimentation, that if you're going to try a probiotic and you haven't ever tried one before, if it doesn't make you feel good, stop. That's not your combo and try something different. What you're doing with your gut is you're regulating both your immune system and your nervous system. So 80% of your immune system is in your gut and more than that for your nervous system. In fact, the microbes in your gut are responsible for making much of the serotonin in your body, and serotonin is contributing to your immune response. So, keep in mind that if your gut's not healthy, then even if every aspect of you feels healthy, you're not healthy.
Gazella: Great, great points. Well, once again, Dr Zwickey, this has been very informational. Thank you so much for joining me and keeping us abreast of the various complexities associated with Covid-19. Thank you so much.
Zwickey: You're welcome.
Gazella: So this podcast is brought to you by Natural Medicine Journal. You can find more information at naturalmedicinejournal.com. Thank you for listening. And if you found this information interesting, please share it with your colleagues. Stay safe, everyone.
Colon cancer is one of the most preventable cancers, and yet it is the third leading cause of cancer deaths after lung cancer, and prostate for men and breast cancer for women. In this interview, naturopathic oncologist Tina Kaczor, ND, FABNO, discusses how clinicians can help patients reduce their risk of developing colon cancer. Kaczor has been working in oncology for 2 decades and is a Fellow of the American Board of Naturopathic Oncology.
Approximate listening time: 32 minutes
About the Expert
Tina Kaczor, ND, FABNO, is editor-in-chief of Natural Medicine Journal and a naturopathic physician, board certified in naturopathic oncology. She received her naturopathic doctorate from National University of Natural Medicine, and completed her residency in naturopathic oncology at Cancer Treatment Centers of America, Tulsa, Oklahoma. Kaczor received undergraduate degrees from the State University of New York at Buffalo. She is the past president and treasurer of the Oncology Association of Naturopathic Physicians and secretary of the American Board of Naturopathic Oncology. She has been published in several peer-reviewed journals. Kaczor is based in Portland, Oregon.
There has been some misinformation circulating regarding Covid-19 and natural medicine. On this episode, critical questions regarding Covid-19 are answered by immunologist and integrative health expert Heather Zwickey, PhD. Zwickey is executive program chair and a professor at National University of Natural Medicine in Portland, OR, who also has specific training in infectious diseases.
About the Expert
Heather Zwickey, PhD, is Dean of Research and Graduate Studies and a professor of immunology at the National University of Natural Medicine, Portland, Oregon, as well as Director of Helfgott Research Institute. Currently, she heads several pilot studies looking at the effects of botanicals, hydrotherapy, energy medicine, and diet on immunological parameters. Zwickey trained at the National Jewish Medical and Research Center in Denver, Colorado. She received her doctorate in immunology and microbiology from the University of Colorado Health Sciences Center and completed a postdoctoral fellowship at Yale University.
Compelling research now shows that brain activity in the frontal cortex is a key cause of insomnia and sleeplessness. In addition, research demonstrates that temperature can play a role in calming the frontal cortex to alleviate insomnia. In this interview, listeners will learn about a new medical device that helps treat insomnia by cooling the frontal cortex. Eric Nofzinger, MD, is the creator of the first FDA-cleared wearable device for patients with insomnia. Nofzinger has more than 30 years' experience in clinical sleep disorders and sleep research.
About the Expert
Eric Nofzinger, MD, is the founder and chief medical officer of Ebb Therapeutics, a medical device company developing and commercializing medical devices in the area of insomnia treatment. He previously was a professor of psychiatry and the director of the Sleep Neuroimaging Research Program at the University of Pittsburgh, School of Medicine. He is a past-president of the Sleep Research Society and a past-president of the Sleep Research Society Foundation.
Nofzinger received his medical degree from the Ohio State University School of Medicine in Columbus, Ohio. He completed residency training in psychiatry and a postgraduate National Institute of Mental Health (NIMH) extramural research fellowship in Sleep Research at the University of Pittsburgh, School of Medicine.
Nofzinger has over 30 years' experience in clinical sleep disorders medicine and in sleep research. Most recently his work has focused on the development of novel brain-based interventions for the treatment of sleep disorders. He has presented and published extensively on the results of his sleep neuroimaging research in leading journals and textbooks, including SLEEP, the Archives of Internal Medicine, the Archives of General Psychiatry, the American Journal of Psychiatry, Sleep Medicine Reviews, and Brain.
About the Sponsor
Ebb Therapeutics aims to improve sleep through the power of cooling technology. It offers a first-of-its-kind wearable sleep device that targets a racing mind, using precise cooling to reduce metabolic activity in the frontal cortex of the brain and relieve sleeplessness. Visit Ebbsleep.com.
The research regarding intermittent fasting has grown significantly over the past five years. Why is that? In this interview, integrative medical expert Ronald Hoffman, MD, describes the health benefits and provides advice about why and how to talk to patients about this way of eating. Hoffman is recognized as one of America's foremost integrative medicine practitioners.
Here is a link to the paper by de Cabo and Mattson that Hoffman mentions in this interview: https://www.gwern.net/docs/longevity/2019-decabo.pdf.
About the Expert
Ronald Hoffman, MD, is a physician in private practice of integrative medicine in New York City. He is a graduate of Columbia College and Albert Einstein College of Medicine. Since 1984, he has served as Medical Director of the Hoffman Center in Manhattan. Hoffman is past president of the American College for the Advancement of Medicine (ACAM).
Hoffman is the host of Intelligent Medicine, a nationally syndicated radio program, and he produces the daily Intelligent Medicine podcast. He is a certified nutrition specialist (CNS) and the author of several books, including How to Talk with Your Doctor (About Complementary and Alternative Medicine).
On this episode, immunologist and researcher Heather Zwickey, PhD, discusses the present coronavirus and how infectious diseases take hold. She also talks about how patients can reduce risk of coronavirus, as well as cold and flu. Zwickey describes the practitioner’s role in helping to control disease spread and improve patient outcomes during an infectious outbreak. Zwickey is executive program chair and a professor at National University of Natural Medicine in Portland, OR.
About the Expert
Heather Zwickey, PhD, is Dean of Research and Graduate Studies and a professor of immunology at the National University of Natural Medicine, Portland, Oregon, as well as Director of Helfgott Research Institute. Currently, she heads several pilot studies looking at the effects of botanicals, hydrotherapy, energy medicine, and diet on immunological parameters. Zwickey trained at the National Jewish Medical and Research Center in Denver, Colorado. She received her doctorate in immunology and microbiology from the University of Colorado Health Sciences Center and completed a postdoctoral fellowship at Yale University.
In this interview, kidney health expert Matthew Hand, DO, describes how an integrative approach can help improve outcomes and quality of life for patients with kidney disease. Hand is the section chief for pediatric nephrology at Children's Hospital at Dartmouth. He provides practical clinical advice on how best to support patients who have kidney disease or those who are at high risk.
About the Expert
Matthew Hand, DO, is the section chief for pediatric nephrology at Children’s Hospital at Dartmouth. He graduated from Chicago College of Osteopathic Medicine in 1989 and did his pediatric residency and chief residency at Maine Medical Center. Hand then completed his fellowship in pediatric nephrology at Children’s Hospital in Boston. Subsequently, he developed the pediatric nephrology division at the Barbara Bush Children’s Hospital at Maine Medical Center. In 2008 he graduated from Andrew Weil’s fellowship in Integrative Medicine at the University of Arizona and created the pediatric integrative medicine division at Maine Medical Center. In 2011, Hand was hired by New Hampshire’s Hospital for Children at the Elliot Hospital to develop the pediatric nephrology division and to create a children’s hospital with integrative medicine as its cornerstone. He has been featured in a number of international television shows including 20/20, the Discovery Channel and the Oprah Winfrey Show.
Nicotinamide adenine dinucleotide (NAD) is a hot topic in antiaging medicine. In this interview, Christopher Shade, PhD, describes the key pathways that NAD uses to exert its health-promoting and antiaging functions in the body. He also explains how NAD levels can be increased by utilizing the salvage pathway with targeted nutrients. Shade is an expert who specializes in biological, environmental, and analytical chemistry.
About the Expert
Christopher Shade, PhD, obtained bachelor of science and masters of science degrees from Lehigh University in environmental and aqueous chemistry, and a PhD from the University of Illinois where he studied metal-ligand interactions in the environment and specialized in the analytical chemistries of mercury. During his PhD work, Shade patented analytical technology for mercury speciation analysis and later founded Quicksilver Scientific, LLC, to commercialize this technology. Shortly after starting Quicksilver Scientific, Shade turned his focus to the human aspects of mercury toxicity and the functioning of the human detoxification system. He has since researched and developed superior liposomal delivery systems for the nutraceutical and wellness markets and also specific clinical analytical techniques for measuring human mercury exposure. He used his understanding of mercury and glutathione chemistry to design a unique system of products for detoxification that repairs and then maximizes the natural detoxification system.
About the Sponsor
Quicksilver Scientific is a leading manufacturer of advanced nutritional systems with a focus on detoxification. We specialize in superior liposomal delivery systems and heavy metal testing to support optimal health. Our advanced liposomal supplements are highly absorbable, and support the body in the elimination of ubiquitous toxins, enabling you to achieve your genetic potential. At Quicksilver Scientific, we are passionate about health and well-being, and are committed to improving the lives of everyone we touch.
Learn more about Quicksilver Scientific NAD+ Gold™.
Natural Medicine Journal editorial board member and frequent contributor Kurt Beil, ND, LAc, MPH, specializes in the use of natural environments and urban green space as a key bridge to healing. In this podcast, he discusses how he utilizes the healing power of nature with his patients. Beil describes the most recent green space research and gives healthcare professionals advice on how they can incorporate this healing tool into clinical practice.
About the Expert
Kurt Beil, ND, LAc, MPH, is a naturopathic and Chinese medicine practitioner in Sandy, Oregon with an ongoing commuter practice to his native Hudson Valley in New York state. He is a Research Investigator at NUNM’s Helfgott Research Institute, where he completed his post-doctoral research project on biomarker and psychometric assessment of the restorative and therapeutic effect of natural vs. built urban environments. Beil holds a Master’s degree in public health focused on the benefits of green space as a sustainable public health promotion tool, and speaks and writes regularly about these topics. He has taught courses on these topics at NUNM and the Academy of Integrative Health & Medicine, has been an advisor to the Children & Nature Network’s “Nature Research Database” and was the founding co-chair of the Nature & Health subcommittee of the Intertwine Alliance in Portland. He is currently an editor and regular contributor to the Natural Medicine Journal, and writes a weekly blog on the topics of Nature & Health. Beil also maintains a Facebook group (“Naturopaths for Nature”) for the naturopathic medicine community on the clinical health benefits of contact with nature. He can be reached at drkurt@earthlink.net or www.drkurtbeil.com.
In this interview, Robert MacCuspie, PhD, discusses the safety and efficacy of bioactive silver hydrosol, a special form of colloidal silver. MacCuspie also describes the various clinical applications, dosages, and how to best use this product in clinical practice.
Continuing Education Credits Available
This podcast interview qualifies for 0.5 general continuing education (CE) units. The Oregon Board of Naturopathic Medicine has approved this educational content for 0.5 “general” CE units for naturopathic physicians. Naturopathic physicians licensed in any U.S. state except California may obtain general CE by listening to this podcast and completing a 10-question test on the material contained within the clinical topic. Click the button below to take the test for FREE, thanks to an educational grant from Natural Immunogenics Corp. Upon successful completion, you will receive an email confirming you passed. This CE approval may also qualify for the CE requirements of other practitioner types.
About the Expert
Robert MacCuspie, PhD, is the director of science for Natural Immunogenics Corporation. He holds a PhD in nanotechnology and materials chemistry and has 20 years of experience in nanotechnology, including over 12 years specifically in silver nanotechnology. MacCuspie has worked for several US national labs, including the US Food and Drug Administration, the Air Force Research Laboratory, and the National Institute of Standards and Technology, where he developed their silver nanoparticle reference materials and was an international leader in nanomaterial environmental health and safety research. MacCuspie was the first faculty and director of Nanotechnology & Multifunctional Materials programs at Florida Polytechnic University and served on their board of trustees. MacCuspie holds 1 US patent and has written 2 book chapters and 42 peer-reviewed manuscripts, which have been cited more than 2,900 times with an h-index of 29.
About the Sponsor
Natural Immunogenics Corporation (NIC), the leader in Hydrosol Technology, is a family-owned business in Sarasota Florida, established in 1998. With its commitment to the principles of Health Freedom and Health Sovereignty, NIC is a market leader of silver based dietary supplements and topical products, and is the manufacturer of Sovereign Silver and Argentyn 23 Bio-Active Silver Hydrosol and Homeopathic First Aid Gel. The company’s retail brand Sovereign Silver has 64% market share in the natural products retail space, and Argentyn 23 is sold exclusively through licensed practitioners in thousands of clinics around the globe.
In this interview, Anne McTiernan, MD, PhD, discusses the ongoing program with the American Institute for Cancer Research (AICR) that analyses research associated with diet and lifestyle efforts to reduce cancer risk. Known as the Continuous Update Project (CUP), findings from this effort are used to form AICR's expert cancer prevention recommendations. McTiernan will also discuss her present research at the Fred Hutchinson Cancer Research Center in Washington.
About the Expert
Anne McTiernan, MD, PhD, is a full member at the Fred Hutchinson Cancer Research Center, Seattle, and research professor at the University of Washington Schools of Medicine and Public Health. Her research focuses on exercise, diet, obesity, and risk for cancer development and prognosis. She served on the U.S. Physical Activity Guidelines Advisory Committees and the AICR/World Cancer Research Fund expert panels. She has published more than 400 scientific manuscripts and is lead author of the book Breast Fitness (St. Martin’s Press). McTiernan’s memoir is Starved: A Nutrition Doctor’s Journey from Empty to Full (Central Recovery Press). For more information about the AICR, visit aicr.org. For more information about McTiernan, visit annemctiernan.com.
Innovation is vital to the development and execution of new practices, techniques, and tools in healthcare. But with that innovation, ethical issues can arise. In this interview, seasoned healthcare expert and educator Howard Gershon describes some of the key concerns associated with innovation and medicine.
About the Expert
Howard Gershon is a principal with the New Heights Group, an independent management consulting firm to the healthcare industry. He has also been a faculty member with the American College of Healthcare Executives for more than 18 years. Howard holds a BA in Business/Managerial Economics from Alfred University and he earned his Masters in Health Care Administration from The George Washington University.
In the United States cases of autism and attention deficit hyperactivity disorder (ADHD) continue to rise. In this podcast, pediatric expert Matthew Hand, DO, describes why an integrative approach makes sense. Hand, who is the section chief for pediatric nephrology at Children's Hospital at Dartmouth, discusses his focus on diet, lifestyle, and dietary supplements to treat these 2 conditions.
About the Expert
Matthew Hand, DO, is the section chief for pediatric nephrology at Children’s Hospital at Dartmouth. He graduated from Chicago College of Osteopathic Medicine in 1989 and did his pediatric residency and chief residency at Maine Medical Center. Hand then completed his fellowship in pediatric nephrology at Children’s Hospital in Boston. Subsequently, he developed the pediatric nephrology division at the Barbara Bush Children’s Hospital at Maine Medical Center. In 2008 he graduated from Andrew Weil’s fellowship in Integrative Medicine at the University of Arizona and created the pediatric integrative medicine division at Maine Medical Center. In 2011, Hand was hired by New Hampshire’s Hospital for Children at the Elliot Hospital to develop the pediatric nephrology division and to create a children’s hospital with integrative medicine as its cornerstone. He has been featured in a number of international television shows including 20/20, the Discovery Channel and the Oprah Winfrey Show.
About the Sponsor
DaVinci Labs believes that better health starts with better information. We have compiled an array of educational media aimed at providing the most cutting-edge education and practice support for today’s integrative practitioner, as well as providing everything an inquisitive consumer needs to know to take control of their own health:
Empowering Patients & Practitioners for a Naturally Healthy World
In this interview, Esther M. Sternberg, MD, provides an overview of the research initiatives taking place at the University of Arizona Andrew Weil Center for Integrative Medicine. She describes the center's 2-pronged approach to the use of wearable devices to track biomarkers in sweat and monitor the impact of built environments. Sternberg emphasizes collaboration, integration, strong science, and clinical relevance in wearable device research.
About the Expert
Esther M. Sternberg, MD, holds the Inaugural Andrew Weil Chair for Research in Integrative Medicine at the University of Arizona College of Medicine and is research director of the Andrew Weil Center for Integrative Medicine, and director of the University of Arizona Institute on Place, Wellbeing & Performance. She earned her degree in medicine from McGill University and did both her residency in internal medicine and her fellowship in rheumatology at McGill University in Montreal, Canada. She has received many awards, including an honorary doctorate in medicine from Trinity College in Dublin, and was named by the National Library of Medicine as one of 300 women who changed the face of medicine. She is the author of 2 best-selling books, Healing Spaces: The Science of Place and Well-Being and The Balance Within: The Science Connecting Health and Emotions. She is an international leader in the science of mind-body interactions, stress and illness, and the impact of the built environment on health, wellbeing and performance. For more information, visit esthersternberg.com.
In this interview, integrative optometrist Elise Brisco, OD, FAAO, FCOVD, CCH, discusses how vision can be impacted following a brain injury or brain surgery. As one of only a few optometrists who has specialized expertise in this area, Brisco describes her integrative approach to rehabilitative eye care after brain injury. She also gives some examples of patients she has treated using this approach.
About the Expert
Elise Brisco, OD, FAAO, FCOVD, CCH, is an integrative optometrist and certified clinical homeopath. She is the founder of Hollywood Vision Center and cofounder of the Rehabilitative Vision Clinic at Cedars Sinai Medical Center in the Department of Physical Medicine and Rehabilitation. She is also the cofounder and inventor of NearSight, vision solutions for smart devices. Brisco earned her doctorate degree from Southern California College of Optometry.
In early 2019 the Association of American Medical Colleges released its findings from the fifth annual study on physician supply and demand. They predict a shortage of nearly 122,000 physicians by 2032 with more than half coming from primary care. In this interview, Michelle Simon, PhD, ND, president and CEO of the Institute for Natural Medicine, discusses a potential solution that is gaining traction.
Michael Lewis, MD, FACPM, FACN, is the president of the Brain Health Education and Research Institute, which he founded in 2011 upon retiring as a Colonel after a distinguished 31-year career in the US Army. In this interview, Lewis provides listeners with an overview and update on the clinical applications of cannabidiol (CBD). In addition to discussing recent research, Lewis describes mechanisms of action, safety, and dosage of CBD in clinical practice.
About the Expert
Michael D. Lewis, MD, FACPM, FACN, is an expert on nutritional interventions for brain health, particularly the prevention and rehabilitation of brain injury. In 2012 upon retiring as a Colonel after 31 years in the US Army, he founded the nonprofit Brain Health Education and Research Institute. He is a graduate of the US Military Academy at West Point and Tulane University School of Medicine. Lewis is board-certified and a Fellow of the American College of Preventive Medicine and American College of Nutrition.
He completed postgraduate training at Walter Reed Army Medical Center, Johns Hopkins University, and Walter Reed Army Institute of Research. He is in private practice in Potomac, MD, and is a consultant to the US Army and Navy as well as several nutrition companies around the world. A highly sought-after speaker, Lewis has done hundreds of radio shows, podcasts, medical conferences, and television appearances and is the author of the Amazon best-selling book, When Brains Collide: What Every Athlete and Parent Should Know About the Prevention and Treatment of Concussions and Head Injuries.
About the Sponsor
CV Sciences is on a mission to improve the well‐being of people and planet. We believe that the future of hemp is unlimited. Through innovative and responsible application of science, we strive to enhance the prosperity and health of our employees, customers, and communities. We are committed to pioneering the CBD evolution as the leading producer of quality hemp CBD products under the PlusCBD™ Oil brand. For more information please visit www.PlusCBDoil.com.
Transcript
Karolyn Gazella: Hello. I'm Karolyn Gazella, publisher of the Natural Medicine Journal. Today I'll be talking with Dr Michael Lewis about the clinical applications of cannabidiol, or CBD. Before we begin, I'd like to thank the sponsor of this topic, who is CV Sciences Incorporated. Dr Michael Lewis is the president of the Brain Health Education and Research Institute, which he founded after retiring as a colonel in the US army. Dr Lewis, thank you so much for joining me.
Michael Lewis, MD, FACPM, FACN: Oh, it's a great pleasure to be with you today.
Gazella: So before we begin, I'm always curious about why physicians are interested in what they're interested in. So, as a physician, what draws you to the use of CBD in clinical practice?
Lewis: Well, the easy answer is because it's effective, but of course there's always a longer story. How did I fall into this? I mean, I spent 31 and a half years, my entire adult life in the army. And cannabis is not something that's a particularly ... It's rather frowned upon as, as you might guess. And so I really had no experience with cannabis or cannabidiol at all, but I've always been open to nutrition, and in the last 10, 15 years more much more open towards is there ways we can use targeted nutrition or nutritional therapy to ... I was in the army, so I was looking at it for helping people, helping soldiers recover from traumatic brain injury or concussions. So it really started out of fish oil and omega 3s, because the brain's made of fat. And then it kind of ... As I started to learn more and more, there started to be this interaction with the CBD industry. I finally, after I retired from the army, took a good look at it, and, more importantly, started to get great experiences with my patients using the combination of fish oil and CBD.
Gazella: Yeah. And you focus a lot on brain health, so that makes sense, the connection between a traumatic brain injury. So what conditions ... In addition to, I'm assuming traumatic brain injury, what conditions do you feel that CBD works well for either as a primary or adjuvant treatment or even as proactive prevention?
Lewis: Well, the biggest thing is as far as any specific one thing I would have to say anxiety, for sure. So 100% of my patients have issues with anxiety, and pretty much there's lots of anxiety just in today's society, with a 24-hour news cycle and all the craziness that's going on in the world. So it's about balance, and CBD, it interacts with our cannabinoid receptors and it's really about kind of achieving that balance. Not so much like that pharmaceutical model where you kind of hit something and you shut off a process and relieve the symptoms. The use of CBD is really much more about achieving a better balance, and nowhere has that been more important for my patients than in the world of anxiety. Helping calm that voice down in the back of your head. But I also find that it helps with chronic pain, particularly headaches. Can help decrease it. It doesn't always eliminate them, but I can tell you without a doubt, anxiety is my number one reason, whether you have a head injury or just dealing with anxiety.
Gazella: Yeah. That makes a lot of sense. Now you're talking about balance and that speaks to potential mechanisms of action, how CBD actually works in the body. Can you expand on that a little bit more? How much do we really know about how CBD works in the human body?
Lewis: Well, the interesting thing is we've known about CBD and its uses medicinally for thousands of years. Every major culture in the history of the world has used cannabis for medicinal purposes. So we know a lot, but yet we don't. Because of the issues with prohibition and then the war on drugs … we really kind of missed this golden era of clinical research, scientific research where we're really able to understand the mechanisms. Whereas in for thousands of years it was used because we just knew it was effective. Now we have a much better way of understanding why, and the why is really ... The why and the how is really it turned out that we have these indigenous cannabinoid receptors throughout our body and principally in our brains, CB1, or cannabinoid type one receptors, CB1 receptors in our brain associated with neurons and, and neuronal function and CB2 type receptors more closely associated with our immune system.
So when you're out of bounds and you think about you're out of balance on your immune system, you're more susceptible to colds and viruses and infections and stuff like that. So it's about this homeostasis, this balance, not just with your immune system but with our brains, with how we're thinking. And the really neat and interesting thing is ... One way to try to describe it is the CB1 receptors in particular, we have these chemicals that are in our bodies. I mean, we know about serotonin and therefore you have serotonin reuptake inhibitors, for example, SSRIs for antidepressant medicines. Well, we also have these internal cannabinoids that we now know about. One in particular, anandamide ananda meaning bliss, or an anandamide bliss molecule, and it's an on-demand thing.
So we used to call them endorphins. That runner's high, we would say that's an endorphin rush. We now know that that's our own body making on demand this stuff called anandamide that interacts with these receptors that keeps us happy, keeps us calm, keeps us thinking more clearly. And you can imagine, as somebody that's struggling with brain health issues maybe from concussion or from chemotherapy or just chronic stress in life, that can really make a difference. Whether or not somebody's happy and functioning in life is whether their cannabinoid system is working internally, but nature also gives us a way to interact with that through the cannabis plant, and as well as diet and exercise.
Gazella: Yeah, it does seem like we're learning more and more about the endocannabinoid system and the fact that that system in the body has such wide-reaching health effects, and I'd like to talk a little bit about the research. I understand what you're saying that we lost some opportunities in researching this plant because it was, frankly, hard to get and illegal and researchers had difficulty in doing really highly organized research. However, it does seem like the research is increasing. Now recently I read a study that was presented at the International Society of Sports Nutrition conference specifically on CBD. Can you tell us a little bit about that study?
Lewis: Well, I wasn't involved in the study. I'm only somewhat familiar with it, but it was a placebo-controlled randomized clinical trial and it was really looking at healthy people and to see if CBD versus a placebo would make a difference in everyday life events, such as quality of sleep and perception of how clear am I thinking, how am I doing throughout the day, energy levels and so on. And there was a ... It hasn't been published yet, but there was a, I'll say, statistically significant difference, particularly, my understanding is with the quality of sleep that those people that were put on the active CBD versus the placebo had a much greater reported quality of sleep, using very standardized sleep quality indexes that are used in research every day.
Gazella: Yeah. That's what drew me to this study is the fact that it was done on healthy people and it did in fact impact sleep quality, because that's a huge issue. And somebody can be deemed as being healthy and yet still struggle with sleep. So I really liked that about that study. Now, what else does the previous published research tell us about the efficacy of CBD? Have there been a lot of studies on efficacy and CBD?
Lewis: There's not been ... Relative to a lot of other things, whether you're talking omega 3s, fish oil or pharmaceuticals, there's not been a lot of research, published research. So it's really just because we're kind of coming out of this prohibition era, there's lots of research starting to get done, and there's some issues on how to actually go about doing some of the research, because your cannabis plant and my cannabis plant may not be the same.
Gazella: So Dr Lewis, you were just talking about the variance between the plants, the cannabis plant, like one plant can be different from another plant. So when we're dealing with any botanical, the way that we extract the active compounds is so important. Tell us about the extraction process that's used for CBD oil.
Lewis: Well, so the extraction is really important, but it actually starts way before that. If you want a consistent product at the end, you've got to have consistency all the way through. And one of the things about Plus CBD Oil that I really like is ever since they even began, when they started to import ... And they're the largest importer of European hemp. It's grown in the Netherlands, it's processed in Germany. But ever since the very beginning, they've only used 2 strains of the cannabis plant. And so the seeds are highly controlled, always using these 2 strains, and so you get consistency all the way from the seed through the entire process. If you're buying hemp left and right from Colorado and from California and from Europe and from Kentucky, you're not going to get that kind of consistency. And I would hope that that's what people want in a product.
Certainly one of the things that I think sets Plus CBD Oil apart is that consistency. And then when it's extracted from the plant, it's not using solvents and alcohol or other things that can adulterate the plant. And we certainly see that with some of the cheap brands that are out on the market. But what we use is a CO2 extraction. So you're not getting that issue with solvents and other things that can adulterate it. And so consistency is really, really important. Not just to me, but to the product and hopefully to the consumer, all the way from the seed to the end product that sits on the shelf.
Gazella: Yeah, that makes a lot of sense. Consistency from seed to extraction. Now, is there anything else that you look for when choosing an effective CBD product?
Lewis: Well, one of the things of course is good documented third party testing. So as an example, there's a barcode or what's the ... QRS code? I always forget the name of those little square codes, but they're on the label of every product and you can scan that and actually pull down that third party certificate of analysis of what's in that particular lot of that particular bottle of that product. And so you're able to look at that and that's really, I think, very important to know what it is that you're taking. One of the concerns is the cannabis plant is widely varied. Everything from how much THC content to CBD content to the turpines to the flavonoids, to the minerals and so on, and different strains, different products are going to be widely varied and so you really want to know what you're going to consume. It's helpful to have that kind of a third party analysis that's right there available to anybody that wants it.
Gazella: Oh, I agree. And the convenience factor alone is great for our healthcare professionals who want to look at that third party testing. That's great. Let's talk a little bit about dosage. So what dosage do you recommend for CBD, and more importantly, does the dosage vary based on if you're using it for proactive prevention or if you're using it for treatment, and if you're using it for treatment for anxiety versus dramatic brain injury? Talk a little bit about dosage and how it's used in clinical practice.
Lewis: Well, it's one of the greatest challenges, I think, that we face as practitioners is knowing what dosage to use because everybody's different. And here's the problem is that your dose and my dose may be very different. And so we've got to start somewhere. And I've got a pretty typical way that I like to start with patients, but I'm always ... It's all about educating the patient and to emphasize that you've got to find your individual dose.
So if we look at the Plus CBD Oil products, I think the thing that's made the biggest difference for me and my patients was about 3 or so ... 3 or 4 years ago, they came out with little soft gels, tiny little pearl-sized soft gels. That to me may make all the difference in the world. I mean, tinctures and drops under the tongue and lysosomal and all these different ways to do and deliver CBD are great, but patient compliance is so much better when it's just a tiny little pill, and you know, for example, the gold soft gel, you're getting 15 milligrams of CBD as part of the whole plant, broad-spectrum hemp complex. But you know every soft gel you're getting 15 milligrams, and you can look at the certificate of analysis and third party studies by consumer labs and so on to know that they're always dead on, and there that's not necessarily the case with a lot of other products. They're widely varied.
So I think that that is really important. I like 2 different products and the 3 main lines, they have soft gels, they have a red label, which is for their raw product and that's actually mostly CBDA, the acidic form of the cannabinoid, of CBD and the other cannabinoids. And then it's gently heated because you have to decarboxylase the CBDA and the other cannabinoids to make them active, which is why in terms of marijuana you have to smoke marijuana or bake it because you have to activate it for it to be active for it to cross the blood-brain barrier and do the job on the brain that you want to use THC for. But with hemp of course we're only dealing with trace amounts of THC, virtually none, but still trace amounts. So I actually ... The function of CBDA in their raw product is very different than the CBD.
It's great for inflammation, great for the body. And then I like to combine that with one that's really good for the brain, and that's their more concentrated product, their gold product. So I actually start patients on a gold and a red soft gel, and I start them twice a day, one of both morning and bedtime, and then have to educate. Some people, they don't like how the gold makes them feel during the day and they like to only take it at night. I have patients that take 3 at night and none during the day. I have people that take 2 every couple of hours during the day. So it just really depends on the person. But the easiest thing is start twice a day and adjust from there, either more frequently, or to a higher amount.
Gazella: Yeah, that makes a lot of sense. Because we are very individualized, especially when it comes to a substance like this. So let's talk a little bit about the future. As a clinician, I'm curious as to what you would like to see happen with CBD in the future? What more needs to be done from a research or clinical perspective when it comes to the use of CBD?
Lewis: Well, I think the obvious thing is that it's not widely accepted, and this holds true for a lot of botanicals, but the stigma that cannabis has had for the last 70, 80 years, it's going to take a little bit of time to overcome that. And one of the ways we can overcome that is with good science to prove that it works, but we'd certainly have challenges because the variability in a plant and the variability in products. We always try to boil it down to what's that one thing? And that one thing we always [inaudible 00:19:04] nomenclature we say at CBD ... Well, when we talk about CBD oil, almost always we're talking about not really CBD oil. We're talking about industrial hemp oil that happens to have CBD and has a lack of THC. But that strain and this strain can be very different.
So that consistency among products is really difficult. How do you do research around something that varies so widely? And that's one of the bigger challenges. Well, again, we will always want to boil it down to that one thing and that's why the FDA approved Epidiolex, because it's 99.9% pure CBD, but it misses out on all of those other important things in the hemp plant that make that entourage effect, that synergistic effect between all the different things. And so the safety profile is actually very different compared to something like Plus CBD Oil that has a tremendous safety profile.
Gazella: Yeah, I was actually going to ask you about safety. So are there any patients who should not use CBD?
Lewis: Every once in a while you run into a patient that just is exquisitely sensitive to pretty much anything. And so whether it's Tylenol or Benadryl or other things. Most patients, if you give them Benadryl, it makes them sleepy. That's why I send Tylenol PM or Advil PM, so on. But every once in a while you run into that patient that is a hyper metabolizer, and Benadryl makes them wired. It keeps them awake.
Well, you can have a similar thing with CBD, it's processed through the P450 system in the liver. So genetically some people are just prone to have different effects in medications that are metabolized by the liver. So those are the ones that you have to watch out for. So what I typically do is I drop them way back and start them really, really low dose, like get a dropper, and we just do one drop or one spray once a day and see how they do, and then go to 2 and then 3 and then 4 and build them up so that their body gets used to it. It doesn't mean that they don't need CBD or else I wouldn't be doing this with a patient, but their bodies just need a much slower ramp up to be able to adjust to it.
Gazella: You know, that makes a lot of sense. Because I've heard about the reverse effect with other substances like melatonin, you mentioned Benadryl. It's good to know that if there is that reverse effect that you don't have to just stop completely. You can just do this titration where you start really small and just ramp up slowly, so that's good to know. And you've had good luck with that in clinical practice?
Lewis: Very much so. And those are the patients that ... I'm dealing, again, with head injury patients or concussion patients that have been struggling for months or even years with the symptoms following a concussion and they're the ones that really need it. They really need the CBD. And so I'm not so quick to just say, "Stop taking it." But where I've found the success is, all right, we're going to start back over at ground zero and we're going to step up really cautiously, really slowly. And once you work through that process over a month or so, it is absolutely life-changing for those patients.
Gazella: That's great. That's good to know. And I would agree with you. I think in the future it would be good to see the stigma ... To overcome that stigma, to get some more consistency with the plant and some more human trials associated with the efficacy of CBD. I think those are all really great future goals for this particular substance. Well, Dr Lewis, once again, thank you for joining me today, and I'd also like to thank the sponsor of this topic, and that is CV Sciences Incorporated. Thanks again, Dr Lewis.
Lewis: Oh, my pleasure. Hopefully we can do it again sometime soon.
Gazella: Absolutely. Let's stay in touch. Well, have a great day everyone.
Michael Lewis, MD, FACPM, FACN, is the president of the Brain Health Education and Research Institute, which he founded in 2011 upon retiring as a Colonel after a distinguished 31-year career in the US Army. In this interview, Lewis provides listeners with an overview and update on the clinical applications of cannabidiol (CBD). In addition to discussing recent research, Lewis describes mechanisms of action, safety, and dosage of CBD in clinical practice.
About the Expert
Michael D. Lewis, MD, FACPM, FACN, is an expert on nutritional interventions for brain health, particularly the prevention and rehabilitation of brain injury. In 2012 upon retiring as a Colonel after 31 years in the US Army, he founded the nonprofit Brain Health Education and Research Institute. He is a graduate of the US Military Academy at West Point and Tulane University School of Medicine. Lewis is board-certified and a Fellow of the American College of Preventive Medicine and American College of Nutrition.
He completed postgraduate training at Walter Reed Army Medical Center, Johns Hopkins University, and Walter Reed Army Institute of Research. He is in private practice in Potomac, MD, and is a consultant to the US Army and Navy as well as several nutrition companies around the world. A highly sought-after speaker, Lewis has done hundreds of radio shows, podcasts, medical conferences, and television appearances and is the author of the Amazon best-selling book, When Brains Collide: What Every Athlete and Parent Should Know About the Prevention and Treatment of Concussions and Head Injuries.
About the Sponsor
CV Sciences is on a mission to improve the well‐being of people and planet. We believe that the future of hemp is unlimited. Through innovative and responsible application of science, we strive to enhance the prosperity and health of our employees, customers, and communities. We are committed to pioneering the CBD evolution as the leading producer of quality hemp CBD products under the PlusCBD™ Oil brand. For more information please visit www.PlusCBDoil.com.
Transcript
Karolyn Gazella: Hello. I'm Karolyn Gazella, publisher of the Natural Medicine Journal. Today I'll be talking with Dr Michael Lewis about the clinical applications of cannabidiol, or CBD. Before we begin, I'd like to thank the sponsor of this topic, who is CV Sciences Incorporated. Dr Michael Lewis is the president of the Brain Health Education and Research Institute, which he founded after retiring as a colonel in the US army. Dr Lewis, thank you so much for joining me.
Michael Lewis, MD, FACPM, FACN: Oh, it's a great pleasure to be with you today.
Gazella: So before we begin, I'm always curious about why physicians are interested in what they're interested in. So, as a physician, what draws you to the use of CBD in clinical practice?
Lewis: Well, the easy answer is because it's effective, but of course there's always a longer story. How did I fall into this? I mean, I spent 31 and a half years, my entire adult life in the army. And cannabis is not something that's a particularly ... It's rather frowned upon as, as you might guess. And so I really had no experience with cannabis or cannabidiol at all, but I've always been open to nutrition, and in the last 10, 15 years more much more open towards is there ways we can use targeted nutrition or nutritional therapy to ... I was in the army, so I was looking at it for helping people, helping soldiers recover from traumatic brain injury or concussions. So it really started out of fish oil and omega 3s, because the brain's made of fat. And then it kind of ... As I started to learn more and more, there started to be this interaction with the CBD industry. I finally, after I retired from the army, took a good look at it, and, more importantly, started to get great experiences with my patients using the combination of fish oil and CBD.
Gazella: Yeah. And you focus a lot on brain health, so that makes sense, the connection between a traumatic brain injury. So what conditions ... In addition to, I'm assuming traumatic brain injury, what conditions do you feel that CBD works well for either as a primary or adjuvant treatment or even as proactive prevention?
Lewis: Well, the biggest thing is as far as any specific one thing I would have to say anxiety, for sure. So 100% of my patients have issues with anxiety, and pretty much there's lots of anxiety just in today's society, with a 24-hour news cycle and all the craziness that's going on in the world. So it's about balance, and CBD, it interacts with our cannabinoid receptors and it's really about kind of achieving that balance. Not so much like that pharmaceutical model where you kind of hit something and you shut off a process and relieve the symptoms. The use of CBD is really much more about achieving a better balance, and nowhere has that been more important for my patients than in the world of anxiety. Helping calm that voice down in the back of your head. But I also find that it helps with chronic pain, particularly headaches. Can help decrease it. It doesn't always eliminate them, but I can tell you without a doubt, anxiety is my number one reason, whether you have a head injury or just dealing with anxiety.
Gazella: Yeah. That makes a lot of sense. Now you're talking about balance and that speaks to potential mechanisms of action, how CBD actually works in the body. Can you expand on that a little bit more? How much do we really know about how CBD works in the human body?
Lewis: Well, the interesting thing is we've known about CBD and its uses medicinally for thousands of years. Every major culture in the history of the world has used cannabis for medicinal purposes. So we know a lot, but yet we don't. Because of the issues with prohibition and then the war on drugs … we really kind of missed this golden era of clinical research, scientific research where we're really able to understand the mechanisms. Whereas in for thousands of years it was used because we just knew it was effective. Now we have a much better way of understanding why, and the why is really ... The why and the how is really it turned out that we have these indigenous cannabinoid receptors throughout our body and principally in our brains, CB1, or cannabinoid type one receptors, CB1 receptors in our brain associated with neurons and, and neuronal function and CB2 type receptors more closely associated with our immune system.
So when you're out of bounds and you think about you're out of balance on your immune system, you're more susceptible to colds and viruses and infections and stuff like that. So it's about this homeostasis, this balance, not just with your immune system but with our brains, with how we're thinking. And the really neat and interesting thing is ... One way to try to describe it is the CB1 receptors in particular, we have these chemicals that are in our bodies. I mean, we know about serotonin and therefore you have serotonin reuptake inhibitors, for example, SSRIs for antidepressant medicines. Well, we also have these internal cannabinoids that we now know about. One in particular, anandamide ananda meaning bliss, or an anandamide bliss molecule, and it's an on-demand thing.
So we used to call them endorphins. That runner's high, we would say that's an endorphin rush. We now know that that's our own body making on demand this stuff called anandamide that interacts with these receptors that keeps us happy, keeps us calm, keeps us thinking more clearly. And you can imagine, as somebody that's struggling with brain health issues maybe from concussion or from chemotherapy or just chronic stress in life, that can really make a difference. Whether or not somebody's happy and functioning in life is whether their cannabinoid system is working internally, but nature also gives us a way to interact with that through the cannabis plant, and as well as diet and exercise.
Gazella: Yeah, it does seem like we're learning more and more about the endocannabinoid system and the fact that that system in the body has such wide-reaching health effects, and I'd like to talk a little bit about the research. I understand what you're saying that we lost some opportunities in researching this plant because it was, frankly, hard to get and illegal and researchers had difficulty in doing really highly organized research. However, it does seem like the research is increasing. Now recently I read a study that was presented at the International Society of Sports Nutrition conference specifically on CBD. Can you tell us a little bit about that study?
Lewis: Well, I wasn't involved in the study. I'm only somewhat familiar with it, but it was a placebo-controlled randomized clinical trial and it was really looking at healthy people and to see if CBD versus a placebo would make a difference in everyday life events, such as quality of sleep and perception of how clear am I thinking, how am I doing throughout the day, energy levels and so on. And there was a ... It hasn't been published yet, but there was a, I'll say, statistically significant difference, particularly, my understanding is with the quality of sleep that those people that were put on the active CBD versus the placebo had a much greater reported quality of sleep, using very standardized sleep quality indexes that are used in research every day.
Gazella: Yeah. That's what drew me to this study is the fact that it was done on healthy people and it did in fact impact sleep quality, because that's a huge issue. And somebody can be deemed as being healthy and yet still struggle with sleep. So I really liked that about that study. Now, what else does the previous published research tell us about the efficacy of CBD? Have there been a lot of studies on efficacy and CBD?
Lewis: There's not been ... Relative to a lot of other things, whether you're talking omega 3s, fish oil or pharmaceuticals, there's not been a lot of research, published research. So it's really just because we're kind of coming out of this prohibition era, there's lots of research starting to get done, and there's some issues on how to actually go about doing some of the research, because your cannabis plant and my cannabis plant may not be the same.
Gazella: So Dr Lewis, you were just talking about the variance between the plants, the cannabis plant, like one plant can be different from another plant. So when we're dealing with any botanical, the way that we extract the active compounds is so important. Tell us about the extraction process that's used for CBD oil.
Lewis: Well, so the extraction is really important, but it actually starts way before that. If you want a consistent product at the end, you've got to have consistency all the way through. And one of the things about Plus CBD Oil that I really like is ever since they even began, when they started to import ... And they're the largest importer of European hemp. It's grown in the Netherlands, it's processed in Germany. But ever since the very beginning, they've only used 2 strains of the cannabis plant. And so the seeds are highly controlled, always using these 2 strains, and so you get consistency all the way from the seed through the entire process. If you're buying hemp left and right from Colorado and from California and from Europe and from Kentucky, you're not going to get that kind of consistency. And I would hope that that's what people want in a product.
Certainly one of the things that I think sets Plus CBD Oil apart is that consistency. And then when it's extracted from the plant, it's not using solvents and alcohol or other things that can adulterate the plant. And we certainly see that with some of the cheap brands that are out on the market. But what we use is a CO2 extraction. So you're not getting that issue with solvents and other things that can adulterate it. And so consistency is really, really important. Not just to me, but to the product and hopefully to the consumer, all the way from the seed to the end product that sits on the shelf.
Gazella: Yeah, that makes a lot of sense. Consistency from seed to extraction. Now, is there anything else that you look for when choosing an effective CBD product?
Lewis: Well, one of the things of course is good documented third party testing. So as an example, there's a barcode or what's the ... QRS code? I always forget the name of those little square codes, but they're on the label of every product and you can scan that and actually pull down that third party certificate of analysis of what's in that particular lot of that particular bottle of that product. And so you're able to look at that and that's really, I think, very important to know what it is that you're taking. One of the concerns is the cannabis plant is widely varied. Everything from how much THC content to CBD content to the turpines to the flavonoids, to the minerals and so on, and different strains, different products are going to be widely varied and so you really want to know what you're going to consume. It's helpful to have that kind of a third party analysis that's right there available to anybody that wants it.
Gazella: Oh, I agree. And the convenience factor alone is great for our healthcare professionals who want to look at that third party testing. That's great. Let's talk a little bit about dosage. So what dosage do you recommend for CBD, and more importantly, does the dosage vary based on if you're using it for proactive prevention or if you're using it for treatment, and if you're using it for treatment for anxiety versus dramatic brain injury? Talk a little bit about dosage and how it's used in clinical practice.
Lewis: Well, it's one of the greatest challenges, I think, that we face as practitioners is knowing what dosage to use because everybody's different. And here's the problem is that your dose and my dose may be very different. And so we've got to start somewhere. And I've got a pretty typical way that I like to start with patients, but I'm always ... It's all about educating the patient and to emphasize that you've got to find your individual dose.
So if we look at the Plus CBD Oil products, I think the thing that's made the biggest difference for me and my patients was about 3 or so ... 3 or 4 years ago, they came out with little soft gels, tiny little pearl-sized soft gels. That to me may make all the difference in the world. I mean, tinctures and drops under the tongue and lysosomal and all these different ways to do and deliver CBD are great, but patient compliance is so much better when it's just a tiny little pill, and you know, for example, the gold soft gel, you're getting 15 milligrams of CBD as part of the whole plant, broad-spectrum hemp complex. But you know every soft gel you're getting 15 milligrams, and you can look at the certificate of analysis and third party studies by consumer labs and so on to know that they're always dead on, and there that's not necessarily the case with a lot of other products. They're widely varied.
So I think that that is really important. I like 2 different products and the 3 main lines, they have soft gels, they have a red label, which is for their raw product and that's actually mostly CBDA, the acidic form of the cannabinoid, of CBD and the other cannabinoids. And then it's gently heated because you have to decarboxylase the CBDA and the other cannabinoids to make them active, which is why in terms of marijuana you have to smoke marijuana or bake it because you have to activate it for it to be active for it to cross the blood-brain barrier and do the job on the brain that you want to use THC for. But with hemp of course we're only dealing with trace amounts of THC, virtually none, but still trace amounts. So I actually ... The function of CBDA in their raw product is very different than the CBD.
It's great for inflammation, great for the body. And then I like to combine that with one that's really good for the brain, and that's their more concentrated product, their gold product. So I actually start patients on a gold and a red soft gel, and I start them twice a day, one of both morning and bedtime, and then have to educate. Some people, they don't like how the gold makes them feel during the day and they like to only take it at night. I have patients that take 3 at night and none during the day. I have people that take 2 every couple of hours during the day. So it just really depends on the person. But the easiest thing is start twice a day and adjust from there, either more frequently, or to a higher amount.
Gazella: Yeah, that makes a lot of sense. Because we are very individualized, especially when it comes to a substance like this. So let's talk a little bit about the future. As a clinician, I'm curious as to what you would like to see happen with CBD in the future? What more needs to be done from a research or clinical perspective when it comes to the use of CBD?
Lewis: Well, I think the obvious thing is that it's not widely accepted, and this holds true for a lot of botanicals, but the stigma that cannabis has had for the last 70, 80 years, it's going to take a little bit of time to overcome that. And one of the ways we can overcome that is with good science to prove that it works, but we'd certainly have challenges because the variability in a plant and the variability in products. We always try to boil it down to what's that one thing? And that one thing we always [inaudible 00:19:04] nomenclature we say at CBD ... Well, when we talk about CBD oil, almost always we're talking about not really CBD oil. We're talking about industrial hemp oil that happens to have CBD and has a lack of THC. But that strain and this strain can be very different.
So that consistency among products is really difficult. How do you do research around something that varies so widely? And that's one of the bigger challenges. Well, again, we will always want to boil it down to that one thing and that's why the FDA approved Epidiolex, because it's 99.9% pure CBD, but it misses out on all of those other important things in the hemp plant that make that entourage effect, that synergistic effect between all the different things. And so the safety profile is actually very different compared to something like Plus CBD Oil that has a tremendous safety profile.
Gazella: Yeah, I was actually going to ask you about safety. So are there any patients who should not use CBD?
Lewis: Every once in a while you run into a patient that just is exquisitely sensitive to pretty much anything. And so whether it's Tylenol or Benadryl or other things. Most patients, if you give them Benadryl, it makes them sleepy. That's why I send Tylenol PM or Advil PM, so on. But every once in a while you run into that patient that is a hyper metabolizer, and Benadryl makes them wired. It keeps them awake.
Well, you can have a similar thing with CBD, it's processed through the P450 system in the liver. So genetically some people are just prone to have different effects in medications that are metabolized by the liver. So those are the ones that you have to watch out for. So what I typically do is I drop them way back and start them really, really low dose, like get a dropper, and we just do one drop or one spray once a day and see how they do, and then go to 2 and then 3 and then 4 and build them up so that their body gets used to it. It doesn't mean that they don't need CBD or else I wouldn't be doing this with a patient, but their bodies just need a much slower ramp up to be able to adjust to it.
Gazella: You know, that makes a lot of sense. Because I've heard about the reverse effect with other substances like melatonin, you mentioned Benadryl. It's good to know that if there is that reverse effect that you don't have to just stop completely. You can just do this titration where you start really small and just ramp up slowly, so that's good to know. And you've had good luck with that in clinical practice?
Lewis: Very much so. And those are the patients that ... I'm dealing, again, with head injury patients or concussion patients that have been struggling for months or even years with the symptoms following a concussion and they're the ones that really need it. They really need the CBD. And so I'm not so quick to just say, "Stop taking it." But where I've found the success is, all right, we're going to start back over at ground zero and we're going to step up really cautiously, really slowly. And once you work through that process over a month or so, it is absolutely life-changing for those patients.
Gazella: That's great. That's good to know. And I would agree with you. I think in the future it would be good to see the stigma ... To overcome that stigma, to get some more consistency with the plant and some more human trials associated with the efficacy of CBD. I think those are all really great future goals for this particular substance. Well, Dr Lewis, once again, thank you for joining me today, and I'd also like to thank the sponsor of this topic, and that is CV Sciences Incorporated. Thanks again, Dr Lewis.
Lewis: Oh, my pleasure. Hopefully we can do it again sometime soon.
Gazella: Absolutely. Let's stay in touch. Well, have a great day everyone.