The Holistic Medicine Podcast by Dr Julie Moltke Dr Julie Moltke

Professor Saoirse O’Sullivan on cannabis research, how to influence the endocannabinoid system naturally, and CBD delivery methods!

Professor Saoirse Elizabeth O’Sullivan (@ScienceSaoirse) received her doctorate from Trinity College Dublin in 2001 and moved to the University of Nottingham in 2002 as a Research fellow where she began researching cannabinoid pharmacology through basic and clinical research.  She was made Lecturer in 2007, Associate Professor in 2011, and Full Professor in 2019.  She has over 40 peer-reviewed articles and 3 book chapters on the topic of cannabinoid pharmacology.  Her specific interests are on the therapeutic potential of cannabis-based medicines in cardiovascular disease, stroke, diabetes, and inflammatory bowel disease.  Her research methodologies spanned from cellular and animal models to human healthy volunteer studies, systematic reviews, and early phase
clinical trials.  In 2016 she was named the International Cannabinoid Research Society Young
Investigator of the Year.  Saoirse now runs an independent consulting company called
CanPharmaConsulting Ltd, and through this, acts as scientific advisor to Artelo Biosciences,
CBDScience Group, Therapix Biosciences, FSDPharma, and Dragonfly Biosciences. She is the science lead for the Centre for Medicine Cannabis (CMC), a non-profit organisation working to shape the UK’s new medicinal cannabis regime in the interests of patients, and secretary to the International Cannabinoid Research Society. She also works with charities, patient groups, and healthcare professionals to educate on the benefits of cannabis-based medicines.


9:15 Two major problems in our society are stress and anxiety: how does the endocannabinoid system work to regulate this? Are there natural ways we can influence our endocannabinoid system (We will talk about the singing and exercise article https://pubmed.ncbi.nlm.nih.gov/30534062/)
9:15 Let's talk a bit about the cannabinoids - namely CBD: What does the research say about the best delivery methods for CBD; what are the major problems we are facing now, and how does the future of CBD delivery look?

https://pubmed.ncbi.nlm.nih.gov/32872355/
33:00  In which areas do we have the biggest potential for using CBD therapeutically based on the research we have so far?  CBD is only one among many cannabinoids: Which other minor cannabinoids do you see having therapeutic potential based on the current research?

Promising studies with CBD and diabetes type 2 and CBD for Fatty-liver disease. Different cannabinoids for weight management and appetite regulation. THC for appetite induction.  THCV (natural CB1 antagonist) for reducing appetite or for metabolic syndrome. CB1 antagonist rimonabant was developed as an anti-obesity drug withdrawn because of psychiatric side effects. CBG to promote weight gain in palliative care without THC side-effects.  CBDV is neuroprotective and anti-epileptic, CBDA has higher potency to treat anxiety or pain.  The endocannabinoid system protects against cardiovascular effects.
https://pubmed.ncbi.nlm.nih.gov/32128848/
https://pubmed.ncbi.nlm.nih.gov/27573936/
https://pubmed.ncbi.nlm.nih.gov/32608035/

What are your personal top 3 tips for optimal health and wellbeing? 
Sleep, exercise, do things that give you the joy to increase that anandamide levels 

Learn about the best ways to support menopause naturally!
Dr Vera Martins is a naturopath and herbalist with a PhD in Cancer Biology. Having worked as a scientist for several years, Vera’s passion for natural medicine led her to study Naturopathy. She specialises in women’s health, providing a body-mind and highly personalised patient-centered approach. Her main area of expertise is hormone balance, particularly peri-menopause and menopause, however, Vera also works with younger women supporting them with conditions such as PMS, PCOS, and infertility. In her practice, Vera uses a combination of nutrition, supplements/herbal medicine, and lifestyle advice, to help women feeling their best. 
3:00 What is a Naturopath? A health practitioner who takes a 360-degree view of health. Vera believes in natural healing, individual uniqueness, and understanding the root cause of the symptoms. 
6:00 What is a herbalist? Vera is specialised in herbalism - using the healing powers of plants. Modern conventional medicine has its roots in herbal medicine
8:05 Why did you choose to go down the holistic herbalistic route?  
11:30 What made you specialize in Women's health? Vera used to work in a clinic in London who was pioneering in the treatment of bioidentical hormone replacement therapy (B-HRT).
16:40 How do you treat perimenopause and menopause from a naturopathic perspective? 
Symptoms of perimenopause are often anxiety, mood swings, sleep problems, fatigue, changes in blood sugar leading to sugar cravings, weight gain. 
Menopause: fatigue, hot-flashes, bone-loss increase cardiovascular 
Treatment focuses on the 4 pillars: Stress management, gut-health, liver-function, and blood-sugar balance. 
22:00 Stress Management the foundation pillar - When stressed, your body will upregulate the stress response and downregulate the production of sex hormones estrogen and progesterone, and testosterone. 
Supplements for stress reduction: ashwagandha (adaptogens) (improve libido, memory, and mood), Magnesium.  
Other stress reduction tips: Self-care, yoga, breathing, mindfulness meditation. 
28:40 Which supplements can help support women in menopause and perimenopause?
Dr. Martins makes homemade herbal tinctures and powders made based on the client's need. These could be Vitex Agnes Castus, black cohosh, sage, and adaptogens. 
 34:15 Top 3 overall supplements for perimenopause and menopause: Ashwagandha, Magnesium, Slippery Elm for gut-health (reduce acid reflux, anti-inflammatory, and increase gut-motility). As well as vitamin-D3 and K2 + Omega-3 for bone health and brain and heart health. 

35:25 Gut Health Support: When hormones decline you get a reduction in stomach acid and this can lead to partly digested food and problems with an unbalanced microbiome. This can contribute to further hormone imbalance.  

39:00 MPowder and the development of powders for perimenopause and menopause. Creating a community for Women around menopause, working with experts to support their clients. 

51:00 Dr. Martins owns favorite menopause tips: 
Stick to a balanced inclusive diet including proteins at every meal, including healthy fats, and reduce refined carbs. Do not completely cut out carbs. Breakfast with PFF (protein, fiber fats). Do not drink coffee early in the morning (hard for adrenal glands and your gut - substitute with a warm of hot water with lemon. Slow down and incorporate self-care into your life. 10 minutes of me-time in the morning with meditation, yoga, or any other self-care practice.   In ancient times it was believed that menopause was a time where women transformed their accumulated knowledge into absolute wisdom.
Resources: 
www.veramartinsnaturopath.com  
www.mpowder.store

Clarissa Lenherr is a Harley Street registered nutritionist and leading workplace wellbeing consultant. As a private nutritionist, Clarissa has helped hundreds of clients back to optimal health and she specialises in digestive health, auto-immune conditions, and hormone health. Her mission is to take the science of nutrition and convert it into easy to implement strategies so that her clients can achieve ultimate wellbeing. 
4:30 - What is the enteric nervous system: the connection of nerve fibers in the gut is called the enteric nervous system (ENS) and it is sometimes called the second brain. 
8:10 - The brain-gut connection: There is a bidirectional link between the central nervous system and the enteric nervous system in the gut.
12:50: The microbiome is a collection of bacteria that live in our gut. Some of them produce neurotransmitters including serotonin, GABA, and dopamine. 95% of serotonin, one of the most important hormones for mental health, is made in the gut. 70% of the immune system is in the gut which is why an unhealthy gut is often associated with poor immune health, autoimmune disease, and inflammation. 
15:10 - Can stress, anxiety, and mental health disorders originate from the gut?

18:30 - How can we use nutrition to improve gut health and mood? Disclaimer: if you have a preexisting medical concern you should see a doctor or nutritionist 
Tips to improve gut health and mood
30 grams of fiber per day (The average consumes only eats 18 grams) - It benefits digestive health, heart, and liver health. It feeds the good bacteria and can improve constipation dominant IBS.Prebiotic fibers are insoluble and they are hard to break down in the gut. It moves whole to the large intestine where the gut-bacteria eat them and produce by-products including short-chained fatty-acids (SCFA). Some prebiotic foods are: Artichokes, Asparagus, bananas, barley, berries, chicory, garlic, green vegetablesProbiotics: food or supplements containing live-bacteria to support our microbiome. They can be found in fermented food like kefir and live yogurt, kombucha, sauerkraut and kimchi, tempeh, and soy. Can be used 3 times/week. Or take probiotics in supplement form.  Start low and go slow: Too many fibers and probiotics can cause bloating and diarrhea so start slowly when increasing fiber intake. Red wine can be good for the microbiome in small quantitiesStay away from: 
Processed meats and processed foodContains lots of nitrate and unhealthy fats Sweeteners have been shown to reduce the diversity in the microbiome Stay away from chewing gum which contains a lot of sweeteners Be cautious with caffeine which can cause bloating and diarrhea Alcohol affects our absorption of nutritions and our mood and sleep. Refined sugar - less than 30 grams per day30:20: Can food reduce symptoms of anxiety and stress? Simple diet changes to a whole-food, high in fruits and vegetables. Nutrients to support mental health:
Omega-3: From fatty-fish like salmon and mackerel, chia seeds and walnuts  Vitamin-3: diary milk-foods, eggs, mushrooms, and from the sunshine. As a supplement - recommended dose: 25-50 microgram/day. 35:10 Is intermittent-fasting good for gut-health and mood? Fasting can help the digestive system to fully clear out and reset. 
Tips:  Have 12-16 hours fasting period overnight (start low and go slow)
4-hour gaps between mealsReduce snacking (not for people with diabetes, pregnancy, or high-stress levels)You can have water, tea or black coffeeEat a balanced diet in the 8 hours - eat the colors of the rainbow, hydrate, and drink lots of water

Dr. Andrew Agius is a family doctor with a special interest in obesity, weight-loss, and lifestyle medicine and he has recently set up a pain clinic in Malta. Dr. Agius is well-known in Malta for appearing regularly on national TV and he has been one of the driving forces behind the new medicinal cannabis reform in Malta. Dr. Agius owns a pain clinic in Malta from where he prescribes medicinal cannabis among other things to help his patients. We spoke about medicinal cannabis at Malta:

2:30 - How Dr. Agius discovered cannabis medicine to help patients who did not respond to conventional medicine. He learned about cannabis from a patient who used it illegally and who had studied the endocannabinoid system. He started by using CBD (cannabidiol) in 2016; primarily CBD for chronic pain with inflammation. He has since treated fibromyalgia, hypersensitivity, anxiety, PTSD, and chronic pain among others.
 
7:40 - The endocannabinoid system is the missing link in the puzzle to why cannabis works so well.

8:40 - Getting medicinal cannabis to Malta; CBD became a novel food and Dr. Agius was told not to recommend CBD and the import was stopped. The campaign for cannabis begun. Dr. Agius started an educational program for cannabis and the ECS but was soon told to stop this as he was reported by his fellow doctors. In 2018 medical cannabis became legal and available in pharmacies in Malta.

14.10 - Public education. Educating patients about the endocannabinoid system and how to use medicinal cannabis. Empowering to manage the dose and side-effects. Providing the tools to self-medicate and manage symptoms.

16:35 - At the beginning of medical cannabis in Malta you needed to have control and follow-up after 15 days. Now the first follow-up is after 1 month. In Malta, the only choice is high THC flos, cannabis flower, which is vaporized. After the second follow-up, the prescription can be extended to 6 months with control every half year.

19:35 - The available products in Malta are only 4 different flower products (flos). Only GMP-certified products are allowed in Malta. There are now production facilities in Malta growing GMP-flowers. 

20:55 - Some doctors are afraid to prescribe because of the strict guidelines with all the responsibility being put on the doctor. It can be prescribed for any chronic condition which has not responded to one other approved alternative. Insomnia, sleep disorders, chronic pain, mental health, anxiety,

25.00 - Mental health issues are well treated with medicinal cannabis and chronic pain is often associated with anxiety, depression, and sleep disorders. Dr. Agius is also treating neurological disorders and inflammatory disease. A good tool in the tool kit. Very safe and few side-effects.

27:35: How well does cannabis medicine work? In Dr. Agius's view, the success rate is over 95% when using a pharmaceutical-grade cannabis product which is vaporized and combined with lifestyle changes, supplements, and vitamins. 

30:32 What is the best delivery method? Dr. Agius believes full-spectrum or broad-spectrum is the best product. He believes in the entourage effect compared to single-molecule preparations. He also thinks the vaporization is a good way of getting pain relief. Terpenes, flavonoids, and minor cannabinoids like CBG, CBN THCA. Certain strains or chemovars are better for certain indications. It is a good idea to change the chemovar to reduce the risk of tolerance.

37:40 The future of medical cannabis in Malta. Less control and easier access. Give cannabis the same status as opioids/morphine. More research and access to more delivery methods and products from Malta.

Links:
http://www.painclinic.com.mt/andrew-agius/

Karen Pallisgaard is a Danish senior yoga & meditation teacher and psychotherapist in training. She is also a bestselling author of several books about yoga, meditation, mental health, and slow living. She is known for making yoga and meditation everyday-friendly and accessible to everybody.
We end with a breathing meditation.
Listen to the podcast here: 

Content:
1:10 - Introduction to Karen as an author, meditation and yoga teacher, journalist, and bestselling author. A curious soul, writing her way through life, trying to live as conscious as possible.
3:00 - No fitting into the box; multipotentiality, working with many identities.
4:40 - Hverdagsmeditationer: Karen's newest book about meditation, what is meditation.
6:45: Meditation is non-dual; the experience of non-separateness, the philosophical background of meditation.
9:30 - The science of meditation, the benefits of meditation: reduction of stress, depression, and anxiety rewiring the brain, lowering cortisol, improved immune system, help focus, creativity and productivity, improve sleep, lower blood pressure, reduce chronic pain. It makes us more compassionate and helps us live better lives.   
14:15 - Meditation and mindfulness for children, getting familiar and comfortable with emotions. 
15:45 - Training your meditation muscle, why we need to meditate every day, the negativity bias, how to deal with the reptilian brain. Either you are a slave of your thoughts and emotions or you become the master.
18.38 - Building a meditation routine; have discipline, in the book you find a 4-week program, starting slowly, start with 5 minutes.
20.00 - Breathing to connect with your body, different meditation techniques, finding a meditation teacher.
22.40 - Meditation apps can be helpful in the beginning, you need to be able to meditate without later.
23.30 - Karen's journey, working with trauma with spirituality, the 7-year rule of spiritual growth. 
27:10 - Dealing with pain and suffering, pain as part of life, and as a spiritual practice. Acceptance is key for meditation and mindfulness, meditation is not wellness.
32:40 - There is no destination to the journey, waking up every day, the ambition to stay present and not be ruled by rules of society, stop comparing ourselves to others.
35:20 - What happens after COVID-19, how to stay with the slow living, keeping a consciousness practice, make fewer plans, walk slowly, eat slowly, lessons from COVID-19. 
39:25 - Collaborations at the Mindfulness Manor - Retreat with Karen from October 22nd-25th, 2020.
40:00 - Mindfulness of breath meditation.

Resources:
https://www.karenpallisgaard.com/ 
Køb hverdagsmeditationer: https://www.saxo.com/dk/hverdagsmeditation_karen-pallisgaard_haeftet_9788740055054
Retreat: https://www.mindfulnessmanor.com/retreats/becoming-who-you-are
Meditation and mindfulness resources:
Yoga videos with Karen: https://www.youtube.com/channel/UCoO42_aCyG-q9ok79kdkS8g
Sally Kempton: https://www.sallykempton.com/
Yoga Glo: https://www.glo.com/
Headspace meditation app: https://www.headspace.com/

In this episode, Dr Julie Moltke speaks to one of the leading cannabis psychiatrists in the world. Based in Colorado, Dr Mark Braunstein has been prescribing cannabis for two decades. On his own journey as a physician, he has changed his practice from following a traditional poly-psychopharmacology treatment regime to more plant-based and lifestyle-based treatments, including medical cannabis and cannabis-assisted psychotherapy.
Dr Braunstein explains his way to become a cannabis psychiatrist, his interest in psychedelics, his traditional training in psychopharmacology, and moving to Colorado to prescribe cannabis which was newly legalized.
The conversation touches wilderness treatment/using nature as a treatment, the nature of wellness, and how to incorporate it with medicinal cannabis use.
Dr Braunstein explains about treating PTSD with medicinal cannabis and how it can help balance the endocannabinoid system, helping nightmares, anxiety, and insomnia.
Dr Braunstein talks about treating children with medicinal cannabis for conditions like autism, ADHD, and bipolar disease and the stigma associated with treating children with medicinal cannabis.
Dr Braunstein discusses cannabis dependence and points out that "Intentional conscious use, prevents misuse". Dr Braunstein is also educating us about dosing and titrating the dose of CBD and THC, and lastly, he explains about his work with drug-assisted psychotherapy.

For more resources:
Dr Mark Braunstein:
https://www.linkedin.com/in/mark-braunstein/
Medicinal cannabis & psychiatry reading:
https://www.amazon.co.uk/Marijuana-Mental-Health-Michael-Compton/dp/1615370080
Drug-assisted psychotherapy:
https://maps.org/research/mdma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041963/