May 24 2021 . 12 min read
Elevating the Conversation with Dr. Swathi Varanasi
Elevating the Conversation with Dr. Swathi Varanasi
Integrative Health Pharmacist
Integrative Health Pharmacist
Dr. Swathi Varanasi is a bilingual pharmacist specializing in integrative health and botanical medicine. A plant-based wellness expert, Dr. Swathi emphasizes an innovative and evidence-based approach combining both Eastern and Western medicine. Dr. Swathi received her Doctor of Pharmacy (PharmD) from the Medical University of South Carolina College of Pharmacy and is certified in Medical Cannabis in Healer and Plant-Based Nutrition from Cornell University.
What is an integrative health pharmacist?
A lot of people aren't aware of it because it's a newer role. I'm one of the few integrative pharmacists. There's definitely less than a dozen of us at this point. In terms of integrative health pharmacy, the way that I define it is looking at all the different modalities of health and healing and seeing how we can use them in combination to best achieve and optimize patient outcomes.
How do you effectively do that?
By speaking to the patient, working with them as a team and figuring out their treatment goals, and what is the best combination of these different modalities that can help them reach those goals. What that ends up looking like, for a lot of people, is a combination of some prescription drugs and then maybe some therapeutic aromatherapy, maybe some botanicals and herbs, including cannabis, of course, maybe some meditation and mindfulness. Also looking at nutrition and looking at what it means to have a nutrient dense diet. And then also movement, and exercise, and, of course, the importance of sleep. So just looking at all these different possibilities and trying to achieve what the patient is looking for. As a pharmacist, we're the medication experts, and we're the ones, especially in the US, on every street corner in the pharmacies. So, for pharmacists to know as much as possible when it comes to holistic health and healing is just so key and important. That's a big part of what I do is try to educate practitioners and students and patients on all the different possibilities that we can look at when it comes to being the best version of ourselves and really doing that through having the best health and wellness options for us. So, to me, Integrative Health Pharmacy is just trying to piece it all together and base it around the person and what they want and how I can be a guide in that process.
How did you get involved with cannabis?
When I knew that I was interested in preventative medicine, I knew I was interested in integrative health. That just really lent itself to looking into all these different possibilities and all these different options. So, one of them being, of course, botanical medicine and looking at adaptogens, looking at cannabis. I just started learning more and more about it for two reasons. One reason because it is so fascinating from a super nerdy biochemical standpoint and physiological standpoint—the endocannabinoid system, and how that functions in the body, how it impacts so many different organ systems and neurotransmitter systems. Secondly, just the amount of questions I was getting from patients and practitioners alike asking me: Can I use this with that? Or what is CBG? Especially now with CBD being so prevalently used and more and more people interested in it. So the combination of that demand, plus how incredibly fascinating it really is has lent itself to so many different, educational opportunities and working with patients and colleagues.
Was it difficult to find a college-level course to learn about cannabis?
In my final year of my Doctor of Pharmacy program, that's all clinical rotations, I was trying to find some practitioners I could do one of my clinical rotations with. The practitioner that I ended up finding was in LA. She was probably one of the first two integrated pharmacists in the country. She's been doing it for almost 30 years. Through that opportunity I had the chance to learn about cannabis and start learning about cannabis from practitioners themselves. For me, that was really pivotal—that opportunity for postdoctoral residency training for a whole year and talking to and connecting with various practitioners in the field. It was multifaceted. But it came down to a combination of seeing what was published, seeing what was out there, and then asking practitioners what they actually like, what they didn't practice. That combination really helped.
Have you passed your knowledge on?
I found an opportunity to work with an educational platform called Medical Cannabis Mentor, and through my experiences and a lot of questions I received, I helped co-write the first ever online course specifically for pharmacists and healthcare professionals interested in broadening their knowledge on the endocannabinoid system, cannabis science, and cannabis medicine. Something that a lot of people don't know is that cannabis is not a part of the core curriculum in any healthcare professional curriculum, whether we're talking about physicians, or nurses or pharmacists, or anyone else. Everyone is getting these questions, but they don't know how to answer them. Being able to be a part of their educational process has really been transformative for me.
Also, I'm co-writing the first course online that’s specifically for consumers interested in cannabis, CBD, the endocannabinoid system, and basing that around patient questions. So, more details on that soon.
Has it been easy or challenging to weave your cannabis knowledge in with your pharmaceutical practice?
So many people have asked me that. I get questions from trained practitioners who don't understand how you can do both. Then I get people from the other side with their own very strong opinions about it. What it comes down to is looking at it through the integrative lens, which is: what does the patient want? Because there are some patients who are taking a particular drug and it's really helped them with XYZ. So I don't want to stop that, but I want to know what else I can do for symptom relief and for side effects. Then that's a chance for us to start talking about cannabis or other modalities of healing. Then there are also some people who come in and say, ‘I've been taking this drug for X amount of years, it makes me feel dreadful and I have all these side effects, and I don't want to take it anymore. So, is there something else I can take?’ That opens a discussion of maybe there is a way we can ween them off one or maybe decrease the dose on their prescription, and start integrating more natural therapy. It really depends on the patient, but to me it comes down to what they want versus practitioners saying this is what's best for you because everyone should be motivated to want to take care of themselves and live their best lives.
Regarding opioids versus cannabis, how do you guide patients with chronic pain?
As a practitioner, particularly as a pharmacist, you're always thinking about benefit versus risk. In terms of just looking at one versus the other, it's patient specific. But as a more blanket statement, I look at how the benefits outweigh the risks a lot more often with cannabis than with opiates. However, of course, it depends on the patient's situation. But I think cannabis can have an incredible role, especially in tapering off opiates. It's amazing to hear some of the stories from my colleagues who work with patients that are specifically looking for a way to stop taking opiates. I've heard such amazing things about people going from taking six opiates a day, multiple times a day to only needing one and supplementing that with cannabis, even if it's short term. And then a lot of the patients don't even need to take cannabis long term because it's “served its purpose.” There are so many ways of utilizing cannabis.
Does cannabis’ status of being federal illegal ever jeopardize your pharmaceutical practice?
Definitely. The main way that it does get in the way is simply because of the perceptions that people have about it. Both the patient perception as well as from the practitioner standpoint is that people just kind of look at its criminalized history and they make these assumptions. They don't actually know a lot of the details when it comes down to it because it's only one or two headlines that they've seen, and they base a lot of their perceptions on the use and the validity and just the overall benefit of cannabis on those things. So, I would say when it comes to federal regulation, and the way that it's impacted therapy, it's mainly just been an obstacle.
When people ask about regulating their endocannabinoid system, is there one cannabinoid you recommend over another?
Given the research that has been done and the breadth of research on CBD, I think CBD really does show incredible benefit for optimizing the endocannabinoid system. I say that because the way it modulates the endocannabinoid system or the way that it impacts the functionality of the endocannabinoid system, I think that it can have an amazing effect. That being said, I think once we learn more and more about the other minor cannabinoids, there is potential for other ones to play a big role too. So, I'm not sure I have a concrete answer but at the moment if I were to choose one, I think CBD really does have quite a quite a breadth of possibility.
Do you consider cannabis to be an adaptogen?
The way that I define adaptions are plants or substances we can utilize that can help us build resilience to internal and external stress and resilience, meaning that it helps the body react to it. And especially if there is that stressor, having some incredible adaptogens on board really can dampen that shock and effect to your system. So, if we're thinking about it simply in terms of the definition, CBD can be thought of in that way. However, when I look at the lists of adaptogens, either in the literature or what's talked about in popular culture, cannabis is not generally part of the conversation. I think it depends on who you ask. Everyone has a different opinion. I would say objectively, yes. But subjectively, perhaps not.
What do we know about cannabis’ bioavailability?
Bioavailability means the amount of the substance or plant or drug that we're taking that can actually have an active effect or use in the body. So, if we're thinking about it in terms of that definition, it really depends on how we're taking in cannabis. Are we smoking it? Are we putting it on our skin topically like a lotion? Are we using a suppository? Everyone's endocannabinoid system functions just a little bit differently and has a different endocannabinoid tone. But at the end of the day, it depends on how we're ingesting it, and, of course, the dose that we're ingesting too.
Is there any way to increase the efficacy of cannabis?
I think a lot of product lines are starting to integrate more terpenes in their products. For example, if it was just a CBD isolate, now they're considering a CBD isolate plus terpenes. Quite a few companies are looking at the possibility and the power of terpenes. Sometimes terpenes can really help in terms of synergizing. And, of course, that speaks to the entourage or the ensemble effect in the body and the way a lot of the cannabinoids and terpenes all work together in the body to help the absorption and optimize their effect.
What is one of the biggest health fallacies about cannabis?
One of two things, that it has absolutely no therapeutic value. I think a lot of people get that perception from the history of criminalization. Also, the fact that it is still a schedule 1 drug. What that means is that it has no perceived therapeutic value at all, zero. It's put in that same category with other illicit substances like cocaine and LSD. And like LSD, for example, they're looking at amazing research now with the utilization of that, or MDMA and other things, too. So, a lot of those drugs in that category now are being looked at as having therapeutic value at very low doses or micro-doses. I think people either have one thought or the other: it's either all or nothing. It's either cannabis has no benefit whatsoever, we should throw it out, or we can use cannabis for absolutely everything. I think that it's somewhere in the middle. I think the therapeutic possibilities are amazing, we just need to see a little more research in the utilization of it for a lot of different things. Because the truth is there is a good amount of research but a lot of it is still in the animal models. I'd love to see the clinical version of that. Thankfully, if you look on clinical trials.gov or at other top researchers in the field, there are a lot of people looking at cannabis and it can be used in so many different therapeutic conditions. But for now, we just have to think about it per person and per condition.
What's the most surprising thing you’ve discovered about cannabis?
The most fascinating thing for me, as someone who comes from the western practitioner world and as someone who didn't grow up with cannabis around me, I think it’s looking further into it and seeing how complex and amazing it is. Also, seeing how the education has transformed people's lives has been amazing. For instance, the role I've been able to play in the lives of family members, friends, colleagues—so many different people in my life—and just being able to give them a very succinct answer: maybe you can use it for this, or did you know what the endocannabinoid system does. Even those little nuggets of knowledge have been so transformative to people's thought processes around cannabis. It just goes to show that if we all are just a little more educated on the actual evidence that's out there, the actual use of it versus everyone's perceptions one way or another, I think that really could be such a benefit for so many people.