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What you’ll hear in this episode:

• What CBD is
• How can CBD help people
• The stigma behind it

Dr. Andy Ruiz is a repeat guest on Apple a Day Doc Talk. You can listen to his previous episode on hormone therapy here! Dr. Ruiz earned his Doctor of Pharmacy in 2008 from The University of Texas at Austin College of Pharmacy. Dr. Ruiz is now the president of Stonegate Pharmacies, located in Austin and San Antonio. He’s also a partner at Renew Pharmacies in San Antonio and cofounder of Endotech Solutions, LLC. Dr. Ruiz joins our host Dr. Khris Ramdeen to discuss something that historically had been illegal but quickly made its way to the mainstream: CBD. Even in states where cannabis is illegal, CBD has become legally available to the public by deriving it from hemp.

There is a stigma surrounding CBD due to the association between it and THC; its psychoactive “cousin.” CBD stands for cannabidiol and has a great number of health benefits without the psychoactive properties. People should talk to their doctor before taking any supplement to ensure it will not interact with the body or any medications negatively, but CBD has been proven to be a safe supplement to take to aid in different medical issues. We’re still learning exactly how CBD works to help the body, but we know it has to do with interactions between the CBD and the body’s endocannabinoid system.

There are multiple routes that CBD can be administered. Dr. Ruiz suggests taking the supplement sublingually (underneath the tongue) due the simplicity, purity, and history of it. He says that these under the tongue drops are the most common, but it can also be ingested via capsule or gummies; these methods just take longer to metabolize the substance.

Tune into the eighth installment of Apple a Day Doc Talk to learn more from Dr. Ruiz about the history of CBD, how it works, and how it can help. If you enjoy the episode be sure to share it with friends and colleagues. You can listen to more Apple a Day Doc Talk here!

Apple a Day Doc Talk is a founding_media podcast created in partnership with Dr. Khris Ramdeen.

Host: Dr. Khris Ramdeen

Guest: Dr. Andy Ruiz

Find Stonegate Pharmacy on Instagram

 

Transcript:

this is a founding media podcast if Hey guys welcome Napoli the doc talk I’m your host Dr indeed and we have gained E. Ruiz doctor angel Ruiz again thank you it ain’t me he is a pharmacist doctor pharmacy and he’s the president partner at Stonegate pharmacies here in Austin and San Antonio and he’s a he’s a partner at renew pharmacies in San Antonio and cofounder of into Texas Lucian’s LLC he and he went to the university of Texas at Austin for two years prior to entering the university of Texas at the Austin college of pharmacy where he earned his doctor of pharmacy in two thousand eight and after completion of that he assisted in the design and implementation of the first combined master of science in pharmacy in community pharmacy residency in India always makes me read these really super long the things because no really he’s a he’s a really smart guy he’s got a lot under his belt and so the Stonegate pharmacy here in Austin is just a critical resource and I mentioned this before to a lot of the docks in the area in Austin and San Antonio who go to A&E for questions with things like bio identical hormones and compounding because sterile fill pharmacy as well but today we’re gonna talk about something a little bit different CVD oil 

something that the at first regulatory bodies were not excited about so here in historically it’s been illegal yeah so CBDs interesting though because it’s even in states where cannabis is illegal CBD is made its way into legal form via hemp was so it’s interesting because you know you think of cannabis as marijuana as as T. H. C. as psycho active and stigmas of hippie you know other things yeah but the irony of it is that it CVD has amazing properties to it and it’s a it’s a it’s a great substance that we can utilize a chemical that we can utilize it our body makes naturally I mean if you think about the endocrine system there is an endo cannabinoid system and that’s kind of the irony in the the catch twenty two this whole CBD dilemma is that how can we go with the laws or more laws changes were seen them change now and how can we really utilize these these preparations are products that are good for us and healthy forests so yes that’s CBD is a is a cannabinoid in these whole spectrum of cannabinoids Canada dial to most simply put it is C. B. D. so that’s kind of in its simplest form of CBD is a cannabinoid 

and even you mention this you know this being analogous to one of our already existing chemical pathways but is it safe how do we know that that particular formulation we’re using it right that that’s okay that’s great because Siemian itself is safe in the sense that I think what most people have heard about it initially and I could be wrong on that but is when that the children seizures right especially the videos that just breaks your heart sings for children go to procedures and how hemp derived substance could help them with their seizures but which you which you kneel on there’s the formulations it’s become such a hot topic in although well intended on the regulation of it through farm bills except for it allowed us to use hemp as a source for CBD throughout the United States but in doing so we’ve had a lot of people rushed to market with this and the formulations and how they’re prepared could cause issue or harm in some cases right are they using certain pesticides or the extracting it properly are they what are they doing to get this CBD right and so the preparations themselves you know and do your homework look at it see which one is it is as bad as reputable for lack of better words something that you know is is trusted and tried and proven to be safe and effective so here’s where it comes into play of getting to it talk to your provider about and not feel shameful getting talk to your pharmacist or nurse or provider in general about it right so is it CVT safe I can’t say give it a kid that’s having seizures yeah I’d say it’s pretty soon and so really comes down to like you said indeed the formulation and there are so many different types out there just like all supplements and extracts and herbs rice things that you really do have to do your research when you choose one and 

if I’m not mistaken you offer one at stone gate can you tell me why you chose that wonder yes so we we you CV sciences and we choose them for two reasons one to one of the early adopters early entrepreneurs enter into this market and their trusted the reputable they’ve gone through all the regulatory rigmarole early on in are still around to they guarantee what what you’re receiving in in doing so you’re getting these products that are have little to no THC anthems are using hemp rain so have been itself has very residual amounts of THC right however it’s what we’ll call clinically insignificant so that’s why we choose CV’s CV sciences but they’re also cost effective there’s some just like anything you’ll hear you get what you pay for right but I also want to keep my limbs you know the whole thing and on a cost an arm and a leg but it so that’s why we choose in because they’re cost effective and a great product right and and one thing I I just want to sidestep a little here and is that when ever we talk about any substances supplements Ms extracts anything my blanket statement always is check with your doctor to make sure you know where your labs are intermediate conditions that may may require caution if you’re to do something like this and even when you do take something like this because it’s not heavily regulated I want to watch your organ function your kidney and liver your electrolytes sell anything you take even if it’s a medication it’s important that you first check with your doctor and continue to be monitored by one right while you’re taking in unit 

and it’s funny though because you nailed it because at first you do we move that you and I may have pauses to what are the negative or what’s this in but there really are things that you have to bring up to your provider because let’s just say you try to use the V. D. N. you’re on lever dope or something that might some Parkinson’s disease ride or something of that nature CVDs also been found a slightly bump up your dopamine levels right so if if you that’s not something you commonly think of so if you start with opening that book per se that you are a provider it really gives a better understanding of what is going on especially if you’re already on a medication these are easing the supplement you may feel better but it is important for the long term effects sister disclosing Hey this is what I’m taking in this is why am use it utilizing it and it may be that they’re just maybe minor medication just mansard maybe in a hundred percent fine disclosing is because you have to for sure and and this goes for any supplement in right right you just want to be able to interpret the in the context of your history and current medications really sometimes just what we should be watching out for him may not you know you may not disqualify you from taking it but it will be a better symptom we can interpret in the context is actually on the ceiling we we we talk a lot of science indebted to but as professionals we use our professional judgment right so you made the first throw out the word anecdote and though it has a negative stigma to it it’s not necessarily a bad thing it’s through my experience to my understanding this is how I interpret things and it totally it’s us just saying I’m not going to quote some research right now right right and to my experience but not only we are clinical decision making and even do I want to conduct the research study do I want to read the studies may guide us towards that so that feedback that you may give us to provide anecdotes for us guide our our decision making our desire to look at certain research or even conduct our own research so I think it’s like you said it’s beyond critical because a more feedback we get the more hypotheses that we have here 

and that anecdotal experience in that one on one personalization is decision making is so important because when you talk about supplements and things like this what is not beneficial I feel is when you have a blanket statement saying don’t do any of that and then there maybe patients or people that really want to try it so now they’re gonna go to non medical settings to do that actually not just this other things and then if there is a side effect they’ll end up back to us with the big blind spot gap between the beginning what they started in now so I think it’s just important to to try to rein in corporate what people are doing as long as it’s not hurting them he don’t know if it’s not hurting them unless you’re monitoring the exact that continuity of care which you may read a it’s a fancy term just say it’s important for your provider providers to know where your where you have been where you’re going and what’s in between right especially with C. B. D. where the the research has been limited throughout the years significantly it’s you know hemp our constant from not mistaken I think our constitution was written on hemp paper I mean it’s it’s it’s really been used throughout history it’s a great a source for paper for supplements for nutrition but at the same time because of laws that we’ve had in place it’s it’s inhibitor research so in times we do work off anecdotes it’s not ideal for us especially in the age of that were in of the research and data is at our fingertips in this case we are limited to a degree a large degree to what even is even available especially when it’s something as newly available is that you don’t have these large randomized double plus level two hundred placebo controlled trial thousands and thousands of patients exactly anecdotal information’s important exactly in in honesty has there been some research out there you get a lot of it from like Israel and other countries if it’s written in a language we may be hindered from how we can access that literature so it’s just not a the anecdotes are good in this case right like how removed from our experience can we utilize this in if the research is an available hopefully can you validate in the research some day right or somebody can look into that theory that we may have but yes C. B. D. has a lot it’s at its infancy right now and it’s awesome it’s also be a part of it’s awesome to see it’s awesome to see people get benefits from it it doesn’t see providers like yourself just be open and accepting of it and he’ll talk about let’s start the discussion right in and again the reason I do that is because if you just have the you know paternalistic don’t do this ever right that may work sometimes right often times it won’t and then again now they’re out of your supervision during things that you can’t see her and then they come back if they do have some side effect or maybe it was in a the greatest formulation right you just are playing catch up exactly try telling your children now see what 

and then any how does it work what has on a farmer called pharmacology level tells us it so if you think of it I just endocrine regular medium should be like us the integrated system is beautiful but yet complicated and intricate so we’re still understanding how it works but the way I relate it to is natural hormone replacement therapy were we were twenty years ago ten years ago right to where it was a stigma of like worse is going and it turned into this beautiful magical thing that is just truly accepted by so many organization and he’s very passionate yes that’s my bias magical the company it’s the endocrine system so that in the cannabinoid system that you mentioned earlier it’s a it’s a part of it right so CBD or can can be dial fits on the certain receptors that in turn because this whole cascade to occur and that cascade in turn can cause J. genes are enzymes to be expressed maybe on the hormone profile maybe in your brain like I said dopamine so fully characterizing its it’s mechanisms of action if you will is difficult because we know that it’s had some effectiveness in premature ejaculation yeah right we know it’s had effectiveness and seizures we know it’s had effectiveness in tremors right so peripheral mental psychological inflammation swelling on the Senate’s appearing to be as panacea right it’s a fix all but it’s not snake oil writers true science behind it and in some cases it doesn’t work for everybody and that’s something that we’re still trying to identify and learn as to why does it work in patient a or individual a and not individual be right so what what is it about that but we know we’re born we have this endo cannabinoid system and it there is this locking key that it fit this that’s the key that fits in the log but who and how and what is something I think that we’re still reading and learning about resolutely doing research on yep but it’s awesome 

absolutely any any mention dopamine a couple times so that’s an air transmitter a radical in the brain that you mentioned can become elevated right if you take ends and what conditions so like we need to watch out for Parkinson’s writes of you have tremors you’re taking medications to help stabilize us trimmers generally it affects on the dopamine is those medications you’re you’re dealing with so for Parkinson’s are we trying to so it’s a lot of kids are trying to increase the dopamine levels and severity and then you take the C. B. D. N. and magnifies it more it can cause too much of a trimmer said it’s great that healthy balance you know right hi you want to go too low you’re finding that that key balance and there’s other medications like Provigil or modafinil that work on the alpha brain waves but they also work on dopamine so you may have this enhanced euphoric feeling although non psycho active with C. B. D. because it may give you a slight bump in your dopamine levels so if you’re taking an SSRI some actually increase your dopamine so selective ripped a selective serotonin reuptake inhibitor or just generically call anti depressants they may actually also increase your dopamine levels so it’s things like that that it’s important that you tell your provider your doctor your nurse practitioner of Hey I’m taking the CBD and I feel better was it a cumulative effect or is its own unique effect right so it’s kind of hard to but it’s that’s where the importance of talk to your provider button hope you’re taking diminishing the heritage and part of the shame and you know lack of communication comes from it being a quote you know drug yeah and and schedule one drug is that right Gary right and 

then so one of the questions that’s typically asked you is that is this addictive if I start C. B. D. oil among any addicted to it so that’s a great point because addiction generally classified in its true form you can’t get addicted you cannot become addicted to CBD however there are addictive personality types right into it they’d find pleasure in certain things so therefore you will become non chemically addicted right so if I had chronic knee pain and I needed CVD because it’s going to help me in my addicted to it and maybe by definition non chemically addicted but you know if you want to think of it from a chemical addiction most likely not there you don’t have the same it doesn’t act on the same psychoactive component is teach the and not to the same degree as THC right which is its brother sibling however you want to define and the chemical addiction is really the important question to ask because if that quote addiction happens in and you need basically more to achieve an effect over time and you can build tolerance that’s really concerning because that because then you need more more for effect and when you take it away you can have withdrawal but it’s not that kind of a direct no it’s not that kind of addiction and so it that’s important thing to understand you won’t have this chemical dependence on this this new threshold is doctrine dean said that you’re trying to always hidden attain now there are always genetic abnormalities that predispose people to certain alcohol addiction right the nicotine tobacco type of addictions opiate addictions in a there is some controversy on does generally marijuana have some addictive properties or some research that shows yes to what severity we don’t know but CBD to what we have seen and understood from the research it’s non psychoactive it’s not addictive and so 

and then what route do you feel is best to have this administered and what are the different types of route to listen so again I am biased my early research was formed around sublingual there be meaning under your tongue I appreciate that route of administration because it’s simplicity purity and history of it so you put it on your tongue it absorbs pretty instantly and then from there it avoids deliver naturally goes through the liver for its metabolic process for any of these in the form of drops that you’re drawn to something or little tablets that you can find but the drops are by far the most common and CBT is a bitter substance too so you might wanna get a flavor to it some people don’t mind as some people are genetically ironically are predisposed to enjoying bitter substances they don’t really mind however it is better you can ingest it be a capsule gummy with those preparations once it’s metabolized in the stomach you have other metabolites so it may act a little differently you may have a longer affect so you it’s it’s something to consider if you’re trying to I’ve I’ve anecdotally I’ve had feedback from other health care professionals who have been veterans right with experience war and had PTSD nightmares the whole dramatic experience which is understandable they’ve used CBD gummies over drops because a it helps their PTSD at their nightmare subside or limited significantly they sleep through the night or less anxious in the morning and that is been and these are dogs that you’re talking about general one was a physician and one was an early PharmD yeah and I think these anecdotal stories are very phenomenal we have because it’s like I never thought of that and then as providers you know we can go back in and talk to the patients back look this is what I’ve understood from another person it’s not necessarily how it will work in you but Hey if it’s safe it’s efficacious it’s appropriate for you it may not be bad to at least try it and see if it’s a better route versus maybe harder medications if you will you know more harder on the body harder on the brain versus CBT 

and other than the sublingual route any other routes that are popular right now right now the gummies are pretty popular I don’t know if it’s the idea of eating a gummy bear or something like that stylistic vignette which you should not bring those around children all right it has a big issue right now but you know the bombs or the oil even unscented oil right so if there’s joint pains knee pains you can rub that on the joint and it gets to the site pain and real elite beats the endocrine system is throughout the body right and it’s in it’s interesting how CBD or cannabis dial is part of this whole Indo cannabinoid system is a subset of the endocrine system and at you with all your training understanding of the body you can attest that the endocrine system is a web of this throughout your whole body and so I would like if we play to the knee how would you a simple I guess simply put that it would respond to the brain and throughout the rest your body that’s actually a really good question I honestly can’t answer that very well so the the question is you know that Assam times is that if it is the endocrine system working through this capital a pathway what and that’s everywhere why then if you apply it to your knee let’s say if you have any pain why does that help your joint pain you know the way I think of it I mean we could be wrong but it simply put I I think back to what’s that movie with the little blue creatures and their inducted to Mother Earth but they’re in this alternate universe I have no idea avatar hello yeah as I said in an avatar is that the whole bodies connected right into before we’re connected to everything else but the indifference but simply put away I think of it is that if we put it on our knee that relayed the message has to get back to the rest of our body right so from the sensation of pain has to research received back to the brain so it stimulates part of the endocrine system to relay that message back in other ways what it may actually do is at least start a signaling pathway to help bring down the information interrupted some of those other processes that are occurring locally so the thing I like about local administration especially like for arthritic conditions is that you don’t have to again I’m conservative although the pharmacist and not scared to try things on myself which is bad science is you know right up to the locals possible if my knee hurts I want to play something to my knee do I necessarily want to take something tackles throughout my body typical is not like that yeah Dr philosophy start going go slow smallest dose in the Chinese place and then work your way up exactly so I guess if it’s like the endocrine system how does that how does that miss message relate I think of it is okay well where’s my integrin receptors throughout my body so hopefully it’s touching on there’s clearly got to be something on a ligament on enzyme on inflammatory marker that it’s interrupting or enhancing or improving upon and disk into cannabinoid receptors may actually be localized pain receptors as well that we’re still learning about so the one that you provide there’s still get 

what what route is that we have all all the different routes of administration yeah so we’ll have the gummies will have currently need to order more which is my fault I forgot gummies drops of flavor drops bombs capsules so yeah there’s explain the bombs so a bomb is more of like if you think of for lack of better words than petroleum jelly yeah right it’s it’s a CBD that it’s more of like an oil based product that you can rub for arthritis on your hands or on your knees or any types of joints like that how often your patients doing that so for arthritic type symptoms I it’s not uncommon to see patients just carry around with them and when they get flares as needed right then two times a day three times a day I’ve never seen a just continuously but you will see two to three times a day is not uncommon PTSD really at night here a lot of Hey I just take two three gummy instrument it tight trees need is what we’re seeing so far and is there any toxicity issues are taken too much being a problem I think that’s what’s still being presented in the research but there hasn’t been not to my knowledge seen any yet I could be mistaken but I haven’t I’m not aware of any at this point if anything it’s more of a it helps with the nervous system healing process for instance the endocannabinoid system is beyond important during the third trimester in pregnancy is when the nervous system fully forming really integrating and that’s when your into cannabinoid system started spiking flair right it especially in the fetus because it’s starting to create those neural connections of just but most importance 

absolutely yep and you this is a common question I get to is that when you take the C. B. D. oil do you get a high has that happened I think some people would wish to do but generally no you don’t get the high the high that you may be a euphoric feeling again this earlier maybe a slight increase in dopamine especially were taking other medications to maybe more amplified but there’s not us it’s non psychoactive meaning you’re not gonna have a high you’re not going to have an altered mental status or anything like that and what’s your sense in the on this becoming prescription type medication strength FDA regulated I think regulations great yeah because it’s important we don’t want to just have rogue pharmacists anybody right right or just into intelligent people just going out there and you know bio hacking is what’s the hot trend right now it’s it’s very very a non supervise it’s not good news but I’m conflicted because I think it’s insurers may pay for it may increase availability but the same time will that hinder other companies that have been making this available for me to make it available yeah or is it all of us and can have a negative stigma on these other on things we’ve been doing because there’s trying to push you towards what’s pharmaceutical available right so the I think it’ll be wait until we can see what all happened but at this point we’ve already had these availabilities why rock the boat while this and turn it into this whole pharmaceutical only ranks and that’s my fear into 

any final thoughts on CBD oil indie don’t stigmatize no this is phenomenal it’s a really important I think that we just start the conversation exactly with people like us exactly and this and that one of medicine’s 

Dr I think it’s important yes I already talked to provide it don’t worry about it and a lot of patience you know it my patience right now are asking me about this and I said well let me talk to Indian and I think it’s gonna be a really good jump off Spotify hearing the to start here don’t judges were still learning so that’s very true we have all the answers yet but exactly or in the talk about agree and indie doctor Ruiz thank you so much you get over to him to his death I like to think founding media for hosting us and thank you guys again for tuning in we’ll see you next time thank you the apple a day Dr hockey podcast team includes me doctor Randy producer Mariah gossip and audio engineer Jake Wallace thank you to everyone in the media for your support the apple in the dock talk is available on iTunes stitcher Spotify or wherever you get your podcasts you can follow me on Instagram Brandyn M. D. L. R. A. N. D. E. N. T. or check out the link to my YouTube channel and website mission thanks for listening