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Power of Compounding
Episode 437th March 2022 • Back Talk Doc • Sanjiv Lakhia - Carolina Neurosurgery & Spine Associates
00:00:00 00:39:43

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Bryana Gregory works at a compounding pharmacy, an option that many physicians in traditional medical circles have never considered.

But compounding could be the key to recovery and better long-term health for some patients. Rather than seeking only to relieve pain, compounding pharmacists take a holistic approach to a patient’s health to create personalized treatments.

“It’s like back in the day, when we used to have apothecaries, and see doctors and pharmacists behind the counter mixing up medications that were customized for the patient,” Bryana says. “Compounding pharmacy is more of an individualized approach.”

Often, treatments for pain involve as little medication as possible, with compounding pharmacists opting instead for supplements that can replenish or rebalance the entire body.

On this episode of Back Talk Doc, Dr. Lakhia talks with Bryana about what makes a good compounding pharmacist and how functional medicine can address pain.

We also talk about some popular treatments, including topicals like low-dose naltrexone, CBD, and even oxytocin, better known as “the love hormone.”

Read the Full Show Notes on our website BackTalkDoc.com.

💡 Featured Expert 💡

Name: Bryana Gregory, PharmD, RPh

What she does: Bryana is a pharmacist and physician liaison who is passionate about compounding pharmacy and personalizing options for her clients to help them maximize their health. She majored in kinesiology at the University of California, Davis and later earned a PharmD at Harding University. In between, she competed as a professional golfer.

Company: Physicians Preference Pharmacy

Words of wisdom: “I think that the best thing that a patient or just anybody can do for themselves is to self-educate, to be your own advocate.”

Connect: Website | LinkedIn | Facebook

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode CBD: Beyond the Hype with Matt Parks.

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com. 

Transcripts

Voiceover (:

This podcast is sponsored by our partner, QxMD. QxMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out read for easy access to research personalized for you and calculate for over 500 easy to use decision support tools. Try them today at qxmd.com/apps. Again, that is qxmd.com/apps.

Voiceover (:

Welcome. You are listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery and Spine Associates. We're providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

Sanjiv Lakhia (:

In the world of back pain, inflammation, and spine care, it really takes a team. And for those that have followed me on this podcast over the last two years, I've been really fortunate to bring in clinical care providers from multiple arenas to help us figure out what's the best thing for our spine and for our back. And today, I am going to be discussing all things and everything related to compounding pharmacy, compounding options for people with pain and inflammation, and I'm having this conversation. I'm delighted to be talking to Bryana Gregory. Bryana, welcome to the show.

Bryanna Gregory (:

Thank you, Dr. Lakhia. I appreciate it. It's a pleasure to be here, chatting with you today.

Sanjiv Lakhia (:

Awesome. Now she's calling in out of Houston, Texas. Is that correct?

Bryanna Gregory (:

Yes, sir. That's right.

Sanjiv Lakhia (:

All right. And let me just introduce you to the listeners. Bryana is a California native, born and raised near Sacramento. I'll have to stop you right there though because I'm from Cincinnati. And if you're rooting for the Rams and the Super Bowl, this could not go well for you.

Bryanna Gregory (:

We'll table that for now.

Sanjiv Lakhia (:

Okay. She attended the University of California, Davis where she majored in kinesiology and following graduation, competed internationally as a professional golfer until 2012. And then, she decided to pursue a career in pharmacy, and she earned a PharmD at Harding University and then took interest in oncology research and did a lot of research and focused on the area of genetic mutations and how they impact the treatment of female breast cancer. And she's had multiple publications in this area and really is passionate about learning new techniques and compounding pharmacy and really personalizing the options for her clients and patients just to help them maximize their health.

Sanjiv Lakhia (:

And I got to know Bryana really looking at several things for some of my patients and even family members. And I thought it'd be a great idea today to have you on the show and talk about an area that doesn't get a lot of publicity, at least in traditional medical circles. And I think a lot of physicians aren't even aware of the options that are available, so excited to have you and let's dive in today, okay?

Bryanna Gregory (:

Yeah, absolutely. Thank you. I really appreciate it.

Sanjiv Lakhia (:

One of the things I think we should start with as today's topic is basically compounding pharmacy, compounding options to help with back pain and inflammation is for someone who's listening and doesn't really understand what that is, I think most people can understand they get a prescription from a provider and they go to their CVS or Walgreens. How is a compounding pharmacy different from a traditional pharmacy?

Bryanna Gregory (:

Yeah. This is a great question. Like you said, it's not one area of medicine that just a whole lot of attention. And when it comes to compounding pharmacy, I think a lot of people can do independent pharmacy. So not your big-box chain stores, not your CVS, not your Walgreens, but these may be smaller mom-and-pop stores, but some of the pharmacies are actually a little bit larger.

Bryanna Gregory (:

The whole point of compound pharmacy really is to practice individualized medicine. So back in the day, when I used to have apothecaries and see doctors and pharmacists behind the counter mixing up medications that were customized for the patient, that's how my patient were made at one point. There were not big factories that manufacture them in mass amounts. And so compounding pharmacy is more of an individualized approach.

Bryanna Gregory (:

Compound pharmacy is a random pharmacy that offers customized prescriptions for the patient. And this might mean that their medication comes in a different dose than what's a commercially available at the CVS and Walgreens. It might come in a different dosage form, so if that's a cream or a tablet that dissolves underneath the tongue, that the patient may require because they have different certain needs. And then, sometimes we remove a bottle inactive ingredient that if you go to a traditional pharmacy, something that they're taking from that pharmacy might not set well with them.

Bryanna Gregory (:

We all have certain environmental and clinical responsibilities that, as pharmacists, we need to be aware of that. And a lot of times it requires removing those ingredients from the medication so that the patient can achieve their health and wellness goals the best way for them. And so, the way that works is that the patient will bring their prescription in and it's going to be their customized in a certain dose for them. If it's with their chemical makeup, their biology, and genetic differences that they have, these are all things that we take to account as well as patient compliance.

Bryanna Gregory (:

How many times the patient seek medication and how we minimize it for so that they can get to where they need to be? So it's really all about individualized and personalized medicine.

Sanjiv Lakhia (:

Yeah. I first got introduced to compounding pharmacy years ago when we were looking at some options for a family member, and I had no idea that you could, for example, have a medication compounded and remove the dye or lower the sugar amount, things that people nowadays more than ever are sensitive to. And I think when I kind of put on my integrative medicine hat as a physiatrist, I think these are low-grade triggers of inflammation in the body, so it's really interesting.

Sanjiv Lakhia (:

And also, the route of delivery, not everyone can just swallow pills. So the ability to take a prescription and provided in a form that's easier for the individual to take and comply with, whether it's a liquid or topical, I think it's just really cool and underrated aspect of healthcare.

Sanjiv Lakhia (:

And if I didn't mention, so you work at Physicians Preference Pharmacy, and we'll put a link to your website in our show notes, but you got a big team. I'm looking at your website and there's at least eight of you pharmacists there. This is a big deal, right? I mean, it's not just a small... I mean, some of the compounding pharmacists yes are very small boutique, but I think what you guys have going on there is really on a bigger scale.

Bryanna Gregory (:

Yeah, you're exactly right. It works for other compounding pharmacies in the past back in California actually, and each compounding pharmacy has usually a different specialty. It came from one that we actually specialize in pets, companion animals, which there's a huge market for that as well. But for what we do, Physicians Preference Pharmacy is for human medicine.

Bryanna Gregory (:

One of the things that I really emphasize as a pharmacist, especially as a compounding pharmacist, is that there has to be consistency month to month as far as the medication product goes for these people, because remember you're already dealing with somebody who is sensitive. And generally, the pharmacy is not the first place people end up. It's typically the last. I wish it was opposite than that, but with that being said, they show up in a world of trouble.

Bryanna Gregory (:

And so they need to be sure that what they're receiving month to month is very consistent, and it fits the entire team of pharmacists and very well-trained embedded technicians and a lot of testing processes both internally and externally, meaning that we lay and test everything onsite before we send it out for third party testing to be sure that what the patient is getting is the same every time.

Bryanna Gregory (:

But when it comes to hormones [inaudible 00:09:09] and antioxidants and things that are already naturally present in the body, but that we are replenishing, these patients cannot afford to be receiving inconsistent doses. And if you don't have the right quality processes in place, that can go right pretty quickly. So not all compounded pharmacies are created equally. That is for sure. So I'm blessed to be on a wonderful team where I'm at.

Sanjiv Lakhia (:

That ties right into my next question for you. Particularly in the world of spine care, we will get alerts periodically that talk about compounded medications that may have a bit of contamination and they're being recalled, certainly a concern for injecting those within individuals. So for people who are considering working with a compounding pharmacist, what are some of the, I guess, good manufacturing processes, regulations, what are some of the things they should look for that signals to individual, "Hey, you know what? These guys have their act together, their product is clean, it's reproducible, it's safe."?

Bryanna Gregory (:

That's a fantastic question. I wish more people asked it. First and foremost, you should have full access to your pharmacist. If your pharmacist can't answer questions about the testing processes [inaudible 00:10:32] medications in your pharmacy, how do you test that product for consistency and for quality and for potency before it leaves your pharmacy? If your pharmacist cannot answer those questions, that's a red flag for one.

Bryanna Gregory (:

And also, one distinguishing accreditation is PCAB, P-C-A-B, that's the Pharmacy Compounding Accreditation Board. That's an organization that actually overlooks compounding pharmacy that holds them to a higher standard. So that's something that you apply for, you get inspected for. And that organization comes in, inspect your pharmacy, accredits you, and says that you are following good manufacturing processes that are [inaudible 00:11:20], that keep the compounder or the person using the medications safe while they're doing it because they're being exposed to high quantities of these medications on a daily basis when they're making it.

Bryanna Gregory (:

But also, the processes that are in place in that pharmacy to be sure that when the patient receives those compounds, that they are clean, that they are safe, that they have minimal ingredients in them, and that on a daily basis for them to use them, they'll also be safe.

Bryanna Gregory (:

And then I would say, lastly, the pharmacy should be transparent about what the results are when they send out their products for third party testing. So for example, if we're making capsules or tablets or creams or whichever dosage form that may be, we have testing processes in place to be sure that they meet our standards of what we expect.

Bryanna Gregory (:

Now, when it comes to commercially available products that are made by large companies in limited amounts of doses, there is by law [inaudible 00:12:21] that can occur in those medications, meaning that if the dose from the outside of the bottle says that it's one milligram, for example, it can actually legally deviate from that plus or minus 3% of that dose, which might not be the biggest deal if we're talking about one medication. But when it comes to something like, let's say thyroid, for example, or something that we consider to be a neurotherapeutic drug, where we really can't afford to have huge fluctuations of the dose of that medication. It's important that you're getting one milligram every single time. And so that's what we test for at all pharmacy.

Bryanna Gregory (:

And then, we have the third party lab that we use that we send it out and they tell us, did we fall within our expected range or not? Now, going back to the plus or minus 10%, that's what's allotted for in the commercially available processes. In compounding, by PCAB accreditation, we're really only supposed to deviate plus or minus 5% of the expected dose, but we set our standards even more strict plus or minus 3%. And I will tell you that it takes a lot of training of a team to be sure that that is consistent every time, but we can confidently say that our patients do better because they're receiving a consistent product.

Bryanna Gregory (:

So all I could say now, we could talk about these processes all day because there's so many, but everything I just told you, I would tell a patient if they call me on the phone, and I think that that's really important to be transparent about it.

Sanjiv Lakhia (:

Okay. I don't know if I heard you correctly, but did you just say that medications that you pick up from the pharmacy can fluctuate by as much as 10% in terms of their potency?

Bryanna Gregory (:

Yes. Plus or minus 10% and so, it's a little bit different with brands and generics, but all that to say, yes, that's a huge deviation as much as think about 20%. If one month they receive it on the low end and the next month they receive it on the high end.

Sanjiv Lakhia (:

Right.

Bryanna Gregory (:

And from a physician standpoint and more pharmacist [inaudible 00:14:35], I also serve as a physician liaison, which means that I manage those relationships with the physicians that use our pharmacy. At the same time, they go into the offices, and I explain to them how to write clinically the medications customized for the patients because there is "formula" out there to do it. But what I do know is that if the patient's not feeling well, they may look up to you as physicians and prescribers very, very highly. They take your word for what it is, and they hold you in very high regard.

Bryanna Gregory (:

And what I know is that if you prescribe something to your patient and you can't figure out what's going on with them, it might be that they're not compliant with their medication. It might be that their medication isn't consistent. And so, for better outcomes and better patient-prescriber relationship, it's good to work with pharmacy that can provide you that consistent product. Because again, it's going to come back to the prescriber and the patient might think that the reason that they're not performing well or getting to meet their goals is because of something that the prescriber is doing.

Bryanna Gregory (:

So that's why a pharmacy, particularly a compound pharmacy, should have a good relationship with the prescriber and the prescriber's office and of course the patient completing that patient-prescriber-pharmacist triad, but the compounding pharmacy actually serves as an extension of the purpose itself. And that's where that relationship becomes important. Right? But to your point, if there's so much of a gap that can occur with the potency of the medications, there are things to be communicated between all parties of the consistency and the importance of the consistency of the medication month after [inaudible 00:16:20].

Sanjiv Lakhia (:

Well, we could probably talk all day on this, but I'm going to let it go other than say, that's really good information and something to consider. The other question I have before we really get into what I think people want to hear about today would be, can you describe for individuals kind of the state of the union with regards to compounding pharmacists being able to serve patients out of state?

Bryanna Gregory (:

Yes. So there is some continuity from state to state, as far as the pharmacy licensure goes. There, of course, is a state board of pharmacy for all of our different states and for a pharmacy like our own in Texas, to be able to ship out of state, we've got to have a pharmacist license in that state. And so we have, I think, a plus pharmacist at this point and we all... Well, not all of us but several of us hold multiple state licensure. That being said, for us to be able to ship out of state, we've got to have a pharmacist license there to do so. That requires testing, board of pharmacy testing, to be sure that we can comply with their laws and rules and regulations.

Bryanna Gregory (:

And when it comes to shipping out state, we always have to abide by the strict of standards. I came from California, California has pretty strict standards when it comes to their state board of pharmacy. No surprise, right? And so if in Texas we're shipping out to California, if their laws are more strict, we have to abide by theirs. So it requires a lot of licensure and knowledge on the pharmacist part to be sure that we're complying with each particular state board of pharmacy. And then if we're licensed, then we can ship there.

Sanjiv Lakhia (:

Yeah. This sounds very similar just for medical licensure laws and telemedicine and things like that. You just need to be licensed in the state that you're looking to serve. Okay. Well, thank you for that.

Sanjiv Lakhia (:

Let's get into... I know you got a lot of ideas to share or just some experience to share about how you've helped people throughout your career who suffer with... My podcast is about spine care, back pain, pain and inflammation. I've talked about nutritional influences on the show. We've talked about injections. We've covered surgery, but my understanding would be that what's unique about compounding pharmacy, one of the main kind of areas would be topical medications. I want to get your thoughts on that. And then, anything else you want to share about some successes that you have found.

Bryanna Gregory (:

Absolutely. Yeah. You, when you were talking about nutritional deficiencies, something I thought about is functional medicine, which we would say that our pharmacy partners, primarily with functional medicine or integrative medicine practitioners, that are looking at the body as a whole. And the reason that this is important is because people don't get fit because they have a low level of pharmaceutical [inaudible 00:19:22] in the blood, right? They get sick because it's a result of some sort of a deficiency or an imbalance, which causes that inflammation and that pain and maybe that showed up in the back or the neck or manifest in organ or something like that.

Bryanna Gregory (:

So if we can actually focus on what the root cause of the pain and inflammation is, then we can work backwards from where the patient is to what the root cause is, treat that, and help so many using pharmaceutical drugs because that's the point for how we're treating our patients, is we want them to be on minimal medications as possible. And so in case we need to use them, primarily what we focus on is replenishing what the patient is deficient in.

Bryanna Gregory (:

So we may use topicals to help with pain. We may use supplements orally what the patient is deficient in. Let's say four months, for example, but one topical option that we have is LDN, which is low-dose naltrexone. Low-dose naltrexone is actually only available as a compound. Naltrexone itself is commercially available for a different use, but at very low doses it's used to help mitigate pain, it's used to help with inflammation, and we can use it both orally and topically. But it's interesting that the way that it works is it binds at the same areas within the body that opiates would, the opiate drugs, as well as the endorphin that we make, those feel-good hormones.

Bryanna Gregory (:

And so when LVN bounds there, it makes us feel better. It helps to mitigate that pain, it decreases inflammation, it helps to control the inflammatory process because with inflammation, if you take a natural process, we fall and we scrape our knee, and we get some skin and some stabbing and bruising, that's all normal. That's how the inflammation process, right? But it's just stop at some point. And if it's not stopping for people and they're in a point of chronic inflammation, that's usually when they end up in a place like this, where they need some sort of medication to help mitigate or control the inflammatory process.

Bryanna Gregory (:

LDN is a good option. We can make it as a topical cream, typically a 1% concentration and what that does is it helps to control the inflammation locally. If we're using endocrine, you can just apply it to the area that the patient is experiencing pain at or you can also point right into oral capsules or sublingual tablets which are great for being injected into the body, which get absorbed in systemic circulation into the blood for the patient to be able to use this tool to help stimulate their own immune system.

Bryanna Gregory (:

So if we're able to give a patient something that is going to replenish what their deficiency is on or give them something that's going to stimulate their body to do what it knows how to do on its own, we're always going to be in that shape because we have a loose number of side effects that way, and that's the goal.

Sanjiv Lakhia (:

Okay, let me stop you right there. So LDN and... I didn't know you were going to lead with that. LDN is a very interesting medication. And for those who aren't familiar with it, low-dose micro doses. When you look in the literature, it's exactly what you said, it does have an immune modulating effect. We believe it does calm down some of these, what we call glial cell hyperactivity, which correlates with multiple pain conditions, fibromyalgia is one of them. I've read literature that it's used in adults and even in the pediatric population for inflammatory neurologic disorders, so it's a very, very interesting option.

Sanjiv Lakhia (:

I think the [inaudible 00:23:12] is emerging, growing, and probably turning in a positive direction. So what else comes to mind in terms of if we're trying to lower inflammation in the body? Now, it sounds like nutritionally, and I would totally agree replenishing... repleting is super important. And in my experience, things such as... Particularly for pain in neuropathy, so you're looking at B12 or folate, B complex. Magnesium has been very important for some of my patients. What's been your experience?

Bryanna Gregory (:

In talking about the replenishment, you said magnesium, it's that particularly when you're in Western diets. We have diets that deplete us or just fail to nourish us in some of the things that we need. It can pull up magnesium, it can pull out of our food. Magnesium is a big one. Magnesium is something that is depleted quite easily by a lot of medications that we take can deplete our bodies of magnesium. We are at a high level of stress, particularly now, which strips our gut, our gastrointestinal trap, of the nutrients that it needs. Magnesium being one of those because it's imperative for tissue repair. And that's kind of how it helps with the muscles working correctly, which of course lead into pain and inflammation. So magnesium is a big one, very big proponent of magnesium. Vitamin C as well, which is a natural antioxidant. Actually, humans don't make our own vitamin C, which is why we need to replenish it.

Bryanna Gregory (:

So it's particularly important to take... We recommend 1000 milligrams for every 25 pounds of body weight. So if someone weighed a hundred pounds, they would take 4,000 milligrams that's per day. And that really helps that kind of consider the high-dose vitamin C as we refer to it, but it really helps to keep that inflammation down.

Bryanna Gregory (:

Another one is vitamin D, and we know that in conditions such as diabetes and heart disease even people with COVID, things like this, where everything is very inflammatory driven, and there's a lot of imbalance occurring due to inflammation, but typically these people's vitamin D levels, if you [inaudible 00:25:25] in the blood are very low. They're very deficient in it. With some mental health disorders, vitamin D is very low. Vitamin D is one of the things you can give that turns people around the fastest when it comes to their mental health, their mental clarity, as well as inflammation, so I would say that those are good ones.

Bryanna Gregory (:

Something else that we use that's very interesting thing is oxytocin. Oxytocin is a natural hormone outside that occurs in the body, but I think it can manage stress and therefore manage inflammation, therefore manage pain. Talking about nerve responses, which [inaudible 00:26:08] as a pain, of course, throughout the whole body, particularly in the back as well is the clusters of nerves that are present in the brain is highly populated by oxytocin.

Bryanna Gregory (:

There's a lot of oxytocin in our brain. People know about oxytocin. We call it the love hormone usually or cuddle hormone. It's what is secreted in high volumes when you touch somebody or you've been intimate with somebody, but it's a [inaudible 00:26:37]. It does so much more than that. It helps to balance cortisol and stress within the body, and there's a lot of it in the brain. So when it comes to pain management, we can give oxytocin to replace it. If someone is oxytocin deficient, but we can also give it to them to help them manage their cortisol levels, which is good for long-term chronic stress because if someone is constantly making high level of cortisol, it does a lot of inflammatory damage to the body.

Sanjiv Lakhia (:

That is very interesting, and I think for people listening as a reminder, my goal is to bring out some of the best information out there on pain and inflammation, but it is for informational purposes only. And if you're listening and you're thinking, "Wow, could this be for me?" Definitely, get a consultation set up, talk with your doc, give them a call. The oxytocin, is that delivered as a nasal spray?

Bryanna Gregory (:

Typically, that's how people are familiar with it. We do make it into a nasal spray, but we actually put it into a sublingual tablet, which another goal of compounding, and I'm glad you brought that up, is that when it comes to compounding pharmacy, we have a lot of option as far as the dosage route goes. So we can either apply it topically like I said or they can swallow, oral patch, or a sublingual tablet.

Bryanna Gregory (:

To be clear, sublingual tablet is a tablet that dissolves under the tongue, sub meaning under, lingua meaning tongue. I think what's special about dosage form is it gets absorbed directly into the bloodstreams so it works very fast. Intra-nasal sprays also work very fast, but I might give someone [inaudible 00:28:12] intra-nasal spray versus sublingual tablet depending on what they have going on.

Bryanna Gregory (:

So if they need some help with mood management or anxiety or depression, a lot of that is stemming from what is going on in the brain, serotonin, dopamine levels, things like that. I want to give that person a nasal spray. They can use it when they experience that and often get almost immediate relief.

Bryanna Gregory (:

If I've got someone that has chronic pain, for example, that is widespread all over their body, it might be more likely to be the sublingual tablet because they're going to get systemic absorption into the bloodstream and that oxytocin is going to be flowing throughout their entire body and their entire body is going to be benefiting from it. So we compound both. It completely depends on that particular patient needs.

Sanjiv Lakhia (:

I recently did a podcast on the topic of CBD, and I wanted to get your thoughts on what you observed in your patient population. If you have any thoughts on CBD and its applications to pain.

Bryanna Gregory (:

Oh, wow. Yes, I do. I actually have zero experience with CBD prior to 2020 and... I believe this was 2020. And then, in early 2020 pure CBD became a product that we could compound as compounding pharmacies. And within just a matter of a few months, it was reclassified or re-regulated by the government as far as something we could not compound anymore. And without getting into the logistics of all of that, we've never seen anything being ripped from the market. And it really broke my heart because when I have a new product that's available to us, I go 100% into it. I want to know everything about it, I want to try it, I want to be able to tell the patients what they're going to be experiencing and so I went just full board on CBD, learning everything about it, [inaudible 00:30:17] about it.

Bryanna Gregory (:

And we saw the most amazing results from CBD. I mean, I had patients who came to me that said, "Walked through this lady [inaudible 00:30:27] on the phone." She said, "I haven't slept in 50 years." I said, "What? You haven't slept in what?" She says, "50 years, five zero. I haven't had a good night's sleep in 50 years. When I took that CBD sublingual tablet that you guys made for me, and I had my first full night's sleep." That's incredible.

Bryanna Gregory (:

What I didn't know about CBD is how well it brings our body back to homeostasis. I mean, we've got things that the second you walk out your front door, you're being stimulated by all types of environmental, chemical, just signals all around. The whole goal is for us to be just consistently simulated by something. All these ups and downs that we experienced throughout the day, it's no wonder why we ended [inaudible 00:31:11], right?

Bryanna Gregory (:

And CBD is really helping not only to calm people that were overstimulated, but to help energize people that were understimulated. And that's something about CBD, I think of it almost like an adaptogenic, as we refer to it in the supplement herb world is something that brings your body back to normal. It doesn't always stimulate you. It doesn't always bring you down. It helps your body find that healthy balance for you again. And so it's enormously successful with sleep, with pain, with inflammation. It is primarily how we were using it, but we probably saw the most success of it in sleep primarily. I mean, people that were using it [inaudible 00:31:58] sublingual tablet were people that get a good night's sleep. They never could before, which we know that sleep is so imperative to healing, so it's incredible.

Bryanna Gregory (:

There are a lot of products out there, and I guess the last thing I'll say about it is if you're going to get a CBD product, be sure, or even if it's a full spectrum pen product, that it has all the different cannabinoids in it, not just the CBD cannabinoid, is that with the product you get a CofA, which is a Certificate of Analysis, which means that it's made by a place that tests the product and that it's [inaudible 00:32:37] basically because you don't want to go to Joe Blow's CBD shop on the corner and not know what you're getting, but those are all over the place and you don't really know what's in it. You can have a lot of trace elements in there that could be put to your body and that's what you want to stay away from. If you can get a refill from clinical stores for the CBD, I think it's fantastic.

Sanjiv Lakhia (:

Yeah. I, I would agree with your observation just clinically with my patients in the feedback because many of them just take it, and physicians don't even need to recommend it. It's just out there, but from what I've heard and what I've read the literature, I think it's quite helpful for sleep and anxiety. And then, third on that realm would be pain. But I think what listeners should understand is the same physiologic system influences all of those. So the endocannabinoid system and opioid system within the body, the hormonal access, stress access, like the same blood goes everywhere, one of my mentors has said before.

Sanjiv Lakhia (:

And I think that's why in some of these areas, particularly in the plant medicine, you mentioned the word adaptogen, it's really unique. I think different than traditional pharmaceuticals, which you basically take a substance, you concentrate it to maximize a singular therapeutic effect. When you're looking at some of these natural interventions, they're not as potent, but they're more diverse in how they influence our physiology.

Sanjiv Lakhia (:

So thank you for sharing that feedback and really, I wasn't sure what to expect and which way we would go today. But if you're listening, I think you get a general sense that working with a compounding pharmacist is much more holistic and integrative in nature. And I think there's a tremendous place and role for that within the spectrum of healthcare. And Bryana covered everything from topicals to optimizing your nutrition, talked about sleep. We talked about several different options, so I think that was really great. Anything that we've left out that you wanted to add in before I kind of let you get out of here and enjoy your weekend?

Bryanna Gregory (:

Well, I think that one of the most important things is having an awareness. I like what you said, same blood goes everywhere, but also that everything is connected. I think that the best thing that a patient or just anybody can do for themselves is to self-educate, to be your own advocate, and to also find a team of healthcare professionals that will advocate for you and ask the questions that other people maybe haven't asked before. Understanding that everything is connected, so finding a functional medicine or an integrative medicine practitioner, meaning you're looking at your whole body, is extremely important with everything disconnected.

Bryanna Gregory (:

And sometimes it's the smallest connection that we find that fixes the problem. And sometimes it's so close with the slapping face, and I think it's just important to have someone that's very open-minded and to apply encouragement to people out there. Just don't be afraid to ask the questions and be sure that regardless of what type of practitioner you're working with, whether it's a psychiatrist or a pharmacist, they should be able to answer your questions very transparently.

Sanjiv Lakhia (:

And what a lot of people don't understand is the world of integrative health and functional health, and I myself, I'm just wrapping up my two-year fellowship through University of Arizona Integrative Medicine, but it is replete with evidence. I mean, the evidence is robust for many of these evolving natural interventions, and it's just not red.

Sanjiv Lakhia (:

So definitely, when you work with a provider, I think we should be held to a standard that there should be some clinical evidence or literature that support what we're doing, but there is a whole world out there for some that can be explored and can be helpful. And I know for you, as I kind of close the podcast today, I know you got an athletic background, but I really want to ask you, in your bio you say you love trying bizarre foods. So tell me about that.

Bryanna Gregory (:

Oh boy. Well, one thing that popped into my head is when I was competing in golf, I was playing on the Asians [inaudible 00:36:57], that was one of the [inaudible 00:36:59] I was competing on. And I remember the first time I went to Thailand and I was brought up where you don't say you don't like something. You just try it and finish your food. But there's very few things for that reason that I don't like. And I remember I went to Thailand and [inaudible 00:37:15], but they're very resourceful with their food. So I mean, if they're cooking from a plant, they're using the whole plant.

Bryanna Gregory (:

And I had some of the weirdest [inaudible 00:37:22] there, some of them I couldn't necessarily stomach, but most of it was great food. And I'll try anything once, but I traveled so much for competitive golf that there's some [inaudible 00:37:37] events that I love to submerge myself or immerse myself with the local people, and I want to try what their trying. I've tried a lot of cool stuff, but yeah, I think that's important to connect with people and to live like they live. And sometimes you like it. Sometimes you don't but at least you can say you tried it.

Sanjiv Lakhia (:

That's awesome. It definitely expands our horizon and helps us learn other perspectives. Well, thank you so much for your time today. We will link to the physician preference, rx.com in our show notes. But how can, if there's someone who's listening, whether they're clinical or not, how can they get ahold of you? Is that the best way to go through the website? Or do you have any other information you want to share with people?

Bryanna Gregory (:

Yeah. So website's a great place. Physicians Preference Pharmacy is a great place and you can of course call us. If you want to reach me individually, you can find me on both Facebook and LinkedIn. On Facebook, I'm Bryana Gregory RPh, which is Registered Pharmacist. And then on LinkedIn, I'm just Bryana Gregory. So hit me a message, I'd love to chat with you. Every question is a great question, and I look forward to connecting with your audience. I appreciate it.

Sanjiv Lakhia (:

Very good. Thank you again for your time and let's definitely stay in touch. I know you're on the cutting edge of treatments and it's really great to share this with the listeners today. So thank you so much, Bryana, for your time.

Bryanna Gregory (:

My pleasure. Thank you so much.

Voiceover (:

Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.

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