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medical cannabis arthritis w
General Education, Podcast

Medical Cannabis & Arthritis 101 with Registered Dietitian Cristina Montoya

May 9, 2022
47 min read
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Summary:

On Episode 68 of the Arthritis Life Podcast, Cristina Montoya shares her personal and professional journey using medical cannabis to help relieve symptoms of fibromyalgia, rheumatoid arthritis and Sjogren’s disease. She also delves into the science behind how medical cannabis affects inflammation, pain, sleep, mood, appetite, and more. 

Video of Interview

Episode at a glance:

  • How Cristina’s postpartum flare up and difficulty with pain control led her to delve into medical cannabis; helped especially with fibromyalgia. 
  • Cannabis, CBD & THC 101: 
    • How the endocannibinoid system (within our body) helps with homeostasis, memory, pain, mood, inflammation and even skin.
    • The difference between cannabis, help, THC, CBD, endocannabinoids and phytocannabinoids
  • What people with arthritis might want to know about how cannabis affects pain, inflammation, sleep, anxiety, appetite and mood (including a discussion of what risks there are versus benefits) 
  • What are the different methods of consumption for cannabis (Sublingual, Topical creams, Transdermal patch, Oral Suppositories (vaginal), inhalation, IV and more)
  • Where to find valid information about CBD and chronic pain
  • Where to find a dispensary: Check the laws in your area; five things Cristina looks for in a cannabis dispensary
  • Communication to medical team: Cristina discusses the importance of this
  • Cristina answers listener questions
  • How to learn more from Cristina

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, a community support & education program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. Join the waitlist for the next group, which starts in September 2022!

Rheumatoid Arthritis Roadmap, a self-paced online course Cheryl created that teaches you how to confidently manage your physical, social and emotional life with rheumatoid arthritis. 

Speaker Bios:

Cristina Montoya is a Registered Dietitian and Holistic Cannabis Practitioner who has lived with Sjogren’s Syndrome since childhood. She helps individuals with rheumatic diseases to embrace anti-inflammatory nutrition and lifestyle using the Mediterranean Diet and gut health principles. She created the blog arthritisdietitian.com to review evidence on nutrition and rheumatic diseases and share Sjogren-friendly recipes. She also created a new program called H.E.A.L (How to Elevate your Anti-inflammatory Lifestyle). Cristina volunteers with the Sjogren’s Society of Canada and the Arthritis Society by providing feedback on patient resources.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for nineteen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

  •  Cheryl’s Arthritis Life Pages:

 

Full Episode Transcription

[Introductory music]

Hi! My name is Cheryl Crow, and I am passionate about helping people navigate real life with arthritis. I’ve lived with rheumatoid arthritis for 17 years and I’m also a mom, teacher, and occupational therapist. I’m so excited to share my tricks for managing the ups and downs of life with arthritis. Everything from kitchen life hacks, and how to respond when people say, “You don’t look sick”, stress, work, sex, anxiety, fatigue, pregnancy, and parenting with chronic illness — no topic will be off limits here. I’ll also talk to other patients and share their stories and advice. Think of this as your chance to sit down and chat with a friend who’s been there. Ready to figure out how to manage your arthritis life? Let’s get started.  

Cheryl:  

I’m so excited to have my friend Cristina Montoya on today, who’s a registered dietitian and also my RA twin ’cause she’s had it the same amount of time. We both have one child, and they’re both boys. So, anyway, I would love you to just give a quick introduction, like where you live, and I already gave it away, but what’s your relationship to arthritis?

Cristina:  

Thank you, Cheryl, for having me here again. I’m really excited about today’s topic. And yes, so while you didn’t mention that I’m from Colombia and I live in Canada, but I’d really like to say this — I’m a woman surviving and thriving with rheumatoid arthritis, and Sjögren’s, and fibromyalgia. Sometimes I survive, I’m in survival mode, and other times on thriving mode.

Cheryl:  

Yes, I relate to that.

Cristina:  

Right? Like, that’s what it is. I started with this journey when I was a child with Sjögren’s syndrome. But then at 21, 22, I was diagnosed with rheumatoid arthritis as well. So, what is it you want to know — what else you would like to know about me?

Cheryl:  

Yeah, yeah. No, that’s perfect. And today’s topic is all about cannabis, CBD, THC and what is their relationship to arthritis and chronic pain. I know that’s a huge topic. There’s tons of studies being done, but I know it’s something that you personally have delved into and so, but my question first for you is what got you interested in delving into this topic in the first place? 

Cristina:  

Of course, as you mentioned, I’m a registered dietician, and I’ve been a registered dietician for 15 years now. I started in Colombia. And most recently, from maybe the past three years, I’ve been very passionate about learning and reading on anti-inflammatory lifestyle, including nutrition, and lifestyle changes. But what really triggered me is that I reached a breaking point in terms of managing my pain when I had my boy in 2019. So basically, I had an early postpartum RA flare up. I was told after six weeks; I had it the next day I had my boy. It was the most horrible pain I ever had since I was diagnosed. 

The first thing that they offered me was opioids, and I just could not tolerate the side effects and especially because I couldn’t even function with a newborn baby. All my biologics failed. Cimzia, that I’ve been thinking for 10 years, failed. I tried Actemra, failed. Went back to using methotrexate. And then, I had a very honest conversation with our new rheumatologist; I love her. And it was a shared decision. We started kind of jumping at ideas, okay, what is it that we’re going to do? So, I said, “You know what, I’m going to go full force and using medical cannabis.” She said, “That’s fine. But let’s try this biologic as well.” So, I started on Orencia. 

So, that’s when I started using medical cannabis. I particularly found relief from the fibromyalgia pain, first thing. And so, I really wanted to know, okay, so there’s gonna be a reason why this is working for me, or is just the hype, or what is happening? And also, I had the huge stigma of being Colombian and with our history, I was terrified of even mentioning the name of cannabis or marijuana. And so, that. But I said, you know, let me just learn. So, very skeptical about the whole thing. I completed a program during the pandemic with the Holistic Cannabis Academy which was founded by a registered dietitian in the U.S. 

So, I thought, okay, if she had read up, if she’s learned about cannabis, why can’t I? I got hooked, and I said, well, okay, so this is what’s happened in the US, I want to know what’s happening in Canada. So, I continued with a certificate Cannabis Educator Program in Toronto. It was catered more towards medical cannabis. But then I realized that as a regulated health professional in Canada, I was really not allowed to, you know, prescribe or write medical documents, which I understand. We’re also kind of limited on the amount of the type of education we’re providing, which I’m a rebel and I’ve been advocating for changes.

Cheryl:  

She’s gone rogue. No, I love it. Yeah. So that’s, I think that’s really difficult for people to figure out. Okay, I think at this point, we’re recording this in April 2022, there’s so many stories out there of people who’ve been helped by this, but yet it’s not legal everywhere. And there’s like systemic barriers to accessing it as a potential tool in your toolbox. But, so, first of all, I’m so grateful to have you here to help unpack a little bit what is it. Like, let’s say I knew absolutely nothing about cannabis, THC, and CBD, which I know a little bit but it is overwhelming to figure out the differences between the terminology. I feel like I’m a newbie with RA, again, you know, when people are like, “What’s a biologic? What’s a flare up? Like, what are you talking about?” So, what are some basic pointers that you, or basic pieces of information people should know when they’re just delving into learning about this?

Cristina:  

I think the most important thing and the reason why I started studying more about cannabis is understanding why cannabis works in our body. And it’s because we have a system that actually works with it. It interacts with cannabis and is called the endocannabinoid system. So, that system is designed to maintain homeostasis, or homeostasis or balance, within our body. And it’s also responsible for — and it’s involved in processes that involves memory, pain relief, immune, inflammation, and even reproduction. I didn’t know about that. But all the endocannabinoid system is that it’s the largest, kind of neurotransmitter system, right, that they have receptors everywhere in our bodies. 

And that’s why when you say, “Well, but cannabis works for everything,” it’s because we have receptors everywhere, including our skin. So, that’s why it’s so important to really understand that we do have a system that interacts with cannabis. So, we actually, just a very basic, the endocannabinoid system is comprised of three main components. First, you have the endocannabinoids. So, we actually produce endocannabinoids that are similar to the ones that are produced by the cannabis plant, and they’re called anandamide and 2-AG. Those are the main endocannabinoids. I don’t know if you heard of the ‘runner’s high’, but sometimes we use to say that.

Cheryl:  

Yep, yeah, I’ve experienced that. Yeah, yeah.

Cristina:  

So, that is rise of the anandamide. And it was actually given that name because of the honor of this Sanskrit word ‘bliss’. So, it means like a supreme joy. So, when you’re running, you’re actually getting a load of anandamide, so you’re feeling happier. When you’re hugging, when you’re smiling. There’s a rise of anandamide. So, we actually have those components in our bodies, that there are ways to nourish that endocannabinoid system even beyond cannabis. And that’s something to think about.

Cheryl:  

Yeah, so basically, we already in our body — tell me if this is the right — that we already have this endocannabinoid system and that’s not related to any quote-unquote ‘drugs’ or anything. It’s a system in our brain, and our neurons, and our whole body. And it just so happens that the cannabis plant taps into that. And I’m looking at this Harvard health page all about the endocannabinoid system, which I’m going to put in the show notes as well. It’s really helpful to understand because I guess I still — I was, I’ll just preface this, I grew up in the 1980s in the United States where there’s this huge push in the early 90s as well for this program called ‘D.A.R.E.’, dare to keep kids off drugs. 

And it really worked on me in the sense that it scared the living daylights out of me and I was like, “I’m never going to do any drugs and never going to drink alcohol. I’m never going to smoke pot,” and they always talked about marijuana as like the gateway drug to other more hardcore drugs and there’s so many negative things that were talked about it that when I even hear like endocannabinoid system, I’m like, “Oh, like, that’s some bad thing,” but it’s like, no, this is literally in your body already. Anyway, sorry, I already got us off track.

Cristina:  

No, but you actually — you actually — I’m kinda gonna tag on that comment as the gateway to drugs. And to me, it has been the gateway to wellness and freedom from drug prescriptions. And I think that’s powerful in terms of it’s very personal. Again, anyone, when you start embarking on a cannabis journey, it’s unique, right? And because that endocannabinoid system is as unique as your personality, so that’s why how when we can both take the same CBD oil, or take the same cultivar, or like known as the strains or kind of a strain, is this same cannabis, but we may react differently because it depends on what your body needs, and what that endocannabinoid system needs. So, that’s why we cannot just kind of generalize, “Oh, this strain is for pain, and this is for anxiety,” because it might work for you for anxiety; it might work for me for pain,

Cheryl:  

Right. And you don’t know till you try on your own body, right?

Cristina:  

Exactly. So, I think that’s probably the main message, that we do have that system and we can talk about that the whole show here. But I think, and actually something very interesting, there is a neurologist, Dr. Ethan Russo, very kind of well-known in the area of cannabinoids research, is that he proposed a hypothesis that patients with fibromyalgia, irritable bowel syndrome, and migraines may have a condition called endocannabinoid deficiency, clinical endocannabinoid deficiency, where I think there have been small studies where they have kind of tested the amount of endocannabinoids, but in the spinal fluid. So, it’s not really something that you can measure on a blood test or something, right. And so, it’s a theory they have seen, because you see that these conditions, they don’t have a specific cause, right? 

Cheryl:

Right. 

Cristina:

And so, and people, particularly those who have those conditions, respond very well to cannabis, so that’s where he kind of brings in this theory.

Cheryl:  

Okay, awesome. I’m putting these links in the show notes as well. It’s so interesting. Okay, so yeah, so how does — first of all, little one-on-ones, I’m sure I already messed up some of the lingo, what’s the difference between when I say the words like cannabis, CBD, and THC? Those are the words I hear all the time. Like, what’s the difference between those? 

Cristina:  

Well, so first of all, you have to start with a plant. So, cannabis is the plant that sometimes people will say like, “Oh, it’s kind of as the same as —”, oh, people say, “Oh, cannabis is the medicinal plant and the marijuana is the recreational.” I think you’ve also kind of heard that, right? But in reality, is just that one plant, is the cannabis plant. And then, this one, it actually has like a separate male plants and female plants. And then the female plants are where we’ve found most of the medicinal ingredients. But there’s also areas, right, where they’re like, hemp. Hemp is also a cannabis plant from the cannabis species, but then there’s more control into the amount of THC that they can kind of produce. So, the hemp is the one that contains less than 0.3% of THC. So, I understand the many legal states in the U.S., the hemp is legal right and so is the use of CBD, but not the cannabis that contains THC.

Cheryl:  

Okay. What is even — what does THC stand for?

Cristina:  

So, that THC. So, I’m going there. The CBD and THC are like the major cannabinoids. So, you remember when I was telling you that we had those endocannabinoids, anandamide and 2-AG? So then, the plant also produces major cannabinoids — a concentration of delta-9-tetrahydrocannabinol, that’s the THC; and then the cannabinoid oil, CBD. So, they are the largest, they are in the cannabis plant in a large amount but there are also many other minor cannabinoids, even up to a hundred, which is still haven’t been studied fully. So, that’s the difference, right. So, just think about endocannabinoids and the phytocannabinoids because it comes from plants, and that’s kind of the relationship.

Cheryl:  

Okay, awesome. So, when you say ‘phyto’ it’s like P-H-Y-T-O? 

Cristina:

Yes. 

Cheryl:

Right. So, that’s like from the plants. Okay.

Cristina:  

From the plants. And the ‘endo’ is what we produce.

Cheryl:  

Okay, awesome. And then, yeah, what are some things like people — because everyone, most of the people who are listening have some relationship to arthritis or chronic pain. So, like, let’s talk a little more specifically about how cannabis can affect pain and inflammation specifically.

Cristina:  

So, specifically, I think what another thing that we really need to understand, when these cannabinoids are present in the plant they come in an acidic form; they’re inactive. So, if you were to take like the plant or the flower right and you were to consume it, nothing’s gonna happen. There’s no psychoactive effects to it, okay. So, just to see the plant or just touching it, eating it, you’re not going to get high.

Cheryl:

Okay. Now I know.

Cristina:

So, but that’s where you come, that when we heat up the plant, right, is that when we activate those components, so that’s when the THC becomes psychoactive or kind of give that intoxicating effect, because then it interacts with those cannabinoid receptors that we have. And they’re mostly like the CB1 receptors that are located in the brain and then can give you that sensation of, you know, high and kind of pleasantness, which in some, sometimes it could be therapeutic. But when it comes to it in an excess, then it’s just you’re using it for other reasons. You’re not using it for therapeutic reasons, you’re just using it for just kind of, you have to be high. 

But here, we’re talking more about the therapeutic benefits of these components. The same thing happened with CBD, you have to activate it. But remember that cannabis plants also contains other important components like the terpenes which is like the aromatic components that gives it that flavor, like the smell, you know, the distinctive smell, and also flavonoids. So, think about like what you find in fruits and vegetables. Cannabis also has that.

Cheryl:  

Oh, right. It’s a vegetable. It’s like a vegetable, it’s a leaf, right?

Cristina:  

It is a leaf; it is a plant. [Laughs] 

Cheryl:

Oh, okay. I’ve never thought of that, wow.

Cristina:

But then, yeah, so what is really the effect? In general, actually, and research and animal studies, they have found that both THC and CBD have anti-inflammatory and analgesic effects. And in fact, for patients, specifically like I mentioned with fibromyalgia, chronic pain, or neuropathic pain, a combination or even a little bit of a THC seems to be more alleviating than just CBD.

Cheryl:  

Now when we say analgesic, that’s pain reducing. 

Cristina:

That’s pain reducing.

Cheryl:

Yeah, yeah, just for people who haven’t heard that lingo before. Yeah, I mean, that seems like something that every, you know, everyone who lives in pain from arthritis is looking for at some point. What can I do to reduce, especially like inflammatory arthritis, like the autoimmune types like we have, you know, psoriatic, or ankylosing spondylitis, or rheumatoid, you know, how can we reduce our overall inflammation, how can we reduce our pain? So, it’s really significant that this can help.

Cristina:  

It really, it really does. And I think we both participated in last year, World Pain Summit?

Cheryl:

Yes.

Cristina:

So, it was a very interesting discussion, because we have one physician who was like, completely against it, you know, there’s not sufficient evidence, we’re still kind of the earliest stages, I wouldn’t recommend it, only 1 out of 10 patients are benefited. I said to me that one patient is still, yeah, wow. Good for them. But then you have Dr. Hance — Dr. Clark, who he said, hey, but we have to listen to our patients. Pain is the number one reason patients seek cannabis use. So, what is happening here? So, that’s why he started. Oh, he is conducting our research where he’s evaluating the effects of cannabis in pain, sleep and anxiety. 

So, I think we really need to consider and appreciate what other patients are experiencing as the research is emerging, as more legalization starts to spread out, right, because that was really the limitation of doing research. So, what was I gonna say? So, that’s why when it comes to pain relieving properties, I highly advise that, for me, it’s best to really consult a medical care practitioner, right. You can have a physician, a nurse practitioner, someone who can guide you if you’re gonna use this for medical use. I do find and I think I’m gonna mention this two, these great doctors, The Knox Doctors. 

They are a great resource and they’re also advocating for the destigmatized use of cannabis. Because I’ll give you an example. I go to a doctor in the U.S.; I believe that they have qualifying conditions for using cannabis. If my condition is not in that qualifying list of conditions, then I most likely will go to perhaps a dispensary. And if I’m going to use a dispensary, it will be for medical reasons or therapeutic reasons, but then I’m going to be judged for use of it for recreational reasons. So, their advocacy lies is like, medical cannabis, like that even that distinction is damaging, right. It is cannabis, is it for personal use? Is it for therapeutic use? Is it for wellness? It’s the same plant — what are you using it for?

Cheryl:  

Yeah, well. And the thing that, when you were talking about the research, the scientist or the doctor who was against it, you know, I think that one of the first questions that we ask for doing these cost benefit analyses is what are the risks? So, are there any risks of taking cannabis? Can people be allergic to it like they can be allergic to any other plant? Or—?

Cristina:  

They could, they could. That can definitely be, as any other component in nature. You could be allergic to CBD or THC or any other cannabinoids. It also — here in Canada, I think that’s a really good question. Because there’s something that’s very specific for Canada, like the Canadian Rheumatology Association actually recommends the use of medical cannabis for adult people age 25 plus. But it kind of contradicts a little bit because then cannabis is legal in cannabis for personal use. So, any youth from 18 plus or 19 in most provinces can access it. And so, I think that we’re still kind of under that revision of that information. But something that I really wanted to focus on is to see what is the intention, right, like why are you really using cannabis? Are you seeking like advice from the medical care provider? Are you talking to your provider about using cannabis? I don’t know, people — I have so many patients who are very, they feel the stigma when they talk about cannabis.

Cheryl:  

Right. Right. And it’s, it’s hard because it’s like, you know, I have — I’m starting backwards from this bigger belief, which to me, it’s like pain relief is a human right, you know. You have the right to get your pain managed, or pain management is a human right. And so, to me, it’s like, yeah, especially with the risks, there’s not, you know, the risks of marijuana or cannabis, whatever form it is, is not as overwhelming as there’s risks to alcohol, which many people take, and there’s risks to too much caffeine; there’s so many things. 

And there’s risks to — and I’m very, very, very pro Western medicine for rheumatoid arthritis, just because the evidence is so strong for it, but you’re suppressing your immune system during a worldwide pandemic. So, that’s a risk. You’re having — and so, it’s not like you’re comparing just the small risks of cannabis to nothing, you’re comparing it to if I can get a little bit of inflammation controlled with, I mean, like, you’re convincing me now, I still have a mental block about — I bought some gummies. And then I was too scared to take them. But anyway, um, so but, you know, the thing is, or the other thing I just wanted to really quickly say is lack of research or lack of evidence doesn’t equate to evidence that it’s not effective or evidence that it’s harmful. 

And the reasons that you mentioned, you know, and I’m hesitant to say this, because you can say that with a lot of things that are really ineffective, like things that are like snake oil type stuff, like, oh, well, lack of evidence isn’t evidence of a lack. Okay. But if there’s a medical, or a something like cannabis that has been illegal, there’s a huge barrier to getting research done, like you said. And the emerging research is — and not just research, but there’s a pathway in your body for why this works. You know what I’m saying? Sorry.

Cristina:  

No, no, I know, I think that you make complete sense. And I think I even fact checked myself in terms of the risk. So, when you compare the cannabis risks to like opioids, those are the medications that we often use, right, for pain relieving. So, the difference is that there’s no cannabinoid receptors at the respiratory centre in our brain, unlike opioids, right. So, that’s why you could die from an opioid overdose, you cannot die — I think you have to consume over like 1.5 kilograms of cannabis to really have such a severe effect. And then, usually, if you have any side effects, they’re unpleasant but they’re not life threatening.

Cheryl:  

Yeah, yeah. And then, and to go back on the, you know, I think that the — I was looking up a little bit as we’re talking about the effect on adolescents, you know, adolescent, the developing brain. I have read a little bit of interesting kind of researches. It’s unclear how marijuana use affects the developing brain. So, that’s something to look into if you’re talking about juveniles or adolescents, but we’re talking about adults, you know, it seems a little bit less; the risks are not as strong. So, yeah.

Cristina:  

And that’s a really good point. And, again, the same goes for women, like pregnant women and breastfeeding, even though we probably know women who already use it or even there have been cases where women with severe nausea and vomiting, they have found some kind of relief with cannabis. But, again, those are the risks that the person was willing to take. But when it comes to the general population, and so it’s not really advised on pregnant women or nursing women until we have more research on it. Also, people with severe liver disease or cardiac conditions, they should also be cautious. I have some patients with all kinds — with POTS? I can’t remember the name of it, right.

Cheryl:  

Postural Orthostatic Hypotension. Yeah, yeah.

Cristina:  

Exactly. And they have found also that sensitivity to THC, specifically. So, there are situations in which I said, hey, yeah, kind of be cautious. That’s why you need to be kind of full disclosure with your practitioner and as a way of educating your rheumatologist as well. There was a small study, one I saw, it was an animal study and actually became human research. But in patients with lupus, it seems that like CBD, like a high dose of CBD, seemed to increase the release of a protein in the kidney, like approaching the kidney, and we don’t want that in patients with lupus. But again, it’s very individualized.

Cheryl:  

Yeah. Are there any reactions between cannabis and the medications commonly prescribed for rheumatoid arthritis that you’re aware of?

Cristina:  

No. They warned that you could be cautious if you’re on any blood thinners. And typically, when you don’t want to take it alone with the same medications for that, you want to kind of spaced it out. And if you are taking especially particularly edibles, right, like you’re consuming or the oils or the edibles, gummies, that sort of thing, that has to go through the liver to metabolize that, the cannabinoids. Just kind of keep an eye, if you’re taking methotrexate, right? Because it’s also metabolized through the liver. So, just kind of be aware that you’re being monitored, that you made your healthcare provider aware that you’re using cannabis. 

Cheryl:

Totally. It makes sense. Yeah. 

Cristina:

And I know something I really wanted to mention to you about that awareness. So, in 2021, we’re still in the middle of the pandemic. And there was a survey done for cannabis patients here in Canada. A thousand patients, 25% of them reported to the use of cannabis because of arthritis. 

Cheryl:

Oh, wow. 

Cristina:

So, out of like a thousand Canadian patients that were using cannabis, they tried it because they had arthritis and 58% were female. And I think, honestly, you know, the female population, we’re looking more into maybe more discreet options, right. We’re not into perhaps smoking or kind of have a smell, so we’re going towards more the edibles, the oils. So, here in Canada, it’s emerging the use of suppositories as well as a way for the pain relief. I think that women have kind of been left behind in terms of their research. Most of the research has been done in males and young males smoking THC, over like 30%.

Cheryl:  

Oh, wow. What I was gonna say — I forgot this earlier, but in the in the risks section I do want to point out yet that smoking, if you have rheumatoid arthritis, you know, if you have rheumatoid arthritis in general, smoking is definitely not recommended because you already are predisposed to some lung issues. And actually, smoking just tobacco is like considered a risk factor for just developing rheumatoid arthritis in the first place. So, people are usually you know, coached and told medically, please try to get off of smoking if you can. So, I’m assuming that would be something people, you know, rheumatoid should know when it comes to deciding which form that you might want to try, whether we’re talking about oils, or oral gummies, or smoking, right?

Cristina:  

Yeah. The thing is like smoking also kills most of the cannabinoids. Like, you do get the hit but it actually, it affects the availability of the cannabinoids that have the therapeutic effect, you get the high if you’re doing it for more like the personal use, you want the kind of more that recreational side, it might be that option. I support you; I agree with you when it comes — and rheumatoid arthritis and even any other inflammatory rheumatic disease, really not advisable. Things are a little different with when you use the herb vaporizer because you’re not combusting the flower, you’re actually heating it up at a lower temperature and you’re only getting the oils. You’re heating up the oils. So, if they, sometimes the vaporizer can be beneficial for an instant relief, right, like you can just have a breakthrough pain or you just need to kind of get that kick to help you sleep. So, you get that herb vaporizer, one or two puffs. But again, all guided, hopefully, by a healthcare provider that can really give you the right advice.

Cheryl:  

I love it. Yeah. And I think if we would summarize the major benefits to cannabis for somebody with an autoimmune form of arthritis like rheumatoid, it would be — in my head I’m thinking, from the research I’ve seen pain — reduced pain, reduced anxiety, better sleep. And then I put appetite on my little list because it is a good appetite stimulant. And not a lot of people are aware but appetite loss and unintended weight loss are actually symptoms of uncontrolled rheumatoid arthritis, and they’re ones that I personally experienced. So, is there — would you agree with those main benefits?

Cristina:  

Yes, I do. Definitely. And like a mood booster as well.

Cheryl:  

Okay, great. Yeah.

Cristina:  

That, I definitely, yeah, I agree. I think those are like the main reasons why people seek any kind of cannabis and they find relief in those areas. There was, I think, there was always questions about CBD, like, “Where can I find the best CBD,” right? Do you find that? So where is that, and I always get that. And I think this is more problematic, maybe, in the U.S. Never had it here in Canada, or maybe, right. Always check the laws in your country. But what is very important, I always kind of provide the five things that you need to look into. 

Make sure that the product has clear labels, right, like what is the component? What are the cannabinoids kind of concentration? Where is it made? Does it have a certificate of analysis, right? So, was it tested for pesticides, toxins, does it have any additives, any solvents? Because you can take the CBD but you’re taking all those solvents, they’re also toxic and pro-inflammatory. Was it used, you know, using a safe instruction. And particularly, if you can find someone like from an organic hemp kind of source, it probably would be better. But always kind of ask questions. So, one resource that I always kind of direct people in the U.S. is from Dr. Dustin Solak. He’s an excellent cannabis permission in the U.S., and his site is healer.com. And he’s fantastic, like all of his kind of his education, like very basic, but he uses evidence-based; well-known in this area.

Cheryl:  

Okay, great. I’m putting all these links in the chat that you’re mentioning, by the way.

Cristina:  

And so, yeah, that’s why that’s just something to really keep in mind with the CBD. And something very interesting about CBD that for some people, CBD can cause a little bit of fatigue when they just started using it. So, you’re actually using it to fight for tea, but then you might find that even when you’re using it, you’re feeling a little bit tired. So, it’s also in a way when your body’s trying to kind of fine tune with that, with the CBD. It’s like a supplement, right. For some people might use it for sleep, it may work; for others, actually it may stimulate them. So, that’s why the use of cannabis is just, it’s a journey. It’s just to — it really increases your self-awareness, self-care, and what works for you, or what doesn’t.

Cheryl:  

That’s super, super helpful, especially if you know that the fatigue might be a really short-term reaction. That kind of makes sense to me, if you’re kind of like, if it’s affecting your anxiety levels, you might kind of become more like chilled out, so to speak, but then maybe that actually might make you feel a little tired, you know? So, that totally makes sense. And then, on the lines of like, total beginner advice, I think it might be helpful to just list off what are the different forms that cannabis can take, like we mentioned, you mentioned herb vaporizer, smoking in various forms, and then what — and then of course, gummies, like what else? What are the forms?

Cristina:  

So, yeah, so probably the methods of consumption, right. So, we have the inhalation, so inhalation is like this, either smoking or through vaporizers. You also have the disposable vapes, which I am not very comfortable with them. I think they have super concentrated effects, we still really don’t know the long-term side effects. So, personally, I prefer the herb vaporizers are softer, someone as with Sjögren’s, I find it easier because it’s less kind of drying than kind of using any other form of inhalation. [ 36:32 And again, always break through.] 

The other one is ingestible, right. So — oh, no, we have the sublingual, so we use — there are the tinctures. So, the classic tinctures were made in alcohol but they can be very irritating. You put it like a sublingual under your tongue. Or you have like also the oils that you can kind of, the drops, you can use usually see the CBD oil drops and you can start kind of putting the sublingual, but some of it kind of gets ingested, right. Then you have capsules as well that can be ingested, gummies, and even like homemade edibles. That’s also kind of another source that can be ingested.

Cheryl:  

Oh, yeah. Is that — when you make a homemade edible, is that when you take the oil and then make like cookies with it, or —?

Cristina:  

Yes. So, you basically kind of create your own oil kind of butter, that sort of thing. And then, but again, that’s a whole new — [laughs] That’s not a fast catch. But then you also have suppositories, that’s another way of ingesting cannabis, even vaginal, they’re like, you know.

Cheryl:  

Wow, I didn’t know that.

Cristina:  

So, yeah, well, you know, Queen Victoria used to use cannabis suppositories to relieve pain.

Cheryl:  

You learn something every day.

Cristina:  

And then, even intravenous, but that’s more like for research and stuff like that. And also, the topical, right, or transdermal. So, you have the topical creams, but they also have transdermal patches. So, there are many, many ways of using cannabis because remember, the endocannabinoid system is spread out all throughout our bodies.

Cheryl:  

Well, and it’s really consistent with like current pain research, as I understand it, which is that pain is is a very complex phenomenon. I mean, it is processed, the sensation of pain is processed in the brain, but it involves so many different systems like our emotional centers and our, you know, everything is interrelated, in other words, just put it more broadly. Like, how well you sleep will affect your mood, will affect your inflammation, will affect your pain; everything cascades. And so, sometimes we think about things as different, like, “Oh, what helps with my pain,” or, “What helps with my sleep,” but really, like when I do my Rheum to THRIVE, you know, when I do my program and I’m teaching people about this stuff, it’s always like, I’d like to separate them into little silos, like, “Let’s talk about sleep this week. Let’s talk about—” it’s all really, I’m constantly saying it’s all interrelated. Like, how much exercise is gonna, the benefits of exercise are going to affect your sleep, and your pain, and your fatigue, and your mood. Yeah, so anyway, just.

Cristina:  

But it’s true. And it’s kind of worth noting that when it comes to research and cannabis and pain, so there are two particular things that they have noted, is one, is the decrease in pain intensity. So, sometimes you still may have the pain right. But then, I don’t like to use scales because I don’t think they represent, but that’s kind of, but at least the intensity of that pain. So much so that I had the experience once when I was going to the rheumatologist and I apparently had a flare up but had no pain. So, then my doctor started, my rheumatologist started assessing, so I really want to kind of point that out that if you still go and continue with your regular checkups with a rheumatologist, right. And the other thing is that pain also, it reduces like the pain related interference with daily lives. So, sometimes it’s a distraction, like, I guess that’s, in essence is it can be distracting. So, you’re not really focusing so much on the pain because maybe your anxiety levels have come down, you feel a little bit more relaxed. So, you’re not really focusing on the pain that much. And honestly, that’s a gain for me, if I’m not thinking about pain.

Cheryl:  

Yeah, yeah. Yeah. It’s funny, I don’t know why this is occurring to me, but my husband and I once said like, the goal — or I shouldn’t say that he said — I said to him, like, the goal for making money is like, make enough money so I don’t have to worry about money. And that sounds, I know this came out of left field, but it’s my same goal with pain. I want to control my pain enough to where I’m not like, constantly thinking about it and constantly worrying about it. Like, you want to make enough money to where you’re not having to, every single day, every decision, like worry about money.

And so, I don’t know, it just, it relates to that, right. Like, if your pain, you know, you might still have pain, but the degree of pain does not necessarily correlate to the degree of the impact on your quality of life. So, I think that’s super, super, super helpful. And yeah, I think we — I’ve been putting down, writing down as we’ve been saying this or typing down a lot of resources. But in terms of getting started with literally finding a place that dispenses it. I mean, it’s hard to say because of the different areas and there’s different, you know, there’s different laws, but do you recommend like first, of course, you’ve recommended talking to your medical team. Is that something that like a nurse or team could be able to advise you on where to find a good reputable place?

Cristina:  

Well, hopefully, I know in Canada, it’s sometimes it could be, um, I always recommend that, you know, go to a cannabis clinic and get a medical document. Now, it’s very easy, right. You can even do it online. There’s several cannabis clinics. One in particular here in Toronto is called Summertree and I have no affiliation with them. But what I know is that there’s a rheumatologist, Dr. Carolina Landolt, who actually has experience in cannabis sciences, obviously, rheumatology. So, her guidance is golden. I really like her. And I think she’s kind of one of a kind. Maybe there’s another one in B.C. But in general, the cannabis clinicians through the cannabis clinics here in Canada could give you some guidance, but sometimes it can be very confusing, and patients get frustrated and they just give up or they go to the dispensary.

And that’s the reality. And that’s the gap that we have here in Canada. In the U.S., I, you know, I probably said the safest way is to see if you can access the medical marijuana card. But all the laws, it really differs in every state. They have their own qualifying conditions. But I can say that you try your best to get the best guidance through a qualified care practitioner, will probably be the best. I cannot really say, “Go to this dispensary and get this strain,” I think that will be irresponsible of me to say that.

Cheryl:  

Yeah, thank you. Yeah. And that is, I did put up — we both put up on our Instagram stories, you know, asking people for their questions. And yeah, one of them, one of the questions was, “In general, are there strains that are well known for being like better for one thing than the other?” Like one person asked, “What’s the best strain for pain?” and the other person actually asked, “What’s the best strain for sleep?” Is that — or is it really just a person dependent?

Cristina:  

I think the way to discuss it is person dependent, but also the member of the profile that you’re looking for, right. So, then what is this CBD to like THC ratio, or what are the terpenes? Some of the terpenes also kind of modulate the effect of the cannabis per se. So, if you have like terpenes, like myrcene, which is also found like that is kind of connected to the ‘couch lock effect’. So, it makes you sleepy, so that’s probably better for your sleep, right. If you have products that contain CBN, which is another cannabinoid that has more sedative effects, then that will probably be more effective. But if you’re looking more into reducing inflammation, you’re gonna go for cultivars, or a product that has beta caryophyllene, which actually directly interacts with the kind of endocannabinoid system. So.

Cheryl:  

That’s a lot. That you have to talk to — so, basically, what I’m getting from this is you need to find someone who really knows what they’re doing and knows about all these micro differences to help you select the right one to start. And then maybe just, you know, trial, like any of our medications and any of our pain relief techniques or just lifestyle techniques, there’s trial and error, right. When you start a new exercise program, it’s just trial and error. Maybe I’ll try walking for 15 minutes on flat ground today. If I’m not too fatigued, and I’m not feeling bad after that tomorrow, I’ll try 20 minutes and then add a hill. And they’re like, oops, that was too much, you know. So, you just have to, yeah, sometimes it’s about trying. 

And again, all of this, there’s a medical disclaimer on all of my podcasts and all my content, but just to reiterate this, you know, to make sure to say it explicitly. This is not medical advice, individual advice, we’re just kind of providing — or we, generously of me to say this — Cristina is providing, you know, and I’m trying to provide some basic just education because it can be such an overwhelming topic about, you know, what is cannabis? What are the benefits, potentially? And yeah, as someone else wrote in, you know, “Oh, I know, cannabis helps me, but I can’t use it because I’m working in healthcare, and it’s probably just against the law,” like, where they’re working. And so, I just wanna acknowledge that it’s not something that everyone’s going to be able to even try just given where you live. And they asked, I guess, they said, “Do you have any advice?” I don’t really know what advice to give you, you just kind of can’t do it, right? I mean, I’m a rule follower, so I’m like, don’t do it.

Cristina:  

You can’t get around it, or like, I cannot really suggest, “Oh, you have to take this,” or, you know, drink something and it’s gonna disappear. 

Cheryl:  

Yeah, I can’t give you the antidote! Yeah. Okay.

Cristina:  

No, I think is more about education and raising awareness, even at the legislature, right. On those levels is that the government levels is just like, you know, stop the stigma. And the patients are suffering, they’re seeing benefits, why are you limited the access? Why are you setting up all these barriers? Why are you setting them up for failure when you’ve seen there’s evidence when our patients are reducing prescription, drug prescriptions, reducing opioid use? So, why can’t you kind of focus on those maybe positive areas that are benefiting patients, right?

Cheryl:  

Makes perfect sense to me. I mean, unless, yeah, it’s like, there’s so few pain management options out there that don’t have like a lot of, you know, downsides. We want to have all the tools in our toolbox. And I wanted to make sure, and I mentioned earlier, those major benefits like pain, sleep, anxiety, I forgot to say inflammation, reducing inflammation, which again, all is interrelated to that. But I want to make sure to give you a chance to talk about your HEAL program, speaking of inflammation, and how people can kind of learn more from you.

Cristina:  

I say I’m probably one of a kind, I can say. I don’t know, I don’t want to sound cocky about it, but what I really want to say is because I explained earlier is that I’ve come to realize that, first of all, we need to nourish our endocannabinoid system. So, we have a system that even beyond cannabis, there are so many other ways that we can nourish it so it helps us to stay in balance, right. So, that’s what I created, that HEAL pathway program, that is really going to tell you how to elevate your anti-inflammatory lifestyle for when you’re living with chronic pain. And so, I kind of created these steps. So, the first is an eight-week program. So, the first four weeks is no cannabis involved.

So, if you just want to know about like, anti-inflammatory nutrition and lifestyle, that is for you, right. Not everyone wants to know about cannabis. So, the first step, we want heal that relationship, your relationship with food, then heal with anti-inflammatory nutrition, heal your gut, heal with supplements, if necessary. Now I’m not — and actually, here is when we can introduce cannabis as a potential supplement. That’s kind of my view around this. Then, if you want to dive into more, why how cannabis can kind of be incorporated into that wellness toolkit, then on week five, we’ll talk about the role of cannabis for wellness, pain, and sleep, a little bit of canna-nutrition. So, it’s that combination of nutrition and cannabis, a cooking demo, and then putting it all together.

Cheryl:  

I love it. That’s so great. And then, where can people learn more about that? I’ll put it of course in the notes, but —

Cristina:  

Yeah, I’m going to be talking more about the program. I’m launching it on June 4th if every thing goes well, but I’m really working tirelessly on it. You can find me at @arthritis.pain.dietitian. Remember, my original Instagram account was hacked. And although it was a pain, so my apologies for everyone who was getting weird messages. This one is fully protected. And also, on my website of www.thatarthritisdietitian.com. And I know Cheryl is going to share their links.

Cheryl:  

Yeah, no, it’s great. You’re really, you’re providing a service that so many people want and need. And I will, I want to actually say something that we said in the previous episode you were on, the panel about nutrition. And the difference between a registered dietician and like a nutritionist is that a registered dietician is somebody who’s had a lot of rigorous training and you have a license and you’re governed by like a board, versus anyone in the world can just call themselves a nutritionist, like it’s not like a protected thing.

Cristina:  

We have to have kind of mention that I know in the U.S., they have the nutritionist. Like, registered dietitian and nutritionist that you get in the States. And even here in Canada, there was a couple of provinces where they still protect the title, but you want to look for like the red flags that are all holistic nutritionists where they only complete like six months or about a quarter, a six-month course. So, we actually can have like a medical nutritional therapy, right, we can understand medical health conditions, we have work in clinical settings. So, it’s really like regulated health professionals, and we’re here to protect the public, not to kind of make any false promises.

Cheryl:  

Yeah, yeah. Yeah. So, I just, that’s something like I just try to really promote the, you know, the programs that are based on like valid, you know, evidence-based information. Plus, I just think it’s a great mix, you know, taking your personal patient experience, and then blending it with your professional — obviously, that’s that’s what I do too. So, I guess I’m biased, but yeah, is there anything — and this has been so, so helpful. Like, is there anything else you’d want to share with the audience about this topic or anything else?

Cristina:  

Well, you know what, I think this is at the tip of the iceberg. If you can probably just take one thing I will say, like cannabis, use it as any other product. Even a supplement could be, it’s not completely harmless, right? So, just as cannabis, just as any other supplement or medication that you’re taking, and make sure that you are involving your healthcare provider in these decisions. And, you know, tell them that you use and tell them that you want to use it. But don’t keep it to yourself, just in case if there’s any adverse side effects or interaction, then the healthcare provider is aware of it, and they can help you.

Cheryl:  

Yeah, that’s super, super helpful. Yeah. And I think as the years go on, the stigma is, you know, reducing more and more, and I know even, you know, The Arthritis Foundation in the United States has put out some great resources on CBD and cannabis. And the American College of Rheumatology is, I think, going to put out one later this year. So, you know, there’s is, you know, and I think in like, a decade ago, or two decades ago, people were kind of scared to talk about it. But now, definitely, the icebergs kind of tipping, like you said, or that’s the tip of the iceberg. There we go. I’m always mixing metaphors. Well, this has been so, so helpful. Thank you so much again.

Cristina:  

You’re very welcome. Thank you so much for having me. It was a pleasure.

Cheryl:  

Yay. Well, I’ll talk to you later. Bye-bye for now. 

Cristina:

Bye-bye.

[Ending music] 

Thank you so much for listening to today’s episode. This episode is brought to you by Rheum to THRIVE, a membership and support community where you’ll learn how to develop your own THRIVE toolbox so you can live a full life despite your rheumatic disease or chronic illness. Learn more in the show notes, or by going to www.myarthritislife.net. You can also connect with me on my social media accounts on Instagram, Facebook, Twitter, and even TikTok. Check out the links in the show notes.