Globally, stress and anxiety levels have never been higher. According to one recent survey, a full 70% of Americans are stressed out, with a disproportionate impact on people of color. From worry about getting sick, to sick family members, to financial pressures, to home schooling, the list of possible contributing factors is long.
How do we care for our patients or clients in this climate?
Victoria Albina, NP MPH is a family nurse practitioner in NYC – the COVID epicenter. She’s also a cognitive behavioral life coach and breathwork meditation facilitator. In short, she’s remarkably ideally suited to walk us through tools to consider using with our patients immediately. Victoria was an early adopter of using CBD for anxiety, and has a wealth of knowledge around how to work with it for acute anxiety (regardless of how it presents: from insomnia to addictive “buffering” behavior). She also covers lifestyle interventions and key botanicals she’ll use concurrently when the need exists. And to top it off, Dr. Albina walks us through a lovely breathing exercise at the end of our conversation. It was one of the most grounding – and informative- podcasts I’ve done 😊, and I can’t wait to hear what you think. Leave us a review and 5 star rating on iTunes or wherever you listen to New Frontiers. Thank you! ~DrKF
The novel coronavirus has affected almost every aspect of modern life, from work to home to childcare, all while amplifying our fears about health and keeping ourselves and our families safe. Indeed, seventy percent of people report feeling really stressed out. Lifestyle strategies can make a big difference in a patient’s anxiety profile, but many times patients with acute stress need a bridge to help them as they transition to healthier lifestyle habits and embrace functional medicine interventions. In this episode of New Frontiers, Victoria Albina, NP, MPH, a cognitive behavioral life coach, breathwork meditation facilitator, herbalist, licensed and board-certified family nurse practitioner, and host of the amazing podcast Feminist Wellness, talks with Dr. Fitzgerald about using CBD oil as anxiety-reduction intervention with patients.
In this episode of New Frontiers in FxMed, you’ll learn about:
- Root causes of anxiety
- Anxiety pre- and post-COVID
- Dr. Albina’s preferred lab tests for patients who present with anxiety
- Polyvagal theory
- Lifestyle factors, including nutrition, that contributes to anxiety
- Why patients buffer and numb under stress
- Addressing buffering and numbing as coping strategies using CBD oil
- Adaptogens and other plant-based interventions for anxiety in addition to CBD oil
- The thought-feeling-behavior cycle: how it contributes to anxiety and how to break it
- Using CBD oil as a bridge to help patients as they adopt anti-anxiety lifestyle strategies
- Dosing CBD oil
- Liquid CBD vs. capsules and when to use each type
- CBD for anxiety and insomnia, and how to use and dose CBD for patients who wake up frequently during the night
- CBD as “fast-acting fish oil” and using CBD to fight inflammation
- Safety issues and drug interactions with CBD oil
- How to choose a high-quality CBD oil
- Key words to look for on CBD labels
- Signs and symptoms that indicate CBD is dosed too high
- The importance of getting the entourage benefits of broad-spectrum CBD
- Using and dosing Lavela for anxiety
- Best breathing exercises for anxiety
Victoria Albina, NP, MPH is a cognitive behavioral life coach, breathwork meditation facilitator, herbalist, licensed & board certified Family Nurse Practitioner, and host of the podcast Feminist Wellness. She is passionate about supporting folks in a truly holistic way – body, mind, heart and spirit, to reclaim their power and ability to heal themselves by learning to manage their minds, heal their bodies.
Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and today is no exception. I am really delighted to be back with Victoria Albina. She’s an amazing woman, who talked to us about her approach to GERD last October, so go and check that podcast out. Today, we’re going to be talking about using CBD in the anxiety patient.
Let me give you a little bit about Victoria’s background and then we will jump right into the interview. Victoria Albina, NP, MPH, is a cognitive behavioral life coach, breathwork meditation facilitator, herbalist, licensed and board certified family nurse practitioner, and host of the amazing podcast Feminist Wellness. She’s passionate about supporting folks in a truly holistic way, mind, body, heart, and spirit to reclaim their power and ability to heal themselves by learning to manage their minds, heal their bodies. Victoria, welcome to New Frontiers.
Dr. Victoria Albina: Thank you so much for having me, so excited to be back.
Dr. Kara Fitzgerald: Yeah, it’s great to have you back. First of all, I just wanted to, say, circle back to this breathwork background that you have. Victoria recently joined our clinic immersion for a teach-in. If you don’t know anything about that, actually, we could put a link on the show notes, but she just did a teach-in with my team, leading us through a breathwork meditation. It was deep, powerful, and really profoundly meaningful.
Victoria, we’re a little bit cerebral in this camp and we tend to talk about mechanisms and we have either geeky clinicians on or, sometimes, we have scientists talking to us about different topics in our clinic immersion. You just blew the socks off out of everybody who was there taking us in a completely different and really unexpected trajectory. I think a lot of the people in attendance were thinking maybe you would talk about the mechanisms behind breathwork.
Dr. Victoria Albina: Ha. I don’t know. Yeah, instead, I threw them down the well.
Dr. Kara Fitzgerald: You really did, really did. It was powerful and meaningful, so I just want to thank you for that. Today, we’re talking about anxiety and we’re actually, we’re going to be talking about your total approach to anxiety. You’ve been using CBD. You were an early adopter of CBD, so we’re going to be talking about that. I want to say also, folks, that it’s June. COVID is a very real thing. Victoria’s in the epicenter in Manhattan. It’s extremely timely that I’m having this conversation with you today, so just talk to me about kind of how you work your anxiety patient up, what kind of tests you might be running on them, if you’re thinking about things beyond the central nervous system. Go ahead.
Dr. Victoria Albina: Right on. Here in New York, I do have the benefit of many, many, many folks will just present and say, “I’m anxious,” so that, to some degree, is really helpful because they recognize it. It’s such a pervasive part of, well, in one way, pre-COVID city life and, in this new way, current COVID city life. The root causes are, well, they’re different, but they’re also the same. Perhaps we could say the presenting stressors are different.
I think the root causes, fear of uncertainty, fear of losing control, fear of fear, fear of feeling our feelings, being worried we won’t be able to handle our feelings, unprocessed grief, unprocessed trauma, unprocessed loss, insecure attachments, anxious attachments, childhood trauma, all these things that can underlie anxiety. The focus has simply shifted during COVID away from will I get that raise and that promotion and I don’t know if my boss likes me and dating and all those things, right?
Dr. Kara Fitzgerald: Yeah, that’s right, but I would say the physical volume has turned-
Dr. Victoria Albina: Way up.
Dr. Kara Fitzgerald: … way up.
Dr. Victoria Albina: Yeah. Yeah, for sure, yeah. I spoke about some of the situational, the psychosocial underliers, but, of course, I’m always going to use the polyvagal theory and that lens, which we can dive into. I’m always going to work up thyroid, iron, Vitamin D levels. I’m always going to look at gut, right? I’m going to look at the HPA axis. I’m going to ask what are the adrenals doing here, what’s going on with the sex hormones, and, of course, always back to lifestyle, lifestyle A number one.
I know when I was really, really anxious, it’s sort of funny to look back on my early 20s. I was simultaneously chugging coffee because I was in grad school. I was broke, and coffee is cheap. I’m also from Latin America. We just drink a ton of coffee. It fills your belly. It’s quick. Then golly, on my fourth cup, shockingly, I was a lot more anxious, but who puts that together on their own at 24, so really looking at all of those lifestyle factors, even things that people don’t think about that I see so pervasively in a city like New York, like having two to three cocktails and then waking up anxious the next day. You’re not hungover, but you’re anxious, right? It’s that different kind of post-alcohol effect, so all those sorts of things, sugar, all the nutrition points, sugar, gluten, dairy, corn, soy, looking at how those things are affecting the physiology, as well.
Dr. Kara Fitzgerald: How much of this are you getting in your history versus using labs? I mean, are you leaning, I mean, just from your background, I don’t think you’re leaning heavily on labs. You’re doing a lot of really careful history taking. Is that true?
Dr. Victoria Albina: Yeah. Yeah. Yeah, I am a asker of many, many, many questions, and the more fearless I’ve gotten about really getting, just to say it plainly, all up in my patients’ grill, the better their outcomes are, so really being like, “No, no, no, babe. How many drinks do you have a night?” Like let’s get real honest right now. Yeah, so history first, really, really in depth question asking. That question asking has to, in my opinion, has to come with a guilt-free, shame-free, stigma-free framework because if someone thinks you’re going to judge them for being like, “Yeah, I mean, I do have four or five cups of coffee a day. I don’t sleep well, so I wake up tired, and I’m anxious because I’m tired, so then I have a shot of espresso. Then I get to the office and I have free coffee and I’m so rushed I have a second cup and then a third, etc., etc., and yeah, I’ll have a Red Bull and vodka out at night.” If they think you’re going to judge them or shame them or have any opinion about any of that other than like yeah, I hear you, totally, right, totally, they’re not going to be honest. Then yes, you’re go to fall down a labs rabbit hole and start chasing numbers that may or may not be there.
Dr. Kara Fitzgerald: What kind of coping behaviors are you seeing now in this socially distant, isolated COVID world?
Dr. Victoria Albina: Yeah. I’m seeing a lot of buffering, which is a term that comes from the psychological literature in the ’70s, a way to push away our feelings using pretty much anything we can to distract our brains, give us a wee hit of dopamine, and keep us from feeling a challenging feeling for the moment. Colloquially, it’s often called numbing out or binging on Netflix or second pint of ice cream. It has its place when we think about, again, trauma and stress and anxiety. If you don’t have other tools to support yourself and the skills to help yourself come back into ventral vagal, that part of the nervous system where we are calm, feel safe, secure, social it actually can be healthy to numb out and buffer as a protective mechanism. Like everything else, I just has its balance, right?
Dr. Kara Fitzgerald: Yeah. Yeah, I get it. Oh, god, you’ve just said so much extremely useful stuff. I’d love to go through each of these, but anything that comes up as … So you’re doing this big lifestyle intervention. Of course, you’re coaching this whole journey that you take with these people in a really authentic, nonjudgmental safe space, which is beautiful-
Dr. Victoria Albina: Thank you.
Dr. Kara Fitzgerald: … and powerful. Just, I guess, being who I am, I can’t help but ask what are the few labs that are indispensable for you?
Dr. Victoria Albina: Thyroid, thyroid, thyroid.
Dr. Kara Fitzgerald: Okay.
Dr. Victoria Albina: Thyroid, thyroid and I make pretty much every, well, I make no one do nothing. My patients are adults. I lovingly invite my patients to do a stool test and sometimes, they grumble about it, but generally, they get it.
Dr. Kara Fitzgerald: Okay. Okay. Those are the two, a good thyroid panel and stool test.
Dr. Victoria Albina: Yes, very thorough.
Dr. Kara Fitzgerald: What are your numbers? Excuse me. What are the analytes you’re looking for on your thyroid panel?
Dr. Victoria Albina: TSH, T4, T3, free T3, free T4. This is where my little lisp comes out when I say free T3 and free T4, TPO and then I’ll just get TSI on new folks, mostly as a CYA.
Dr. Kara Fitzgerald: Okay. Okay. So a good standard panel, you can calculate ratios and kind of do what you need to do there. Okay. Then you’ll do a stool test.
Dr. Victoria Albina: Just see what comes up. If I’m allowed to pick a third, iron.
Dr. Kara Fitzgerald: Sure.
Dr. Victoria Albina: Because anemia’s exhausting, which is, I’m going to shunt you back to the coffee, rinse and repeat.
Dr. Kara Fitzgerald: Yes. You’re going to just assume HPA-axis is out of whack, I would imagine, in some folks, and then in others, you might evaluate?
Dr. Victoria Albina: Yeah, I would. I’m always conscientious of time and effort and money, so I’ll start with the CBC and the iron and the Vitamin D and the B12 MMA, folate, those things I can get through insurance really easily, work up the gut because there’s so much concurrent, like the concurrent IBS kind of SIBO, GERD situations, which makes sense, again, if we think about polyvagal and sympathetic enervation. Then if that’s not really getting us anywhere, that’s when I’ll bring in, yeah, the adrenal testing, sex hormone testing. I’ll also start ashwagandha, passionflower, the adaptogens.
Dr. Kara Fitzgerald: Again, I want to just remind folks that I had a really nice conversation with Victoria in October on GERD. There’s definitely a strong overlap here. I wanted to ask you about using CBD in this protocol. We were talking about it before and you just mentioned, yeah, CBD is also really good for GERD. I can’t remember if you mentioned it, though, in that conversation. I don’t know that you did.
Dr. Victoria Albina: I don’t know. I think your listeners will have to go back and-
Dr. Kara Fitzgerald: They have to go check in and they’ll listen.
Dr. Victoria Albina: … they’ll have to go, yeah.
Dr. Kara Fitzgerald: I should remember all of it. You’ve cast this wide net. You’re doing lifestyle interventions. I’m curious about you’re using CBD and how you actually stratify for who’s going to be someone who responds to using CBD. I also, when you answer this question, I want to hear about some of your overarching approach, just given that you’ve got this really, this unique background, so the anxiety patient in general and then stratifying for that CBD-appropriate person.
Dr. Victoria Albina: Sure. Anxiety in general, A number one, that amazing exam, B number two, labs. Look at nutrition because what’s going in is going to come out somehow, looking at other habits, so circadian rhythm, movement, stress, like how is stress being managed, always within the framework of we can’t get rid of stress. That’s not possible, but we can learn new skills to manage it and so that’s when I bring in the CBT and positive psychology and somatic life coaching work that I do and bring that counseling piece in.
This is something I get into a ton of detail about over on my podcast, if folks want to learn more about … We were talking about buffering and I do wish we had a whole hour to talk about that, but really looking at the ways people are thinking about their stress, understanding that about 20% of our lived experience on this planet is the result of a cognition. You have a thought, which creates a feeling in your body. Those molecules of emotion float around within you, creating that feeling state, that vibration. Then you take action based on that feeling and create a result in your life. If the thought is one about I need to control everything in my life or we’re doomed … A patient actually said that to me this morning, I feel like I need to control everything my kids do or we’re all going to get COVID and die, that extreme. Definitely not judging that, but just saying.
Dr. Kara Fitzgerald: Right. It’s terrifying.
Dr. Victoria Albina: Yeah. Yeah. New York’s an extra special place to be right now, for sure. Yeah, so really supporting patients and clients to really take a good look at their habitual thought patterns because your thoughts will keep you stuck in those same old feeling patterns. That’s how the monkey mind works and so I’ll bring in a lot of tips and tricks from Buddhism of mediation and mindfulness and becoming your own watcher, to see your own thoughts and how they’re creating those feelings.
One of the things I always talk about is how vital it is to give our patients a bridge, so in our GERD conversation, we were talking about how vital lifestyle is. I believe I said something similar to, I’ll paraphrase myself, it’s really hard to a downward dog if your mouth fills with acid.
Dr. Kara Fitzgerald: Right.
Dr. Victoria Albina: Right. Right, so yes, encourage your patient to do yoga, but who’s going to go to the yoga when you’re so anxious you can barely sit still?
Dr. Kara Fitzgerald: That’s right. Well, this patient that you just described, if she’s worried her kids are going to die, I mean, yeah, indeed, you’re not going to be moving into the bliss of yoga. It’s going to be virtually impossible. Yeah, that’s extremely good point.
Dr. Victoria Albina: Yeah, so that’s when I’ll bring the CBD in, so as a way to give that patient a bridge because it really … The beauty of it is that so little does so much. It has such a short half-life. It works so fast and poof, it’s gone.
Dr. Kara Fitzgerald: Okay. Okay. You would administer it, the form that you’re going to use is going to be contingent on do they need it immediately or-
Dr. Victoria Albina: Right. Yes. Yeah.
Dr. Kara Fitzgerald: I mean, so there’s a good arsenal of interventions. We’ve got theanine. You mentioned passionflower. There’s a lot of beautiful anxiety-
Dr. Victoria Albina: Yeah, Lavela.
Dr. Kara Fitzgerald: Lavela is brilliant, actually.
Dr. Victoria Albina: Phenomenal.
Dr. Kara Fitzgerald: That’s right. That’s right. What’s going to clue you to going to CBD as you’re starting?
Dr. Victoria Albina: My favorite, favorite patient to just jump right to CBD with is the anxiety and sleep, which is, as I was saying earlier, is often where this cycle starts, that people either can’t fall asleep or wake up in the middle of the night, wake up exhausted. They’re not going to take a B12 shot in the morning. They’re going to take an espresso shot and then boom, we’re restarting that cycle of caffeine all day, alcohol in the evening, not sleeping well, etc., so again, a bridge towards the lifestyle stuff.
CBD is amazing, particularly for folks who wake in the middle of the night, so there’s little else that works and less with evidence for those who wake and can’t get back to sleep. Dosing CBD in the middle of the night is super vital and it can sometimes be like a very, very, very small amount. I’ve seen phenomenal results, especially for those for whom this waking in the night is episodic, so two to three, sometimes four nights a week. It’s just so nice to say oh, yeah, I have something for that, and my patients respond really well to it.
Dr. Kara Fitzgerald: Sounds good. It seems to me right now, given the climate that we’re in and, I mean, the application, obviously, for this is probably most of our anxiety patients are going to benefit from it, maybe not forever, but for a period of time and, especially, in the post-COVID world. Incidentally, the statistic you and I were talking about, I think 70% of Americans are stressed out.
Dr. Victoria Albina: Yeah, jeepers.
Dr. Kara Fitzgerald: Yeah, as a result of the virus. Yeah, that was a survey that Washington Post just conducted recently.
Dr. Victoria Albina: Wow, 70%.
Dr. Kara Fitzgerald: 70%, yeah, and one of the things that I’ve seen and you and I were talking about my mom. Sorry, mom, I hope you don’t mind if you … She’ll probably listen to this, but also, our patients’ hypertension. I mean, it would be interesting to actually see the incidence of or the increase in hypertension.
Dr. Victoria Albina: Yeah, that would be really interesting.
Dr. Kara Fitzgerald: Okay. Yeah, go ahead.
Dr. Victoria Albina: Well, just it makes me think of another time I always choose CBD is when inflammation’s an issue.
Dr. Kara Fitzgerald: Okay. All right. Talk about why.
Dr. Victoria Albina: Yeah, so I think I describe it as if fish oil was fast acting, it would be this, like acute onset fish oils, so when you’re anxious and there’s also evidence of inflammation, like a diagnosed inflammatory condition, when weight’s an issue in any direction, joint pain not associated with specific overuse. GI symptoms, in general, for me are a good inflammatory clue. Then that feeling like your anxiety bubbles up to a boil, those patients who are like I just a little anxious, then I’m a little more anxious. Then I just explode and yell at the dog or just lose it.
I’ll also, if anti-inflammatories are generally helpful for that patient, like if they feel better with their fish oil, their curcumin, and they’re anxious either situationally, like COVID, or a general New Yorker, that’s when I’ll choose to add the CBD.
Dr. Kara Fitzgerald: Perfect. Yeah, it makes total sense. I mean, it does enter the endocannabinoid system. I mean, it’s fatty acid at its foundation. Awesome. That’s awesome. That’s a really, really helpful pearl. Then you might, would you think then in the majority of our patients are clearly not eating enough good quality fatty fish. Most of us are deficient in our omega-3s unless we’re actually taking them supplementally, and so would that be another and plus, they’ve got this anxiety picture that we’re kind of fleshing out that would kind of be an obvious clue, too, that this might be appropriate. Okay.
Dr. Victoria Albina: For sure. Yeah.
Dr. Kara Fitzgerald: Okay.
Dr. Victoria Albina: That’s where that nutrition evaluation upfront really comes in.
Dr. Kara Fitzgerald: What about how are you thinking about dosing this? I want to know about so again, post-COVID era, lots of pharmaceuticals are being prescribed, even here, when we talk about it in our clinic, so how are you dosing? What are you concerned about with interactions with other botanicals, other pharmaceuticals? Is CBD safe to use in what context, etc., so talk about that.
Dr. Victoria Albina: Yeah, so CBD has a lot of evidence for being quite safe. I mean, the science is emerging, but overall, I’ll say and I trust plants. Having said that, there are plants we need to take care with. Those are some of my favorites, as well, like the plant anthriscus formula or poke root or datura. I mean, these are poison, but they’re amazing plants that are so useful in the hands of a skilled herbalist, but also not without risk.
Dr. Kara Fitzgerald: Yes.
Dr. Victoria Albina: Luckily, the story is really different here. There’s a lot of safety around all types of cannabis and hemp products and, therefore, CBD. I think it really comes down to, I mean, goodness, like anything else in life, it comes down to quality and just making sure that you are using and you’re recommending a really good quality product made by folks with a lot of integrity, really good scientists behind it, and folks who are really, really dedicated to, yeah, just quality and knowing what’s in their product and being really careful with it so that you know that you’re getting what you’re supposed to be getting from the label.
I prefer liquid for many, many reasons. It lends itself to the faster acting concept, so when I want a quick effect, I go with drops. Who knows how much of it’s placebo, but I hear from patients overall that oh, yeah, the drops work a lot better, so I go with it. I will often start, well, so for the average person, the European CBD regulating agency that regulates hemp and hemp products has said that 70 milligrams a day is safe. I often start much lower than that and have my patients titrate. I do that for several reasons. One, when someone’s just walking in the door really anxious, I don’t know what their phase one, phase two, I don’t know what their liver metabolism looks like until I get to know them and etc., so not knowing what that looks like, start low, go slow is a great way to start.
I also really do it for the energetics of it and for my patient, knowing that I trust them as an adult to know what feels like what in their body. Our functional medicine patients, we are often the clinician of last resort. They’ve been to a thousand PCPs and GIs. They’ve been all over town and they have maybe not gotten either the science or the love and care they need and so when they walk in our door, every single thing we recommend, every word we say can be emotionally restorative experience for them to build trust in us as clinicians and, more importantly, in themselves and their capacity to heal and to know what they need. I’ll say, “Hey, babe, start with two drops.” That’s not going to do much, but I let the patient know if that’s not enough, take another two. You know your body. Listen to your body and work up.
Dr. Kara Fitzgerald: Given the fact that the onset is rapid and the half-life is pretty quick, are you so multiple times through the day or how do you dose?
Dr. Victoria Albina: Yeah, so it depends on the patient, how their anxiety presents and the story, so pre-COVID or post-COVID. A lot of my patients say things like, “Yeah, I get really anxious before I get on the subway.” Or for folks who drive, “Yeah, before I get in that traffic on 95, I can really feel it.” Or, “I have flight anxiety,” or sleep anxiety, so I’ll have them dose it 10, 15 minutes before they head out to that anxiety-producing stimulus. Board meetings made me anxious. Great. Set an alarm 10 minutes before to take two drops, that sort of thing. For my folks who wake in the middle of the night, I’ll have them both take a very small dose before bed, like last thing as they’re getting in bed. Then I’ll have them actually leave the CBD bottle open and I’ll have them fill the dropper because I want as little cognition to happen and so it’s all set. Dose is there, drop it in their mouth, and I’ll have them sort of have a mantra ready. My body knows how to sleep. The CBD reminds it.
Dr. Kara Fitzgerald: Wow. That’s really lovely.
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: I like it.
Dr. Victoria Albina: Good.
Dr. Kara Fitzgerald: What else do I want to ask you about this? In general, I mean, it sounds like you’re really microdosing it, so it’s going to be incredibly safe in this scenario.
Dr. Victoria Albina: Yeah. Yeah, so upper tolerable limits is an interesting thing. I think we, as a very thoughtful, thorough community of clinicians can take patients to higher doses with appropriate control and management, just making sure that we are checking in with folks really frequently, maybe having them touch base with other staff in our offices really frequently while they’re in that titrating and ramping up process. I think safety is possible at much higher doses. You just need to be a loving, attentive nerd about it, you know?
Dr. Kara Fitzgerald: Okay. Okay. What might indicate it’s too much.
Dr. Victoria Albina: Ooh, grogginess.
Dr. Kara Fitzgerald: Okay.
Dr. Victoria Albina: Yeah, hangover kind of feeling. Then there’s really interesting things, so when my gut was a mess, I must’ve had some leaky brain because I remember this one time I took probably about two dropperfuls of CBD. I’m on the smaller side of mammals, of human mammals, that is, pretty large for a mouse. I, having never done cocaine, but having been in the ER when people have come in, ooh, girl, I was like coked out.
Dr. Kara Fitzgerald: Interesting.
Dr. Victoria Albina: Yeah. I’m very, very, very … It’s exceedingly rare that that happens.
Dr. Kara Fitzgerald: A paradoxical reaction.
Dr. Victoria Albina: Yeah, exactly, and so I was like oh, my gosh, put the CBD away, pumped the glutamine, did all that gut healing work. Now I take it every day for the anti-inflammatory uses. I take it at night. I don’t really before COVID need help sleeping, but these days, I figure why not?
Dr. Kara Fitzgerald: If somebody’s titrating way up, obviously, we’re going to be careful about the other supplements and pharmaceuticals they might be on, but would you agree, but then down at your microdose levels it’s safe, less concerns required?
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: Okay.
Dr. Victoria Albina: Even as you get higher up, it’s not, I mean, we can look at cytochrome P450, but it’s not really … I don’t know. I don’t see it as big an issue as other plants, like a St. John’s wort we’re going to be incredibly careful about interactions, so yes, CBD can inhibit 3A4. It can have an effect on P450, but it’s not one of the ones I really am sort of extra, extra careful about.
Dr. Kara Fitzgerald: Good.
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: Got it. Okay. Good. I mean, any issue with adherence or is there any resistance? I find this probably not … People are, probably, by and large pretty excited about trying it.
Dr. Victoria Albina: Yeah. Well, these days, but back in the day, I definitely got a pushback, and I say this with love, from the Boomer generation of isn’t that the weed? I’m a nerd’s nerd and so I explained the difference between the plant families and no, it won’t get you high and etc. Then once folks try it, it just, the payoff of it is just so phenomenal that no … Well, you know what? Actually, one thing that really does limit adherence is the taste. Yeah, so a lot of them, and I don’t know if you’ve tried any of them that taste just disgusting. Some of them will have a really strong cannabis flavor and will mask it with chemicals or flavoring. It’s really it’s in the distillation process that you get that really clean taste and so that’s actually, it’s one way to….
Dr. Kara Fitzgerald: Know a bad product.
Dr. Victoria Albina: Yeah, exactly. Yeah. Yeah. Yeah. Other thing to think about in terms of high potency, well, you always want a high potency supplement because then with that, you’re taking less of the oil and so you skip the side effects like looser stool, which can happen sometimes secondary to the carrier oil used.
Dr. Kara Fitzgerald: Ah, okay.
Dr. Victoria Albina: That could just be olive oil. We love our olive oil, but it could be oils that we want to skip in general like peanut or soy or even canola.
Dr. Kara Fitzgerald: So, read the label.
Dr. Victoria Albina: Yes.
Dr. Kara Fitzgerald: Ideally, you’re looking for, well, you don’t want canola. You don’t want peanut. Yeah, so if we use a good, reputable brand, a company that we’re familiar with that we trust, that we vetted, that we’re using clinically, they’ve got to be using a clean oil that we have no issue with.
Dr. Victoria Albina: Exactly. Exactly.
Dr. Kara Fitzgerald: Okay. Okay.
Dr. Victoria Albina: Yeah. Yeah, and a high potency product means you can take fewer drops.
Dr. Kara Fitzgerald: Yeah. Okay. All right. I got it. What would that be, like how would we determine? I’m just curious about like looking at the label.
Dr. Victoria Albina: Oh, yes, so usually, it will actually say high potency on it. Those are the words that I would look for.
Dr. Kara Fitzgerald: Okay. Okay. All right. From a brand that we like.
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: Now for me, I actually kind of like the taste. It’s sort of nutty, I think, if it’s a good quality product.
Dr. Victoria Albina: Yup.
Dr. Kara Fitzgerald: I mean, there is still kind of almost a tannic taste to it, but I don’t know. It’s like it’s very woodsy.
Dr. Victoria Albina: Yes. Yeah.
Dr. Kara Fitzgerald: Woodsy and nutty. I actually kind of like it for that reason.
Dr. Victoria Albina: That’s all the terpenes.
Dr. Kara Fitzgerald: Yeah. Right. Right. For sure. Then okay, so anything sort of deviating from that and anything that folks are getting OTC or at the gas station..
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: All right. Yeah. It’s likely going to be crap. I know when I was at the IHS in New York City in February, there were these massive Times Square billboards advertising CBD for everything. In fact, there was a woman in the middle of a boxing ring with her CBD product.
Dr. Victoria Albina: That’s bananas.
Dr. Kara Fitzgerald: Yeah, it was just such a random, odd ad, but it was the heart of CBD in Times Square was, yeah, this past winter.
Dr. Victoria Albina: That’s strange.
Dr. Kara Fitzgerald: Really strange.
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: Really strange. All right. What else do I want to talk about? You’re not having any issue with adherence or are you?
Dr. Victoria Albina: Oh, goodness, no, no. Once we get the good quality product and we get our dosing right, people just love it and order it by the case and really, really stick with it.
Dr. Kara Fitzgerald: Okay. Are you using capsules or are you always going with a liquid?
Dr. Victoria Albina: Depends on the patient and what they would be more likely to actually take, but yes, I like the liquid or oil when I want that quick effect. I think the driving story about why we use that sublingual is really compelling, but there’s some people who just won’t take anything in the liquid, so that’s when I’ll go for a pill.
Dr. Kara Fitzgerald: Okay. Okay.
Dr. Victoria Albina: Something just popped into my mind. Other words that you want on the label, you want broad spectrum, not full spectrum.
Dr. Kara Fitzgerald: Oh, okay, so distinguish that.
Dr. Victoria Albina: It’s about so you don’t want an isolate. You want the entourage benefits, so the other components of the CBD that are like those terpenes we were just talking about that help the CBD to work, that bring a lot of synergy into the function of the CBD and so you’re going to be really getting that effect in a broad spectrum. Those are the label words that are allowed.
Dr. Kara Fitzgerald: What would you see if it said full spectrum? Would there be THC or something present in it? I mean, what would be the difference?
Dr. Victoria Albina: Well, I mean, one of the things that’s important and why we always use a brand we really trust is you never know when there’s THC in it, if you’re not using a really reputable brand. The full spectrum’s just not going to have that full sort of breadth of entourage benefits from the terpenes and the other chemicals that are naturally occurring in the CBD.
Dr. Kara Fitzgerald: Okay. Okay, so high potency, broad spectrum, company that we really trust.
Dr. Victoria Albina: Absolutely.
Dr. Kara Fitzgerald: Liquid for quicker onset, more control over dosing, gel or caps for people who might not be willing to take the liquid.
Dr. Victoria Albina: Yeah, exactly.
Dr. Kara Fitzgerald: Okay. Got it. Got. It. Now, what, if you needed to, somebody’s very anxious and you’re in that bridge period, you might be thinking about a pharmaceutical, but you don’t really want to go there or maybe they don’t want it. I mean, would you use CBD concurrently with any other botanical anxiolytic, like you mentioned theanine earlier. What do you think?
Dr. Victoria Albina: Yeah. I love Camellia sinensis. I’d always go with a good L-theanine, 200 milligrams, PO, PRN, or TID depending on the New Yorker. I love Lavela, obsessed.
Dr. Kara Fitzgerald: Yeah, that’s right. Yeah.
Dr. Victoria Albina: You’re going to laugh, but I personally enjoy the lavender burps, I find them hilarious. I tell my patients oh, when you get the lavender burp, that’s how you know it’s working.
Dr. Kara Fitzgerald: Yes, that’s right. That was a study that came out-
Dr. Victoria Albina: Exactly.
Dr. Kara Fitzgerald: … that talked about the actual odor or the little waft of lavender hit that you get with …
Dr. Victoria Albina: Right.
Dr. Kara Fitzgerald: Yeah.
Dr. Victoria Albina: And since it becomes because we take these supplements and you don’t always feel it or if your trauma story, your stress story is such an important part of your psyche and your way of coping, you might not feel the anxiolytic effect, even if it’s happening physiologically. Then something like the CBD oil having a flavor to it or that lavender burp, it can help to shift the story, so I love that combination.
Dr. Kara Fitzgerald: Okay, perfect. Yeah, that’s great. That’s a really good idea. Incidentally, I have a nice, nice blog written on Lavela.
Dr. Victoria Albina: All your blogs are nice.
Dr. Kara Fitzgerald: Well, I can’t claim authorship, actually, to many of the blogs, but this particular one I wasn’t the author of, although I did review it, and the science, the tables, just all of the human clinical trials that have been conducted on Lavela are very impressive comparing it head to head with Valium and, actually, I think, SSRIs, as well. I mean, just good, good research science.
Dr. Victoria Albina: Yeah, it’s those calcium ion channels, which, let me bring us full circle, is what happens in breathwork.
Dr. Kara Fitzgerald: Oh, interesting.
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: Lavela you need to take a little bit longer. It’s not as quick acting as CBD.
Dr. Victoria Albina: Yes, physiologically, yes. Yes, it’s going to take longer to kick in. I find that so much of this, particularly the mental health piece of all of the functional work we do is so story dependent and so if someone’s like oh, yeah, yeah, the Lavela. I’ve had patients tell me, “Oh, I take Lavela and pretty much before I’ve swallowed it, I feel less anxious.”
Dr. Kara Fitzgerald: Ah, interesting.
Dr. Victoria Albina: I say, “Oh, great. Yeah, no, that’s great.”
Dr. Kara Fitzgerald: Now, coming going back to the breathwork, so in our final minutes, I mean, certainly, things have quieted down in some ways, so even in New York, the volume there has been turned way down, although then, everybody’s tucked away in their apartments and they’re homeschooling their kids and they’re working from home. It’s this insanity. I mean, that’s what’s going on here in Connecticut. We’re sort of a New York suburb and so we’re seeing a lot of that, as well. Parents are losing it and probably a lot is, as usual, falling on moms, so you’re using CBD. You can sort of dose it. You can micro dose it throughout the day or titrate up as you’ve been talking about, maybe a little theanine, maybe some Lavela, maybe some chamomile.
Dr. Victoria Albina: Sure.
Dr. Kara Fitzgerald: What about can you, in our final minutes, maybe just being a breathwork guru, are you also prescribing any quick breath interventions you might do or what do you think about-
Dr. Victoria Albina: Oh, sure.
Dr. Kara Fitzgerald: Yeah, can you just share one of those?
Dr. Victoria Albina: Yeah, so I love the 4-7-8 breathing or whatever sort of ratio folks use, so we understand that when we fill our belly and have the sensation of the belly being full of breath … I mean, obviously, it’s not physiologically filling your belly with air, but that sensation, like a big belly breath and a long, slow exhale as we’re breathing out more CO2, it starts to get us into that ventral vagal, that safe and secure part of the autonomic nervous system. Any sort of breathing that has that long whew is really going to help. I remember my grandmother constantly sighing. She has four kids and yeah, it’s a really simple way to help.
The 4-7-8 is to breathe in for a count of four, hold for a count of seven, out for a count of eight. You can do that through your mouth. I call that nose breathing the surgical mask we always wear, so I’ve been encouraging folks to do these exercises through your nose, as well, which is a little more challenging. What happens in anxiety in part is that the brain starts to hyper focus and get into hypervigilance, which takes that sympathetic state your patient may be in and ramps it up and up and up and so any simple breathing exercise that gives the brain a distraction, like a healthy, supportive one versus a buffering one, something to focus on, is going to help bring them back into ventral vagal with themselves and to go more towards oxytocin, rather than dopamine.
Dr. Kara Fitzgerald: Okay. And so dopamine is going to kind of perpetuate maybe needing to act out in the buffering realm?
Dr. Victoria Albina: Yeah, and I think it’s because the half-life is so, so, so short. You eat the chips, you want more chips. You eat the ice cream, you want more ice cream. You yell at someone, you need to yell again because you need another hit and another hit and another hit when it’s the thing you’re leaning on to distract your brain from your hypervigilant thoughts.
Dr. Kara Fitzgerald: Right. Right, but breathing, sort of moving towards oxytocin.
Dr. Victoria Albina: Yeah, that long, slow breathing out all that CO2, temporarily heading towards alkalizing the blood, of course it’s going to buffer quickly. That’s what blood does, but heading towards that for even just a second gives you, well, breathing space to calm yourself and to find that center, that grounding within yourself. I have a free breathwork offering on my website. Is it okay if I share that now?
Dr. Kara Fitzgerald: Yeah. Yeah, absolutely.
Dr. Victoria Albina: If you go to victoriaalbina.com/breathworkgift, G-I-F-T, it’s a present, it’s a 13-minute track that I made that comes with a little video that shows you how to do the pranayama three part journey breathwork that I teach, which is this much longer practice that your staff really enjoyed the other day. I was so glad about that. I also have an online course, so you can find that on my website, as well. It’s a four-week online course for folks to do breathwork with me.
Dr. Kara Fitzgerald: Wow. Good.
Dr. Victoria Albina: It’s really fun.
Dr. Kara Fitzgerald: Yeah, now is the time. I’m just conscious of my breathing right now and I’m feeling really good as we come to a close.
Dr. Victoria Albina: Oh, I’m so glad.
Dr. Kara Fitzgerald: I appreciate this. I think we’ve gotten some good, just some nice tools for addressing the anxiety epidemic that we’re facing even more these days. Victoria, thank you so much for being a good friend of our clinic and our content, our educational content. I know you’ll be back again and, hopefully, not in the too distant future our paths will actually cross physically.
Dr. Victoria Albina: I would love that. I think that would be a blast.
Dr. Kara Fitzgerald: Yeah, it would be.
Dr. Victoria Albina: Yeah.
Dr. Kara Fitzgerald: All right. Thanks for joining me tonight.
Dr. Victoria Albina: Thank you. Yeah, be well.