Meet and Greet with Dr. Diana Martins-Welch

By Nina Chhabra on April 10, 2019

Dr. Martins-Welch is a board-certified Palliative Medicine physician who works in a large, academic cancer center. She focuses on global symptom management for the patient with advanced illness, working collaboratively with various specialists to provide patients the most comprehensive care focused on enhancement of quality of life. Dr. Martins-Welch has a particular interest in studying the effects of early palliative care for cancer patients and medical cannabis for management of symptoms.

Nina:What patients could find use from incorporating hemp based CBD products?
Dr. Martins-Welch: There are many patients likely to benefit from hemp-based CBD products. Patients with chronic pain can see benefit. Those with inflammatory conditions, such as fibromyalgia and rheumatoid arthritis could also benefit. Also patients suffering from anxiety.

Nina:What is your general rule of thumb for starting doses?
Dr. Martins-Welch: Start low and go slow. Generally I recommend starting at a low dose of CBD, which is around 5 milligrams per dose. From there, increase the dose slowly. The method of administration impacts the frequency by which CBD can be administered. For example, sublingual tinctures can be administered 3 to 4 times daily. Capsules are usually taken 1- 2 times daily.

Nina: Are there any patients you would not recommend to use hemp based CBD products?
Dr. Martins-Welch: There are not any strict contraindications to using a hemp-based CBD product. But, one must know that, like many medications, there are potential drug-drug interactions. CBD can affect the breakdown of certain other drugs. It is best to speak with a knowledgeable clinician and/or pharmacist before starting treatment.

Nina: When should a patient consider using medical marijuana (cannabis) as treatment?
Dr. Martins-Welch: Hemp does not contain any significant THC while cannabis does. THC offers therapeutic benefits of its own but is not legal. States each have their own laws on the use of medical cannabis.

Nina: Are there any side effects expected with use?
Dr. Martins-Welch: CBD carries a low side effect profile and in general is well tolerated. Potential side effects include lightheadedness, dry mouth, drowsiness, while others might feel energized.

Nina: How should patients take the oral products?
Dr. Martins-Welch: It is best to take these oral products with some fat.  The base for most of these products is medium chain triglyceride oil, which is fatty acid based. The product will be better absorbed if taken with fat before taking a dose (avocado, yogurt, cheese, etc). It is best to avoid anything acidic (coffee, juice, tea) for at least 30 minutes before and after taking a dose.

Nina:Can a patient use oral and topical products simultaneously?
Dr. Martins-Welch: Yes they can, there is no contraindication to doing so.

Nina: Any drug interactions to be concerned about?
Dr. Martins-Welch: I do not see any major drug interactions, especially at low doses. I tell patients to make their practitioner aware before starting anything new. Any patients with a history of seizures should use with caution. It can change the levels of seizure medications. Any patient who has liver impairment should consult with a practitioner. These products down by the liver. These patients may need further testing of the liver before use.

If you have any other questions regarding the use of hemp derived CBD products, or the use of medical cannabis, send an email to naturalmeds@vivohealthpharmacy.com