What The Cup !? A Podcast
Here you'll find podcast episodes and other resources all about human resiliency, endurance sports, strength and exercise training, Myofascial Decompression, the latest fascial science, and other MSK concepts from your friends at Cup Therapy. Listen to interviews with Dr. Christopher DaPrato and some of the best athletes, clinicians, and researchers in their fields. Thanks for rating and subscribing!
What The Cup !? A Podcast
Ep. 27 - Joe LaVacca PT, DPT: The Science of CBD and Ethical Implementation @JOINFRINGE
Today we are interviewing Joe LaVacca! He is a physical therapist and educator, and is also a strong advocate for the safe and effective use of CBD as it applies to the fitness and rehab world. He talks to Dr. DaPrato about how he got started in this space, the science of CBD, and his role at Fringe, a CBD company.
Find Joe at: @strengthinmotionpt and @joinfringe
I remember when I told my mom about me joining fringe and becoming the educator for them. And she was like, I can't believe you're getting into drugs. She's like, I can't, I can't believe it. Like, what are you going to be like high all the time now?
Arpita:Hey, everyone. Welcome to episode 27. I'm Arpita. I'm a physical therapist and science communicator, and I just joined the cup therapy team as a producer. I'm so excited to be on board. Today, we're excited to share an interview with Joe Lavaca. He's a physical therapist and educator. And there's also a strong advocate for the safe and effective use of CBT as it applies to the fitness and rehab world. Join us as he discusses how he got started in this space the science of cbd and his role at fringe a cbd company
Chris:All right. We are here episode 27. It is flying by and I'm with a really cool guy. This is Joe deBaca. Joe. Tell us where you're from. Tell us your pronouns, tell us what you do and what's going on.
Joe:Yeah. Thank you, Chris. I really appreciate that. Having interacted a little bit on social media. It's nice actually put voice to a face, um, which I think is a little bit harder to do these days. I am a PT out here in New York city. This is where I was born and raised. I, uh, currently live in long island. I have a eight year old daughter. A fiance that lives in Colorado. It's probably a podcast chat for another day. And I've actually been on my own in my clinic in Manhattan since 2018. So that has been quite an adventure navigating through a pandemic when you were just sort of getting on your feet and sort of close again, and then to feel like you're just getting on your feet to close again and, it's uh. Around and around we go, but I hope that the light is at the end of the tunnel
Chris:Don't we all, you know, So, um, we'll definitely talk about how you supplement maybe some of the other aspects of patient care and how to be a creative entrepreneur in the PT field. So our listeners are ATS and chiros and acupuncturist and massage therapists, but I think from an PT perspective, We don't get paid very well at all. And that's really understood. Well, I think ATS get paid even worse than I, I feel so terrible for my compadres out there. hopefully we're all getting more value as time goes on and we, we show what we can do in and how we can do that. Um, and you have this great kind of perspective and your business is called strength in motion PT, where you really collaborate pushing the strength and conditioning aspects with the brain as the central point of it. All right. Tell us how your philosophy has really developed into its current state. And then where did, where did all that come from for you?
Joe:Yeah, absolutely. Um, so. It started really with one patient that I was rehabbing from an ACL reconstruction, not too long ago. Oh, I don't know. It feels like not too long ago, but it was five, five years ago now. Right. Um, back then, I was very adamant about, you know, following the protocol to a T building a relationship with the doctors, because like you mentioned in New York, There's a dime a dozen, there's a PT on every single corner. So how are you going to separate yourself? And for me, I always thought, like I got to separate myself with doctors. That's, who's going to send me patients. That's where I'm going to make the most money. That's where, you know, I'm going to help grow the business I was working before. And at that time I was very interested in like doing, you know, like what exercise was the best. Um, it was a little bit less of assessment. Get to know you because we already knew what was wrong with you. And, uh, this particular client, um, was very challenging for me in the beginning. She would be so anxious and so apprehensive that she would cry anytime I would try to touch her. So her boyfriend would come in through all of her sessions, you know, they had this wonderful support system and I always appreciated that. I was like, wow, I wish all my patients, you know, had something like this. So time goes on, she's getting a little bit better. Soon enough, she's back to doing her sports we all keep in touch. They actually invite me out for a drink. And I said, why not? We'll have a beer together, all three of us. And at that time they gave me a card and they said, we got you a gift. And they were like, well, I don't know. It's not money or anything. It's a, it's a special gift. We've never given this gift to someone. And, um, yeah, in, in the card was just her story and her story involved, a lot of sexual abuse, uh, trauma growing up as a child. And it hit me that this was the reason why it was so difficult to make a connection with her. And in the card she said, but you never stopped trying. She was like, you always made me feel safe and comfortable. You always made, my boyfriend are part of our treatments and, and I just like, wow, that hit me like a ton of bricks. And that's what really started me down this path of trying to be a better communicator. A better educator. So yeah, so that really sparked my interest in developing a better presence with the person that I was working with, um, getting to know them and what their lives were like. So then, you know, to pull back and try to bring this girl though, Hey, you know what I need you to understand. What's happening in your life. I need you to understand that stress is stress and your body doesn't really care if it's good or bad, but how much of it is accumulating? And I think that's, what's probably even pushed me further down the education line. That's what makes me excited about, um, Working for fringe now. So, and then who knows what else? That's going to lead to more conversations like this with people like you.
Chris:That's great. Now you touched on so many great things there. I think to start with, when you get three to five years out and further, you start to realize that those other things are kind of in your, in your pocket. You don't have to stress about looking so intently at the biomechanics because you now kind of own that material pretty well. You can pick up when things are off and you don't have to use so much of your cortex and so much of your processing to see patterns because your patterns or, you know, kind of in you and you have it. So you have the awareness to step back and say, what else is going on? And generally I find also it leads to. Uh, personal story, right? Who is that person? What are they struggling with? Why are they like, they are like, what happened to you?
Joe:Totally. Totally.
Chris:Well, especially as we start to see the chink in the armor of what we thought was the most important stuff, and I think you really bring up the important piece of mental health and mental kind of clarity of where they're at, not just for their physical body, but for their mental. So this is a great segue for us to jump into. How has the world of cannabis and CBD this company, fringe worked its way into this, like tell us that story. Where did that come up?
Joe:Yeah. So the people that I work with now at fringe were sort of colleagues of mine for when we were working at RockTape, and it's been really intriguing because the things that we ended up focusing on first were just, what are the problems that were a lot of us are facing together? It was issues with pain, right? That's been our oldest known medical condition We've been seeking help with that since the beginning of time. And then there seems to be this common thread of sleeping disorders. There seems to be this common thread of anxiety and depression. And it was interesting because I used to always just go along with people like, oh yeah, I can't sleep. Neither can the two o'clock guy, it sucks. Right. You must be so tired right now, you know? And it's sort of like, you don't acknowledge the experience of the person when they're opening up to you and giving them an invitation to be like, Hey, this might be something that I need help with rather than like, well, you're just like everybody else. Some of the ways our forefathers civilizations across time started to manage a lot of these issues that we're seeing today. It was through things like cannabis, things that came from the earth that were natural. They were involved in community. They're involved in religious rituals. There was never just this idea of you go to a doctor and then you go home by yourself. And now you have your exercise program, you have to follow. This is not how we used to care for each other. So when we started to really look at this, we were like, wow, there are, there are threads here that are popping up. You know, like we always relied on community, on touch, on movement, on breathing on meditation, on light, on being in nature. And then as we started to put all these things down on the list, we sort of identified them as fringe factors. So that's where we came into the market as a CBD company, to be able to offer a product to habit stack. With, with all these other factors that we wanted to continually grow on. Expand upon, but this idea of the endocannabinoid system, and then that started taking us down this road wall. Well, what is the CBD? What is the THC, what does the kind of, what, where is this interacting within our body? And then you start to realize that the endocannabinoid system has been there all along, but it's not in our textbooks at school.
Arpita:Hey, RPData again. At this part of the conversation, jokes started dropping some terminology about CBD and the endocannabinoid system that I wasn't too familiar with. So just to back up a bit, most of us know that the cannabis plant is associated with two main compounds, CBD or cannabidiol and THC. Or Tetra, hydro cannabidiol. CBD is the bit that we're starting to learn about more for anxiety, pain cognition. Not the bit that you're probably taking that Saturday night. Joe also talks about the endocannabinoid system. So most of us at this point have heard the sympathetic and parasympathetic nervous systems, which help us self-regulate our needs. In addition to these, we have another system. Called the endocannabinoid system, which works on processes like learning and memory, emotional processing, sleep, temperature control, pain control, inflammatory responses, and eat.
Chris:Yeah, just my limited knowledge of the, of cannaboid cannaboid system. That's a hard one to spit out every time. But my limited knowledge of that has really kind of opened my eyes to like this integrates with all the different subsystems of your like you said, homeostasis of your ability to kind of chill and rest and digest. So. Our issues in today's society are already so stacked on stress, anxiety, sympathetic, this, that, and the other. And we're trying constantly to teach people, breathing patterns or parasympathetic activity, or, you know, different things like that. And I think post COVID is going to be this new awakening. Well, I'm stressed again. I'm back to this area of like doing too much again and I'm starting to feel like I want to go back to, early COVID times when I could chill a little bit. Right. And how can I do that? So tell us what are some of the. Processes or what are some of the mechanics behind cannabis and how it helps those bridges be being built in through?
Joe:Yeah, absolutely. So I think the first question is always like, well, where is the endocannabinoid system? I see where my muscle skeletal tissue is. I see where my pulmonary system. The endocannabinoid system is basically pervasive throughout your entire body. So wherever we sort of are looking on now and discovering tissues, we're seeing CB one and we're seeing CB two receptors. From an, a very sort of easy standpoint, they're CB one and CB two receptors all over our body. However, CB one has much more density in the central nervous system. And CB two has a lot more density in the peripheral system. So when we start to look at, all these receptors, well, what things do we need? That are going to bind with these receptors and we do make our own endo cannabinoids, right? So our primary endocannabinoid are enendomide and two a G.
Arpita:Quick note here. Nanda mind and to AIG are similar compounds to THC and CBD. They bind to the same receptors but they're produced through the body's endocannabinoid system pretty cool.
Joe:So these are made as we need them. And they're literally responsible for cell to cell communication, extracellular matrix health, tissue restoration, how we interpret and maybe feel pain, managing inflammatory cycles through cytokine activity and messaging throughout our body. So now when I, and I think the other thing that's worth noting is the CBD and cannabis are a little bit different. So cannabis, there is a component of THC and CBD, right? THC directly binds to CB one receptors. This is why typically when we have THC mixtures or THC components. Oh, we can feel a little euphoric. Um, there's maybe some other unwanted effects for most people But for the most part, a lot of my clients don't want to feel high. So when we offer them CBD, Or a main CBD component, like a fringe powder they shouldn't be having any psychoactive effects. So they'll be able to get the benefit of the phyto cannabinoid, through, the CBD. Which acts in a more indirect way on CB one receptors. But what we're also seeing is how it interacts in a retrograde manner across a lot of these nervous system junctions or these nerve impulses. So if you can picture a nerve impulse and it's sort of going out of control and it's releasing all these neurotransmitters at a very high rate. Maybe we're responding to stress. So we're releasing cortisol and glutamate but now the stress has gone. So we should be able to start to ramp down. Well, we don't have a healthy endocannabinoid system, those signals are going to keep firing out of control. So CBD essentially will come in and act as a retro grade signal across the space to help enandamide and 2-AG do its job a little bit better.
Arpita:Joe explained that CBD is actually getting more and more popular as the stigma around cannabis slowly lifts.
Joe:More and more people in the U S are taking it are seeking cannabis and CBD products. I think 33% of the people who tried it is for pain, which again makes total sense because that's our oldest problem. So that's going to be the first one when people are scared of taking opioids and scared of taking an NSAID. There's a need to function. And it's hard to do that if you're basically on a depressant or a stimulant or something along those lines. When we take CBD where we're extending the half-life of anandamide and two ag a little bit longer, so they can do their job.
Arpita:I know we said there was no stigma, but really. Really
Joe:I remember when I told my mom about me joining fringe and becoming the educator for them. And she was like, I can't believe you're getting into drugs. She's like, I can't, I can't believe it. Like, what are you going to be like high all the time now? And I'm like, Um, no, that's not what it is. Like. I think you're thinking of cannabis and marijuana and I was like this isn't it there's actually like a lot of medicinal value here. I talked to her about pain. I talk to her about stress and this and that. And of course being a good mom, you know, she's gonna, she's going to try it. And now she has it every night before she goes to sleep. They sit down and she's like I've never been sleeping better. So typically, I'm trying to find, people who would maybe fit more into a central sensitization bucket initially.
Arpita:Joe uses this term, central sensitization. Which is used to describe chronic pain from a neurological standpoint. Essentially, if you're experiencing pain. Your nervous system is in high alert. As you tried to protect yourself from harm. But if the painful stimulus continues for a long time, It can put your body and it almost perpetual state of fight or flight
Joe:The reason why I find these people maybe with more centrally driven, Is because of the effect that, some qualitative studies have had on not actually reducing a ton of pain with people, but actually giving them a better experience about it so that they were still able to function. So I'll tell people that, you know, when you've had pain for such a long period of time, to me that almost becomes your body's new homeostasis, like that is the new balance that it's seeking. So every time you try to fight something or attack your pain, In some ways, I think like flares are your body's way of like, no, like this is, this is what we know. This is safe. Like, this is how we are protecting ourselves. This is the signal that we are most familiar with. So when I see people who might be dealing with some central sensitization of such a sensitivity issues, I'll tell them, look pain right now is creating fear, anxiety. That's typically not what we would think about with pain because pain is protective. So somewhere along the lines, Your body has switched the message.
Chris:I can't really like you can't prescribe it anyways. As a PT, we have some legal responsibilities and we have to frame it. So, so talk about what that does look like. Like how do you shape that conversation? And make it seem, you know, not like you're prescribing something, but you're recommending are what I would do if it was me.
Joe:This product, the CBD, or the cannabis products may actually help you process this feeling better, feel more comfortable with it, where even if you have the same four or five out of 10 pain, you're not going to be anxious about it. And instead you'll be able to start to reframe it as a, protective response. Something that you're trying to learn from, not something that's trying to hold you back from being healthy. I'll bring up that study of quality of life with clients who've tried it. I usually will bring up that, you know, most people in the U S have had some success dealing with pain. And then I sort of just go right into the safety profile where. If this was something that you wanted to try, we know it's safe. There's never been an overdose it's non-addictive. And then I usually will sort of say, well, and then this is how I have incorporated into my life. I use it at night. And then once we got his sleep cycle sort of normalized, well, then this pain cycle got a lot better. And then there's a big connection or that I'm trying to read about it a little bit more between this idea of pain and sleep. Maybe it's the pain disrupting your sleep. And then now we go chicken and egg again, all over the place. But you know, we know that there's a big thing. So if there's a connection between how you're feeling and your sleep, this should start to help push us in the right direction. Along with your healthy lifestyle and your exercise program, and you calling your mom every Wednesday to see how she's doing.
Arpita:For any of us who may have engaged in some recreational activities. There's always the question. How much do I take? Chris asked joe this was an issue in CPD.
Joe:Our motto is always start low and go slow. When you read these studies, some people are taking four milligrams, five milligrams. Some people are taking 300. Now, and while I think that, the importance of what research will come out, over the next five years or so is more proper. Like, okay, you should be taking two milligrams per, you know, whatever, uh, body weight, just like your protein recommendations to people or carbohydrate recommendations for people. And we're just not there yet with it. And what we also know is that when people are taking oils, versus inhalation versus a powder versus a gummy. It sort of also gets broken down a little bit differently. Most studies are probably more oil-based when it comes to the delivery method. But from what we understand now is that oil is very inconsistent in terms of how much you're actually absorbing or a term known as bioavailability. So if you're taking an oil. On average, depending on what you ate, depending on the time of the day, you might actually absorb six to 24%. Of the actual milligrams that you think you're taking. So the water soluble products, it can be up to 20 to 80% of what now you were taking. So we're seeing maybe a fourfold increase in the consistency of delivery when you're using it as a water-soluble product it's in and out of your system in about six hours.
Arpita:And just like any other medication. It affects each of us differently
Joe:So you can continue to really dose it. And then the thing with. The CBD, which is you can take them for pain, right? This 30 milligram packet and say, I felt better about my pain. I wasn't as scared of it. You know, now I'm getting education by Joe and Chris and I'm moving a little bit more on exposing myself, but I feel like I have an edge, Other people will take the 30 milligrams and then say, I was just wiped man. Like I just wanted to go take a nap and I wanted to just sleep the day away. And then other people take it, and they're like, this is the first time I was able to look at my boss and not, almost have a panic attack. And, and this is where, you know, the, the idea of start low go slow really comes from. But really, I think the only barrier to finding a good dose right now is probably more financial than anything else. Because we know it's so safe. If you took 30 and you were like, yeah, Hey, this didn't really give me what I was looking for for sleep. But 90 did. And now you're like, okay, well I have to take 90 milligrams a night. Can I actually afford to do that right.
Chris:Safety's a real thing, right? To feel safe that you're not going to overdose. Like, I think that's the problem with, the whole. Cascade that we went down with the opioid crisis is like, they were trying to say, well, this isn't enough. We're going to give you more. And then like that movie dope, so good. Right. And it's like, well, if we give them this higher dose, that's going to be the thing, that's the ticket. Right. But then, you know, so many things and with CBD, it seems like there's just a lot less risk with that, right?
Joe:Yes. A hundred percent. And then when we start to have maybe like, if someone comes in where they're like, yeah, I took three and I think I slept really good. Um, but taking three is a lot, like I'd have to buy, like seven bags of it to like late last me through the next two months. So I'll usually tell people, like, monitor what you're trying to improve on for the 30 days. Once you find a dose that works for you, give it 30 days, but, but log it. How are you rating your anxiety each day? How are you really rating your pain? Because I think we're such poor subjective reporters. I'll see a person today who I saw last Monday. Hey, how have you been? Uh, you know, well, last Wednesday at like 8:00 AM. I had a lot of pain again. Okay. How about the others? I don't remember the other six days. It was always what I get, like I don't, I don't remember the other six days and I'm like, well, probably means that you're doing pretty good. I think whenever, finances are a concern, then this idea of like, okay, well, I'm going to give it a month and then see what happens. But you know, for my clients, I tell them, look, I'm not trying to have you be on this for the rest of your life. I'm having it try to kick us into a new state if someone's worried about putting something into their body. Well, the other area where we have CB one and CB two receptors is the skin. If we use lotion or CBD cream, those will not cross into our systemic circulation. So will interact with CB one or CB two receptors at the surface of the skin may have a hypo analgesic effect, which is what most people would sort of use it for.
Chris:What type of depth does that get to have they measured or studied? Like how deep the receptors can be, because we know now, like those receptors are in fascia. And what level of the fascial plane would it actually interact with?
Joe:I believe it was at the superficial fascia, which is sort of where, you know, it's
Chris:where all the big money is anyway.
Joe:Yeah, exactly. There's less consistent studies on cream. I've only seen like one or two, as opposed to, these oil based alternatives or, now more water-soluble things may be coming to market, but it doesn't seem like there's a ton of studies on the lotions, which makes it sort of hard to postulate on like the when and how long, and if I put a thousand milligrams of the CBD on my skin is that better than 500 milligrams
Chris:So many studies on yeah the receptor location, but also the demographic, like you're saying it's not going to respond in this demographic the same as that demographic. You're going to have to study these groups over the course of the next 10 years to have a better idea of the dosage of it, which brings up an interesting ethical dilemma. Fringe seems like a very high level group, that's really doing it for the right reasons, but who's to say other groups don't come and push for studies that are going to incorporate higher levels, higher dosages from an economic standpoint. I'm just playing devil's advocate with that.
Joe:No, absolutely
Chris:Crazy. Right?
Joe:Yeah, absolutely. I mean, right now it's the wild west, you know, and, the house passed the decriminalization of marijuana bill. I think it was a week ago. Everyone doesn't seem to think it's going to get past the Senate. But there is hope again, like I said, I think it's important that the conversations are being had. I think it's important that states are now being allowed to sort of explore on their own. But there's still so much red tape. CBD or THC right now is listed as a supplement, uh, anywhere over the counter supplements are not regulated. At least not in the United States. There was this third party study done, um, I think only about one in four or maybe 20% actually had the correct amount of CBD that they advertised on their labels. And quite a number of them tested hot, which means that there were still THC in it, even though they said that. You know, an isolated, you know, everything was removed. Um, so now those are, that is concerning. Right. Because now if you're taking it and you're in the healthcare field and you're getting a blood tested or urine tested Now you're reading the label of something and you're like, okay, well now there's all this distrust. Anyway. Now I read a study like this, where half the companies aren't being regulated, aren't even regulated themselves. So at fringe what we talk about as part of our education, is look, even if you don't buy anything from fringe, here's how you know, you're going to get a good product, right? You need three different tiers of testing you need to see things get tested when it gets pulled off the crop. You need to be tested for toxins and metals from the soil, it needs to be tested when it gets boiled, when it becomes an oil and then it needs to get tested again off the shelf. So as it's getting packed who's there on the line pulling a few out and measuring and saying, okay, yeah, these are all good. So you can see that process actually about what's called a certificate of analysis. Each product that you or your clients buy in the future should have a barcode on. And the barcode should take you to that specific certificate of analysis. We're really comfortable being in the CBD space and, you know, and thus far it's been really, really great to be able to empower someone to say, Hey, this is something that is a hundred percent safe. I can help you tier your way through it, how to document it and how to maybe then even come off of it. I think it's just important that people know what they're taking. But you know, once they feel comfortable in it, then it's like, okay, here's how we're going to monitor it.
Chris:Yeah, I'm all here for it. Creating that strategic Alliance that is really been pushed to the forefront of the importance of patient outcomes anyways. And I think you're giving people right now, like this discussion an opportunity to explore the space and create a better therapeutic Alliance. That's super important. Tying this up. How do you tell the listeners here to go out and be an advocate for themselves to find the best information and kind of be a resource for their patients or their clients or their family members, their moms that says you're dealing with drugs now, what are you doin with your life. How does someone go out and find this information? What are, what are good resources for them from a core standpoint?
Joe:I'll just, I'll be sort of selfish here. And I would say to first, just check out the tools we have at joinfringe.com. We have a whole Q and a section. We have a weekly newsletter that we release. Trying to approach these very commonly asked questions. Genevieve Newton is our research director. She breaks down a new research article each week, what it means for the future of the field and what it can mean for you right now. Uh, I touch on our fringe factors once each week and how to start to incorporate those ideas. If you're going to explore other brands, be a curious consumer look for that certificate of analysis, know where they're getting the crop from all the crops should be coming from the USA. For right now be mindful of licensed or a specific formulaic mixtures of like, Hey, we took five milligrams of CBD and mixed it with, um, you know, 18 milligrams of ginseng and then we crush it up in a strawberry smoothie and we made these like strawberry capsules for you that are going to be the best ever from what we've seen in research. Well, okay. But we have no idea how all these things and end up interacting together if they do it all. So, you know, I would say away from like special brand formulas and then stick to Your pure CBD. Um, whether that's going to be an isolate or like a broad spectrum and then know which way you're going to take it. And then obviously start with our Q and a on joint.
Chris:That's awesome. Do you think in the next generation, like 10 years from now, you have a daughter, right? Like, do you think in 10 years people will just, anybody has this, like they take their vitamin D every day or they take their fish oil everyday, right? It's is it going to be a general supplement that you buy at Costco?
Joe:Yeah, I do think it's going to become that. Um, and what's, it's going to be even a more interesting conversation.
Chris:So interesting. Yeah. It's a whole new area that we're just scratching the surface. Joe, thank you so much for sharing this quick information on it. Tell us where we can find you more on all the social media stuff.
Joe:Yeah. So you can find me directly at strength in motion PT, you can also find me on my website, same name, strength, and motion, pt.com. And if you want to, again, learn more about fringe check out the website, or find us on Instagram and social media at join fringe.
Chris:That's great stuff again. We're just getting started. It's going to be exciting, exciting stuff coming through, but thank you, Joe. And you have an awesome day and keep spreading that great word you're doing. Thank you, Chris. You as well, take care of.
Arpita:Thanks for listening. This episode was produced by me, Arpita and Krista Prado. Follow us on Instagram for updates and please like subscribe and rate the podcast to keep more great episodes coming. To follow joe and his adventures find him at strength and motion pt.com and@fringeatjoinfringe.com.