Thinking Outside the Box: Integrating Wellness and Natural Medicine Into Pharmacy With Swathi Varanasi, PharmD

Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Keira Smith, and today I'm joined by Dr. Swathi Varanasi. Thanks so much for coming on today.

Swathi Varanasi, PharmD: Thank you so much for having me.

Oncology Data Advisor: Would you like to start off by introducing yourself and sharing what you do in your work?

Dr. Varanasi: I'm Dr. Swathi Varanasi. I am a pharmacist, and I identify as an integrative health pharmacist. You might be wondering, what is integrative health? Everyone has a different definition. To me, integrative health is really about this intersection and interplay of all the possibilities for healing, health, and wellness. To me, it is meeting the patient where they are and thinking about it from what is referred to as patient-centered shared decision making. It's thinking about what is going to align with the patient's treatment goals, but also how it is going to align with their lifestyle. I like talking about everything from sleep hygiene, to supplementation, to the safe and effective use of prescription medications, and everything in between. It's really about serving as a guide for a patient.

Let's say someone comes to me and they have issues with sleep. It's talking about all the possible things that they can do for sleep and what is going to be best for them. If you do overnight shift work, for example, you can try sleep hygiene and turning your lights down 30 minutes before going to bed. Or maybe other strategies like that don't really suit the way you live your life, but it could work for someone else. We also talk about supplements or even mindfulness—what they can do throughout the day to amplify the way that they're living. Every patient is unique, so to me, integrative health is really about how I can help the patient achieve their goals in the best way possible.

Integrative health is not really a normal path for a pharmacist. I hope that one day it is, but it's still seen as unconventional. Throughout my training, I was looking for a mentor, and I found one who's out in Los Angeles, named Dr. Pam Tarlow. We started the first-ever and still only integrative health–focused postdoctoral residency training program for pharmacists interested in pursuing this path. I focused in my residency on specific methodologies and topics, from Ayurveda, to Traditional Chinese medicine, nutrition, and cannabinoid medicine, and how we can look at them as safe and effective strategies to use as a complement or sometimes as a replacement for prescription medications.

Again, it really depends on the patient. The average person in the United States or in North America is on one to six medications, and a lot of them are working really well for people. If they don't want to get off their medications and they want to improve certain other aspects about their life, that's where I can play a role and look at the drug interactions, look at the drug-herb interactions, and look from an evidence-based perspective as a health care professional to see how I can help them.

Oncology Data Advisor: Awesome. It's really such a unique and interesting field. Why did you decide to focus on integrative health and natural medicine in your work, and how did you come about getting involved in it?

Dr. Varanasi: Initially, it was growing up around Ayurvedic herbs and Ayurvedic methodologies. It started off there. I always viewed healing, health, and wellness as this multi-prong or multifaceted approach, where maybe one day I was taking Aleve for my headache and then the next day I was looking at an Ayurvedic balm for my foot pain. Depending on the day, depending on the ailment, and depending on the scenario, I was using all of these options. It's about figuring out how we can use all of these strategies together. I feel like that is something that is really missing from the conventional health care professional curricula.

I delved into the literature and found that there is actually so much research on the use of these natural remedies. I thought that this was a path that could lead me to a lot of opportunities that could really make a difference and disrupt the space. Even as a young child, I always was interested in innovation and disruption and even entrepreneurship. It was like a match made in heaven, where my upbringing met the evidence-based perspective and the trends that we're seeing in health and wellness. So many people are interested in seeing how they can live their best, healthiest lives. The fact that I get to play a role in that in perhaps an unconventional way is really exciting to me too. So, it really was a variety of factors that came together at the end of the day.

Oncology Data Advisor: That's awesome. You mentioned how integrative health is an unconventional field in pharmacy. What are some of the ways that it interacts with the field of pharmacy?

Dr. Varanasi: To me, it was really this opportunity to almost forge this new path within what it means to be a pharmacist. I think every pharmacist should have an aspect of what they're doing that incorporates integrative health, because it's really thinking about the patient and individualizing the therapy to every single person.

I always say, and my mentor always says too, that the most dangerous supplement or drug is the one we don't know about. If I'm talking to a patient, I first say, "Give me your full medication list." Then after that, I always ask them for their full supplement list and their full herb list. I ask about all of those important questions because if we don't know, for example,that they're taking a supplement, but they're also on a medication that interacts with it, that's potentially dangerous because I don't know if there is a possible drug interaction if they don't tell me that they're on it.

But if they tell me that they're on it, then I can know that. I need to know everything that I can to help me make the best decision for the patient. If they let me know, then I can let them know, "All right, this is a great, safe option. Or, maybe this other one is not the best option, but because of my background in natural medicines or other integrative modalities, let's think about these three other options that could be a better fit that won't interact with the medications that you're currently taking or the other supplements that you're taking."

I really hope that integrative health becomes an integral part to many avenues of pharmacy, especially in oncology pharmacy.

Oncology Data Advisor: Absolutely. There are definitely a lot of considerations and a lot of ways that it can fit into oncology. What are some of the specific roles of integrative health for patients who have cancer?

Dr. Varanasi: One of the ways that I've really worked with oncology patients throughout the years has been thinking about the X, Y, Z medication that has been prescribed from their oncology team, that fits best for the type of cancer that they have, and looking to see how they can optimize their side effect profile.

For example, oncologists have reached out to say, "My patient mentioned that they're interested in taking peppermint or cannabinoids. This is their current drug list. What do you think as a natural medicines expert, as an integrative health expert? Is this going to get in the way of the mechanism of action of this drug? Is this going to therefore not be the right choice for them? Or could this actually help decrease their nausea from therapy, or is it something that can stimulate their appetite or improve their overall sleep quality or decrease their anxiety from their treatment protocol?"

Also thinking about nutrition—nutrition is so important for oncology patients. Some medications, as we know, are appetite suppressants. Thinking about how we can incorporate more vitamins, more minerals, and more micronutrients into the diet is really important. Bioflavonoids and their potential opportunity within the space are really amazing from a preventative and a potentially curative standpoint. I think the opportunities are limitless, and I really hope that integrative health can penetrate a lot of specialties, but I also hope that every single oncology health care professional is thinking about these integrative options for their patients too.

Oncology Data Advisor: I really like what you said about thinking outside the box too, because I'm sure there are so many different avenues that a lot of people might not have thought of that are something that could really help their patients. For oncology pharmacists as well as other clinicians who are interested in incorporating more of this into their practice, is there anywhere they can go to learn more?

Dr. Varanasi: Yes, there are really great resources out there, but it's something that I don't see often discussed. There aren't enough people talking about the top resources for health care professionals where you could go to find this information. Also, there's not enough widespread access, I would say, to this type of information.

One of my favorite resources, which is free, is run by a pharmacist at Memorial Sloan Kettering Cancer Center. It is called About Herbs. There are full herb monographs on what you need to know and what the research says about using these particular herbs. I'm always out there looking for reputable free or low-cost resources for health care professionals. It's an online platform, but you can also access it on your phone through a free app.

One of the things that I want to see more of are continuing education (CE) programs specifically for the utilization of natural medicines in oncology. I've been a part of CE programs where we've talked about natural medicines or we've talked about integrative health for various conditions or for overall wellness, but I haven't seen or been a part of one yet that's focused on oncology. I think that that is the next new exciting frontier.

Oncology Data Advisor: That's a really great resource. I'm looking forward to sharing that with the audience for them to check out.

Dr. Varanasi: Yes, definitely. And another thing, if people are interested in learning more about cannabinoids, I was very happy to be a part of a course online that's through my brand, Element Apothec. We have a self-paced online course on medical cannabis that is for health care professionals.

Oncology Data Advisor: Fantastic, that sounds really helpful as well. Any other parting thoughts you'd like to share about your work in this field?

Dr. Varanasi: Thank you for the opportunity to share more information about integrative health and integrative medicine in general. I really think that this is the next step to thinking about how we can personalize therapy and help each and every patient—not just looking at the set protocol, not just looking at the guidelines, but determining how the guidelines can apply to each and every person. I can't wait to see more health care professionals incorporating different methodologies like this in their practice.

Oncology Data Advisor: Definitely, and we're looking forward to talking more with you in the coming months as well.

Dr. Varanasi: Amazing.

About Dr. Varanasi

Swathi Varanasi, PharmD, is an integrative health pharmacist who is passionate about incorporating wellness, innovation, and sustainability into pharmacy. She has created postdoctoral training programs, industry internships, and online courses that have paved the way for health care professionals to pursue non-traditional career paths integrating wellness into their practice. Dr. Varanasi has published her work in peer-reviewed academic journals and has spoken at colleges and conferences throughout the world. She is the Co-Founder and Chief Scientific Officer of international award-winning wellness brand, Element Apothec. In 2023, she was named on the 50 Most Influential Leaders in Pharmacy.

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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.