The gut or digestive tract, although enclosed within the body, is, in effect, an ‘outside’ surface that carefully regulates what is allowed to pass through and what is kept out. This selective barrier function is fundamental to digestion, immune defence and nervous system regulation, and is profoundly influenced by the microorganisms that do, or do not, inhabit it.

Much like global ecosystems that suffer when biodiversity is lost and monocultures dominate, human gut ecology is becoming increasingly depleted. Reduced microbial diversity and the loss of key species have been linked to a range of inflammatory, metabolic and immune-mediated conditions (2).

Few systems in the body are as directly affected by daily inputs as the gastrointestinal tract. The foods we eat, the herbs and spices we use, the rhythm and timing of meals, and the state of the nervous system when we eat all shape this internal ecosystem. 

The gut microbiome consists of bacteria, fungi, archaea and viruses that perform essential physiological functions, including fermentation of dietary fibre, synthesis of certain vitamins, modulation of immune responses and protection against pathogenic organisms (3). A diverse and balanced microbiome is associated with reduced inflammation, improved metabolic health and greater resilience to physical and psychological stress (4).

Diet is the primary modulator of microbiome composition. Diets rich in whole plant foods support microbial diversity, while Western-style dietary patterns high in refined carbohydrates and ultra-processed foods are consistently associated with reduced microbial richness and increased inflammatory species (5).

Common digestive symptoms such as bloating, constipation, diarrhoea, reflux and abdominal discomfort are clear signs of compromised gut function. However, gut imbalance frequently presents systemically, manifesting as fatigue, skin conditions, recurrent infections, mood disturbances and food sensitivities. The gut is lined with extensive immune tissue that interacts directly with the microbiome, highlighting its central role in immune regulation (6).

A truly ecological view of gut health also requires attention to bile, a digestive fluid often overlooked outside of gallbladder disease. Bile is essential for the digestion and absorption of dietary fats and fat-soluble vitamins, but it also plays a critical role in shaping the gut ecosystem. Through antimicrobial properties and signalling activity, bile influences the microbiome, the gut barrier, motility and immune regulation (7).

Chronic stress, very low-fat diets, disrupted circadian rhythms, medication use and impaired liver function can all compromise bile production or release. Research increasingly demonstrates that bile acids act as metabolic and immune signalling molecules, influencing inflammation, intestinal permeability and microbial diversity (8).

Both food and herbs play a central role in supporting healthy bile flow. Whole-food dietary fats such as olive oil, oily fish, nuts and seeds stimulate bile release. While bitter foods and herbs, including leafy greens, chicory, dandelion root (Taraxacum officinale) and artichoke leaf (Cynara scolymus), enhance bile secretion and digestive function- traditionally used to support ‘digestive fire’, they support both digestion and microbial balance (9).

Fibre-rich plant foods

Despite growing awareness of gut health, many people in Western societies remain chronically fibre deficient. Modern dietary patterns shaped by ultra-processed foods, convenience eating and more recent trends towards low-carbohydrate or very high-protein diets often displace the whole plant foods that traditionally formed the foundation of human nutrition. This reduction in dietary diversity has important implications for gut ecology, as fibre is the primary fuel for many beneficial gut microbes.

Dietary fibre is fundamental to gut health. Although predominantly indigestible by humans, fibre is fermented by gut microbes into short-chain fatty acids, including butyrate, acetate and propionate. These metabolites support intestinal barrier integrity, immune regulation and inflammatory balance (10).

Fruits, vegetables, whole grains, legumes, nuts and seeds all contribute distinct fibres and phytochemicals that encourage microbial diversity. From a herbal perspective, medicinal plants such as chicory root (Cichorium intybus) and dandelion root (Taraxacum officinale) contain inulin, a prebiotic fibre shown to selectively support beneficial bacterial species (11).

A clinical approach that encourages diverse and regular plant intake rather than rigid targets, counting not only fruits and vegetables, but also nuts, seeds, beans, pulses, herbs and spices favours a principle of crowding out, shifting attention towards nourishing foods rather than restriction.

Fermented foods

Central to almost every traditional dietary model, primarily as a method of preservation, fermented foods provide live microorganisms and microbial metabolites that support gut barrier function and immune signalling. Yogurt with live cultures, kefir, sauerkraut, kimchi, miso and tempeh are all valuable additions when tolerated. Regular intake has been associated with improved microbial diversity and reduced inflammation (12). For many individuals, regular consumption of fermented foods may be more supportive than probiotic supplementation, which can sometimes disrupt rather than restore microbial balance.

Polyphenol-rich foods and herbs

Polyphenols are bioactive plant compounds with antioxidant, anti-inflammatory and microbiota-modulating effects. Gut microbes metabolise polyphenols into compounds that support intestinal health and immune balance (13). Deeply pigmented fruits and vegetables, such as blueberries, pomegranates, red onions and cabbage, sweet potatoes and dark leafy greens, alongside olive oil, tea, coffee and cacao, are valuable dietary sources.

Herbs and spices including common culinary herbs; oregano (Origanum vulgare), rosemary (Salvia rosmarinus) and thyme (Thymus vulgaris) are all polyphenol rich, while turmeric (Curcuma longa), ginger (Zingiber officinale) and green tea (Camellia sinensis) provide good amounts with additional digestive benefits. 

Healthy fats

Dietary fats influence bile flow, microbial composition and gut permeability. Omega-3 fatty acids from oily fish, flaxseed, walnuts and chia seeds are associated with reduced intestinal inflammation and increased abundance of beneficial bacteria (14). Traditional dietary patterns rich in whole-food fats support digestion, nutrient absorption and immune resilience.

Ultra-processed foods are associated with reduced microbial diversity, increased gut permeability and chronic inflammation. Additives such as emulsifiers and artificial sweeteners have been shown to disrupt microbial balance and metabolic signalling (15). Excess added sugars promote dysbiosis, while chronic alcohol intake damages gut barrier integrity and alters microbial composition (16).

The gut is deeply interconnected with the nervous and immune systems via the gut–brain axis. Chronic stress alters gut motility, permeability and microbial balance, while poor sleep disrupts circadian rhythms that regulate digestion and microbial activity (17).

Regular moderate exercise improves gut motility, microbial diversity and immune regulation (18).Living in alignment with natural rhythms, including regular meal times, consistent sleep–wake cycles, time in nature and stress-modulating practices, further supports gut health.

Herbal nervines such as lemon balm (Melissa officinalis), passionflower (Passiflora incarnata) and chamomile (Matricaria chamomilla) have traditionally been used to support nervous system regulation soothing nerves, while also gently aiding digestion, reflecting the bi-directional nature of the gut and brain.

Gut health sits at the crossroads of digestion, immunity and nervous system regulation, with the gut microbiome acting as a central mediator between diet, lifestyle and long-term health. Although gut health is currently receiving heightened attention, this reflects a rediscovery rather than a new idea. Both traditional herbal medicine and contemporary research point to digestion as the foundation of vitality.

Short-term gut healing protocols can be valuable and are often used to reduce symptoms and restore balance. However, their lasting effectiveness depends on what follows. Just as a garden is not simply weeded and seeded and then left alone, the gut requires ongoing care and a supportive environment in which to flourish. Daily nourishment, microbial diversity, adequate bile flow and nervous system regulation are what ultimately sustain a resilient ecosystem.

Everyday digestive symptoms are often dismissed as benign consequences of modern life. Yet bloating, discomfort, reflux, altered bowel habits and food sensitivities frequently reflect or lead to deeper imbalances and may signal a need for additional support. Paying attention to these early signs creates an opportunity not only for digestive relief, but for broader improvements in energy, immunity and emotional wellbeing.

By integrating whole-food, plant-focused nutrition with traditional herbal wisdom, gut health becomes achievable through everyday choices. Consistent care, rather than restriction or short-term intervention alone, allows the gut ecosystem to thrive, supporting long-term health, resilience and balance.

1. Clarke G, Stilling RM, Kennedy PJ, Stanton C, Cryan JF, Dinan TG. Gut microbiota: the neglected endocrine organ. Mol Endocrinol. 2014;28(8):1221–1238.
2. Lynch SV, Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016;375(24):2369–2379.
3. Sender R, Fuchs S, Milo R. Revised estimates for the number of human and bacteria cells in the body. PLoS Biol. 2016;14(8):e1002533.
4. Valdes AM, Walter J, Segal E, Spector TD. Role of the gut microbiota in nutrition and health. BMJ. 2018;361:k2179.
5. Sonnenburg JL, Bäckhed F. Diet–microbiota interactions as moderators of human metabolism. Nature. 2016;535(7610):56–64.
6. Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell. 2014;157(1):121–141.
7. Mills S, Bone K. Principles and Practice of Phytotherapy. 2nd ed. Edinburgh: Churchill Livingstone; 2013.
8. Ridlon JM, Kang DJ, Hylemon PB. Bile salt biotransformations by human intestinal bacteria. J Lipid Res. 2006;47(2):241–259.
9. Fiorucci S, Distrutti E. Bile acid–activated receptors, intestinal microbiota, and metabolic regulation. Trends Mol Med. 2015;21(11):702–714.
10. Koh A, De Vadder F, Kovatcheva-Datchary P, Bäckhed F. From dietary fibre to host physiology. Cell. 2016;165(6):1332–1345.
11. Roberfroid M, Gibson GR, Hoyles L, et al. Prebiotic effects: metabolic and health benefits. Br J Nutr. 2010;104(S2):S1–S63.
12. Marco ML, Heeney D, Binda S, et al. Health benefits of fermented foods. Curr Opin Biotechnol. 2017;44:94–102.
13. Ozdal T, Sela DA, Xiao J, et al. Polyphenols and gut microbiota interactions. Nutrients. 2016;8(2):78.
14. Watson H, Mitra S, Croden FC, et al. Omega-3 fatty acids and the human intestinal microbiota. Gut. 2018;67(11):1974–1983.
15. Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers and gut microbiota disruption. Nature. 2015;519(7541):92–96.
16. Leclercq S, Matamoros S, Cani PD, et al. Alcohol, gut permeability and inflammation. Brain Behav Immun. 2014;40:16–26.
17. Mayer EA, Tillisch K, Gupta A. Gut–brain axis and the microbiota. J Clin Invest. 2015;125(3):926–938.
18. Monda V, Villano I, Messina A, et al. Exercise and gut microbiota. Oxid Med Cell Longev. 2017;2017:3831972.

Inflammation is the combination of redness (rubor), heat (calor), swelling (tumor) and often pain (dolor) that occurs after an injury, irritation or infection. Inflammation is a protective, restorative response of the immune system, essential to the healing process of the body. When resolution is reached the body then produces anti-inflammatory chemicals to stop the inflammatory process and restore healthy tissue function. However, if the cause of acute inflammation is sustained — for example, an untreated infection or continued exposure to allergens or toxins — inflammatory activity becomes

an ongoing chronic process that causes tissue damage and dysfunction, and eventually chronic disease. Simply using anti-inflammatory medication to suppress the symptoms will not resolve the problem and will create new issues due to side effects.

A key consideration in managing chronic inflammation is diet (1). A deficiency of foods that reduce inflammation, in particular whole grains, fruit vegetables, nuts and seeds and omega 3 fatty acids can contribute to a rise in inflammation. Another consideration is whether a diet is high in foods  that increase inflammation. 

Pro-inflammatory foods include sugar, ultra-processed foods (UPFs), processed meat products, refined carbohydrates, trans fatty acids, gluten, alcohol, non cold pressed vegetable oils, artificial additives and, for many people, dairy products (2,3). The physiological effects of carbohydrates vary according to their composition and metabolic impact. Glycaemic load (GL) is a measure that reflects both the quality (glycaemic index) and quantity of carbohydrate in a given portion of food, thereby estimating its overall effect on postprandial blood glucose levels. Diets characterised by a lower glycaemic load have been associated with reduced postprandial hyperglycaemia and lower inflammatory markers (4).

Sugar has an especially significant impact on the inflammatory process. Dietary sugars are mainly glucose, fructose, sucrose and high fructose corn syrup (HFCS). Table sugar (sucrose) is composed of equal parts of fructose and glucose. Until the 18th century the human diet contained small amounts of sucrose and fructose, naturally present in fruits, vegetables and honey.

The Romans and Greeks knew of sugar in the first century CE and it very gradually appeared in Europe. Yet, sugar remained rare and expensive until sugar plantations were established in the 18th century on the Caribbean islands, relying on systems of enslavement to sustain production. By the 19th century sugar became a commodity used by all, in Britain, mostly to sweeten tea, but then in confectionery.

The use of sugar beet, starting in Europe in the early 19th century, in sugar production contributed to the reduction in price. In the 1960s, high fructose corn syrup (HFCS) was produced from corn by industrial production, and this became the cheapest form of sugar available, resulting in vastly increased consumption.

HFCS is sweeter and more soluble than sucrose, has a longer shelf life, and does not crystallise as sucrose does. HFCS has become a major component of industrial baked goods (cakes and biscuits) as well as sweetened soft drinks; all of which have become a major component of the modern Western diet (5). 

The way fructose is metabolised by the body is important. In nature, sweet foods — such as fruit, vegetables and honey — contain a diverse combination of sugars, with fructose present, but only in small amounts and alongside glucose. This makes all the difference in the effect of fructose on the body, as the metabolism of fructose in the body is very different to that of glucose.

Fructose metabolism for cellular uptake is largely insulin independent and is primarily processed by the liver. The body’s capacity to metabolise  fructose is limited. As such, processing large quantities puts high metabolic demands on the liver, which, if sustained, can increase risk of fatty liver disease or metabolic dysfunction-associated steatotic liver disease (MASLD) (6). MASLD is correlated with metabolic disease and obesity, as well as increased body fat and the amount of secreted pro-inflammatory cytokines and other inflammatory mediators. 

Obesity itself is associated with chronic low-grade inflammation as adipose (fat) tissue functions as an endocrine and immune-modulating organ that secretes a range of inflammatory cytokines and other inflammatory chemicals, such as adipokines, contributing to systemic inflammatory signalling. Central (abdominal) obesity is more strongly associated with inflammation, with increasing visceral adipose tissue mass correlating with increased secretion of pro-inflammatory cytokines (7,8).

Metabolic diseases, including insulin resistance, type II diabetes, cardiovascular diseases and obesity, are all closely associated with chronic inflammation, which both contributes to and is exacerbated by metabolic dysfunction (9). A study of 29 healthy people found that consuming one 375 ml can of a soft drink containing 40 g of sugar per day for three weeks resulted in increased risk factors for cardiovascular disease. These risk factors all involved inflammation with weight gain, increased LDL, inflammatory markers and blood sugar. This is a relatively low intake over a short period of time (10). 

Another study found that people given a single 50 g dose of fructose showed an increase in the inflammatory marker C-reactive protein CRP in just 30 minutes. The CRP level remained high for over two hours (11). Eating high GL foods has a similar result, with a study showing increased inflammatory markers after ingestion of 50 g of refined carbohydrate in the form of white bread (12). Studies have found that this is dose dependent — the greater the quantity of inflammatory foods eaten, the greater the resulting inflammation (13).

Severe inflammatory diseases including rheumatoid arthritis, multiple sclerosis, psoriasis and inflammatory bowel disease have been associated with dietary sugar intake, with higher sugar intake exacerbating symptom severity (14).

From the point of view of herbal medicine, an important consideration is the use of sugar in herbal preparations, as syrups. These use sugar in a high concentration (typically 65–70% sucrose) to preserve a herbal extract and also improve its taste, which is especially helpful for children. Historically syrups were often used, especially for cough medicines.

The active compounds are extracted with the water content, not the sugar and the shelf life of syrups is limited. An alternative option for a sweet-tasting herbal medicine is organic vegetable glycerin (glycerol), which both extracts constituents and preserves them, so has a better extraction ability than water, tastes sweet, offers an alcohol-free preparation, is typically stable concentrations greater than 60% (the remainder can be water as infusion or decoction, and/or alcohol), and most importantly in this context, it has much lower glycaemic impact (GI) than sugar (15). 

Owing to the lower GI, glycerine has a lesser effect on blood sugar levels and insulin. So, for palatable, alcohol-free (though technically glycerine is an alcohol) herbal extracts, preparations made with glycerine (glycerites) may be a favoured method.

Evidence associating high sugar intake with metabolic and inflammatory disease informed the UK government’s introduction of the Soft Drinks Industry Levy (SDIL) in 2018, a tiered tax designed to incentivise reduced sugar content of soft drinks (16). However, to satiate consumers’ sugar cravings manufacturers subsequently swapped HFCS and sugar for artificial sweeteners.

Yet, these also cause inflammation, particularly gut inflammation, as well as changes in the gut microbiome. Even stevia, considered to be a healthy non-sugar sweetener, appears to modify the gut microbiome. Saccharin, sucralose and aspartame have all shown deleterious effects on the gut microbiome and the liver, as well as increasing release of lipopolysaccharides (LPS), which contribute tosystemic inflammation (17).

Erythritol has been found to cause endothelial cell inflammation, particularly affecting the microcirculation to the brain, increasing the risk of stroke (18). Despite data that suggests that artificial sweeteners may be helpful for weight reduction, they have contrarily also been found to contribute to weight gain. Disruptions in gut flora can dysregulate glucose metabolism and insulin sensitivity, increasing susceptibility to metabolic syndrome (19,20).  

Advising individuals to remove sugar from their diets, is unlikely to be effective. A substantial body of evidence suggests that high sugar intake promotes addictive-like eating behaviours and is associated with neurobiological alterations in reward and stress pathways.

Diets high in refined sugars have been linked to dysregulation of mood, associated with anxiety, depression, as well as heightened cravings to eat more sweet things (20). Sugar reduction is often more sustainable when implemented gradually and accompanied by clear information about its potential physiological and psychological effects.

In the context of rising rates of inflammatory disease, public health approaches have increasingly focussed on nutritional education and reformulating products with artificial sweeteners. Yet, substituting sugar with non-nutritive sweeteners does not address established preferences for sweet tastes, and may therefore leave underlying patterns of consumption and reward-seeking behaviour largely unchanged.

Evidence implicating chronic inflammation in the pathophysiology of many of the chronic conditions that burden healthcare systems globally today is ever-growing. Similarly, studies are mounting that elucidate the inflammatory pathways and further implications of high dietary sugar intake. These expanding fields of research establish reducing sugar in the diet as a valuable means of supporting chronic inflammatory disease prevention and management.

1. GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019 May 11;393(10184):1958-1972 Ma X, Nan F, Liang H, et al
2. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. Published 2022 Aug 31. https://doi.org/10.3389/fimmu.2022.988481 
3. Tristan Asensi M, Napoletano A, Sofi F, Dinu M. Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review. Nutrients. 2023;15(6):1546. Published 2023 Mar 22. https://doi.org/10.3390/nu15061546 
4. Neuhouser ML, Schwarz Y, Wang C, et al. A low-glycemic load diet reduces serum C-reactive protein and modestly increases adiponectin in overweight and obese adults. J Nutr. 2012;142(2):369-374. https://doi.org/10.3945/jn.111.149807 
5. Agarwal V, Das S, Kapoor N, Prusty B, Das B. Dietary Fructose: A Literature Review of Current Evidence and Implications on Metabolic Health. Cureus. 2024;16(11):e74143. Published 2024 Nov 21. https://doi.org/10.7759/cureus.74143 
6. Agarwal V, Das S, Kapoor N, Prusty B, Das B. Dietary Fructose: A Literature Review of Current Evidence and Implications on Metabolic Health. Cureus. 2024;16(11):e74143. Published 2024 Nov 21. https://doi.org/10.7759/cureus.74143  
7. Ferrucci, Luigi, and Elisa Fabbri. “Inflammaging: chronic inflammation in ageing, cardiovascular disease, and frailty.” Nature reviews. Cardiology vol. 15,9 (2018): 505-522. https://doi.org/10.1038/s41569-018-0064-2 
8. Ellulu, Mohammed S et al. “Obesity and inflammation: the linking mechanism and the complications.” Archives of medical science : AMS vol. 13,4 (2017): 851-863. https://doi.org/10.5114/aoms.2016.58928 
9. Franceschi, C., Garagnani, P., Parini, P. et al. Inflammaging: a new immune–metabolic viewpoint for age-related diseases. Nat Rev Endocrinol 14, 576–590 (2018). https://doi.org/10.1038/s41574-018-0059-4
10.  Aeberli I, Gerber PA, Hochuli M, et al. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr. 2011;94(2):479-485. https://doi.org/10.3945/ajcn.111.013540 
11. Jameel F, Phang M, Wood LG, Garg ML. Acute effects of feeding fructose, glucose and sucrose on blood lipid levels and systemic inflammation. Lipids Health Dis. 2014;13:195. Published 2014 Dec 16. https://doi.org/10.1186/1476-511x-13-195
12. Dickinson S, Hancock DP, Petocz P, Ceriello A, Brand-Miller J. High-glycemic index carbohydrate increases nuclear factor-kappaB activation in mononuclear cells of young, lean healthy subjects. Am J Clin Nutr. 2008;87(5):1188-1193. https://doi.org/10.1093/ajcn/87.5.1188 
13. Buyken AE, Flood V, Empson M, et al. Carbohydrate nutrition and inflammatory disease mortality in older adults. Am J Clin Nutr. 2010;92(3):634-643. https://doi.org/10.3945/ajcn.2010.29390 
14. Ma X, Nan F, Liang H, et al. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. Published 2022 Aug 31. https://doi.org/10.3389/fimmu.2022.988481 
15. Personal Communication, Lisa Ganora Herbalist
16. UK Government. Soft Drinks Industry Levy. GOV.UK. Published April 2018. Available at: https://www.gov.uk/government/publications/soft-drinks-industry-levy/soft-drinks-industry-levy. Accessed February 9, 2026.
17. Basson AR, Rodriguez-Palacios A, Cominelli F. Artificial Sweeteners: History and New Concepts on Inflammation. Front Nutr. 2021;8:746247. Published 2021 Sep 24. https://doi.org/10.3389/fnut.2021.746247 
18. Auburn R. Berry, Samuel T. Ruzzene, Emily I. Ostrander, Kendra N. Wegerson, Nathalie C. Orozco-Fersiva, Madeleine F. Stone, Whitney B. Valenti, Joao E. Izaias, Joshua P. Holzer, Jared J. Greiner, Vinicius P. Garcia, and Christopher A. DeSouza The non-nutritive sweetener erythritol adversely affects brain microvascular endothelial cell function Journal of Applied Physiology,2025;138 (6):1571;https://doi.org/10.1152/japplphysiol.00276.2025 
19. M M, Vellapandian C. Exploring the Long-Term Effect of Artificial Sweeteners on Metabolic Health. Cureus. 2024;16(9):e70043. Published 2024 Sep 23. https://doi.org/10.7759/cureus.70043 
20. Huimin Xue, Xiping Kang, Kexin Hong, Yunxiao Gao, Yunyu Tang, Yuchen Lin, Xiangjun Liu, Weidong Huang, Jicheng Zhan, Yilin You, Effects of artificial and natural sweeteners on host metabolic health: A double-edged sword, Food Research International, Volume 220, 2025, 117158, ISSN 0963-9969, https://doi.org/10.1016/j.foodres.2025.117158.
21. Angela Jacques, Nicholas Chaaya, Kate Beecher, Syed Aoun Ali, Arnauld Belmer, Selena Bartlett,The impact of sugar consumption on stress driven, emotional and addictive behaviors,Neuroscience & Biobehavioral Reviews,Volume 103,2019,Pages 178-199,ISSN 0149-7634,https://doi.org/10.1016/j.neubiorev.2019.05.021 

Āyurveda is a 5000-year-old all-encompassing system of medicine and philosophical guide to aligned living. It is both a system of curative medicine and preventative health through diet, lifestyle, rituals, ethical living, herbs and more. Ayurveda considers good health as far more than the absence of disease. To thrive with optimal health, we need to cast the net much wider.

How vibrant and alive do you really feel in the body, how calm and focused do you feel in the mind, how settled do you feel in your emotions and how nurtured do you feel from your social network and environments? All these elements contribute to our well-being.

Immunity is often only really considered during illness yett the immune system is constantly working in the background, maintaining health throughout life, bringing balance, homeostasis, healing wounds, and resisting invading pathogens. Immunity is the front-line defence of physical existence. 

In modern science, immunity refers to the system that protects the body from illness and infections that are caused by foreign invaders (pathogens), such as bacteria, viruses, fungi and toxins that cause disease in the body.

Bala, ojas and the three dimensions of strength
How the body responds to infectious conditions is deeply influenced by our underlying health or what is known as our bala (inner strength). Sage Vāgbhaṭa explains that bala sustains life, supports endurance, and determines resistance to disease, however the depletion leads to vulnerability (1). In Ayurveda, immunity is understood through three pillars of strength (bala):

• Hereditary (sahaja bala) — our innate immunity and strength we are born with
• Seasonal (kālaja bala) — immunity influenced seasons, stage of life, time
• Established (yuktikṛta bala) — acquired immunity developed through diet and lifestyle and self-care 

While we may not have total control over our encounters with infections or diseases, we have the power to navigate how our body responds. Through conscious choices in diet and lifestyle, we can build our immune resilience. This adaptive immune resilience is known as vyādhi-kṣhamatva’and it has two fundamental aims:  

• To maintain resistance to disease by building strength (bala)
• To enhance our capacity to adapt, recover and rebuild ojas after illness 

In other words, as mentioned in Charaka Saṃhitā scripture (2)Vyādhi-kṣamatva is both the art of preventing the onset of disease and of reducing disease severity once it has manifested. Immunity in Ayurveda is not merely about fighting disease, but about sustaining strong healthy body tissues from within that subsequently preserves vitality (ojas) (3) and supports long-term resilience (bala).

The purpose of immunity is to help us maintain balance in a world that is constantly changing. Today, immune challenges show up as infections, allergies, intolerances, autoimmune patterns, hormonal imbalance, and sensitivity to stress — all signs that the system is struggling to adapt.

Building strength (bala) and vitality (ojas) happens gradually over time and our task is to support our immunity through daily choices in diet, routine, rest, and how we relate to stress. When bala and ojas are strong, the immune system responds well, neither overreacting nor underperforming, but constantly adjusting to restore equilibrium.

From an Ayurvedic perspective immunity becomes compromised by a gradual wearing down of the body’s ability to adapt and self-regulate. The gradual loss of resilience reflects how well digestion (agni), doṣic balance and the body channels have been functioning over time. As these elements become strained, bala declines, and the formation of ojas is compromised. Some key factors that weaken immunity over time include:

• Improper diet, poor gut microbiome and ongoing digestive issues such as irregular or weak agni (visamāgni/mandagni) — disturbing how the body tissues get nourished.
• Nervous system dysregulation caused by excessive vāta, ongoing stress, negative mindset and emotions
• Lack of recovery time after an illness prevents the immunity from being fully recharged.
• Ongoing misalignment to daily and season rhythms including poor quality and lack of sleep, irregular eating patterns, lack of or excessive exertion.
• Excessive or prolonged cleansing or long-term stimulating / suppressive medications.

75–80% of immunity is formed in the gut, so it’s only as strong as agni (digestive fire). We are what we digest, and healthy ojas formation is the result of the healthy nourishment of the body tissues.

Through the Ayurvedic pathological lens immunity weakens when:

• Agni (digestive and metabolic fire) becomes impaired
• Āma (metabolic waste) accumulates
• Doṣas (vāta, pitta, kapha), the body’s functional intelligence becomes chronically aggravated
• Dhātus (tissues) are under-nourished, reducing ojas (the subtle essence of immunity and vitality)

Ayurveda aims to rebalance us at the root level. There are no short cuts to long-lasting wellness. The focus is to restore the doṣas to equilibrium, clear toxins from deep within and rebuild strength in every body tissue, rejuvenating the body at a cellular level.

The two-stage process of restoring mind-body-emotional balance.

1. Langhana – Lightening and cleansing therapies, including palliative measures and purification practices such as fasting, pañcakarma, to reduce excess, clear toxins and restore balance.
2. Rasāyana – Rejuvenation therapy focused on rebuilding strength in the tissues after cleansing. This includes supportive ahāra and vihara – wholesome diet, proper daily routines, good conduct and medicines when necessary.

Ayurvedic immune support through rasāyana

Rasāyana (rejuvenation therapy) focuses on protecting and rebuilding ojas. Through supportive diet, lifestyle adjustments, and targeted tonics, rasāyana helps restore strength, resilience, and long-term wellbeing, especially during periods of depletion or vulnerability.

In Ayurveda, herbs and home remedies are selected according to their energetic qualities — taste (rasa), potency (vīrya), action, and post-digestive effect (vipāka) — and the way they influence the doṣas, body tissues, channels, senses, and mind. This is the same principle applied to food, reinforcing the Ayurvedic view that food itself is medicine.

Immune-supportive herbs are traditionally used to build yuktikṛta bala, support digestion, clear metabolic waste, and nourish ojas. Classical formulations such as the Ayurvedic elixir Chyawanprāsha is valued for its holistic rejuvenating qualities.  Sitopalādi, Tālisādi are valued for their respiratory-supporting qualities. Single herbs such as tulsi (Ocimum sanctum), guduchi (Tinospora cordifolia), amalakī (Emblica officinalis), turmeric (Curcuma longa), garlic (Allium sativum), ginger (Zingiber officinale), shatavari (Asparagus racemosus), and ashwagandha (Withania somnifera) are commonly used to support resilience, digestion, vitality, and stress adaptation.

How herbs are taken is equally imperative. Traditional carriers (anupāna) such as milk, ghee, water and honey help guide the action and absorption of herbs to specific tissues. Rasāyana herbs are always personalised and used consciously, since herbal remedies work gently with a cumulative and nourishing approach to immune health as opposed to the quick fixes, we have become accustomed to. 

Actively cultivating yuktikṛta bala, begins with the first pillar of life in Ayurveda: satmya āhāra, a diet that is suitable for one’s constitution, digestive capacity, and current state of balance.

The body is shaped by what we are able to digest and assimilate making seasonal, local, whole foods the most supportive. Home-cooked, freshly prepared warm meals and slower cooking methods are becoming rare, yet they are the foundations for digestive and immune health. Our modern pace and reliance on processed foods weaken digestion (agni), contributing to rising food intolerances and gut imbalance. Stale, leftover, and heavily processed foods contain little vital energy (prāna) and do not support the formation of ojas.

Meals such as soups, stews, and gently spiced dishes provide grounding, easily absorbed nourishment for our immunity. A balanced immune-supporting diet may include wholesome grains and legumes, eggs or ethically sourced meats where appropriate, seasonal fruits and vegetables, nuts and seeds, and healthy fats such as ghee.

The connection between digestive health and immune resilience makes prebiotics and probiotics a vital part of the dietary mix. Traditional foods such as takra (spiced buttermilk) and fermented vegetables help support gut flora.

Eating consciously, in appropriate portions, and avoiding excess are just as important as food quality. Diets rich in vitamin C, zinc, healing spices, and warming teas gently kindle agni and support long-term resilience.

Building strength (bala)

Certain foods are traditionally known to build strength and resilience (rasāyana), including milk, ghee, green gram, figs, dates, and almonds. These are best supported with digestive spices and ingredients such as ginger, cumin, lemon, takra, and fresh seasonal fruits.

Movement, rest, and rhythm

Balanced exercise (vyayāma) is key to maintaining and build strength (bala), yet ensuring ojas is not depleted. Too little movement can lead to stagnation; excess can deplete strength. Regular conscious movement such as walking, yoga, strength training, massage, or breath-led practices support immunity, lymphatic flow, and the movement of prāna (life force energy). Just like the ebb and flow of life, it is equally important knowing when to rest and recover. 

Mind, breath, and emotional balance

Ayurvedic wellness is complete only when the mind, senses and emotions are cared for alongside the body. Chronic stress, mental overload, and emotional strain can erode bala. Practices such as conscious breathing, meditation, mudras, mantras, prayer, time in nature, and grounding routines help regulate the nervous system and restore balance. Traditional therapies like shiro-abhyanga (head massage) and shirodhāra (oil pouring on the 3^rd eye), along with medhya rasāyana, further support mental clarity and resilience when needed.

1. Vāgbhaṭa. Aṣṭāṅga Hṛdaya. Sūtrasthāna 11.1–2. Translated by Murthy KRS. Varanasi, India: Chowkhamba Krishnadas Academy; 2008.
2. Agniveśa, Charaka. Charaka Saṃhitā. Sūtrasthāna, Chapter 28, verse 7. In: Sharma RK, Dash B, trans. Charaka Saṃhitā (Text with English Translation). Vol 1. Varanasi, India: Chowkhamba Sanskrit Series Office; 2014.
3. Agniveśa, Charaka. Charaka Saṃhitā. Sūtrasthāna, Chapter 28, verse 7. In: Sharma RK, Dash B, trans. Charaka Saṃhitā (Text with English Translation). Vol 1. Varanasi, India: Chowkhamba Sanskrit Series Office; 2014.

Where low mood and melancholia has not reached the status of clinical depression, there are remedies derived from nature which offer natural approaches to lifting the spirits. In observing the cyclical patterns of nature, we can be afforded some comfort in the knowledge that as humans, we are a part of this cycle and feeling the need for rest and a turning inwards is a reflection of this rhythm.  At the very darkest, coldest, lifeless part of the year when many animals hibernate and are in a state of metabolic depression, studies have demonstrated neurobiological similarities to clinical depression, including changes in cortisol, neurotransmitters, metabolism and other biomarkers (3). Occurring at the same time, seeds and rootstocks are also at their most potent, conserving energy to use later for spring growth (4). 

Hibernating animals rest in the awareness that they will emerge with the next turn of the seasons. For many centuries humans have adapted to the cold, quiet darkness with a shared instinct to foster joy, connection and ritual such as the northern hemisphere midwinter festivals, Christmas, the Roman Saturnalia, Jewish Hannukah, Slavic Koliada, pagan Yule, Persian Yalda, or Asian Dongzhi, are all a call for celebration and community. Earlier in the season the Hindu festival Diwali symbolizes the victory of light over darkness and good over evil. Often the best way to beat the winter blues is in accepting the inherent cyclical nature of the world, and that  darkness has its role in the cycle as the precursor of light and life.

Being able to get out for a walk in nature, taking a moment to observe and be present with the plants, can be enormously enriching and mood enhancing, offering a subtle but profound healing opportunity. Nature can also be brought into the home— in Japan, small gardens are often found on doorsteps, balconies and small corners, bringing life to dense  urban landscapes. Tending a garden, even in pots, is a great source of serenity. The act of walking can also be significant as exercise is an efficient and rapid way to stimulate neurotransmitters including serotonin and dopamine which are responsible for uplifting mood  (5). 

In respecting the cycle of the seasons one is also in connection with the natural instinct to sleep and eat more. In Ayurveda winter is known as kapha time, time to build resources for the hungry gap in spring, when historically people would have worked hard to get the crops in and be left with limited food supplies. A gentle increase in body weight during winter is a normal physiological response to reduced activity, daylight and hormonal shifts, this often reverses itself in spring (6). Similarly, the need for extra sleep and change is impacted by lower light and colder temperatures (7).  

The following plants bring some of the comforting qualities of nature to support the body and mind during the winter period. Each is a powerful tool for lifting the spirits. The best approach is to get to know each herb as an individual first. Ideally, make a single preparation, perhaps a cup of strong tea or decoction, and build up towards a higher dose, the maximum from the range provided below. Taken in this form, at robust levels, benefits can be rapidly felt  and it is soon possible to work out which is most helpful. They can be experimented with to discover which ones resonate best with the body’s constitution. 

These herbs are not antidepressants in the conventional sense. Instead, in different ways they strengthen the constitution, offer a sense of calm and an ability to cope better, whilst also reducing inflammatory pressures on the brain.St John’s wort, widely thought of as a herbal antidepressant, is traditionally used as a tonic specific for the winter months to help bring in the light, offering a feeling of resilience (8). 

For more in depth information on these herbs, please see our herbal monographs. 

Brahmi (Bacopa monnieri)

A classic Ayurvedic brain tonic, and saponin-rich adaptogen, Brahmi appears to work in a number of ways to protect brain cells and improve cognitive functions, especially when these are challenged by long-term stresses, illnesses and ageing (9). It has been used to help recover from chronic fatigue and associated low energies. Brahmi is also calming and helps directly in anxiety and tension conditions, and in helping cope with stress (9,10).

The recommended dose is 2–6 grams of the dried leaf per day, either as  tea or, as popularly taken in India, several teaspoons of the fresh leaf juice (9). Dosages are meant as a guideline only, and it is recommended to consult a medical herbalist for safety considerations. 

Cinnamon (Cinnamomum verum)

This common spice offers an organoleptic treat, with good quality cinnamon stimulating the taste buds and warming the body. Cinnamon is particularly useful in facilitating recovery from illness or chronic fatigue, and especially for those who are particularly prone to feeling the cold (8) It helps restore a healthy appetite and reduce digestive problems such as sluggish digestion that can be associated with being run down. To increase the heating quality and stimulate more warmth, combine it with fresh ginger (Zingiber officinale) in a tea. Cinnamon can be combined with any of the other herbs on this list as a stimulating, warming remedy (9). 

Take a teaspoonful of freshly powdered cinnamon (Ceylon cinnamon has the most complex flavour profile), add 50 ml of boiling water, stir and steep for 5–10 minutes and sip. Feel the mix of spicy and sweet tones reverberating at the back of the mouth, with a slightly woody quality, followed by a warmth emanating from the chest chest. A slight bitterness can be experienced afterwards, with a profound sense of warmth moving throughout the entire body. 

The suggested dose of cinnamon powder is up to 8 grams per day (9).

Gotu kola (Centella asiatica)

This popular traditional Asia restorative tonic is revered in Asia for ‘opening the mind’, sometimes accompanying meditative practices as a tea. Taken in this way, gotu kola offers an initial bitter flavour, followed by an  aromatic sweetness. It has a particular effect in supporting cognitive function, including improving memory and concentration, especially when these are compromised by increased  stress (9,10).

The dose starts at 3 grams of dried leaf per day, titrating up to 30 grams, if the initial dosage has proved effective with no unwanted side effectsGotu kola is traditionally consumed as a tea (8–10). 

Rosemary (Salvia rosmarinus)

There is something inherently uplifting about the smell and taste of this common garden herb— it can be felt heading straight to the brain. Rosemary is an excellent tonic to raise spirits and boost recovery after illness or periods of low energy. Even inhaling the fresh leaf from a garden or window box will stimulate mental energy and the tea taken internally will expand on this effect. 

There is promising evidence that rosemary may reduce inflammatory pressures on the brain now implicated in many conditions associated with low mood and depression, including chronic fatigue syndrome, dementia as well as clinical depression. Further research indicates it can improve cognitive performance in the elderly adding to its reputation as a  brain tonic (11).

Taking rosemary as a tea can be overpowering, however very uplifting. The dose is up to 4 grams a day of the dried leaf (9).

St. John’s wort (Hypericum perforatum)

This is often described as the herbal antidepressant, however it has a much wider range of actions than its mood enhancing properties. The herb and flowers of St. John’s wort have been used in European traditions to relieve nervous tension and anxiety. Importantly, this calming effect is combined with underlying restorative benefits and the plant was also used as a convalescent treatment for melancholic conditions, depression and recovering from illness or trauma (8–10).

This makes St John’s wort ideal in situations where tension and exhaustion combine. Its most useful modern application is towards a programme of recovery from chronic fatigue conditions. It also has a long reputation as a support to those experiencing symptoms during the menopause (8,10).

Note that St John’s wort has been shown as an active inducer of drug metabolism, so it may reduce the activity and active life of many medicines. It is wise to avoid in conjunction with medications and consult a medical herbalist for further guidance (8–10).  it if there are any powerful treatments underway, where reducing the effect of a medicine may be critical.

St John’s wort can come in a variety of preparations, including powder, tincture and tea. It is recommended to combine the herb with others as a tea, for flavour considerations, however the easiest is to take it as a tincture. The traditional calming and tonic dose was the equivalent of 2 to 5 grams of the dried leaf and flowers per day (9). 

1. Heald A, Stedman M, Farman S, Ruzhdi N, Davies M, Taylor D. Seasonal Variation in Antidepressant Prescribing. The Primary Care Companion For CNS Disorders. 2021;23(2). https://doi.org/10.4088/pcc.20m02790 
2. Clery E, Morris S, Cooper C, Das-Munshi J, McManus S, Weich S. Mental health treatment and service use. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England. Published online 2025.
3. Tsiouris JA. Metabolic depression in hibernation and major depression: An explanatory theory and an animal model of depression. Medical Hypotheses. 2005;65(5):829-840. https://doi.org/10.1016/j.mehy.2005.05.044 
4. Klupczyńska EA, Pawłowski TA. Regulation of Seed Dormancy and Germination Mechanisms in a Changing Environment. International Journal of Molecular Sciences. 2021;22(3):1357. https://doi.org/10.3390/ijms22031357 
5. Ren J, Xiao H. Exercise for Mental Well-Being: Exploring Neurobiological Advances and Intervention Effects in Depression. ProQuest. 2023;13(7):1505. https://doi.org/10.3390/life13071505 
6. Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Seasonal fluctuations in weight and self-weighing behavior among adults in a behavioral weight loss intervention. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. Published online May 15, 2019. https://doi.org/10.1007/s40519-019-00707-7 
7. Honma K, Honma S, Kohsaka M, Fukuda N. Seasonal variation in the human circadian rhythm: dissociation between sleep and temperature rhythm. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 1992;262(5):R885-R891. https://doi.org/10.1152/ajpregu.1992.262.5.r885 
8. Hedley C, Shaw N. Plant Medicine. (Waddell G, ed.). Aeon Books; 2023.
9. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
10. Mcintyre A. Complete Herbal Tutor : The Definitive Guide to the Principles and Practices of Herbal Medicine (Second Edition). Aeon Books Limited; 2019.
11. Rahbardar M, Hosseinzadeh H. Therapeutic effects of rosemary (Rosmarinus officinalis L.) and its active constituents on nervous system disorders. Therapeutic effects of rosemary (Rosmarinus officinalis L) and its active constituents on nervous system disorders. 2020;23(9). https://doi.org/10.22038/ijbms.2020.45269.10541 

Nutritional therapy is my primary discipline, and it makes sense to me. It hacks into something that most people do each day — eating — and aims to improve the quality of each of these encounters with food, making them more nourishing.

Working in health stores whilst studying, offered an exceptionally wide range of encounters with people’s health problems and the multifarious ways in which these needed to be tackled. 

Despite nutritional therapy being the discipline that called me most, it became apparent that there’s a place for more than just dietary guidance when coaxing a body back into balance. Having had the joy of working in a health food cooperative that stocked jars of herbs and spices sold by the ounce, the very simple ways that herbs could produce mild but meaningful results, weaving a comforting base of support on which to build the dietary improvements, went on to inform my practice as a nutritionist. 

This wasn’t anything in the realm of being a trained herbalist, but instead following in the tradition of herbal use over the centuries — use what nature’s made available, in simple forms such as herbal teas or tisanes. 

One of the many things to love about using herbs is that they have been around for so long that we now know a great deal about what they do and don’t achieve. Back in the days when natural medicine was the only option, herbs that caused horrible side effects, killed more than they cured, or didn’t work at all were unlikely to have been handed down to following generations. 

Our ancestors did the hard work, and from their traditional usage and written records we can learn what is worth using and how best to employ it. 

Understanding the supportive potential of food in the body’s healing processes, as nutritional practice does, allows for an appreciation of the value of herbal preparations derived from nature, minimally processed, and benefitting from an affinity with receptor sites within the human digestive system (2).

Whilst digestive processes are being strengthened during the initial stages of a client’s programme, remedies that contain the same components as foods (and many herbal remedies are familiar for their culinary roles) have the potential to absorb more easily than supplements created from non-food materials. This is particularly the case where remedies are minimally processed, using traditional extraction methods, rather than focusing on individual constituents (3).

An interesting example of this is seen in the case of the well-recognised herbal medicine, Echinacea purpurea. Research shows that although specific alkylamides could be shown to exhibit greater activity than others in vitro, their overall effect was greater when they were part of a whole extract (4). 

Additionally, herbal remedies with their excellent safety profile and rich historical background can give hope to clients in the early stages of their nutritional programmes, supporting compliance and investment in the process of healing.

In practice, it is uncommon for clients to arrive at our clinics at the first signs of trouble. Instead, they tend to come once other avenues have proven unsuccessful, so they have a string of unproductive strategies behind them, with their expectations blighted and fear of failure heightened. All of which adds stress to their original situation, which may well have had stress as one of its causative factors.

Vicious circles abound in many conditions that are regularly encountered in clinic. These circumstances don’t call for complicated, high hurdle programmes, but instead simple tactics that will interrupt vicious circles without adding to the stress. Herbs fit excellently into this space. 

What’s more, they are often fast-acting and give the client the first hint that things may improve – that their body is capable of feeling better again; and this glimpse of a positive outcome is extremely important for boosting confidence and moving the client into a more optimistic place. A growing body of research is showing that positive emotions can have a positive effect on physical conditions (5).

Hippocrates is also credited with the concept that what is important is “not what a person eats, but what they absorb”. It’s not possible to confirm his authorship, but whoever said it first, it’s extremely relevant to all those wondering why their dietary efforts are not paying off.

It’s not uncommon to encounter people who make huge efforts to eat a pure and blameless diet of lightly steamed organic goodness, and yet never seem well. Similarly, there are those who fret continually in an effort to hit all the nutritional targets, but never appear to reap the rewards of their diligent exertion. For a practitioner to add more dietary regulations or exhortations to these situations increases the client’s stress levels and thereby increases the problem, because stress is notoriously detrimental to digestive function, diverting energy to everything except the ability to turn food into nourishment. 

“What some call health, if purchased by perpetual anxiety about diet, isn’t much better than tedious disease.”— George Dennison Prentice

Other strategies are needed to improve digestion in such scenarios, once the reason for the initial lack of absorption has been pinpointed. 

It might be a stressful lifestyle or a particularly traumatic time from which the client hasn’t recovered; or medication that has undermined digestive power; or a bout of H. pylori with antibiotic treatment from which gut flora are still reeling. It could equally be poor eating habits: the ‘how’ of eating carries importance as well as the ‘what’. Eating on the run, or mobile meals in minutes are not conducive to digestive diligence. 

To take an example of stress affecting absorption, and stressful solutions aggravating the situation, my client Anna (I have used a different name) came into clinic literally in tears, after a food allergy test done elsewhere had thrown up multiple ‘allergies’ that left her with a frightening vision of minimal food options. Already very slim and of a nervous disposition, it was clear that worrying about her diet was just adding to the strain. 

So, for the first phase of her programme, we used passionflower (Passiflora incarnata), an excellent remedy for anxious clients, due to its gentle action and lack of common side effects (6). 

Passionflower is best-known for its relaxing nervine properties and as a mild sedative. It is also antispasmodic, which helps contribute to its calming effect. It is indicated for conditions with restless agitation, exhaustion with muscular twitching or a tendency towards spasms. It has anodyne and anxiolytic properties, and acts as a cerebral vasorelaxant (7).

Anna was adamant she didn’t want to take pharmaceutical medication for her nervous system, due to fear of side effects, in particular any negative effect on her ability to concentrate. As research has shown that passionflower can reduce symptoms of generalized anxiety disorder without impairing job performance, this was one concern dispelled (8). 

Reducing daytime stress often helps improve sleep, which in turn promotes more daytime resilience (9). Anna certainly improved quickly, and having more energy enabled her to focus better on our other strategies, which featured more dedicated attention to how she ate. Gradually, her digestive responses reactivated, no longer turned off by adrenalin surges, and she found she could eat most foods when calm and happy. 

Another client, Lisa (not her real name), had been told that a viral infection was probably to blame for her exhaustion. The virus hadn’t been identified, despite numerous tests, but her doctors felt this was the most likely cause. She was, however, not sleeping much at all, due to the pain of a hip that was due for replacement. Until the operation, we used a fresh arnica (Arnica montana) extract gel topically, and a devil’s claw (Harpagophytum procumbens) extract orally. Both of these have rapid-acting anti-inflammatory actions that don’t lose efficacy with repeated use, as many painkilling medications do (10,11).

Both these herbs are available as products with Traditional Herbal Registrations (THRs), making it very easy for non-herbalist practitioners to recommend, as they come with Patient Information Leaflets explaining the safety profile and giving contact details for additional information. THRs are worth looking out for, as they are also tested rigorously for quality and safety.

An anti-inflammatory diet, high in antioxidants and elements such as ginger (Zingiber officinale) and rosemary (Rosmarinus officinalis), was also a focus in Lisa’s programme. Rosemary is rich in flavonoids such as diosmetin that have anti-diarrhoeal and spasmolytic activities (12); whilst its rosmarinic acid content makes it anti-inflammatory for the gut lining, as well as calming digestive irritability (13). Ginger’s anti-inflammatory and antioxidant properties are accredited to its gingerols; whilst its zingerone content calms nausea (14). Ginger is generally carminative for the digestive system, and can reduce pressure on the lower oesophageal sphincter, with beneficial effects shown on dyspepsia and bloating (15). 

With the reduction in pain came improved sleep and better energy levels for Lisa. 

The classic scenario of poor digestion causing poor absorption, leading to nutritional deficiencies epitomises the benefits of herbal remedies. Stocking up with nutritional supplements or making radical dietary changes is problematic at the start of these cases (although supplements in liquid form often work when solid formats are not broken down well). Instead, whilst starting the process of introducing the client to good eating mechanics (sit down, relax, focus on your food, chew, take your time, don’t wash your food down with drinks…), we use bitter herbs such as gentian (Gentiana lutea) and blessed thistle (Cnicus benedictus), taken as drops before meals. 

Foods and herbs containing bitter compounds are thought to regulate metabolic and digestive functions via activation of a family of oral taste type 2 bitter receptors (16). More simply, the bitter taste initiates digestive processes in the mouth and stomach that then trigger healthy digestive responses further down the digestive system (17). What’s more, it’s an exceedingly easy ask for the client. Often they actually appreciate the bitter taste, as their body welcomes the digestive support. 

The average Western diet is tragically lacking in bitter flavours, and as the client’s digestive response improves, foods with bitter elements such as chicory, radicchio, and artichoke can be gently introduced, taking over from the bitter tonic. Many clients will, however, keep a bitter remedy to hand for weak moments, when a busy schedule or temporary dietary hitch throws them back in their progress. 

Using herbs in this way is simple, it’s satisfying, and very welcome in the complex world of today to be reminded of our roots in the earth and our fundamental connection to plants.

1. Smith CM. Origin and uses of primum non nocere–above all, do no harm! Journal of clinical pharmacology. 2005;45(4):371-377. https://doi.org/10.1177/0091270004273680 
2. Depoortere I. Taste receptors of the gut: emerging roles in health and disease. Gut. 2013;63(1):179-190. doi:https://doi.org/10.1136/gutjnl-2013-305112 
3. Zhao Q, Luan X, Zheng M, et al. Synergistic Mechanisms of Constituents in Herbal Extracts during Intestinal Absorption: Focus on Natural Occurring Nanoparticles. Pharmaceutics. 2020;12(2):128. https://doi.org/10.3390/pharmaceutics12020128 
4. Modarai M, Gertsch J, Suter A, Heinrich M, Kortenkamp A. Cytochrome P450 inhibitory action of Echinacea preparations differs widely and co-varies with alkylamide content. Journal of Pharmacy and Pharmacology. 2007;59(4):567-573. https://doi.org/10.1211/jpp.59.4.0012 
5. Doan S, MacDonald S, Swaminathan K. The Socialization of Positive Emotions: Implications for Physical Health and Psychological Adjustment. Mental Health & Prevention. Published online March 2023:200272. https://doi.org/10.1016/j.mhp.2023.200272 
6. Harit MK, Mundhe N, Tamoli S, et al. Randomized, Double-Blind, Placebo-Controlled, Clinical Study of Passiflora incarnata in Participants With Stress and Sleep Problems. Curēus. Published online March 20, 2024. https://doi.org/10.7759/cureus.56530 
7. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
8. Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. Journal of Clinical Pharmacy and Therapeutics. 2001;26(5):363-367. https://doi.org/10.1046/j.1365-2710.2001.00367.x 
9. Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. Journal of sleep research. 2018;27(6):e12710. https://doi.org/10.1111/jsr.12710 
10. KNÜSEL O, Klein P, Suter A. AtroMed-Gel bei rheumatischen Beschwerden am Bewegungsapparat. SONDERDRUCK AUS ARS MEDICI. Published online 2006.
11. Warnock M, McBean D, Suter A, Tan J, Whittaker P. Effectiveness and safety of Devil’s Claw tablets in patients with general rheumatic disorders. Phytotherapy Research. 2007;21(12):1228-1233. https://doi.org/10.1002/ptr.2288 
12. Naqvi S, Rehman NU, Azhar I, Palla A. Unraveling the multi-faceted role of Rosmarinus officinalis L. (rosemary) and diosmetin in managing gut motility. Journal of ethnopharmacology. 2024;332:118395. https://doi.org/10.1016/j.jep.2024.118395 
13. Li K, Wu J, Xu S, Li X, Zhang Y, Gao X. Rosmarinic acid alleviates intestinal inflammatory damage and inhibits endoplasmic reticulum stress and smooth muscle contraction abnormalities in intestinal tissues by regulating gut microbiota. Microbiology Spectrum. 2023;11(5). https://doi.org/10.1128/spectrum.01914-23 
14. Lemlem Gebremariam Aregawi, Teferi Gebru Gebremeskel, Zoltan C. Preventive and Therapeutic Effects of Ginger on Bowel Disease: A Review of Clinical Trials. Pharmacological research Modern Chinese medicine. 2024;12:100457-100457. https://doi.org/10.1016/j.prmcm.2024.100457 
15. Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Science & Nutrition. 2019;7(1):96-108. https://doi.org/10.1002/fsn3.807 
16. Behrens M, Meyerhof W. Oral and Extraoral Bitter Taste Receptors. Results and problems in cell differentiation. Published online September 4, 2010:87-99. https://doi.org/10.1007/978-3-642-14426-4_8 
17. McMullen MK, Whitehouse JM, Towell A. Bitters: Time for a new paradigm. Evidence-Based Complementary and Alternative Medicine. 2015;2015(1):1-8. https://doi.org/10.1155/2015/670504 

Dandelion is a common herbal remedy which well-known for aiding natural detoxification processes. The root has a particular affinity with the liver, where due to its bitter taste, it promotes the production and flow of bile, acting as a digestive aid and assisting in cases of constipation. 

Dandelion is commonly given by herbalists, often being a first port-of-call in cases of constipation where digestive support is required and liver detoxification processes need a nudge in the right direction.

Dandelion is generally gentle, yet very effective.

Dandelion can be helpful when there is constipation accompanied by an overall feeling of sluggishness in the digestion, when fats are not well tolerated and there may be dyspepsia (discomfort or pain in the upper abdomen, particularly after eating or drinking).

Slippery elm acts as a bulking agent which can be helpful in cases of constipation. This means that it bulks the stools, creating contact with the bowel wall and promoting peristalsis which is the movement that helps with the passing of stools. In addition to this bulking action slippery elm also has demulcent properties due to its mucilage content.

Mucilage is a gelatinous constituent (5) found in some herbs which can be thought of as a kind of ‘slime’ beneficial for soothing inflamed mucous membranes, as well as providing lubrication which is helpful for softening stools that are particularly hard or difficult to pass.

Slippery elm is also a nutritive tonic for healing tissues and can help to heal anal fissures or tearing which may have occurred as a result of straining to go to the toilet or passing large hard stools.

In cases of sensitivity or inflammation in the digestive tract, it can help to heal and soothe the mucous membranes. In addition to this, slippery elm has the benefit of helping to modify the bowel flora (6), creating a more harmonious environment which is conducive to passing healthy stools.

Aloe vera juice is soothing to the digestive tract, and due to the presence of bitter principles it stimulates bile flow from the liver, which is thought to be the mechanism which means aloe juice can help to regulate and stabilise bowel movements It has a gentle laxative effect in some cases of constipation.

According to the traditions of Ayurveda, aloe tonifies the agnis. The agnis are linked in part to digestion, and are known as the digestive fire with the function of regulating digestion, absorption and assimilation. When agni is strong, it is considered that food is digested properly and toxins are eliminated.

Energetically speaking, agni is also proposed in a much broader sense than digestion as a creative flame which is key to all transformations in life. Plants also contain agni, which can be passed to humans when they take herbs, thus influencing the power of digestion (7).

Please note: Aloe vera juice is considered cooling, soothing, and has a gentle laxative effect because of its mucilaginous properties, and is not to be confused with aloe resins, taken from a different part of the same plant, which are a strongly stimulating anthraquinone-laxative and only recommended as a last-resort, in small doses, and for very short-term use.

Liquorice is one of the most widely used herbal remedies, with many applications across the world, where it is unanimously applied as a nutritive for healing tissues amongst other things. It has an affinity with mucous membranes in various body systems, including the digestive system.

It has mucilaginous properties that help to heal and repair damaged or inflamed tissues, which combined with its mildly laxative effect make it a wonderful herb for aiding smooth bowel movements.

Senna is an anthraquinone-containing herb which has a strongly stimulating laxative effect. It is recommended as a last resort, or a very short-term temporary measure to get things moving, while other herbs are employed to rebalance the body’s systems so that digestion works efficiently and bowel movements become easy and regular.

Senna is among the well-known strong herbal laxatives (alongside cascara and aloe resins), containing anthraquinones which have a stimulating laxative effect. Whilst this can be very effective in the short-term to aid bowel movements, just as with the pharmaceutical version of strongly stimulating laxatives, these are only recommended as a last resort. 

From a holistic herbal medicine perspective, the effect of anthraquinone-laxatives is only really symptomatic (2). This means it does not address the root of the issue, and in addition to this, they tend to cause wind and griping which can aggravate certain conditions associated with constipation such as bowel irritability. Therefore they are best avoided altogether in these cases.

As such, these anthraquinone-containing laxative herbs are only recommended in some cases of constipation where the bowel itself requires stimulation due to their direct effect on the colon where they create peristalsis (movement) (8), and as a very short-term measure.

If in doubt about which herbs might be best for you instead of laxatives, or if you have ongoing issues with constipation, then an appointment with a herbalist will provide you with the relevant guidance and specific treatment plan to best assist you. You can see our resources page for details of how to find a herbalist.

1. Constipation. NHS website. https://www.nhs.uk/conditions/constipation/. Accessed 17 December, 2022.
2. Bone K, Mills S. Principles And Practice Of Phytotherapy. China: Churchill Livingstone Elsevier; 2000.
3. Laxatives. NHS website. Laxatives – NHS (www.nhs.uk). Accessed 18 December, 2022.
4. Constipation. Merck Manual website. https://www.msdmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/constipation. Accessed 17 December, 2022.
5. Hoffmann D. The New Holistic Herbal. Shaftesbury, Dorset: Element Books Limited; 1996.
6. Bone, K, The Ultimate Herbal Compendium. Warwick, Queensland: Phytotherapy Press; 2007.
7. Frawley D, Lad V. The Yoga of Herbs. 2^nd ed. Twin Lakes: Lotus Light Publications; 2008.
8. Yarnell, E. Phytochemistry and Pharmacy for Practitioners of Botanical Medicine. USA: Healing Mountain Publishing; 2004.

Sleep is an altered state of consciousness where changes in the brain’s activity take place (3), and it is essential for human life.

Although sleep is in part for resting, it is also actually quite a busy time for the body and it requires a certain amount of energy to maintain good quality sleep. Sleep is the time for cellular repair and is where maintenance mechanisms are actioned and healing for the body occurs.

Normal sleep consists of two parts: non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. NREM is broken down into stages 1 -3, and stage 4 of sleep is where REM sleep takes place (4).

These four stages of sleep are thought to gradually merge (3, 5):

Stage 1

This is where the transition between wakefulness and sleep which is normally up to about 5 minutes in duration. During this stage the person may have fleeting thoughts and if they wake think they have not been sleeping. Many people struggle with this stage as it takes them a while to get to sleep.

Stage 2

Light sleep is the first stage of true sleep.  There may be fragments of dreams and the duration is around 10 – 60 minutes.

Stage 3

Moderately deep sleep, referred to as slow-wave (SWS) sleep.  During this stage the body temperature and blood pressure tend to decrease, this usually occurs around 20 minutes after falling asleep. This stage of sleep is thought to be critical to restorative sleep, allowing for growth and recovery of the body. Experts believe it also is vital for the immune system and other bodily processes (5).

Stage 4

The deepest level of sleep, REM sleep. Duration 10 – 60 minutes. The eyes may move rapidly (hence the name). Most vivid dreaming usually occurs during REM sleep.

Sleep ideally consists of a single block of three to five cycles of sleep stages, usually happening during the night (6).  Typically a person goes from stage 1 – 4 of sleep in less than an hour and during a typical night’s sleep of 7 – 8 hours there will be approximately 3 – 5 episodes of REM sleep as a person passes between NREM sleep and REM sleep, with REM sleep occurring approximately every 90 minutes.

A baby’s sleep consists of around 50% of REM sleep, whereas in adults it usually makes up about 25% of sleep.  Although it is not fully understood, this high level of REM sleep in infants suggests that it is important for the maturation of the brain. Neuronal activity is high in REM sleep, brain blood flow and oxygen use are equal to or higher in REM sleep than in intense mental or physical activity while awake (3), indicating that sufficient energy is required to actually be able to sleep well and access all the stages of sleep.

Sleep is in part a time when organising and housekeeping in the brain takes place and is thought to play a vital role in retention of new learning (7). This may be considered again in the context of new-born babies who need between 14 – 17 hours of sleep per day (2). This is because aside from supporting the growth which is taking place in their bodies, they are creating neural networks as they learn new information about the world. Sufficient sleep necessary to facilitate this.

Sufficient good quality sleep is necessary for physical and mental health, and for quality of life.  Sleep is known to be important for regulation of the nervous system, helps with overall resilience, immune system function, ability to deal with stress, mental and emotional health. It is vital for the maintenance of overall health and wellbeing.

Sleep deprivation disturbs the circadian physiology, exerting a negative impact on the brain and behavioural functions, and can cause neuroinflammation and oxidative stress (8). Long term, this can lead to neurodegenerative issues. Mental health issues such as depression have also been linked to neuroinflammation now. Circadian rhythms are natural changes in physiology over a 24-hour day-night period, particularly hormone levels which typically influence sleep and wake cycles and our ability to fall asleep easily at night.

There is an ever-increasing body of evidence to suggest that insufficient sleep contributes to a host of adverse medical and mental dysfunctions, such as unbalanced body systems, increased incidence of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, issues with cognitive function, increased accidents, and depressive symptoms (1).

It is suggested that sleep plays a key role in the optimization of energy as during sleep energy reserves are redirected to processes such as maintenance of cells, anabolism (‘rebuilding’ and repair), immune function, and neural plasticity (6).

Neural plasticity refers to the capacity of the nervous system to modify itself both functionally and structurally in response to experience and injury. Ultimately it ensures the healthy development and function of the nervous system (9) which can also impact on memory.

A recent study has found that sleep also seems to play a role in facilitating the clearance of molecular waste products from the brain which accumulate during waking hours (10). The authors noted that sleep seems to increase the brain’s interstitial volume (meaning the space between the tissues), and that the impact of one night of complete sleep deprivation on the molecular clearance was not recouped in the following 2 -3 night’s sleep.

This potential build-up of molecular waste in the brain which may occur as a result of consistent sleep deprivation is of particular relevance when considering the development of neurodegenerative health conditions such as Alzheimer’s disease (10).

For adults, 7 – 9 hours of sleep per night are usually recommended (2). Although there is a lot of focus on the number of hours of sleep, and whilst this is important, it is also necessary to consider sleep quality and whether the time spent sleeping is actually restorative.

The smooth progression through the stages of the sleep cycle is necessary multiple times during a sleep period to ensure that the rest taken whilst sleeping is high-quality and actually restorative (5). An example of this is the suggestion that whilst sleep stages each have their unique qualities, it is also thought that the change between SWS in NREM sleep stage 3 and REM sleep stage 4 is actually important for memory (7).

It is clear to see that although sleep is in some ways a time of rest from our usual waking activities, there is actually still a lot of activity going on during sleep which can be thought of as the ‘behind the scenes’ housework to keep everything functioning well. This is particularly true for the nervous system, and this requires a certain amount of energy to maintain.

Insufficient sleep is a prominent problem in today’s modern 24-h society, with the increased usage of smart phones and electronic devices worsening this epidemic (1).

Problems with sleep are often caused by (2):

• Environmental issues: Night-time noise, screen light from phones, TVs and tablets, and light from the outside can trick your body into delaying sleep. Air pollution can also disrupt your sleeping patterns.
• Life events: You may feel distracted, stressed or worried about something going on in your life while you’re trying to go to sleep, which can affect your ability to relax.
• Thinking cycle: Anxious thoughts about not getting enough sleep can cause distress, which can prevent you from relaxing and falling asleep. This can become a vicious cycle. Also an overactive mind when going to sleep delays sleep latency.
• Lifestyle: Developing poor habits around sleep, such as not having a regular routine, can cause problems.
  • Not having a regular sleep-awake routine
  • Eating late at night
  • Consuming alcohol, nicotine or caffeine around bedtime
  • Vigorous exercise late at night
  • Using smart devices (phones, tablets etc.) before bed
  • Checking and responding to work emails outside of working hours

It’s common for most people to experience periods of poor sleep at some point in life, but short bouts of sleep problems don’t usually result in health problems. However, consistently poor sleep can begin to contribute to health issues, including being a symptom and cause of mental health problems (2).

‘Tired but wired’ is a phrase coined to explain when the nervous system is in overload (in sympathetic or ‘fight and flight’ mode) and it can become difficult to switch off. Although one may feel tired or even exhausted, falling asleep (known as ‘sleep latency’) and/or maintaining sleep can become difficult. This is partly because of higher than normal levels of the hormone cortisol tend to circulate the bloodstream when we are over-stressed.

When the body is functioning well, cortisol levels naturally dip at night as part of the circadian rhythm, easing us into a restful night’s sleep. Understanding this contextualises why and how living removed from the rhythms of nature can have an impact on our sleep.

In addition to this from a holistic perspective when the nervous system is depleted due to chronic stress, we are tired and really need sleep. There are often not actually enough energy resources available to achieve and maintain the good quality sleep we really need.  This can become a vicious cycle where the over-tiredness prevents sufficient sleep, and the lack of sleep exacerbates stress on the body and further inhibits the capacity to sleep well.

This is where herbs can really help to reset this cycle.  Herbs which are classed as nervous system tonics can be helpful in restoring the nervous system so that it becomes less frazzled, which can be considered energetically as providing ‘food’ to the nervous system so that it has the sufficient nourishment required to maintain sleep. 

Herbs which are classified as adaptogens can also be beneficial to help reset the stress response, allowing the nervous system to function well, and redress the natural balance of stress hormones throughout the sleep-waking cycle of the circadian rhythm. 

In addition to this, herbs classified as sedatives and hypnotics can assist with getting off to sleep (sleep latency), and often have additional benefits of helping with anxiety or nervousness which often accompany sleep issues. However, the primary goal with herbal support is always to rebalance the body by addressing the root cause of issues.

This means that the natural processes can be restored and systems can function in a healthy way. Therefore, herbs which act as hypnotics and sedatives are only recommended as short-term solutions while the body systems are further restored and regulated, and lifestyle factors are addressed so that a healthy sleep cycle can be re-established.

It is best to note when considering herbal support for sleep is that if there are underlying factors at the root of sleep issues then these must be addressed alongside taking herbs. In the case of long-term issues then the guidance of a herbalist is recommended to tailor a personalised treatment plan. You can find clinical herbalists on our “Where to find a herbalist” page.

Valerian (Valeriana officinalis)

Valerian is traditionally considered a convalescent tonic to calm the nervous system and enhance its function. Its name comes from the Latin valere – meaning “to be strong, powerful, healthy”, which explains why, although it is typically considered to be a hypnotic and sedative herb, it can in some people also be stimulating due to providing an increase in vital energy.

Despite this, it is often helpful in restoring the nervous system. Therefore even in cases where it is stimulating as a bedtime remedy, it can sometimes be beneficial to continue taking the herb to help restore the nervous system so that deeper more relaxed sleep can be accessed eventually.

Valerian is often helpful when there is difficulty getting to sleep or staying asleep. It is particularly helpful when this is accompanied by emotional stress, excitability, or a sense of irritability. This is because it not only provides the tonic support to rebuild the nervous system allowing deeper more nourishing sleep to be possible, but it also has a sedative effect so can also be beneficial in assisting with getting off to sleep.  Valerian is also a muscle relaxant so can be a great support where muscle tension is present along with sleep issues.

Ashwagandha (Withania somnifera)

This is a tonic for both the nervous system and for restoring sleep.  It is best thought of as when the body is too exhausted or worn out to be able to sustain good quality sleep, because sleeping also requires a certain amount of energy. When one becomes “tired and wired” the depth of good quality sleep can become difficult to sustain.  In these instances, ashwagandha helps on a deeper level than simply sedating or aiding falling asleep, it can be considered as laying a deep restorative foundation which provides a base from where better-quality sleep becomes possible, allowing the body to truly rest and restore. 

Occasionally because of this restorative effect ashwagandha can sometimes be felt as stimulating, in which case it can be taken during the daytime rather than at night, where it will still have a restorative effect which will over time nurture better quality sleep.  Ashwagandha is considered an adaptogenic herb, so it also improves the bodies resilience to stress, and helps to reset the balance of the stress response. This makes it particularly beneficial when frazzled nerves and being overly stressed is a factor in sleep issues.

St John’s wort (Hypericum perforatum)

This is a nervous system tonic which is traditionally used for insomnia, particularly when emotional stress, anxiety, or depression are also a factor.  Because of its restorative effect on the nervous system, St John’s wort can benefit the onset of sleep and staying asleep (insomnia which involves waking in the night and difficulty getting back off to sleep is common feature of depression).

Passionflower (Passiflora incarnata)

This is helpful in cases where sleep issues are accompanied by anxiety, excitability or irritability.  Traditionally it has been given as a tea by Native Americans for sedative and anxiolytic effects and continues today to be given for this and its hypnotic effect.

Passionflower can aid getting off to sleep, as well as staying asleep.  It is considered particularly beneficial where circular thinking is preventing sleep onset (for example, worrying and repetitive over thinking). Passionflower helps to switch off this thinking and so getting to sleep becomes easier. It is also a nervine so helps to relax the nervous system and assists the ability to stay asleep.

Vervain (Verbena officinalis)

This herb is not particularly sedative as such, but as more of a tonic for the nervous system it tends to relax the body, energetically bringing a sense of grounding.  This can allow a better quality of sleep which will be overall deeper and more nourishing, especially when combined with other herbs which have sedative or hypnotic qualities such as valerian or passionflower. Herbalists may consider it for people who feel they sleep lightly, wake easily, or simply do not feel well rested after sleep. The grounding effect allows the sleep to become deeper.

Hops (Humulus lupulus)

Hops can be helpful when there is difficulty getting off to sleep or in staying asleep.  It tends to be hypnotic and mildly sedative and is particularly helpful if sleep issues are accompanied by a sense of excitability or restlessness, and also for people who experience excessive libido.  It is also beneficial for people experiencing sleep issues associated with the menopause.  It is best avoided in depression due to its slightly depressive effect.

Chamomile (Matricaria recutita)

This is a well-known remedy for sleep and suitable for children due to its gentleness. However, it is traditionally said of chamomile that ‘gentleness should not be confused with weakness’.  Although gentle in nature due to its calming effect Chamomile can be a simple but beneficial sleep remedy. It can be taken as an evening drink to aid getting off to sleep, particularly when sleep issues are accompanied by a feeling of restlessness or mild anxiety.

Limeflower (Tilia spp.)

Popular in France where it is a common home remedy taken as a relaxing evening drink to aid getting off to sleep.  It is relaxing and helpful if anxiety accompanies sleeplessness.

Skullcap (Scutellaria laterflora)

This is a wonderful herb when sleep issues are due to emotional stress, or when excitability, irritability, or anxiety are present with sleep issues.  It is a tonic for the nervous system, and as with other nervous system tonics it helps to restore the ability to achieve good quality deep sleep. It is also sedative so aids getting off to sleep. Herbalists consider it to have an affinity with the head (from the name skullcap), and is helpful to stop worrying about things that you cannot do anything about.

Lemon balm (Melissa officinalis)

Helpful for promoting better sleep quality, a calming herb that blends well with chamomile and lime flower for a pleasant tasting evening beverage. It is also considered energetically helpful for nightmares, and irritability in children and the elderly.

Key components to healthy sleep are ensuring healthy sleep routines and where possible eliminating or managing stressors which may be contributing to a lack of sleep.

The following guidelines have been recommended by Mental Health UK (2) as tips for getting a good night’s sleep:

• Create a regular sleeping pattern of sleeping and waking
• Create a restful sleeping environment (dark, peaceful and a comfortable temperature)
• Assess your stressors from work (for example workload, commute, work environment and boundaries at work)
• Regular exercise releases stress from the body, and tires us out in a healthy way so we can slip into a deep regenerative sleep. Avoid vigorous exercise too close to bedtime when possible as this can keep you awake.
• Be mindful of food and drink consumption. Caffeine takes at least 5 hours to leave the body and massively disrupts sleep for most people, as does alcohol. A herbal tea in the evening from the plants mentioned above could be a wonderfully soothing alternative.
• A sleep diary can be helpful for seeing how much sleep you are actually getting, allowing you to analyse your patterns and take informed action.
• A wind down routine will help you to relax before bed and nurtures a good night’s rest. This can include a warm bath, some gentle yoga or a relaxing and quiet podcast or music. Its important to support the transition between the day’s chores and activities and rest.
• Write down your thoughts, especially if you tend to lie and think about all you have to do the next day. Simply writing these down allows us to release them and have a clearer mind so we can get to sleep more quickly. 
• Create and maintain good sleep hygiene by avoiding bright lights at bedtime and screens for at least 30 minutes to an hour before bed.

In addition, Yoga Nidra can be helpful for re-establishing healthy sleeping habits.  It is also referred to as ‘Yogic sleep’, and is a guided relaxation practice which accesses the space between the conscious and subconscious mind, aiding the release of physical and mental tension, and promoting deep relaxation.

It helps to re-establish balance in the body-mind complex, nourishing the nervous system, and can be a great aid for re-establishing the balance and energy resources necessary to access sufficient good quality sleep. Yoga Nidra can be practised during the daytime, or as part of a wind-down routine before going to bed at night.

1. Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel). 2018;7(1):1. doi:10.3390/healthcare7010001
2. Sleep and mental health. Mental Health UK website. https://mentalhealth-uk.org/help-and-information/sleep/. Accessed December 3, 2022.
3. Tortora, G, Derrickson, B. Principles of Anatomy and Physiology. Vol. 1. 13^th ed. Asia: John Wiley & Sons; 2011.
4. Patel AK, Reddy V, Shumway KR, et al. Physiology, Sleep Stages. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK526132/ Accessed December 8, 2022.
5. Stages of Sleep. Sleep Foundation Website. https://www.sleepfoundation.org/stages-of-sleep.  Accessed December 3, 2022.
6. Nollet M, Wisden W, Franks NP.Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 2020;10:20190092. http://dx.doi.org/10.1098/rsfs.2019.0092. (Accessed 02.12.22).
7. Newbury, CR, Crowley R, Rastle K, & Tamminen J. Sleep deprivation and memory: Meta-analytic reviews of studies on sleep deprivation before and after learning. Psychological Bulletin. 2021;147(11):1215–1240. https://doi.org/10.1037/bul0000348.
8. Bishir M, Bhat A, Essa MM, Ekpo O, Ihunwo AO, Veeraraghavan VP, et al. Sleep Deprivation and Neurological Disorders. BioMed Research International. 2020;5764017. https://doi.org/10.1155/2020/5764017.
9. R, Bernhardi LE, Eugenín J. What Is Neural Plasticity?. Adv Exp Med Biol. 2017;1015:1-15. doi:10.1007/978-3-319-62817-2_1.
10. Eide PK, Vinje V, Pripp AH, Mardal KA, Ringstad G. Sleep deprivation impairs molecular clearance from the human brain. Brain. 2021;144:3: 863–874. https://doi.org/10.1093/brain/awaa443.

Hot flushes are most prevalent in African Americans and Caucasians. It is least prevalent in East-Asian people. It’s thought this is because of the soy-rich diet of those in places like Japan. But it is also because the ageing process is revered in East-Asia where it is not in Westernised countries such as America.

To support someone with hot flushes phytoestrogens such as sage are key. Sage is especially nice because it is also cooling and helps with hyperhidrosis (excessive sweating). Another herb worth considering is peppermint (Mentha piperita) for its cooling properties. 

Anxiety is worst in people who are approaching perimenopause and already burnt out from life’s demands. To abate this, phytoestrogens like black cohosh can help because it’s also a nervine.

But it can be complemented with other nervines like chamomile (Chamomilla recutita) and passionflower (Passiflora incarnata). I also like to give people suffering with anxiety herbs to help with burnout such as oat straw (Avena sativa) and perhaps even an adaptogen such as ashwagandha (Withania somnifera) because it relaxes and strengthens. 

I see lethargy as another symptom of burnout. Adaptogens are key here, as well as tonics. I particularly like nettle (Urtica dioica) in addition to the ashwagandha I’ve already mentioned. Eating a low glycemic load diet will also help with lethargy as it improves slow release of energy. This is vital for anyone surviving on coffee which will stress the adrenals further.

Weight gain is somewhat unavoidable and potentially beneficial as fat cells are where we make a lot of our oestrogen. But when it seems to be going on too fast, or too much, it’s important to try and work to stop that.

Weight-bearing exercises such as weight lifting is a great way to improve muscle bulk and metabolism, not to mention bone health. Eating a low glycemic diet will help stop the fat from depositing in the middle of the body, as will managing stress levels with relaxants (as mentioned in the anxiety section).

You can also work with herbs that help balance blood sugar levels, like cinnamon (Cinnamomum zeylanica).

If you’re struggling to get to sleep, it’s partly because it takes much longer to produce melatonin as we age. This means that we need longer in the dark than we used to before bed.

It’s crucial to have at least an hour away from all screens before bed in order to promote its production. But interestingly, working with chaste berry (Vitex agnus castus) can help with this at the right dose. 

Poverty, stressful life events and negative attitudes to ageing contribute to menopausal depression more than ethnicity. But it’s interesting to note that Chinese Americans have the least amount of depression in western society. Possibly because they still revere their older generations.

Gambian women are known to feel renewed and strengthened during the perimenopause as they are relieved from childbearing and become a respected elder.

Our western attitudes to ageing have a lot to answer for. But whilst I’d love those attitudes to change overnight, they won’t. In the meantime, we’re left with depressed perimenopausal populations.

Anti-depressants like St John’s wort (Hypericum perforatum) may help, but I don’t particularly like it. I actually much prefer lemon balm (Melissa officinalis) and orange blossom (Citrus auratium) as they are incredibly uplifting. It’s hard not to see the brighter side of life while taking those herbs.

Any and all of these herbs can be made into an infusion or decoction. For an infusion, just pour boiling water on top of a heaped teaspoon of herbs and let it infuse for 5 minutes before drinking. Drink that 3 times a day. But if you don’t have time for that you can get them as tinctures, an alcohol extract, and taken as drops each day. I’d recommend 2-5ml of a herb twice a day. Or 5ml three times a day if you go with a combination of herbs.

Finally, we want to note that due to the rise in popularity of herbs for women’s health, some of the popular species are now in danger. For example, this is true for black cohosh. Therefore, buy from reputable suppliers, and ideally places that source cultivated plants rather than wild-harvested to be sure that your medicines are sustainable. Read more about Endangered plants and women’s health: Fertility herbs at risk.

Arguably, one of the most interesting and useful qualities of essential oils is how they can have a direct impact on our nervous system, simply through inhaling them. Olfaction, or our sense of smell, is one of the lesser-understood senses and has the power to evoke moods or memories almost instantaneously when we inhale an evocative aroma (1).

When we inhale, essential oil molecules can pass through into our olfactory bulb, the organ that detects scents, and are then recognised by smell receptors.

The olfactory bulb is directly connected to the brain (2) and passes the aroma nerve impulse generated by the aromatic molecule, which is sent directly into our limbic system – the part of the brain that is associated with emotion and memory (3).

As such, essential oils can have a profound impact on our mood since the nerve impulses triggered by smells pass through the amygdala – the part of the brain associated with interpreting the “emotional significance” (4) of what is around us – as well as impacting the hypothalamus, which largely controls our endocrine (hormonal) system. The production of hormones is often influenced by what we inhale (5) and variations in hormone levels can have a significant effect on our mood, as well as the status of our nervous system (6).

When our sympathetic nervous system is activated, we are in ‘fight or flight’ or “hyperarousal” mode, and as such, cortisol (commonly known as the stress hormone, although we need it for various functions in the body) levels are typically high (7). This can prevent our parasympathetic nervous system from activating, which is responsible for helping us feel calm and relaxed.

The parasympathetic nervous system is sometimes described as putting the ‘brakes’ on the sympathetic nervous system (8), preventing or slowing its activation, and allowing our body to enter the ‘rest and digest’ mode needed for sound sleep.

So, if we are experiencing high levels of brain activity, lots of stimulation or anxiety before bed, this can significantly impact our body’s ability to regulate and produce the hormones necessary for sleep.

Research papers suggest that cortisol levels are higher in those experiencing insomnia (9), and others note that stress in particular inhibits slow-wave sleep (10) which is thought to be the most restorative form of sleep (11).

There are a number of approaches to promoting restful sleep, with tips for creating a bedtime routine, reserving the bedroom for rest, exercising and finding other ways to de-stress (12).

Whilst aromatherapy is not a cure for serious sleep disorders such as insomnia, it can play a part in the wider picture of developing healthy ‘sleep hygiene’ (13).

Since aromatherapy taps directly into the nervous system and can therefore cause the production or reduction of hormones in the brain and rest of the body, it is a useful tool in our arsenal for helping to create the right internal environment in the body which can allow sleep to come.

Aromatherapy in the context of sleep has a strong focus on reducing stress, promoting a calm, positive mood, and gently allowing the nervous system to re-regulate. This decreases the activity of the sympathetic nervous system, and allows the parasympathetic nervous system to naturally activate as the hormonal ‘barriers’ such as cortisol are allowed to decrease. It also focuses on creating a positive environment to allow the client to reframe their approach to sleep and relaxation.

Creating mood-aroma associations

Throughout our lives, we might have developed positive emotional associations with some aromas, and not with others. This phenomenon is due to the link with between and our limbic system. The good news is that we can harness this link to our advantage, creating a “smell-mood memory” (14), establishing (or reinforcing) positive associations between aroma and mood that help us feel rested and ready for sleep.

For example, if a client comes to see me for help addressing insomnia or broken sleep, over the course of our treatments, I will co-create a blend of essential oils with them, using oils which already have a strong, positive and calming emotional association for them, or are new, but that they find calming. Then, over time, they begin to associate with a calm, restful time and environment – their monthly massage treatment.

My favourite essential oils for treating sleep disorders are those that work to calm the nervous system whilst also relaxing the muscles. By regulating our breathing, slowing our heart rate and releasing tension from muscles, we can ‘tell’ our brain that it’s time to rest, and literally trigger the activation of our parasympathetic nervous system (15).

Inhalation, as well as topical application of essential oils, can be synergistic since inhalation is the most effective way to use aromatherapy for psychotherapeutic effect (16).

Below, you will find some information and recipes for aromatherapy blends to support you the get a good night’s sleep.

Therapeutic touch to calm the body

Massage itself is also a brilliant way to prepare the body for rest. Moderate pressure massage can generate a response from the parasympathetic nervous system (17), and therefore support the work of the aromatic oils which are applied to the body topically as part of a blend in a base oil, and then absorbed into the bloodstream, and inhaled by the client as they receive the massage treatment.

Creating a sleep blend of calming essential and carrier oils and applying it to your neck, shoulders and arms 30 minutes before sleep as part of a wider wind-down ritual is soothing for the nervous system on both levels.

Suggested blend for pre-sleep massage or bath oil (2% blend)

Ingredients

10ml carrier oil e.g. sunflower oil (Helianthus annuus)

10 drops (total) of ant-spasmodic, anti-inflammatory, anxiolytic and nervine essential oils, to include any of the following:

• German Chamomile Matricaria recutita (anti-inflammatory, nervine, sedative)
• Roman Chamomile Chamaemelum nobile (anti-inflammatory, nervine, sedative)
• Lavender Lavandula angustifolia (anti-inflammatory, analgesic, sedative, relaxant, hypotensive)
• Juniper Juniperus communis (antispasmodic, analgesic)
• Mandarin (Citrus reticulata (antidepressant, antispasmodic, sedative for central nervous system, relaxant)
• Marjoram Origanum majorana. (relaxant, hypotensive oil, musculoskeletal antispasmodic)

How to make a pre-sleep massage oil

Stir well to combine, and apply to the affected area using gentle massage, preferably on warm skin. This is particularly effective post-shower or bath.

Inhalation to soothe the mind

Perhaps the simplest and most effective way for generating an impact on our mood and emotions, inhalation is my preferred method of application for regulating sleep. I have found that for myself and my clients, using a diffuser or aromatherapy inhaler 30-60 minutes before sleep whilst maintaining a dimly-lit room for the same amount of time can help to create a contextual association between “down time”, the aroma, and feeling calm. By reinforcing this routine daily, you can help to cement an ‘odour response’ (18) and with time may find that sleep is improved.

Suggested Inhaler sleep blend

Using a diffuser, fill with water to the maximum fill line and add up to ten drops of the following essential oils. Diffuse for 30-60 minutes before sleep, in the bedroom.

• Tarragon* (Artemisia dracunculus): Antispasmodic, hypnotic, neuromuscular tonic
• Bergamot (Citrus bergamia): Calming, antispasmodic
• Clary sage* (Salvia sclarea): Calming, sedative, tonic
• Cypress (Cupressus sempervirens): Antispasmodic, balances sympathetic nervous system
• Geranium (Pelargonium graveolens): Anxiolytic, antispasmodic, anti-inflammatory
• Jasmine (Jasminum officinale): Sedative, calming, antispasmodic

*Caution: avoid in pregnancy

Sleep ointment recipe

Mmakes 1 ~60ml pot at a ~2% dilution

Ingredients

8g Beeswax (or soy wax)

50ml Carrier oil, e.g. herbal infused St John’s Wort (Hypericum perforatum) oil, or sweet almond (Prunus dulcis) oil

30 drops of total essential oil from the following list:

• Marjoram (Origanum majorana) – works to calm the nervous system whilst simultaneously relaxing muscle tissue
• Grapefruit (Citrus paradisii) – a “cooling, cleansing” (19) oil that clears the mind and helps ease feelings of frustration and tension.
• Valerian (Valeriana officinalis) – a sedative essential oil that helps relax the body and mind, and relieve stress
• Vetiver (Vetiveria zizanoides) – sedative, grounding, and calming

Orange Petitgrain Citrus arurantium amara (fol). – uplifting without being stimulating, antispasmodic and calming. Particularly useful for nervous exhaustion.

How to make a sleep oil

1. Use a bain-marie on a low heat to melt the carrier oils and wax together. Stir until completely melted and combined.
2. Take off the heat. Allow to cool to 50-60 degrees C.
3. Add up to 57 drops of essential oils, from those listed above.
4. Stir well to combine, pour into a 60ml sterilised tin and allow to cool.
5. When solid, the balm is ready to use. Use within 6 months.
6. Apply topically to the neck, shoulders and arms 30 minutes before bed, massaging gently.

The wider picture of sleep

These recipes and suggestions are designed by a clinical aromatherapist to help support you to integrate aromatherapy into your pre-sleep ritual. Whilst aromatherapy has been shown by studies to improve sleep quality (20) these blends are not designed to cure insomnia or other disorders, and are to be used as part of a holistic approach to promoting healthy sleep which might include addressing areas such as food, exercise, levels of stimulation, reducing stress and establishing a regular sleep routine.

1. Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
2. Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
3. Walsh, C. (2020, February 27). How scent, emotion, and memory are intertwined – and exploited. Harvard Gazette. https://news.harvard.edu/gazette/story/2020/02/how-scent-emotion-and-memory-are-intertwined-and-exploited/#:~:text=Smells%20are%20handled%20by%20the,related%20to%20emotion%20and%20memory.
4. Ramachandran, V. S., & Blakeslee, S. (1998). Phantoms in the brain: Probing the mysteries of the human mind. William Morrow.
5. Lobmaier, J. S., Fischbacher, U., Wirthmüller, U., & Knoch, D. (2018, September 12). The scent of attractiveness: Levels of reproductive hormones explain individual differences in women’s body odour. Proceedings of the Royal Society B: Biological Sciences. Retrieved December 1, 2022, from https://royalsocietypublishing.org/doi/10.1098/rspb.2018.1520
6. Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
7. American Psychological Association. (n.d.). Stress effects on the body. American Psychological Association. Retrieved December 1, 2022, from https://www.apa.org/topics/stress/body#:~:text=When%20the%20body%20is%20stressed%2C%20the%20SNS%20contributes%20to%20what,adrenalin%20(epinephrine)%20and%20cortisol.
8. Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
9. Roehr, T., & Roth, T. (2019, April 25). Hyperarousal in insomnia: Pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment. Sleep Medicine. Retrieved December 1, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S138994571930125X
10. Kim, E.-J., & Dimsdale, J. E. (2007). The effect of psychosocial stress on sleep: A review of polysomnographic evidence. Behavioral Sleep Medicine, 5(4), 256–278. https://doi.org/10.1080/15402000701557383
11. Dijk, D.-J. (2009, April 15). Regulation and functional correlates of slow wave sleep. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. Retrieved December 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824213/
12. Harvard Health Publishing, Harvard Medical School. (2021, September 30). 8 secrets to a good night’s sleep. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
13. Sleep Foundation. (2022, September 29). Sleep hygiene. Sleep Foundation. Retrieved December 1, 2022, from https://www.sleepfoundation.org/sleep-hygiene
14. Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
15. André, C. (2019, January 15). Proper breathing brings better health. Scientific American. Retrieved December 1, 2022, from https://www.scientificamerican.com/article/proper-breathing-brings-better-health/
16. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, p 15.
17. Diego, M. A., & Field, T. (2009). Moderate pressure massage elicits a parasympathetic nervous system response. International Journal of Neuroscience, 119(5), 630–638. https://doi.org/10.1080/00207450802329605
18. Herz, R. S. (2005, January 1). Odor-associative Learning and Emotion: Effects on Perception and Behavior. Academic.oup.com. Retrieved December 1, 2022, from https://academic.oup.com/chemse/article/30/suppl_1/i250/270391
19. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 80.
20. Ko, L.-W., Su, C.-H., Yang, M.-H., Liu, S.-Y., & Su, T.-P. (2021, January 13). A pilot study on essential oil aroma stimulation for enhancing slow-wave EEG in Sleeping brain. Nature News. Retrieved December 1, 2022, from https://www.nature.com/articles/s41598-020-80171-x#:~:text=found%20that%20inhaling%20lavender%20aroma,whole%20brain%20during%20waking%20times.

• American Psychological Association. (n.d.). Stress effects on the body. American Psychological Association. Retrieved December 1, 2022, from https://www.apa.org/topics/stress/body#:~:text=When%20the%20body%20is%20stressed%2C%20the%20SNS%20contributes%20to%20what,adrenalin%20(epinephrine)%20and%20cortisol.
• André, C. (2019, January 15). Proper breathing brings better health. Scientific American. Retrieved December 1, 2022, from https://www.scientificamerican.com/article/proper-breathing-brings-better-health/
• Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997
• Diego, M. A., & Field, T. (2009). Moderate pressure massage elicits a parasympathetic nervous system response. International Journal of Neuroscience, 119(5), 630–638. https://doi.org/10.1080/00207450802329605
• Dijk, D.-J. (2009, April 15). Regulation and functional correlates of slow wave sleep. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. Retrieved December 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824213/
• Harvard Health Publishing, Harvard Medical School. (2020, July 6). Understanding the stress response. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
• Harvard Health Publishing, Harvard Medical School. (2021, September 30). 8 secrets to a good night’s sleep. Harvard Health. Retrieved December 1, 2022, from https://www.health.harvard.edu/newsletter_article/8-secrets-to-a-good-nights-sleep
• Herz, R. S. (2005, January 1). Odor-associative Learning and Emotion: Effects on Perception and Behavior. Academic.oup.com. Retrieved December 1, 2022, from https://academic.oup.com/chemse/article/30/suppl_1/i250/270391
• Kim, E.-J., & Dimsdale, J. E. (2007). The effect of psychosocial stress on sleep: A review of polysomnographic evidence. Behavioral Sleep Medicine, 5(4), 256–278. https://doi.org/10.1080/15402000701557383
• Ko, L.-W., Su, C.-H., Yang, M.-H., Liu, S.-Y., & Su, T.-P. (2021, January 13). A pilot study on essential oil aroma stimulation for enhancing slow-wave EEG in Sleeping brain. Nature News. Retrieved December 1, 2022, from https://www.nature.com/articles/s41598-020-80171-x#:~:text=found%20that%20inhaling%20lavender%20aroma,whole%20brain%20during%20waking%20times.
• Lobmaier, J. S., Fischbacher, U., Wirthmüller, U., & Knoch, D. (2018, September 12). The scent of attractiveness: Levels of reproductive hormones explain individual differences in women’s body odour. Proceedings of the Royal Society B: Biological Sciences. Retrieved December 1, 2022, from https://royalsocietypublishing.org/doi/10.1098/rspb.2018.1520
• Martin, I. (2007). Aromatherapy for Massage Practitioners (1st ed.). Lippincott Williams & Wilkins.
• Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005
• Ramachandran, V. S., & Blakeslee, S. (1998). Phantoms in the brain: Probing the mysteries of the human mind. William Morrow.
• Roehr, T., & Roth, T. (2019, April 25). Hyperarousal in insomnia: Pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment. Sleep Medicine. Retrieved December 1, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S138994571930125X
• Sleep Foundation. (2022, September 29). Sleep hygiene. Sleep Foundation. Retrieved December 1, 2022, from https://www.sleepfoundation.org/sleep-hygiene
• Walsh, C. (2020, February 27). How scent, emotion, and memory are intertwined – and exploited. Harvard Gazette. Retrieved December 1, 2022, from https://news.harvard.edu/gazette/story/2020/02/how-scent-emotion-and-memory-are-intertwined-and-exploited/#:~:text=Smells%20are%20handled%20by%20the,related%20to%20emotion%20and%20memory.

What is the microbiome?

The gastrointestinal tract harbours a diverse microbial community of which up to 99.99% are anaerobic bacteria. Concentrations as high as 10¹¹/ml may be found in the colon, with densities thinning upstream, towards near sterility in the stomach. The bacteria are classified into four main phyla and up to 1000 distinct species, with the most dominant, Faecalibacterium prausnitzii making up much of the stool bulk. Viruses, archaea and eukaryotes (such as Candida) are also normally present at varying levels.

Phylum	Summary	Commonly detected constituent genera
Actinobacteria	Gram positive	Atopobium, Bifidobacterium(I), Collinsella, Eggerthella
Bacteroidetes	Gram negative bacilli Typically obligately anaerobic	Alistipes, Bacteroides(III), Barnesiella, Parabacteroides, Prevotella
Firmicuttes	Gram positive Uusually abundant and dominant members of the gut microbiota Contains the greatest degree of species diversity Dominant phylum of bacteria closest to the gut wall	Clostridia class (obligate anaerobes) Acidaminococcus, Anaerostipes, Anaerotruncus, Blautia, Butyrivibrio, Clostridium(II), Coprobacillus, Coprococcus, Dialister, Dorea, Faecalibacterium(I), Finegoldia, Lachnospira(I), Megasphaera, Phascolarctobacterium, Roseburia, Ruminococcus(II), Subdoligranulum, Veillonella Bacilli class (typically facultative anaerobes) Enterococcus(II), Lactobacillus(I), Streptococcus(II)
Proteobacteria	Gram negative Typically facultatively anaerobic species Includes many conventional and opportunistic pathogenic species	Alcaligenes, Bilophila, Campylobacter(II), Desulfovibrio(II), Enterobacter(III), Escherichia(III), Hafnia, Helicobacter(II), Klebsiella(II), Oxalobacter, Parasutterella, Proteus(III), Sutterella
Other phyla	Only a limited number of species	Fusobacterium, Akkermansia(I), Victivallis

It is important to note that the microbiome population is stratified. There is a resilient commensal population, mostly species of the Firmicutes phylum, that are adherent to the gut wall.

These residents provide the most consistent element in the community, readily reclaim their niche when disturbed and compete against interlopers. Further away from the gut wall are more transient populations, largely evacuated with stool movements.

Each person’s microbiome is unique – and always changing (to some extent with each meal). Even identical twins share only 50% of their microbiome profile (1). However, healthy microbiomes are resilient, able to return to steady state after being perturbed (2).

What does the microbiome do?

Overall the microbiome contains at least 100 times as many genes as the human genome. Not surprisingly, therefore, the microbiota mediate many functions, including modulating gene expression in the host. There is no function in the body that is not affected, with digestion, metabolism, detoxication, circulation, and hormonal, nervous, immune and inflammatory activities notably influenced.

For example, beneficial microbiota induce expression of opioid and cannabinoid receptors (comparably to morphine) (3), modulate inflammatory cytokines, reduce obesity and symptoms of anxiety and depression (4).

People with Alzheimer’s disease, Parkinson’s, depression and irritable bowel syndrome have been shown to have significant differences in gut bacteria when compared to healthy people (2). There is particular consensus that changes in the microbiome are critical for metabolic syndrome conditions like insulin resistance, non-alcoholic fatty liver disease (NAFLD), obesity and diabetes (5,6).

Intriguingly, it may even be that one of the most widely used medicines for diabetes may mediate its benefits partly through changes in the microbiome (7)! There is also an emerging concept of the ‘microbiome-gut-brain axis’ to augment the widely understood ‘gut-brain axis’ with the important role of microbial metabolites on brain function (8).

Fortunately innate microbiome resilience and a diversity of phenotypes ensures core ‘housekeeping’ functions are maintained (9). These include:

Metabolism and nutrition:

• vitamin synthesis (e.g. vitamin K and folate);
• regulating the uptake and deposition of dietary lipids;
• converting otherwise indigestible dietary elements, e.g. lactose (into glucose and fructose) and alcohols (into short-chain fatty acids: SCFAs).

Protection:

• maintenance of intestinal barrier integrity;
• barricading against invading pathogens by competitive exclusion (production of antimicrobial peptides e.g. non-specific fatty acids and peroxides, specific bacteriocins);
• engagement of attachment sites;
• reduction in host stress responses (microbiota–gut–brain axis).

Immunomodulation:

• inducing tolerance to dietary and microbial antigens;
• activating intestinal dendritic cells;
• induction of IgA from B cells.

How to manage a biome?

Our gut microbiome shares many of the properties of other complex self-organizing ecological systems of mutually interacting living organisms. An obvious parallel is the soil biome that nourishes the plants that grow in it, and which for example is the basis of new insights into the ‘wood-wide web’ through which trees are known to communicate with each other.

A biome provides an immediate challenge to the usual reductionist approach to biological and medical science. In the case of the gut microbiome this means:

• It can never be fully measured as it is in constant flux: any culture or -omic reading will be partial and soon out of date;
• It cannot be controlled, as the interactions between its thousands of elements are unknowable: even faecal implants need to bed-in with resident flora and to find a new modus vivendi.

A quick insight is that managing the inner microbiome requires a respect comparable to that in managing a healthy soil, as is the aim for example of the organic farmer. It requires nurturing rather than manipulation.

Above all is the recognition that this biome is in communication with the rest of us – it engages in ‘crosstalk’. We will come back to this in the next section.

Current gut microbiome management approaches

There are two familiar therapeutic approaches to maintaining a healthy microbiome, the probiotic and prebiotic. We argue here for the inclusion of a third emerging term ‘postbiotic’ to apply to a wide range of plant constituent effects.

Probiotics

Probiotics are living organisms added to the gut in the hope that they may seed new colonies. They’re usually added to yoghurts, provided as fermented foods or taken as food supplements. There is evidence that probiotics may be helpful in some cases, such as helping prevent diarrhoea when taking antibiotics (10), reducing symptoms of lactose intolerance (11), and helping to ease some symptoms of irritable bowel syndrome (IBS) (12), but for example there is no clear benefits in reducing diarrhoea generally (13), and other evidence for benefits remains scanty.

The clear challenge with introducing live organisms orally is that a healthy stomach is a sterilising chamber (14). This suggests more benefits might arise with low stomach acid conditions (possibly marked by a tendency to gut infections), including those induced on purpose by regular use of antacids and PPH drugs like omeprazole. Even in a healthy stomach a tiny percentage of live organisms may survive and could quickly build populations further down the gut; however, they then still face competition from the resident flora.

Prebiotics

Prebiotics are generally defined as plant materials that can support a healthy gut microbiome. They include the inulin-type fructans, which are linked by beta (2-1) bonds that limit their digestion by upper intestinal enzymes, and fructo-oligosaccharides. Both can reduce levels of various Firmicutes species and increase those of Bacteroidetes, as well as improving glucose sensitivity, fat metabolism, and inflammatory responses.

Specifically, beta-glucan induces the growth of Prevotella and Roseburia with a concomitant increase in SCFA propionate production (15).  Inulin and all oligosaccharides have a strong bifidogenic effect. A high fructo-oligosaccharide and fibre diet has led to significant increases in butyrate-producing Bifidobacterium (16). These compounds are present in significant amounts in many edible fruits and vegetables, including wheat, onion, garlic, leeks, artichokes, and bananas.

Fibres

Fibre, including resistant starch and non-starch polysaccharide dietary components such as cellulose, also exerts prebiotic effects (17). Many of the postulated benefits of consuming a diet that is high in fibre may be mediated, at least in part, via short-chain fatty acid (SFCA) production by intestinal microbes. As well as nourishing the gut wall tissues, SCFAs have anti-inflammatory properties (18) (see also in the next section).

It is known that changes in diet can affect SCFA profiles. For example, obese individuals fed low-carbohydrate diets showed severe depletion in faecal butyrate levels, probably as a result of reduced abundance of butyrate-producing gram-positive Firmicutes species following the change in diet. Similarly, European children have lower amounts of SCFAs in their faeces than high-fibre consuming rural African children.

Moreover, fibre also acts to generate faecal bulk, decrease transit time, and therefore reduce exposure of the intestinal lumen to harmful or toxic compounds (19). Increasing the range of carbohydrate substrates for microbial metabolism to SCFA’s is increasingly seen as critical for good metabolic health and to protect against metabolic problems like obesity and diabetes (20).

As we will see, there are many other plant constituents that are being shown to have prebiotic effects. However, these benefits most often come secondarily out of bacterial transformation in the gut.

It’s a team effort

Our inner biomes are not independent universes. A healthy gut microbiome is a product of a dynamic equilibrium with its host. There are extensive interactions between our microbiome and the rest of us and this conversation could be the main factor in maintaining the health of both. It certainly opens many new prospects for therapeutic interventions.

There are many mechanisms already identified by which the host and microbiota can influence each other.

Host secretions and receptors

Mucins

Goblet cells in the gut lining secrete these glycoproteins to form mucous layers as an innate frontline defence mechanism. Near the gut wall are several adherent layers that are also home to the most resilient bacteria. Further out there are less adherent mucin layers which are eliminated by peristaltic movement. There is evidence that mucin production is also a protective response in inflammatory events (21).

Enteroendocrine cells

These are the primary chemoreceptors and modulators of appetite and digestion in the GI lumen. They appear to be sophisticated “tastebuds” responding to changes luminal content, especially those mediated by bacteria, by releasing chemical messengers such as cholecystokinin, ghrelin and secretin that in turn activate neuronal pathways. They could also be microbiota-operated gateways to the gut-brain axis (22).

Among other functions, they express glucagon-like peptide-1 (GLP-1), that plays a key role in metabolic health and protection against diabetes. Among other ligands are curcuminoids from turmeric (23).

Enteroendocrine cells appear to have two distinct sensing pathways, to nutrients and bacteria. The former are known to affect enteroendocrine function after absorption (i.e. systemically) so may reach these cells from behind. On the opposite side the cells have a small narrow opening to the luminal surface and it is possible this may sense bacterial inputs.

Some bacterial Toll-like receptors (e.g. TLRs 4, 5, and 9) are exclusively expressed on enteroendocrine cells. When these are stimulated by bacterial ligands (e.g. LPS or flagellin) CCK and other chemokines are secreted (24).

Enterochromaffin cells

These are the body’s most abundant endocrine cells and produce about 90% of the body’s serotonin (5-HT). They serve as bidirectional transducers that modulate the relationship between the gastrointestinal lumen and the nervous system, sensing the luminal content of the gut and controlling the function of the whole digestive tract.

Microbial influence on enterochromaffin cells suggest a role in the regulation of visceral pain. Volatile components of herbs and spices are ligands for olfactory receptors on enterochromaffin cells, now seen as a relatively accessible target for the treatment of IBS, of conditions following anticancer therapy, and other gastrointestinal disorders (25).

Bitter receptors

Once thought to be restricted to the mouth, there are up to 30 types of G-protein coupled bitter taste receptors (T2Rs) throughout the body, activated by numerous ‘tastants’. T2Rs in the bowel (e.g. T2R38) are sensitive to bacterial metabolites. T2Rs have been thought to serve as ‘danger receptors’, to respond to potentially harmful substances, and are upregulated by inflammation.

There is also evidence that T2Rs in the gut wall are co-located with enteroendocrine cells, marked by chromogranin A and a-gustducin reactivity. The latter is associated with expression of cholecystokinin, GLP-1, PYY and ghrelin from enteroendocrine cells. These in turn modulate appetite, increase fat metabolism and insulin sensitivity (26).  The herbal materia medica has many bitter principles that are likely to be active on these receptors.

Olfactory receptors

Exciting research has identified chemosensitivity in cells around the body mediated by the same sensors that mediate taste and smell. They have been identified in the airways, throughout the gut lining, kidneys, the microvasculature, brain, muscles and pancreas.

A key olfactory G protein-coupled receptor, initially discovered in the renal juxtaglomerular apparatus of the kidney is Olfr78, also found throughout the vasculature. Among Olfr78’s ligands are propionate (the microbiome that generates this SCFA has also been shown to alter blood pressure) (27).

Microbiome products

The microbiome can generate a wide range of metabolites with activity on host functions. Many of importance will feature when we consider their impact on bile acids, and on various types of plant constituents below. However their greatest single impact on host functions is their generation of short chain fatty acids.

SCFAs

A universal activity of the intestinal microbiota is the breakdown and fermentation of carbohydrates into short chain fatty acids, principally acetate, propionate and butyrate. SCFAs are rapidly taken up by the colonic mucosa, contributing up to 10% of the body’s calorific needs, and act as important stimuli for the absorption of sodium and water by the colon.

Intestinal epithelial cells derive as much as 60–70% of their energy needs from butyrate and this SCFA has important effects on intestinal barrier integrity and repair and mucin production.  All SCFAs reduce intestinal inflammation, although there is less robust evidence for benefits on metabolic health (28).

Bacterial metabolites also include non-SCFAs like amino acid metabolites and bacterial amyloids also with protective effects on host health (29).

Bile: The gut coach?

Bile is a major modulator of gut performance (in former times it was referred to as ‘endogenous senna’). Increasing bile production and elimination (with choleretics and cholagogues respectively) has been a productive focus among herbal practitioners in correcting bowel and other digestive problems.

Bile also has a major role in managing the microbiome, with overgrowth a complication of cholestasis and liver disease. Bile and the microbiome have an extremely complex interaction, with bacteria processing bile acids (BAs) to a variety of more or less irritating or even toxic metabolites, potentially a key factor in inflammatory bowel diseases, hepatitis and bowel cancer (30).

Apart from their detergent properties in lipid digestion, BAs have been recognized to control a range of metabolic and immune functions throughout the body. These effects are mediated via dedicated receptors. One is farnesoid X receptor (FXR). In the gut this maintains epithelial barrier integrity, including by induction of healthy microbe populations.

Overall the microbiome induces FXR-dependent suppression of both BA synthesis in the liver and BA import from the ileum. The FXR receptor not only affects cholesterol metabolism but is also involved in the body’s sugar and fat metabolism (31).

Postbiotics: Crosstalk in action?

Postbiotics have been defined as soluble factors secreted by live bacteria, or released after bacterial lysis, which may have anti-inflammatory, immunomodulatory, anti-obesogenic, antihypertensive, hypocholesterolemic, anti-proliferative, and antioxidant activities, and that may contribute to the improvement of host health (32).

The term has come to mean different things in various contexts and a consensus definition is still elusive. For example ‘postbiotic supplements’ are industrially produced by bacterial vat fermentation, to complement probiotics. Locking the term as product related, the International Scientific Association for Probiotics and Prebiotics (ISAPP) in 2021 defined a postbiotic as “a preparation of inanimate microorganisms and/or their components that confers a health benefit on the host” (33).

A variation ‘parabiotic’ refers to denatured bacterial material that is used instead of probiotics. However other medical sources without a product focus equate ‘postbiotics’ with short chain fatty acids (SCFAs), and the authoritative Harvard Health for example adds nutrients such as vitamins B and K, amino acids, as well as antimicrobial peptides that slow the growth of harmful bacteria (34).

This latter direction suggests the use of the term ‘postbiotic’ for any product of bacterial metabolism in the gut. This would conveniently fill a gap in the range of dietary benefits for the microbiome, as the term ‘prebiotic’ is consistently restricted to fibre and dietary carbohydrates referred to above (35).

The many examples of other plant constituents with beneficial effects on gut microbiota increasingly are known to rely on microbial metabolism, and may even engage in host-microbe crosstalk. Some of these products are likely to generate ‘postbiotic’ effects, both on the microbiome and on host health. There is an early review of these issues in relation to Chinese herbs (36). We will look at some examples in the following section.

All plant foods support a healthy gut biome

It appears that a plant-based diet generally promotes the development of a more diverse microbiome. Vegetarian/vegan diets are associated with higher levels of protective biota such as Prevotella and Ruminococcus along with lower levels of bile-consuming Bacteroides and generally other genera of the Firmicutes phylum (37,38).

Most spices and kitchen herbs have been shown to promote the growth of Bifidobacterium spp. and Lactobacillus spp. to varying degrees. A combination of spices exhibited high inhibitory activity against Ruminococcus species, though minimal activity against selected strains of Bacteroides, Finegoldia, E. coli, Salmonella, and Staphylococcus. Fusobacterium spp. were susceptible to cinnamon, and F. necrophorum also to oregano and rosemary.

Cinnamon exhibited modest activity against toxigenic C. difficile and cinnamon, rosemary, or turmeric against a few strains of other Clostridium. Oregano, black pepper, and ginger possessed prebiotic‐like effects by promoting the growth of beneficial bacteria in one hand and suppressing pathogenic bacteria on the other (39).

There is interesting evidence of herbal effects on the microbiome from researchers in traditional Chinese medicines (40,41). One recent line of enquiry here is that the presence of polysaccharides in some traditional herbs may optimise bioavailability of active constituents, perhaps through an interaction with the microbiota (42).

However much of the evidence so far relates to particular plant constituents. We have already seen the role of plant carbohydrate and fibre as prebiotics. What is emerging is that many other elements engage with the microbiota.

As is often the case it is helpful in assessing plant and herbal impacts to revert to the archetypal constituents that would have been recognised in traditional pharmaceutics, by appearance, taste and smell and other immediate impacts after consumption. In the sections below these groups also stand out because they all have their own immediate impact on gut physiology, apart from any on the microbiome.

Mucilages and gums

The ‘slimy’ quality of some plants provides well-known soothing and healing properties externally and internally, based on the physical properties of these complex carbohydrates. It appears that at least one example, gum arabic, performs even better as a prebiotic than inulin. In one study, 10g daily of gum arabic consumed by healthy volunteers led to significantly higher numbers of gut Bifidobacteria, Lactobacilli and Bacteroides than inulin controls (43).

In another controlled clinical trial the reduction in inflammatory markers and symptom relief in rheumatoid arthritic patients after 30g daily of gum Arabic was considered to follow microbiomic engagement (44).

Polyphenols

These ubiquitous molecules, some long recognised by our ancestors for their colouring in plants, and linked to many traditional medicinal uses such as fever and inflammation management, have presented a therapeutic challenge.

In spite of a huge and growing literature on their benefits in the diet and medicine, their bioavailability is notably limited.

A first breakthrough was the realisation that the relatively cumbersome polyphenolic compounds are metabolised into much more accessible and active simple phenols – by the gut bacteria.

The fundamental role of the gut microbiota in realising the health benefits of these important phytonutrients immediately suggests that we should consider polyphenols as interacting with these organisms, even engaging in the crosstalk between host and gut biome, and that any use of the term ‘prebiotic’ becomes insufficient to characterise this relationship.

The polyphenol metabolites produced by gut bacteria do meet at least one definition of ‘postbiotic’ and we will offer this term for relevant plant constituents to follow.

Polyphenols generally interact with intestinal microbiota to activate SCFA production, intestinal immune function, and other protective physiological processes (45,46).

As one author noted: “This interplay provides the central explanation as to the stupefying pleiotropic biological/clinical actions and functions of “parent” polyphenols even though their systemic bioavailability is incredibly limited” (47).

In one research report, phenolic extracts obtained from eight berries containing anthocyanins, flavan-3-ols, B-type proanthocyanidins, and ellagitannins inhibited the growth of food poisoning bacteria, such as Salmonella, Listeria and Staphylococcus aureus, but did not affect the growth of the probiotic bacterium, Lactobacillus rhamnosus (48).

Any benefits of polyphenols on the microbiome would add to the case for the consumption of plants grown organically: a meta-analysis has shown a 20–60% increase in levels of polyphenols: flavonoids (e.g., flavanones, flavones, flavonols, anthocyanidins, isoflavones, and proanthocyanidins), and non-flavonoid polyphenols such as lignans (49). 

This is not surprising: polyphenols are generated by the plant in defence against grazing, infestation, infection and disease. Without agricultural pesticides and other external protections it could be expected that organically-grown plants would need more of their own resources (50).

We shall now look at specific plants whose effects on the microbiome appear to be mediated in part by polyphenols.

Cocoa

Cocoa polyphenols interact bidirectionally with the gut microbiota. They modulate the composition, enhancing beneficial gut bacteria, such as Lactobacillus and Bifidobacterium, and reducing the number of pathogens such as Clostridium perfringens. Microbial cocoa metabolites are themselves bioactive: they enhance gut health, display anti-inflammatory activities, positively affect immunity, and reduce the risk of various diseases (51).

Tea

Polyphenols from Camellia sinensis are metabolised by the microbiome and in turn promote the growth of beneficial species. They promote their growth in lean people and correct the dysbiosis found in obese people, correcting dysbiosis associated with high-fat diets and influencing the growth of some bacterial species involved in lipid or bile salts metabolism (52).  

Tea polyphenols are also able to hinder the growth of some pathogenic bacteria, especially gram-positive species; in general green tea reduces the production of pro-inflammatory substances such as lipopolysaccharides, and its compounds have been shown to correct the microbial dysbiosis associated with inflammatory diseases (53).

Turmeric

This spice is often referred to as a ‘prebiotic’. It increases butyrate-producing bacteria and faecal butyrate levels, and especially anti-inflammatory Bifidobacteria and Lactobacilli, and reduces proinflammatory Enterobacteria, Enterococci and Coriobacterales (54,55). Breath hydrogen increases when turmeric is added to meal indicating increased colonic carbohydrate metabolism (56).

However turmeric’s key polyphenol constituent curcumin cannot serve as a direct energy source for commensal microbiota and thus does not fully meet the definition of ‘prebiotic’. Instead its supportive effects on the microbiome are likely to be driven largely by indirect effects based on alterations in host physiology, which may include changes in barrier function or through selective survival of local bacteria or other microorganisms.

Curcumin stimulates glucagon-like peptide-1(GLP-1) production from enteroendocrine cells (with potential benefits in reducing diabetes) (57); it also inhibits Toll-like receptors (TLR2, TLR4 and TLR9) to induce a cascade of signalling events that leads to proinflammatory cytokine production and is responsible for innate immune system activation. TLR4 in particular responds to bacterial lipopolysaccharides (58). Increasing the absorption of curcumin in the small intestine may reduce these potential benefits in the colon (59).

Curcumin is transformed by microbiota into more active metabolites (demethylcurcumin, bisdemethylcurcumin, dihydrocurcumin, tetrahydrocurcumin and ferulic acid) which have greater bioactivity, bioavailability and therapeutic potential than their parent. They increase microbiomic diversity, reduce absorption of inflammatory bacterial lipopolysaccharides (LPS) with quantifiable benefits for IBD, hepatic stenosis, tumorogenesis and neurological disease (60).

Turmeric further stimulates gallbladder emptying – by between 25-50% (61). By increasing microbiotic metabolism of secondary bile acid levels it can however reduce consequent laxative action (62). It was found bisacurone B was the most potent choleretic ingredient, followed by ar-turmerone, bisdemethoxycurcumin, demethoxycurcumin, and then curcumin (63).

Baikal skullcap

Baicalin is the active polyphenolic constituent of this widely used medicinal herb, originating in China. This is involved in the interactions of the liver-gut axis by regulating TGR5, FXR, bile acids and the microbiota. It also regulates intestinal flora and gut wall health by promoting the production of SCFA-producing microbes such as Butyricimonas spp., Roseburia spp., Subdoligranulum spp., and Eubacterium spp (64). It also appears to regulate bile acid metabolism by increasing the production of bile salt hydrolase of bacterial origin (65).

Tannins

These astringent principles widely used in human history for their wound-healing are complex polyphenols that rely on the gut bacteria for much of their activity. Hydrolysable tannins, such as gallotannins and ellagitannins, are metabolised by the microbiome to generate gallic acid, ellagic acid, and their catabolites (66).

The formation of bioavailable human gut microbiota metabolites urolithin A, B and C has been established for elagitannin-rich aqueous extracts from the meadowsweet (Filipendula ulmaria), the oak (Quercus robur), Geum urbanum, and species of Geranium, Potentilla and Rubus. Significant inhibition of TNF-α production was determined for all urolithins, while for the most potent urolithin A, inhibition was observed at nanomolar concentrations. Urolithin C also inhibited IL-6 production (67).

Acrids

The heating remedies in traditional medicine, sourced in northern climes from sulfated constituents of the mustard and the onion families, and globally from the spices of Asia, have often been seen as the leading principles in defence against diseases.

Given their concentrated activity doses can be relatively low and it is therefore likely that their systemic effects rely on reflex responses from stimulation of nerve fibres (pain or C-fibres) in the mouth and upper digestive tract. Nevertheless, it appears that these benefits do reach the gut microbiome.

Chilli

A short-term and high-dose capsaicin-enriched diet (10 mg/day, for two weeks) with chilli has been proven to increase beneficial Faecalibacterium prausnitzii levels in healthy humans; these organisms are inversely associated with IBD, immunity, obesity, diabetes, asthma, major depressive disorder, and colorectal cancer.

Both low and high concentrations of dietary capsaicin (respectively 5 and 10 mg/day) administered for each one for 2 weeks in healthy subjects led to an increase in the ratio of the overall intestinal flora balance (68). Capsaicin and other constituents of chilli exert multiple benefits on gut microbiota and crosstalk, involving various and complex mechanisms, with benefits in mainly metabolic and inflammatory diseases (69).

Ginger

Ginger has been shown to improve microbiome biodiversity. In a crossover intervention study on 123 healthy subjects (63 men and 60 women) fresh ginger juice increased the species number of intestinal flora within only a week. A decreased relative abundance of the Prevotella-to-Bacteroides ratio and pro-inflammatory Ruminococcus-1 and Ruminococcus-2 while a tendency toward an increased Firmicutes-to-Bacteroidetes ratio, Proteobacteria and anti-inflammatory Faecalibacterium were found.

Interestingly significant differences were found between these responses in men and women (70). Evidence of relief of antibiotic-induced diarrhoea as available in other models (71).

Mustard glycosides (glucosinolates)

These sulfur-containing acrids require metabolism by the enzyme myrosinase to yield active isothiocyanates, the health-promoting agents from brassica vegetables like broccoli. However cooking inactivates this enzyme in the plant. Recently several studies have showed that the human gut microbiome can provide the necessary myrosinase, although in variable amounts so that individual responses to these plants are confirmed (72,73).

One important isothiocyanate is sulforaphane, a powerful modulator of inflammation sourced especially in broccoli. It down-regulates Toll-like receptor (TLR) 4 activity reducing bacterial induced activation of inflammatory processes (74)

Garlic

Patients with arterial hypertension who received aged garlic extract increased the composition and diversity of gut bacteria, with an increase in Lactobacillus and Clostridium species and modification in Firmicutes/Bacteroidetes ratio associated with improved health (75).

The traditional garlic intensive approach to gut dysbiosis might be justified! Take a clove of raw garlic, repeating at 30min intervals until at least 8 cloves, through an evening after a day of restricted eating. Treat the following day as if managing a fever: stay warm, drink lots of water. Wash yourself and your sheets and clothes the following day!

Saponins

These detergent principles in plants have long had traditional uses in supporting digestion and intriguingly, given their steroidal structures, also adrenal and reproductive functions. However the whole molecules are again poorly absorbed and their access to body tissues relies on metabolism by gut microbiota (76).

Liquorice

Glycyrrhetic acid 3-O-mono-β-D-glucuronide (GAMG), a metabolite with higher bioavailability than the strongly polar parent compound glycyrrhizin, is generated after hydrolysis by β-D- glucuronidase from intestinal bacteria such as Eubacterium sp., Ruminococcus sp., and Clostridium innocuum; they also appear to generate other relevant intestinally absorbed metabolites (such as 3 ⍺-hydroxyglycyrrhetic and 3-oxo-glycyrrhetic acids) with relatively strong pharmacological activities (77).

Glycyrrhiza glabra extract substantially increased propionate-producing species in faecal samples from vegetarians and vegans (Phascolarctobacter, Sutterella; Parasutterella, Cloacibacillus, Desulfovibrio, Roseburia, Bacteroides, Bifidobacterium, Gemmiger) and decreased Eubacterium spp, Enterococcus faecalis, Klebsiella pneumonia) (78).

Ginseng

Accumulating evidence has led ginsenosides from ginseng, its active saponins, being termed ‘prodrugs’. When orally ingested they pass through the stomach, small intestine and into the large intestine without decomposition by either gastric juice or liver enzymes. Colonic bacteria cleave the oligosaccharide connected to the aglycone stepwise from the terminal sugar to generate the major metabolites, 20S-protopanaxadiol and 20S-protopanaxatriol.

These are further activated by intestinal bacterial deglycosylation and fatty acid esterification: diol-type ginsenosides are mainly transformed into compound K and ginsenoside Rh2; triol-type ginsenosides to ginsenoside Rh1 and protopanaxatriol. These metabolites exhibit stronger antitumor, anti-inflammatory, antidiabetic, antiallergic, and neuroprotective effects compared with the parent ginsenosides and are also sustained longer in the body (79,80,81).

Bitters

Given the key role bitter remedies play in herbal treatments for digestive disorders, it is not surprising that as well as on the taste buds in the mouth, bitter receptors (T2Rs – aka ‘danger receptors’) are found in particular concentrations in the colon. This suggests that they are likely to play a part in host-microbiome interactions, and there is particular interest in their putative role in managing metabolic rate (82).

There is evidence that the effects of the bitter alkaloid berberine, found in barberry, golden seal, Phellodendron, Tinospora and Coptis species, interacts with bacterial species found most commonly in those eating high fat diets (83).

Anthraquinones

The laxative constituents in plants like senna, cascara sagrada have long been known to require microbial metabolism, and hence some hours delay, before they become effective. This has been confirmed (84).  An anthraquinone preparation from rhubarb appears to improve gut barrier integrity by promoting mucin-supporting bacteria and other prebiotic effects (85).

What have we learned so far?

The first point to make is that the science and evidence here is only just emerging. An important European review paper confirms that the information gleaned here is still largely speculative and research challenges are daunting (86). However, the pace of discovery is dazzling and the weight of evidence increasingly encourages us to use the plant foods, spices and herbs (87), that we already know have other health benefits, with the likelihood that these are mediated in part, even large part, by their interactions with the gut microbiota.

Dosages

There are immediate logistic challenges in applying plant ingredients to supporting a healthy gut microbiome. The overall weight of this microbial universe is as much as 5 kg and it lives at the back end of a 7-metre tube. To reach this will either require food-level doses, or the activation of reflex activity from triggering receptors higher up the tract.

It is simply impractical to expect the average herbal or supplement dose physically to impact the colonies lower in the gut. As an indication, each day our small intestine receives over six litres of liquid from gut secretions (including 4-5 litres of gastric secretions). Three teaspoons of liquid herbs would make less than 1/400 (0.25%) of this total!

It is also important that if direct contact is required, then the constituents confirmed should not be metabolised or absorbed higher up the tract. This is a case when bioavailability is not important.

In effect, the best ways to impact the gut microbiome are

1. by using plant constituents that survive digestion to reach the gut in sufficient quantities and then consume these in food-level quantities
   • fibre, gums and mucilages
   • polyphenols and tannins
   • spices
2. by triggering responses (e.g. digestive and biliary secretions via upper gut wall receptors) in which case lower doses are achievable. Potential constituents include
   • bitters
   • acrids

Take-home lessons

We may agree that for a healthy microbiome

• the best diets are those with the widest diversity of plant ingredients, to include a range of phytonutrient-rich foods, spices and herbs, in addition to fermented and other probiotic foods
• the use of antibiotics should be minimised
• strategies should be more akin to the organic gardener’s management of the soil than interventionist manipulations

It is also clear that what we know about the microbiome has already transformed the rules of medicine and that it is possible that much of the activity of our herbal remedies is mediated by their relationship with these organisms within us.

1. Turnbaugh PJ, Quince C, J. Faith JJ et al., (2010) Organismal, genetic, and transcriptional variation in the deeply sequenced gut microbiomes of identical twins. Proceedings of the National Academy of Sciences of the United States of America. 107, no.16, pp. 7503–7508, 2010
2. Guarner F, Malagelada JR. (2003) Gut flora in health and disease. Lancet 361: 512–9 doi: 10.1016/S0140-6736(03)12489-0.
3. Rousseaux C, Thuru X, Gelot A, et al. (2007) Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nat Med. 13(1): 35-7
4. Simpson CA, Diaz-Arteche C, Eliby D, et al. (20210 The gut microbiota in anxiety and depression – A systematic review. Clin Psychol Rev. 83: 101943. doi: 10.1016/j.cpr.2020.101943.
5. Bouter KE, van Raalte DH, Groen AK, Nieuwdorp M. (2017) Role of the Gut Microbiome in the Pathogenesis of Obesity and Obesity-Related Metabolic Dysfunction. Gastroenterology. 152(7): 1671-1678. doi: 10.1053/j.gastro.2016.12.048.
6. Harsch IA, Konturek PC. (20180 The Role of Gut Microbiota in Obesity and Type 2 and Type 1 Diabetes Mellitus: New Insights into “Old” Diseases. Med Sci (Basel). 6(2): 32. doi: 10.3390/medsci6020032
7. Forslund K, Hildebrand F, Nielsen T, et al. (2015) Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota. Nature. 528(7581): 262-266. doi: 10.1038/nature15766.
8. Barrio C, Arias-Sánchez S, Martín-Monzón I. (2022) The gut microbiota-brain axis, psychobiotics and its influence on brain and behaviour: A systematic review. Psychoneuroendocrinology. 137:105640. doi: 10.1016/j.psyneuen.2021.105640
9. Aziz Q, Doré J, A. Emmanuel A, et al, (2013) Gut microbiota and gastrointestinal health: current concepts and future directions. Neurogastroenterology and Motility, 25, 1: 4–15
10. Hempel S, Newberry SJ, Maher AR, et al. (2012) Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 307(18): 1959-69. doi: 10.1001/jama.2012.3507
11. Oak SJ, Jha R. (2019) The effects of probiotics in lactose intolerance: A systematic review. Crit Rev Food Sci Nutr. 59(11): 1675-1683. doi: 10.1080/10408398.2018.1425977.
12. Dale HF, Rasmussen SH, Asiller ÖÖ, Lied GA. (2019) Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients. 11(9): 2048. doi: 10.3390/nu11092048.
13. Collinson S, Deans A, Padua-Zamora A, et al. (2020) Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 12(12): CD003048. doi: 10.1002/14651858.CD003048.pub4
14. Cook MT, Tzortzis G, Charalampopoulos D, Khutoryanskiy VV. (2012) Microencapsulation of probiotics for gastrointestinal delivery. J Control Release. 162(1): 56-67. doi: 10.1016/j.jconrel.2012.06.003.
15. Fehlbaum S, Prudence K, Kieboom J, et al. (2018) In Vitro Fermentation of Selected Prebiotics and Their Effects on the Composition and Activity of the Adult Gut Microbiota. Int J Mol Sci. 19(10):3097. doi: 10.3390/ijms19103097
16. Whelan K, Judd PA, Preedy VR, et al.(2005) Fructooligosaccharides and fiber partially prevent the alterations in fecal microbiota and short-chain fatty acid concentrations caused by standard enteral formula in healthy humans. J Nutr. 135(8): 1896-902. doi: 10.1093/jn/135.8.1896
17. Ojo O, Feng QQ, Ojo OO, Wang XH. (2020) The Role of Dietary Fibre in Modulating Gut Microbiota Dysbiosis in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients. 12(11):3239. doi: 10.3390/nu12113239
18. McLoughlin RF, Berthon BS, Jensen ME, et al. (2017) Short-chain fatty acids, prebiotics, synbiotics, and systemic inflammation: a systematic review and meta-analysis. Am J Clin Nutr. 106(3): 930-945. doi: 10.3945/ajcn.117.156265.
19. Walker AW, Lawley TD (2013) Therapeutic modulation of intestinal dysbiosis. Pharmacological Research; 69: 75–86
20. Canfora EE, Meex RCR, Venema K, Blaak EE. (2019) Gut microbial metabolites in obesity, NAFLD and T2DM. Nat Rev Endocrinol. 15(5): 261-273. doi: 10.1038/s41574-019-0156-z
21. J.P. Ouwerkerk et al. (2013) Glycobiome: Bacteria and mucus at the epithelial interface. Best Practice & Research Clinical Gastroenterology 27: 25–38
22. Kuwahara A, Matsuda K, Kuwahara Y, et al. (2020) Microbiota-gut-brain axis: enteroendocrine cells and the enteric nervous system form an interface between the microbiota and the central nervous system. Biomed Res. 41(5): 199-216. doi: 10.2220/biomedres.41.199.
23. Tsuda T. (2015) Possible abilities of dietary factors to prevent and treat diabetes via the stimulation of glucagon-like peptide-1 secretion. Mol Nutr Food Res. 59(7): 1264-73. doi: 10.1002/mnfr.201400871.
24. Posovszky C, Wabitsch M. (2015) Regulation of appetite, satiation, and body weight by enteroendocrine cells. Part 1: characteristics of enteroendocrine cells and their capability of weight regulation. Hormone Research in Paediatrics 83.1: 1-10.
25. Braun T, Voland P, Kunz L et al. (2007) Enterochromaffin Cells of the Human Gut: Sensors for Spices and Odorants. Gastroenterlogy;132:1890-1901
26. Vegezzi G, Anselmi L, Huynh J, et al. (2014) Diet-Induced Regulation of Bitter Taste Receptor Subtypes in the Mouse. Gastrointestinal Tract. PLoS ONE 9(9): e107732
27. Pluznick JL, Protzko RJ, Gevorgyan H, et al. (2013) Olfactory receptor responding to gut microbiota-derived signals plays a role in renin secretion and blood pressure regulation. Proc Natl Acad Sci USA. 110(11): 4410-5
28. Cherta-Murillo A, Pugh JE, Alaraj-Alshehhi S, et al. (2022) The effects of SCFAs on glycemic control in humans: a systematic review and meta-analysis. Am J Clin Nutr. 116(2): 335-361. doi: 10.1093/ajcn/nqac085.
29. Tran SM, Mohajeri MH. (2021) The Role of Gut Bacterial Metabolites in Brain Development, Aging and Disease. Nutrients. 13(3): 732. doi: 10.3390/nu13030732.
30. Wahlström A, Sayin SI, Marschall HU, Bäckhed F. (2016) Intestinal Crosstalk between Bile Acids and Microbiota and Its Impact on Host Metabolism. Cell Metab. 24(1):41-50. doi: 10.1016/j.cmet.2016.05.005
31. Porez G, Prawitt J, Gross B, Staels B. (2012) Bile acid receptors as targets for the treatment of dyslipidemia and cardiovascular disease. J Lipid Res 53(9): 1723-37.
32. Aguilar-Toalá JE, Garcia-Varela R, Garcia HS, et al. (2018) Postbiotics: An evolving term within the functional foods field, Trends in Food Science & Technology, 75: 105-114 doi: /10.1016/j.tifs.2018.03.009
33. Salminen, S., Collado, M.C., Endo, A. et al. (2021) The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nat Rev Gastroenterol Hepatol 18, 649–667 doi:10.1038/s41575-021-00440-6
34. https://www.health.harvard.edu/nutrition/what-are-postbiotics
35. https://prebioticassociation.org/prebiotic-resources/
36. An X, Bao Q, Di S, et al, (2019) The interaction between the gut Microbiota and herbal medicines. Biomedicine & Pharmacotherapy. 118, 109252 doi:/10.1016/j.biopha.2019.109252
37. Tomova A, Bukovsky I, Rembert E, et al. (2019) The Effects of Vegetarian and Vegan Diets on Gut Microbiota. Front Nutr. 6:47. doi: 10.3389/fnut.2019.00047
38. Zimmer J, Lange B, Frick JS, et al. (2012) A vegan or vegetarian diet substantially alters the human colonic faecal microbiota. Eur J Clin Nutr. 66(1):53-60. doi: 10.1038/ejcn.2011.141
39. Lu QY, Summanen PH, Lee RP, et al. (2017) Prebiotic potential and chemical composition of seven culinary spice extracts. J Food Sci. 82:1807-1813. doi:10.1111/1750-3841.13792
40. Zhang HY, Tian JX, Lian FM, et al. (2021) Therapeutic mechanisms of traditional Chinese medicine to improve metabolic diseases via the gut microbiota. Biomed Pharmacother. 133: 110857. doi: 10.1016/j.biopha.2020.110857.
41. Li Y, Ji X, Wu H, et al. (2021) Mechanisms of traditional Chinese medicine in modulating gut microbiota metabolites-mediated lipid metabolism. Journal of Ethnopharmacology 278, 114207. doi:/10.1016/j.jep.2021.114207
42. Zhong P, Zhou J, Fan YT, et al. (2022) Co-existing polysaccharides affect the systemic exposure of major bioactive ingredients in Chang-Kang-Fang, a multi-herb prescription for treatment of irritable bowel syndrome. J Ethnopharmacol. 298: 115601. doi: 10.1016/j.jep.2022.115601
43. Calame W, Weseler AR, Viebke C, et al. (2008) Gum arabic establishes prebiotic functionality in healthy human volunteers in a dose-dependent manner. Br J Nutr. 100(6):1269-75. doi: 10.1017/S0007114508981447.
44. Kamal E, Kaddam LA, Dahawi M, et al. (2018) Gum Arabic Fibers Decreased Inflammatory Markers and Disease Severity Score among Rheumatoid Arthritis Patients, Phase II Trial. Int J Rheumatol. 2018:4197537. doi: 10.1155/2018/4197537
45. Kawabata K, Yoshioka Y, Terao J. (2019) Role of Intestinal Microbiota in the Bioavailability and Physiological Functions of Dietary Polyphenols. Molecules. 24(2): 370. doi: 10.3390/molecules24020370.
46. Mithul Aravind S, Wichienchot S, Tsao R, et al. (2021) Role of dietary polyphenols on gut microbiota, their metabolites and health benefits. Food Res Int. 142:110189. doi: 10.1016/j.foodres.2021.110189
47. Koudoufio M, Desjardins Y, Feldman F, et al. (2020) Insight into Polyphenol and Gut Microbiota Crosstalk: Are Their Metabolites the Key to Understand Protective Effects against Metabolic Disorders? Antioxidants (Basel). 9(10):982. doi: 10.3390/antiox9100982.
48. Puupponen-Pimiä R, Nohynek L, Hartmann-Schmidlin S, et al. (2005) Berry phenolics selectively inhibit the growth of intestinal pathogens. J Appl Microbiol. 98(4): 991-1000. doi: 10.1111/j.1365-2672.2005.02547
49. Barański M, Srednicka-Tober D, Volakakis N, et al. (2014) Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: a systematic literature review and meta-analyses. Br J Nutr. 112(5):794-811. doi: 10.1017/S0007114514001366.
50. Daniel O, Meier MS, Schlatter J, Frischknecht P. (1999) Selected phenolic compounds in cultivated plants: ecologic functions, health implications, and modulation by pesticides. Environ Health Perspect. 107 (Suppl 1):109-14. doi: 10.1289/ehp.99107s1109.
51. Sorrenti V, Ali S, Mancin L, et al. (2020) Cocoa Polyphenols and Gut Microbiota Interplay: Bioavailability, Prebiotic Effect, and Impact on Human Health. Nutrients. 27;12(7):1908. doi: 10.3390/nu12071908
52. Pérez-Burillo S, Navajas-Porras B, López-Maldonado A, et al. (2021) Green Tea and Its Relation to Human Gut Microbiome. Molecules. 26(13): 3907. doi: 10.3390/molecules26133907.
53. Chen H., Sang S. (2014) Biotransformation of tea polyphenols by gut microbiota. J. Funct. Foods. 7:26–42. doi: 10.1016/j.jff.2014.01.013
54. Zam W. (2018) Gut Microbiota as a Prospective Therapeutic Target for Curcumin: A Review of Mutual Influence. J Nutr Metab. 2018:1367984. doi: 10.1155/2018/1367984
55. McFadden RM, Larmonier CB, Shehab KW, et al. (2015) The role of curcumin in modulating colonic microbiota during colitis and colon cancer prevention. Inflamm Bowel Dis. 21: 2483–94
56. Shimouchi A, Nose K, Takaoka M, et al. (2009) Effect of dietary turmeric on breath hydrogen. Dig Dis Sci. 54 8: 1725-9
57. Alli-Oluwafuyi AM, Luis PB, Nakashima F, et al. (2019) Curcumin induces secretion of glucagon-like peptide-1 through an oxidation-dependent mechanism. Biochimie. 165: 250-257. doi: 10.1016/j.biochi.2019.08.013.
58. Panaro MA, Corrado A, Benameur T, et al. (2020) The Emerging Role of Curcumin in the Modulation of TLR-4 Signaling Pathway: Focus on Neuroprotective and Anti-Rheumatic Properties. Int J Mol Sci. 26; 21(7):2299. doi: 10.3390/ijms21072299
59. Peterson CT, Vaughn AR, Sharma V, et al. (2018) Effects of Turmeric and Curcumin Dietary Supplementation on Human Gut Microbiota: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. Journal of Evidence-Based Integrative Medicine 23: 1-8 doi: 10.1177/2515690X18790725
60. Shen L, Ji HF. (2018) Bidirectional interactions between dietary curcumin and gut microbiota. Crit Rev Food Sci Nutr. 59(18):2896-2902. doi: 10.1080/10408398.2018.1478388
61. Marciani L, Cox EF, Hoad CL et al (2013). Effects of various food ingredients on gall bladder emptying. Eur J Clin Nutr. 11, 1182-7
62. Dey N, Wagner VE, Blanton LV (2015) Regulators of gut motility revealed by a gnotobiotic model of diet-microbiome interactions related to traveling. Cell 163, 1, 95-107
63. Wang Y, Wang L, Zhu X et al (2016) Choleretic Activity of Turmeric and its Active Ingredients. Journal of Food Science 81, 7, 1800-06.
64. Hu Q, Zhang W, Wu Z, et al. (2021) Baicalin and the liver-gut system: Pharmacological bases explaining its therapeutic effects. Pharmacol Res. 165:105444. doi: 10.1016/j.phrs.2021.105444
65. Han K, Bose S, Wang JH, et al. (2017) In vivo therapeutic effect of combination treatment with metformin and Scutellaria baicalensis on maintaining bile acid homeostasis. PLoS One. 12(9): e0182467. doi: 10.1371/journal.pone.0182467.
66. Kawabata K, Yoshioka Y, Terao J. (2019) Role of Intestinal Microbiota in the Bioavailability and Physiological Functions of Dietary Polyphenols. Molecules. 24(2): 370. doi: 10.3390/molecules24020370.
67. Piwowarski JP, Granica S, Zwierzyńska M, et al (2014) Role of human gut microbiota metabolism in the anti-inflammatory effect of traditionally used ellagitannin-rich plant materials. Journal of Ethnopharmacology. 155 (1): 801-809. doi./10.1016/j.jep.2014.06.032
68. Rosca AE, Iesanu MI, Zahiu CDM, et al. (2020) Capsaicin and Gut Microbiota in Health and Disease. Molecules. 25(23):5681. doi: 10.3390/molecules25235681
69. Kang C, Zhang Y, Zhu X, et al. (2016) Healthy Subjects Differentially Respond to Dietary Capsaicin Correlating with Specific Gut Enterotypes. J Clin Endocrinol Metab. 101(12): 4681-4689. doi: 10.1210/jc.2016-2786.
70. Wang X, Zhang D, Jiang H, et al. (2021) Gut Microbiota Variation With Short-Term Intake of Ginger Juice on Human Health. Front Microbiol. 11:576061. doi: 10.3389/fmicb.2020.576061.
71. Ma ZJ , Wang HJ , Ma XJ , et al. (2020) Modulation of gut microbiota and intestinal barrier function during alleviation of antibiotic-associated diarrhea with Rhizoma Zingiber officinale (Ginger) extract. Food Funct. 11(12): 10839-10851. doi: 10.1039/d0fo01536a
72. Sikorska-Zimny K, Beneduce L. (2021) The Metabolism of Glucosinolates by Gut Microbiota. Nutrients. 13(8): 2750. doi: 10.3390/nu13082750.
73. Tian S, Liu X, Lei P, et al. (2018) Microbiota: a mediator to transform glucosinolate precursors in cruciferous vegetables to the active isothiocyanates. J Sci Food Agric. 98(4): 1255-1260. doi: 10.1002/jsfa.8654.
74. Youn HS, Kim YS, Park ZY, et al. (2010) Sulforaphane suppresses oligomerization of TLR4 in a thiol-dependent manner. J Immunol. 184(1):411-9. doi: 10.4049/jimmunol.0803988.
75. Ried K, Travica N, Sali A. (2018) The Effect of Kyolic Aged Garlic Extract on Gut Microbiota, Inflammation, and Cardiovascular Markers in Hypertensives: The GarGIC Trial. Front Nutr. 5:122. doi: 10.3389/fnut.2018.00122
76. Luo Z, Xu W, Zhang Y, Di L, Shan J. (2020) A review of saponin intervention in metabolic syndrome suggests further study on intestinal microbiota. Pharmacol Res. 160: 105088. doi: 10.1016/j.phrs.2020.105088.
77. Zhang F, He F, Li L, et al. (2020). Bioavailability based on the gut microbiota: a new perspective. Microbiol Mol Biol Rev 84:e00072-19. doi.org/10 .1128/MMBR.00072-19
78. Peterson CT, Sharma V, Uchitel S, et al (2018) Prebiotic potential of herbal medicines used in digestive health and disease J. Altern. Complement. Med., 24 (2018), pp. 656-665
79. Kim DH. (2018) Gut microbiota-mediated pharmacokinetics of ginseng saponins. J Ginseng Res. 2018 Jul;42(3):255-263. doi: 10.1016/j.jgr.2017.04.011
80. Hasegawa H. (2004) Proof of the mysterious efficacy of ginseng: basic and clinical trials: metabolic activation of ginsenoside: deglycosylation by intestinal bacteria and esterification with fatty acid. J Pharmacol Sci. 95(2): 153-7
81. Yang L, Zou H, Gao Y, et al. (2020) Insights into gastrointestinal microbiota-generated ginsenoside metabolites and their bioactivities. Drug Metab Rev. 52(1): 125-138. doi: 10.1080/03602532.2020.1714645.
82. Turner A, Veysey M, Keely S, et al. (2018) Interactions between Bitter Taste, Diet and Dysbiosis: Consequences for Appetite and Obesity. Nutrients. 10(10):1336. doi: 10.3390/nu10101336.
83. Wang Y, Tong Q, Shou JW, et al. (2017) Gut Microbiota-Mediated Personalized Treatment of Hyperlipidemia Using Berberine. Theranostics. 7(9): 2443-2451. doi: 10.7150/thno.18290.
84. Huang Z, Xu Y, Wang Q, Gao X. (2019) Metabolism and mutual biotransformations of anthraquinones and anthrones in rhubarb by human intestinal flora using UPLC-Q-TOF/MS. J Chromatogr B Analyt Technol Biomed Life Sci. 1104: 59-66. doi: 10.1016/j.jchromb.2018.10.008
85. Cui HX, Zhang LS, Luo Y, et al. (2019) A Purified Anthraquinone-Glycoside Preparation From Rhubarb Ameliorates Type 2 Diabetes Mellitus by Modulating the Gut Microbiota and Reducing Inflammation. Front Microbiol. 10: 1423. doi: 10.3389/fmicb.2019.01423.
86. Thumann TA, Pferschy-Wenzig EM, Moissl-Eichinger C, Bauer R. (2019) The role of gut microbiota for the activity of medicinal plants traditionally used in the European Union for gastrointestinal disorders. J Ethnopharmacol. 245:112153. doi: 10.1016/j.jep.2019.112153
87. Chen F, Wen Q, Jiang J, et al. (2016) Could the gut microbiota reconcile the oral bioavailability conundrum of traditional herbs? J Ethnopharmacol. 179: 2

Herbal syrups have to be one of the most loved herbal medicines by all, especially children. They are simple and fun to make whilst having a naturally sweet and beautiful taste. Syrups are a brilliant way to carry herbs that also captures their unique taste profile, where alcohol preparations such as tinctures may overpower.

Syrups can be made using honey, maple syrup or cane sugar. Cane sugar is a simple carbohydrate that can be used 2:1 (two parts sugar to one parts herb) whereas honey would need a higher ratio of 3:1 to act as an effective preservative.

Syrups are made from strong teas or decoctions that have been gently concentrated through a process of slow and gentle simmering. Follow the steps below to make a herbal syrup.

Herbal syrup instructions

1. For floral or herbaceous plant parts a strong tea infusion is made simmering on a low, gentle heat for 20 minutes (roots, fruits or barks would need a longer simmer of up to 1.5 hours). Usually enough water is added to cover the herb (dried or fresh herb can be used), the ratio would be so the herb is covered but also so the bottom of the pan would not be visible whilst moving a spoon through the mixture.
2. During simmering, stir occasionally with a wooden spoon (if using berries or roots use a potato masher to press the plant material, extracting more of the goodness for your medicine).
3. After simmering for the appropriate time, remove from heat and strain the infusion/ decoction using a muslin cloth on a fine sieve into a sterile container.
4. Return the infusion/ decoction to a clean pan and on the lowest heat setting add the appropriate ratio of sugar or honey until dissolved.
5. Cool the syrup, store and label in sterile glass bottle/ container in the fridge. A syrup can last between 6 months to a year in the fridge.

Calming chamomile honey syrup

Ingredients

• Chamomile (dried) 100g
• Lavender (dried) 100g
• Purified / Spring water approx 200ml (enough to cover herb well)
• Honey (approx 2 x 500g jars)

How to make chamomile honey syrup

To make this syrup follow the above instructions. Chamomile and lavender work both on the nervous and digestive systems. This sweet syrup would be helpful for anxious children who may be experiencing related digestive issues.

This same method can be used for herbs such as i.e. thyme and marshmallow (for respiratory support) or elderberry and rosehips (for immune support), experiment with blends of different plants to build up your home apothecary!

The chamomile and lavender syrup can be taken by the teaspoon up to 3 times daily. The honey syrups can be taken according to herb dosage instructions as per tinctures (see herb monographs for specific information on each herb).

Tinctures are made using either alcohol or glycerin. Vegetable glycerin is a clear, odorless liquid with a syrup-like consistency. It is usually made from vegetable oils such as soy, palm or coconut oil using high temperature and pressure, that splits the glycerin molecule from the fatty acids.

While sweet, it is not metabolised by the body like sugar. Look for an organic, sustainably harvested, non-GMO glycerin to use in medicine making (check the Resources section at the bottom).

The benefit of using glycerin is both for those wishing to avoid alcohol consumption, but an added bonus for using glycerin is that it is an excellent preservative of fresh plant juices, particularly for aromatic plants such as lemon balm, rose, violet etc. Glycerin however, is not as effective in extracting compounds from dried herb matter as an alcohol tincture.

Read our article How to make a herbal tincture.

Glycerite tincture instructions

1. Fill a clean (sterile) jar with, chopped fresh plant material or half-full of dried plant material (dried material will expand as the glycerin is absorbed).
2. A glycerite tincture should contain a minimum of 55% glycerin to herb ratio. For fresh plants, add enough glycerin to fully cover the plant matter, filling the jar to within one inch of the top. For dried herb, dilute glycerin with distilled water in a 3:1 ratio (3 parts glycerin to one part water) and fill the jar with mixture to within one inch of the top
3. Use the end of a clean wooden spoon to gently press the herb under the glycerin to ensure release of air bubbles and allow maximum coverage of materials.
4. Replace the lid and label jar.
5. Macerate or infuse the tincture for between 4-6 weeks, gently shaking the bottle every two days. Top up with glycerin as necessary if plant material is too exposed above the glycerin.
6. After 4-6 weeks, strain the tincture into a clean bowl using a muslin cloth (coffee filter paper works but very slowly; nut milk bags are also effective). With clean hands, gather corners of muslin cloth together, squeezing the tincture out until there is barely a drop left. The last few squeezes will have add some very potent mixture to the final tincture so don’t give up squeezing too quickly!
7. Finally, bottle and label your glycerite tincture. It stays in date for up to a year.

Lemon balm glycerite tincture

Ingredients

• Lemon balm (fresh leaves)
• Vegetable glycerin

How to make lemon balm tincture

Lemon balm is gently nervine and works to support our nervous system through stressful times. It is also indicated for digestive upsets and in respiratory complaints. The lemon balm tincture can be taken by the teaspoon up to twice daily.

Herbal infused or ‘macerated’ oils are a wonderful way to preserve herbs for use in topical conditions. They are also quick and incredibly simple to make and diverse in their applications.

There are a number of different methods to make herbal oils both for use in medicine and for culinary use. This method is called the solar infusion and relies on a warm sunny window.

Herbal infused oils can be used neat or can be made into salves or ointments and also blended into creams, so they are a fantastic base from which to explore other herbal preparations.

For best results use dried herbs (fresh herbs add a water element to oil, which can lead to spoiling), there are different methodologies for fresh herb oils.

Carrier oils that are ideal for topical use include sunflower and olive oils, both excellent carriers whilst offering some resistance to oxidation and rancidity. Herbs that are commonly used in herbal infused oils include calendula, St John’s wort, chickweed and plantain, all having their own unique medicinal qualities.

The most simple way to make an infused oil is as follows.

Herbal-infused oil instructions

1. Add dried herbs in a dry, sterilised container and cover with your chosen carrier oil; usually, the oil should sit 1 inch above the top of the herbs.
2. Use a spoon to press and mix the herb/ oil so that all surfaces of the herb matter is coated and no air bubbles remain.
3. Place a square piece of natural waxed paper or greaseproof paper on top of the jar, then seal jar with a tightly fitting lid.
4. Place the jar in a sunny window for between 4-6 weeks to infuse. The warmth of the sunlight will help to extract the compounds from the herbs into the oil. Stir or shake the mixture every few days.
5. When the infusion time is up, line a sieve with of muslin cloth (folded to layer up) and filter. the mixture into a clean bowl. Gather the corners of the cloth up and squeeze strongly, squeezing as much oil from the herb as possible
6. Cover and let aside overnight in a cool, dark location to allow for any herb sediment to settle at the bottom of the jar. You can also strain the oil through an unbleached coffee filter to remove fine sediment.
7. Pour the oil into dry, sterilised, dark-coloured glass bottles. You can add a couple of drops of Vitamin E into your final oil to slow down the oxidisation process, giving the oil a shelf life of around 1 year.
8. Label your infused oil, and store in a cool, dark place.

Calendula-infused oil

Ingredients

• Calendula petals
• Sunflower oil

How to make an oil infused with calendula

Calendula infused oil can be used directly on the skin to treat all manner of skin inflammations and in first aid for minor cuts, grazes, bruises, sprains and strains. Calendula oil is also useful for slow healing wounds and for the healing of minor burns. This blend can be used as and when needed, up to 3 times a day.

A herbal balm is made from a herbal infused oil, simply adding a wax element such as beeswax or (vegan) carnauba wax. Balms and salves are subsets of an ointment. Salves are typically softer, where as a balm or ointment is more solid. The benefit of infusing a wax into an oil to create balms/ salves/ ointments is that it increases binding to the skin, more successfully than an oil alone, they are also potentially, slightly less messy to use than oils.

Learn more about How to make a herbal balm.

Herbal balm instructions

1. Using a double boiler/ Bain Marie or a water bath method, on a gentle heat. Add your infused oil into the clean pan.
2. Add around 8- 12 % beeswax and gently stir with a silicone or wooden spoon until the wax has fully dissolved into the oil. Remove from the heat.
3. You can add an essential oil at this stage if desired; approx 10 drops (depending what is being used). Essential oils act as a preservative but also help to assist circulation and better absorption into the skin.
4. Slowly pour the mixture into a clean, dark glass jar. Cover but do not close the lid firmly until the balm has fully set/ solidified.
5. Label your jar and close the lid firmly. Store in a cool, dark place. Balms/ Salves/ Ointments should last for unto a year.

Calendula balm

Ingredients

• Calendula-infused oil
• Sweet orange or chamomile pure essential oil
• Beeswax (unfiltered pellets or solid form)

How to make calendula balm

Calendula balm can be used directly on the skin to treat all manner of skin inflammations and in first aid for minor cuts, grazes, bruises, sprains and strains. Calendula is also useful for slow healing wounds and for the healing of minor burns. This balm can be used as and when needed, up to 3 times a day.

For more information on uses of the herbs discussed in this article or other herbs you may wish to explore in medicine making using these recipes, visit our Herbs section.

Medicine making books and other resources

• The Handmade Apothecary by Vicky Chown and Kim Walker
• Hedgerow Remedies by Julie Barlett Bruton and Matthew Seal
• A Herbal Book of Making and Taking by Christopher Hedley
• The Herbal Medicine-Maker’s Handbook: A Home Manual by James Green
• The Herbarium is also a fantastic resource for medicine-making instructions and recipes.
• Earth Song Seeds also provides some very useful information on how to prepare herbs under the “How to…” section

Until recently, the uterus and the placenta were thought to be germ-free and sterile to keep the baby safe from infection. But at just one week old, babies have a complex collection of microbes in their guts. It was thought that a baby received its first dose of bacteria as it passed through the vagina or from the mother’s skin if the child was born via C-section.

We now know that there are microbial inhabitants in the placenta (which nourishes the growing foetus through the umbilical cord) and these closely resemble those that live in the mouth (1). Also, that a disturbance of these bacteria may well be responsible for pre-eclampsia during pregnancy.

A broad range of bacteria are present, including those necessary for metabolising some of the vitamins and nutrients needed by the foetus. The acquisition of the microbiota continues over the first few years of life, and in fact an infant’s GI tract microbiome begins to resemble that of an adult as early as 1 year old. 

Although it was previously thought that the infant gut microbiota would resemble that of an adult by the age of 3, recent studies indicate that the microbiota continues to evolve in both pre-adolescents and 20-year-olds (2). The adult microbiome consists of over a trillion bacterial cells and up to an estimated 1,000 different bacterial species, communities of symbiotic, commensal and pathogenic bacteria along with fungi and viruses.

The predominant organisms found in healthy human large intestine are Gram-negative Bacteroidetes and Gram-positive low-GC Firmicutes, but this varies greatly between individuals. Once established, the composition of the gut microbiota is relatively stable throughout adulthood but can be altered as a result of bacterial infections, antibiotic treatment, lifestyle, surgical, and a long-term change in diet (3).

Common complaints in babies and children include digestive disorders, infections, respiratory problems, skin conditions, nervous or cognitive disorders, allergies and auto-immune disorders.  All these may well have something in common:

• Gut dysbiosis: An altered microbial state in the gut, either lack of bacterial biodiversity or overgrowth of pathogenic microorganisms (SIBO) 
• Leaky gut syndrome: A healthy GI tract serves as a barrier preventing undigested food particles, microbes, toxins and other unwanted substances from entering the body through the bloodstream. When the intestinal epithelium becomes damaged, substances can ‘leak’ into the body where they are attacked by the immune system, which leads to inflammation.

These can affect digestion and absorption of nutrients, disturb immune function and trigger inflammation.

Antibiotics

Even a single dose of antibiotics can create permanent changes in our gut flora, and sometimes the healthy bacteria never fully recover from strong rounds of antibiotics.

The state of the mother’s gut flora during pregnancy and birth

Some bacterial species are more common and others less common in women who give birth prematurely – before 37 weeks of pregnancy – than the typical bacterial profile of the women who go full term.

It has been found that gum disease raises the risk of premature birth. Oral bacteria from diseased and bleeding gums can allow harmful bacteria to reach and colonise the placenta, potentially triggering premature birth (4).

The microbiota that an infant begins to acquire depends strongly on mode of delivery. Twenty minutes after birth, the microbiota of vaginally delivered infants resembles the microbiota of their mother’s vagina, while infants delivered via Caesarean section harbour more microbial communities typically found on human skin.

Nutrition during the first few years of a child’s life

• Diets high in sugar, refined carbohydrates and processed foods and low in fermentable fibre (prebiotics) can contribute to small intestinal bacterial overgrowth (SIBO). Avoiding foods that feed pathogenic bacteria, and consuming fibre-rich foods that feed commensal bacteria can help restore the balance.
• Eating a diet too high in protein, especially if that animal protein has been treated with antibiotics, can disrupt the microbiota.

The Importance of breastfeeding

Every mother produces complex sugars (oligosaccharides). More than 200 human milk oligosaccharides (H.M.O.s) have been identified. They are the third-most plentiful ingredient in human milk, after lactose and fats, and their structure ought to make them a rich source of energy for growing babies—but babies cannot digest them.  

H.M.O.s pass through the stom­ach and the small intestine unharmed, landing in the large intestine, where most of our bacteria live. If babies cannot digest them, they must be food for the microbes!

Bifidobacteria are more com­mon in the stools of breast-fed infants than bottle-fed ones. Human milk contains several oligosaccharides that cow milk does not.

Poor digestion

If our digestive energy is low, enzymes are not secreted as they should be, and food can remain partially digested in the gut, ferment and promote dysbiosis and leaky gut syndrome which can lower resistance to disease.

Mento-emotional state

Stress can severely compromise the quality of our digestive function. We now know that there is a direct connection between the central nervous system and the enteric nervous system in the gut that has been coined the “gut-brain axis”.  When we are stressed, mentally, emotionally or physically, the sympathetic nervous system overrides the functions of the parasympathetic nervous system.

Digestion gets deprioritised because it is less vital to our immediate survival. These factors work together to affect the gut flora, impair nutrient absorption and predispose to leaky gut syndrome.

It is thought that changes in dietary patterns over the last few decades combined with overuse of antibiotics could result in each generation beginning life with a smaller population of ancient microbes than the last as well as being a primary contributor to the epidemic of obesity, diabetes, IBS and allergies that we see today.

This firstly involves taking a detailed case history of the child and examining the body, paying attention to their build, skin and hair type, body temperature, digestion and bowel function, as well as temperament. Tongue and pulse diagnosis are valuable diagnostic tools.

Re-establishing homeostasis in the gut can bring profound healing to the entire body, relieving digestive symptoms as well as disorders of the immune system, nervous system and skin.

Herbal medicines provide us with the solution to many problems in babies and children associated with disruption of the microbiome. We have…

Herbal antimicrobials to prevent the use of allopathic antibiotics:

• Echinacea (Echinacea purpurea/angustifolia)
• Turmeric (Curcuma longa)
• Elder (Sambucus nigra)
• Pau d’arco (Tabebuia impetiginosa)
• Sage (Salvia officinalis)
• Thyme (Thymus vulgaris)
• Burdock (Arctium lappa)
• Cat’s claw (Uncaria tomentosa)
• Andrographis (Andrographis paniculata)
• Basil (Ocimum spp)
• Oregano (Origanum vulgaris)
• Garlic (Allium sativum)

Digestives and carminatives to enhance appetite, digestion, absorption and prevent fermentation in the gut.

Spices such as ginger, cinnamon, cardamom, coriander, clove and black pepper are some of the best remedies for the digestion and for increasing immunity. These can be added to cooking and made into tasty hot teas for all the family.

Take ginger for example. Its pungency warms and strengthens digestion, stimulates the flow of digestive juices and invigorates the whole body. It is highly antiseptic, activates immunity, dispels bacterial and viral infections.

A hot cup of ginger tea is an excellent remedy for the first signs of colds, coughs or flu and will help to clear catarrh. 2-3 cups can be sipped through the day.

Antimicrobial digestives to inhibit and combat small intestinal bacterial overgrowth (SIBO):

• Rosemary (Rosmarinus officinalis)
• Thyme (Thymus vulgaris)
• Cinnamon (Cinnamomum spp)
• Cardamom (Elletaria cardamomum)
• Long pepper (Piper longum)
• Garlic, onion (Allium spp)
• Ginger (Zingiberis off)
• Elecampane (Inula helenium)
• Turmeric (Curcuma longa)
• Cumin (Cumin cuminum)
• Chamomile (Chamomilla recutita)

Astringent herbs to restore the gut wall in leaky gut syndrome:

• Marigold (Calendula off)
• Plantain (Plantago spp)
• Rose (Rosa spp)
• Yarrow (Achillea millefolium)
• Raspberry and blackberry leaves (Rubus spp)
• Tormentil (Potentilla spp)
• Oak bark (Quercus robur)
• Agrimony (Agrimonia eupatoria)
• Meadowsweet (Filipendula ulmaria)
• Elderflower (Sambucus nigra)
• Pomegranate (Punica granatum)

Nervines and relaxants to balance the nervous system:

• Chamomile (Chamomilla recutita)
• California poppy (Eschscholzia californica)
• Lemon balm (Melissa officinallis)
• Ashwagandha (Withania somnifera)
• Rose (Rosa spp)
• Bacopa (Bacopa monieri)
• Lavender (Lavendula spp)
• Lime flower (Tilia europea)
• Wild oat (Avena sativa)

The ways of prescribing herbal medicines vary considerably according to the condition being treated, the herbs employed, the age and build of the child, their constitution, even the time of year. The easiest way is in food.

Babies

• Umbilical powdered herbs
• Teas in bottles/off the spoon
• Teas/dilute tinctures/glycerites/hydrosols in syringes
• Baths/sponging
• Oils/massage including foot massage
• Burners in rooms/on radiators/lights

Children

• Hot/cold infusions and decoctions
• Syrups
• Powders rolled in honey, fruit concentrate, ghee, smoothies, warm water/milk
• Tinctures and glycerites
• Herbal baths – dilute essential oils, infusions, fresh herbs in muslin
• Tablets/capsules for older children
• Hand & foot baths
• Inhalations
• Massage – dilute oils/liniments, chest rubs etc
• Ointments, lotions and creams
• Compresses
• Hydrosols
• Suppositories

Chronic conditions generally require mild herbal remedies which can safely be given, generally 3 times daily, over months at a time if necessary.

Acute conditions may require stronger herbs given up to every 2 hours.

For example, dandelion root has mild laxative properties which can be given to regulate digestion and elimination over a period, while senna root or castor oil have stronger laxative action for acute constipation or to clear heat quickly during a fever.

Some conditions, particularly fevers, colds, catarrh and problems associated with cold, require herbs to be given in hot preparations. Others such as urinary problems are better suited to cool preparations.

Skin problems may improve more rapidly with herbal teas as opposed to tinctures, while tinctures may be preferable when more concentrated medicines are required such as the treatment of a virulent infection.

1. Olaniyi KS, Moodley J, Mahabeer Y and Mackraj I (2020) Placental Microbial Colonization and Its Association With Pre-eclampsia. Front. Cell. Infect. Microbiol. 10:413. doi: 10.3389/fcimb.2020.00413
2. Hollister EB, Riehle K, Luna RA, et al. Structure and function of the healthy pre-adolescent pediatric gut microbiome. Microbiome. 2015; 3:36. doi: 10.1186/s40168-015-0101-x.
3. Juan Miguel RodrÍguez, Kiera Murphy, Catherine Stanton, R. Paul Ross, Olivia I. Kober, Nathalie Juge, Ekaterina Avershina, Knut Rudi, Arjan Narbad, Maria C. Jenmalm, Julian R. Marchesi & Maria Carmen Collado (2015) The composition of the gut microbiota throughout life, with an emphasis on early life, Microbial Ecology in Health and Disease, 26:1, DOI: 10.3402/mehd.v26.26050
4. Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sci Biol Med. 2010 Jul;1(1):40-2. doi: 10.4103/0976-9668.71672. PMID: 22096335; PMCID: PMC3217279.

The term Nature Deficit Disorder (NDD) was originally coined by Richard Louv, a journalist and author of numerous books on the connection between family, nature and community, in which he investigates the relationship of humans and the natural world in both current and historical contexts. The possible outcomes that result from this disconnection or alienation from nature are varied, and may be identified or perceived by those whose lives are typically distanced from green spaces and experiences in nature.

NDD is a description of the human costs of alienation from nature. Note: that NDD is currently not a recognised medical diagnosis but a means to explain the link between health imbalance and nature deprivation and the possible outcomes. Some of the outcomes are understood to be both having a negative effect on physical and emotional health and may include symptoms such as; a diminished use of the senses, attention difficulties, dissociation and higher rates mental illness. In children symptoms are thought to sometimes include hyperactivity, low mood or motivation and lack of attention.

Humans have evolved in the natural world, we come from primitive beginnings where understanding and interacting with the natural environment was a necessity for survival and wellbeing. It is in the wild that we evolved physically, mentally and intellectually.

The relationship between mankind and nature is an oxymoron, mankind ‘is’ nature or is part of nature – we have just forgotten it. When we remember this fact, and remember our ancestors (even those not so distant as we may think), we can see how far removed we are from the world that we are part of. 

Now, in the modern world where our food, medicine, resources etc are produced or manufactured industrially, where we are able to access information at the click of a button – we ‘need’ less to have the connection to natural rhythms.

We can use the internet to check the weather (where we would once have understood the conditions and natural events). We can rely on technological world for almost everything that we would have once understood and depended upon from our direct understanding and connection to nature.

There are a number of reasons that we are spending more time away from nature. Louv describes that as of 2008, for the first time in human history, more people are living in cities than in the countryside. The issue is more the absence of nature and green spaces in cities, rather than the cities themselves. It has been shown that the wellbeing rates in communities where there are more trees and green spaces is higher (5). Among the above mentioned, the following are also factors that may be contributing to the cause of NDD:

Biodiversity and habitat loss

Of course it cannot be ignored that the loss of habitats and biodiversity is a factor. The decline in biodiversity directly reduces our exposure and consequently reduces our value in nature.

Biophobia

There are issues of ‘biophobia’ which is both linked to cultural fear of ‘risks’. There is also a link between biophobia and climate anxiety, where it is thought that children are conditioned at an early age to associate nature with environmental disasters.

Technology

Technology now dominates almost every aspect of our lives, children’s lives are over-programmed and immersed in the virtual world.

Louv describes that ‘as we spend more of our lives engaging in the technological world, our senses narrow; the more time we spend in the virtual world, the less alive we feel’.

The causes are rarely through fault of our own, all of the above are unfortunately side effects of the society that has been built around us, that we have grown up into. However, it is clear that this awareness is spreading and that changes need to be made on a wider scale to help change the course of our discord to nature, for the benefit of both people and the planet.

In most Western cultures we are now at our furthest point of disconnection from the natural world. Yet we have reached a point where we are starting to become acutely aware of the ‘symptoms’ created by this distance.

Many of us, who live in urban or suburban areas will have experienced the yearning that comes with time spent too long away from nature. However, now many are living in conditions so far removed from nature, in the depth of cities or towns, away from anything that resembles an undisturbed natural habitat, these simple experiences are directly inaccessible.

Often times people are so disconnected from nature they do not realize that is what they are actually missing. For example, a Londoner born and raised in the chaos of the city may not have had the privilege of spending extended time in nature and so may not know that this may chip away at their peace.

NDD can affect people whose work or personal life is distanced from nature. It is certainly a problem effecting children, arguably the most. Access to garden or outdoor space is a luxury, let alone having space to fully engage in hands on activities in nature such as growing food or foraging for medicine. Still even if one has a garden or local park, nothing can replace the experience of being in wild nature untouched and unkempt by humans.

Secondary to the more personal effects of NDD, there are of course implications with the wider issue of disassociation to nature and our value in the environment that essentially results in the disregard of it; what we do not connect to or understand we are less likely to care for. Therefore it could be argued that under-exposure to nature is also an environmental problem.

The initial questions asked by the scientific community are; how is this enhanced wellbeing by nature exposure measured, what are these wellbeing outcomes and then, what could the solutions to the health effects of under-exposure look like?

Much of the focus of research, particularly where children are involved, has been on both measuring connectedness to nature in an urban setting and related mental and cognitive functioning and wellbeing (4). The solutions are varied depending on demographic and who is being effected. However the research has identified that for those who are displaying symptoms of NDD, all forms and quantities of exposure are beneficial (1).

There are numerous papers that have evaluated the evidence and the findings are clear; Overall mental health, self-esteem, stress resilience, depression and overall health are found to have been improved by exposure to nature (2,3).

Learning settings that incorporate nature activities with accessible green spaces display significantly improved mental health outcomes in children (2,3), making a clear case for schools and other educational settings to improve access to nature activities and green spaces. See our articles for how forest schools can affect children’s development.

A mixed method pilot study of high school graduates attending a four-week wilderness camp was set up with the intention to investigate whether nature-based camp experiences would increase connection to nature and promote multiple elements of well-being. The study concluded that all well-being outcomes significantly improved, including perceived stress, relaxation, positive and negative emotions, sense of wholeness and social connections. These results can inform future research agendas and reinforce that nature immersion experiences could address the risk of nature-deficit disorder, improving health and social outcomes in young people (7).

In another paper, nine recommendations are drawn for addressing nature deficits at the population level. Some of these include bringing green everyday spaces and views closer to both work and educational settings, and bringing green activities and events into towns and cities. It also includes making green activity programs more accessible in communities, and to be considerate of barriers which can prohibit people starting green activities (1).

For the general population; the responsibilities for improving access to nature in towns and cities truly lies with the government and city/ town council to support better utilisation of public spaces for engaging in green activities and community growing projects. For workers; company owners may be encouraged to integrate nature into the work space or working life where possible, whether this be bringing indoor plants into offices or offering better working hours to allow for more time for workers to access and enjoy green spaces.

It is most clear that better nature education and improved green spaces in schools and educational settings is of upmost importance for the wellbeing of children.

As we have seen, there is a strong case for re-engaging with the outdoors, on a number of different levels- as a means of enhanced personal and environmental wellbeing. It is our natural biological connection to the surrounding ‘life’ that we are part of – which brings us wellbeing.

The issue of nature access is something we can all consider. As we can see, nature is not always directly accessible, particularly in heavily urban areas of cities. The first step is to spread the awareness of this issue whether you are directly effected or not, we can all play a part in supporting people in our communities.

Supporting or engaging with local community projects that offer forest school activities for children or community food growing projects in cities is a great way to help move nature closer to the communities that need it the most.

One can find out about projects that are bringing nature closer to cities by visiting the World Economic Forum ’15 innovations bringing nature back into our cities’ or contact your local school or council to find out if there is a way to support nature projects for children in your area.

We can see a clear link between the missing connection that is caused by a lack of interaction with the natural world and lower level of overall wellbeing, in both mind and body. When humans engage with the world more primitively through walking outdoors, gardening, community growing, foraging or working with natural resources; the value of the human – nature relationship also becomes more immediate, and its importance is realised.

The matter of nature connection is personal and societal but it is also environmental- with restored connection comes a true value for the natural world, a value that would mean we would want to care for it, because we are part of it – both preserving and sustaining it for the future generations and for all life on earth.

1. Ming” Kuo, F.E. (2013). Nature-deficit disorder: evidence, dosage, and treatment. Journal of Policy Research in Tourism, Leisure and Events, 5(2), pp.172–186. doi:10.1080/19407963.2013.793520.
2. Tillmann, S., Tobin, D., Avison, W. and Gilliland, J. (2018). Mental health benefits of interactions with nature in children and teenagers: a systematic review. Journal of Epidemiology and Community Health, [online] 72(10), pp.958–966. doi:10.1136/jech-2018-210436.
3. McCormick, R. (2017). Does Access to Green Space Impact the Mental Well-being of Children: A Systematic Review. Journal of Pediatric Nursing, 37, pp.3–7. doi:10.1016/j.pedn.2017.08.027.
4. Sobko, T., Jia, Z. and Brown, G. (2018). Measuring connectedness to nature in preschool children in an urban setting and its relation to psychological functioning. PLOS ONE, 13(11), p.e0207057. doi:10.1371/journal.pone.0207057.
5. Hunter, R.F., Cleland, C., Cleary, A., Droomers, M., Wheeler, B.W., Sinnett, D., Nieuwenhuijsen, M.J. and Braubach, M. (2019). Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis. Environment International, 130, p.104923. doi:10.1016/j.envint.2019.104923.
6. World Economic Forum. (n.d.). 15 innovations that are bringing nature back into our cities. [online] Available at: https://www.weforum.org/agenda/2022/01/15-innovations-helping-cities-become-nature-positive-biodiverse-hubs/ [Accessed 9 Aug. 2022].
7. Warber, S.L., DeHudy, A.A., Bialko, M.F., Marselle, M.R. and Irvine, K.N. (2015). Addressing ‘Nature-Deficit Disorder’: A Mixed Methods Pilot Study of Young Adults Attending a Wilderness Camp. Evidence-Based Complementary and Alternative Medicine, [online] 2015, pp.1–13. doi:10.1155/2015/651827.

Most people have experienced feelings of loneliness. It often occurs during life transitions such as changing schools, moving to a new city or country or when an elderly person outlives their spouse and friends.

Loneliness is often stigmatised, trivialised or ignored but when loneliness becomes a chronic condition, the impact can be far more serious than many people realise. Loneliness is emerging as a public health issue and the UK now has a designated loneliness minister to tackle the issue.

Elderly people are especially vulnerable to loneliness. According to Age U.K., more than 2 million people in England over the age of 75 live alone. 1.4 million elderly people saying they feel lonely with more than one million elderly people say they go for over a month without speaking to a friend, family member or neighbour.  Covid-19 and the national lockdowns exacerbated loneliness and social isolation (7).

Loneliness is not the same as social isolation. Social isolation is the lack of social contacts and having few people to interact with. A person can live alone and not feel lonely or isolated. Loneliness is an individuals personal, subjective sense of lacking desired affection, closeness, and social interaction with others (8). A person may be surrounded by other people but still feel lonely. This is common with elderly people in care homes or hospitals who are surrounded by others yet still experience chronic loneliness (9).

To truly overcome loneliness requires a sense of belonging which is only achieved through reciprocal connections. Lonely people need to feel they are contributing towards the connection to create a sense of belonging not just being the recipient of help (9).

Studies on Blue Zones, areas around the world where people routinely live to 100 in good health, have found one of the important factors for their longevity and good health is ‘belonging’. These Blue Zones place great emphasis on family, on community connections or being part of a faith-based group. As a result, the elderly in these communities have a feeling of purpose in life, a reason for waking up each morning as the feel loved and needed (6).

Humans have thrived as a species through connection with others. As hunter-gatherers people needed each other to stay alive. Loneliness doesn’t just make people feel unhappy, it makes people feel unsafe both mentally and physically. Evolutionary instincts brought prehistoric people together to work together for food, shelter, and protection.

The mental distress people experience when feeling lonely or isolated is a warning to re-engage or face danger. Short term loneliness can be beneficial as it highlights the need for social connection, but chronic loneliness is harmful to all areas of health and wellbeing.

Just as physical pain serves to protect the body, loneliness protects the social body. It lets us know that social connections are diminishing. According to psychologist John Cacioppo, the brain goes on high alert for social threats and can produce a hyper-reactivity response to perceived negative behaviours in other people. This induces feelings that interactions are unpleasant which can result in self-preservation behaviour of retreating further from people which increases loneliness (9).

Loneliness is linked to worse cardiovascular health, lower quality of life, decreased cognitive function, higher depression rates, mental health issues and decreased life span (2). A 2017 a meta-analysis of forty systemic reviews of mainly observational studies, identified a significant association between loneliness and increased all-cause mortality (1).

Until recently the cellular mechanisms by which loneliness caused declining health were not well understood. A research team lead by psychologist John Cacioppo carried out studies that identified that loneliness creates inflammation and a less effective immune response though over expression of genes involved in inflammation and decreased expression of genes involved in antiviral responses (3). The team called this phenomenon “conserved transcriptional responses to adversity” or CTRA (4).

The team then studied gene expression in leukocyte immune cells (white blood cells), that are involved in protecting the body from bacteria and viruses. The study didn’t just focus on humans but also included the highly social primate species, rhesus macaques (3).

The leukocyte cells from the lonely monkey’s and humans showed as expected CTRA, increased inflammation and decreased antiviral immune responses.  New information was also revealed about a reciprocal relationship between loneliness and leukocyte gene expression suggesting each can help propagate the other over time (3). Loneliness predicted future CTRA gene expression measured a year or more later and CTRA gene expression also predicted loneliness. These results were specific to loneliness and could not be explained by depression, stress, or social support (4).

The team then investigated social experiences and CTRA gene expression in rhesus macaques. The lonely monkeys also had higher CTRA gene expression as well as higher levels of the stress hormone norepinephrine.  Norepinephrine can stimulate blood stem cells in bone marrow to make more immature monocyte immune cells (a type of Leukocyte) that have high levels of inflammatory gene expression and low levels of antiviral gene expression which finally explained CTRA gene expression in white blood cells (4).

Loneliness results in flight-or flight stress signalling, which increases the production of immature monocytes which up regulates inflammation genes and impaired viral response. The danger signals activated in the brain by loneliness affect the production of white blood cells, the shift in monocytes output may propagate loneliness and contribute to its health risks (3).

One potential intervention in helping to reduce loneliness in the elderly is social prescribing. Social prescribing, also known as community referral, enables health professionals to refer people to a link worker (community connector or navigator). Link workers take time to get to know the individuals needs finding out what matters to them and then connect them to a range of local, non-clinical services.

Social prescribing recognises that people’s health and wellbeing are determined by a range of social, economic, and environmental factors. It seeks to address people’s needs in a holistic way and to support individuals to take greater control of their own health (5).

Social prescribing is designed to support people with a wide range of social, practical, or emotional needs usually provided for by voluntary or community organisations connected to link workers through social activities and social groups such as gardening, singing, crafting, learning, befriending, technology lessons or men’s sheds. This initiative is supplemented by investment in community projects such as cafes, art spaces or gardens that can become a social point for social prescribing (5).

Social prescribing is supported by a growing body of evidence that shows it can lead to a range of positive health and wellbeing outcomes.

Studies have pointed to improvements in quality of life, emotional and mental wellbeing and reduced levels of anxiety and depression. However, there are weaknesses as many of the studies are small scale, do not have control groups, focus on progress rather than outcomes or relate to individual interventions rather than the social prescribing model (5).

Social prescribing has generally not had the primary aim of addressing loneliness. To address this gap the British Red Cross in collaboration and funded by the Co-op partnership, delivered a national prescribing service for lonely people (10).

The social prescribing service consisted of paid link workers and volunteers who developed supportive relationships with the lonely service users, assessing their needs and providing individualised care. These three components were considered critical in loneliness interventions. Support was provided for 12 weeks and concentrated on building lonely people’s confidence so that they were then able to use the community activities and services such as crafting groups, adult learning, and leisure facilities (10).

The social prescribing service helped to reduce service users’ loneliness and provide other benefits such as improved wellbeing and confidence. The results are interesting as it was the service users under 50 years old that were more likely to experience improvements in loneliness. This is due to younger people’s loneliness being related to lack of social connections while elderly people’s loneliness is often entrenched (due to self-preservation mode), arises from the death of friends and spouses, or from a loss of functional ability to engage in activities (10).

A key finding was that 60% of service users reported a worsening of their loneliness after finishing the 12 weeks service. One reason was that service users were unable to continue attending community activities because they were reliant on link workers/volunteers for transport (10).

Social prescribing could be a very effective tool in helping to reduce chronic loneliness in the elderly provided there are enough link workers and transport is available to help the less mobile elderly. Consideration needs to be taken about including behaviour interventions to change how lonely elderly people think about other people, helping them to understand that they are in a self-preservation mode and how to come out of it so that they can happily engage in community activities.

Ultimately we all want connection with each other and our community. Nothing can replace a feeling of belonging, sharing and laughing with each other. Unfortunately in our society the elderly do not have as much access as they should to these human needs, but social prescribing can be an antidote to that. There are even social prescribing projects which involve gardening- a wonderful way to connect both with nature and other people.

1. N. Leigh-Hunt, D. Bagguley, K. Bash, V. Turner, S. Turnbull, N. Valtorta, W. Caan, An overview of systematic reviews on the public health consequences of social isolation and loneliness,Public Health, volume 152, 2017,Pages 157-171.
2. Courtin E, Knapp M. Social isolation, loneliness and health in old age: a scoping review. Health & Social Care in the Community. 2015;25(3):799-812. doi:10.1111/hsc.12311
3. Allen S. Loneliness triggers cellular changes that can cause illness, study shows. University of Chicago News. https://news.uchicago.edu/story/loneliness-triggers-cellular-changes-can-cause-illness-study-shows. Published 2015. Accessed August 6, 2022.
4. Loneliness triggers cellular changes that can cause illness, study shows. Science Daily. https://www.sciencedaily.com/releases/2015/11/151123201925.htm. Published 2015. Accessed August 7, 2022.
5. Ewbank L. What is social prescribing?. KingsFund. https://www.kingsfund.org.uk/publications/social-prescribing. Published 2020. Accessed August 7, 2022.
6. Buettner D. Power 9® – Blue Zones. Blue Zones. https://www.bluezones.com/2016/11/power-9/. Accessed August 9, 2022.
7. Loneliness in older people. nhs.uk. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/loneliness-in-older-people/. Published 2021. Accessed August 8, 2022.
8. Rossall P, Iparraguirre J, Davidson S. Loneliness at local and neighbourhood level. Age UK. https://www.ageuk.org.uk. Published 2015. Accessed August 7, 2022.
9. Adams T. John Cacioppo: ‘Loneliness is like an iceberg – it goes deeper than we can see’. The Guardian. https://www.theguardian.com/science/2016/feb/28/loneliness-is-like-an-iceberg-john-cacioppo-social-neuroscience-interview. Published 2016. Accessed August 7, 2022.
10. Foster A, Thompson J, Holding E et al. Impact of social prescribing to address loneliness: A mixed methods evaluation of a national social prescribing programme. Health & Social Care in the Community. 2020;29(5):1439-1449. doi:10.1111/hsc.13200

When I was in my early twenties, I spent several months living in an eco-community in the desert in the South of Spain.

A beautiful, run-down, sun-baked valley peopled with food growers, permaculturists, hippies, turtles and stray cats. In the garden there was a hand-painted sign.

Created long ago, now chipped, it read: If you want to know if something is sustainable, ask yourself – can I do this forever?

For me, this question cuts through the greenwash, the jargon, the myriad ways with which this word is thrown around, to the very heart of the issue.

The etymology of the word sustain speaks to the concept of ‘giving support’, and ‘holding up’. Also a sense of enduring. It is these readings of the word sustain that colours the work that we do with children in the woods.

At our Forest School nursery, children enrol for a minimum of a year. However, most children join at the age of 2 ½, and stay for two years, before they go to school. Spending this formative time immersed in the woods is an experience that embeds itself in their developing psyches. It is the most experiential way to teach children about sustainability that I know.

The children begin their time in the woods in September, in mushroom season. They learn to spot fungi at the base of trees, to let their friends know what they’ve found, to check a guidebook to see if they can identify it. They learn that we do not touch mushrooms with our hands, only poke them gently with a stick. They learn the hard way what a puffball mushroom is, and what it does!

As the seasons change they learn about the changes to the light and the effect this has on the leaves. They learn what deciduous means, and play in the falling leaves. And they discover the value of the evergreens: playing in the safety of Ivy Palace in the depths of Highgate Woods when all of the other trees are bare; climbing its ladder of horizontal branches.

The children learn that the birds eat berries in deepest winter, and so we gather a few blackberries but leave the rest for the robins, crows, magpies that they learn to name. A robin visits us each morning at snacktime, so we sprinkle a few crumbs each day.

We play in the snow, and the slush after the snow, then the mud left after the slush is gone. We pull on waterproofs so that we can play in the woods in any weather, and we celebrate the rain by jumping in the puddles. We notice the buds on the blackthorn before anyone else, because we are in the woods each day down at toddler level, and we spot the hawthorn leaves unfurling early in the spring.

The children learn to spot each small change and to celebrate the changing of the seasons. With change comes loss, and the woods teaches us this too. As the trees become leafy once more the children discover they can no longer see across camp, and the landscape changes completely. The playscape changes as they develop: suddenly they can hide behind the bushy foliage, and so we must grow our trust in them, as they become more confident.

We miss the fungus in the summer, and so instead we gather flower petals for hapa zome, practising our fine motor skills and experiencing the magic of natural dyes. As is the gift of foraging, we understand the brief season of each plant, its finite nature, and we take only a little of each. And in exchange for the many ways that the woods sustains us, giving us resources and opportunities for play, we teach the children to reciprocate their care.

We leave most of the berries for the birds, most of the flowers for the insects. We offer sleepy bees water and we turn over the bugs who we find struggling on their backs. We bury dead birds with ceremony, and we test the branches we climb on with a small bounce to make sure they are strong enough to hold us without breaking. These children learn that they are a part of the woods.

They do not yet know of the innumerous cases of humans destroying natural environments. Nor have they received the message, perpetuated by many contemporary conservation efforts – that humans must stay away and leave nature to itself. Instead they learn each day that we are a part of this environment – that we always were and we always will be, if we can sustain these ancient woodlands and protect them for the future. These children discover that the woods is a place that gives them shelter from rain, shade from sun, wild food, animal friends and endless invitations to play.

As a part of their natural and healthy development, children play with their power. They play with the creative drive, and the drive to destruction. This is a vital part of development, of growing up and discovering the impact you can have in the world. The woods is the place to learn this.

Each child at some point builds a den. Perhaps their friend builds a den. And each child at some point must knock down their den. Perhaps their friend’s den too. Just to see what happens. To experience the thrill of the clatter of the logs, the collapse of the delicate structure. Their friend’s tears, even. Each child too will snap a flower off its stem. Rip every leaf off a stalk. Run after a bird and scare it out of camp. And therein lies the learning.

The den can be rebuilt, the friendship too, in time. But the bird will have to be coaxed back into camp with breadcrumbs, and the flower will not come back this season. Actions have consequences, and the woods is an interactive place in which to learn this. Cree and Rob conclude: ‘the familiar song of the robin is part of the Forest School community, and while we value its company, we need to respect its home and take care of the community. The reciprocal feeling with the robin has the comparable worth of a rainforest or coral reef’ (1).

We can extend our engagement with the woodland, and our discoveries of our own powers to create and destroy, using tools. The sight of toddlers wielding saws, hammers and axes is a sight you will never forget. The sight of two toddlers helping each other to use a bow saw to cut a log in half, or using a froe to split wood for the fire, reminds us that these children are the environmental stewards of the future.

We use only hand tools in the woods – flints and steels to light fires for cooking, mallets to hit pegs when we create shelters. In doing so, we engage more deeply with the woodland as a resource that can be renewable only if we do not exploit it. We remember that wood can be fuel, that stakes and binders from coppice woodlands can be fences, that a hedgerow is a habitat. Each of these acts of tool use is an act of transformation.

Cree and Robb write that ‘being able to make an item from a tree that you can harvest and then used to produce something of utility, while consciously honoring this, provides access to, and gives voice to the more-than-human world’(2).

These simple tools enable us to work with the woodland in a way that is sustainable, that factors in the delicate balance of its ecosystem, but that allows for an interaction with the woods where so much more can be learned than if we simply left alone. Including children in that work develops their relationship with the woodland profoundly. By teaching children to look after the woodland in reciprocation of the ways in which the woodland cares for them, we give them a message that humans can be forces for good within a habitat, if we proceed with care.

At the ages of 2 and 3 our brains and neural pathways are still forming. In later life we can consciously recall very little, if anything, from these years. And yet, the experiences we have during these years, and in particular the attachments that we make, form a key part of our development.

If we experience the reciprocal care of a woodland during these formative years, we carry this sense with us for the rest of our lives. While talking about the transformative potential of Forest School for young children, we must take a moment to look around us at our context.

As a result of rapid urbanisation of environments and the population over the twentieth and twenty first century, children’s access to the natural world has been shrinking correspondingly.

A culture of outdoor play in urban areas has been replaced with ‘stranger danger’, fears of traffic and an unwillingness or inability to give children hours of unstructured time to explore (3). So often this has a socio-economic correlation: parents working long hours on low wages are unable to supervise their children, who must then stay indoors; families living in polluted or built-up areas do not have access to local wild spaces.

While acknowledging the importance of access to outdoor space, and to curated, long-term experiences of nature connection, we must also consider which children have access, and which do not. Bringing Forest School to all primary schools, so that all children can participate in their early lives, is a vital part of developing the breadth and potential of this educational method (4).

Education for sustainability is a critical part of the work that needs to be done in these times. One element of making education sustainable, is to pass this knowledge on to children. This generation will grow up to discover the damage done to wild lands at the hands of humans, and will be well served to act differently when it is their turn to act, with the inherent knowledge of how to exist peacefully within an ecosystem, embedded in them at the age of 2. As David Sobel so eloquently writes: ‘If we want children to flourish, to be truly empowered, we must first allow them to love the earth before we can ask them to save it’.

1. Cree, Jon, and Marina Robb. The Essential Guide to Forest School and Nature Pedagogy. Routledge, 2021. p. 13
2. Cree, Jon, and Marina Robb. The Essential Guide to Forest School and Nature Pedagogy. Routledge, 2021. p. 296
3. Wilson, RA, and D.A. Simmons. “Helping Children Learn to Love the Earth Before We Ask Them to Save It:.” Dimensions Educational Research Foundation, https://dimensionsfoundation.org/wp-content/uploads/2016/07/helpingchildrenlovetheearth.pdf. Accessed 9 August 2022.
4. Knight, Sara, ed. 2011. Forest School for All. SAGE Publication
5. Sobel, David. Beyond Ecophobia: Reclaiming the Heart in Nature Education. Orion Society, 1996

There is an important distinction to make between risky play and dangerous play. At no point during a Forest School session are children in any danger. But at many points during a Forest School session the children are supported to take risks.

In any risk-taking we meet children exactly where they are at, and ensure that they are ready for, and keen to move towards their next steps. This can look like a child who is terrified of climbing trees, practising clambering onto a stump, and jumping off, over and over, holding our hands. And then again, without needing to hold hands any more.

It can be a child who is a confident tree climber, practising climbing up to 3 feet, then 4 feet, then 5 feet above our heads, once they have the skills to do so safely. This can look like handing a 3 year old a hammer and encouraging them to hit a billhook to split a log for firewood. Children show us in their own time, and their own ways, that they are ready to develop independence, balance, strength, and skill.

The great-grandfather, aged 8 in 1919, was able to walk 6 miles alone to go fishing. His son, aged 8 in 1950, could walk about a mile alone. His daughter could walk half a mile alone. And her son, aged 8 when this map was created in 2017, can walk only 300 yards to the end of his street. It goes without saying that urbanisation has changed the landscape dramatically, both physically and socially.

However this map reminds us of the stories our parents and grandparents tell us, about days spent in the wild, picking blackberries, fishing, playing, roaming. So often our favourite childhood memories are spent in nature, and so often, these memories have a quality of timelessness. Time passing unmarked, an entire summer holiday spent by a river, nowhere to get to, and no adults to hurry us along. It is this that is lost for contemporary children, and it is this that we can hand back to them, at Forest School.

Of course we know where the children are during our Forest School sessions, and we do not send them 6 miles down the road to go fishing! But by running child-led sessions, we can offer the children the opportunity to become deeply engrossed in the flow of play. For the children, being given autonomy over their time, and choices over what to do with it, has the direct result of building self-esteem.

In January, a little boy joined our Forest School Club. He was 4 years old. I will refer to him as M.

M was recommended to us after starting primary school, and promptly leaving it again. He struggled with sensory overload, and the intensity of sitting down all day in an over-stimulating environment. He used to run out of class screaming. He didn’t make friends, and came to believe that he couldn’t ‘do’ school. The school found it difficult to cope with him, and by Christmas he had left his reception class, refusing to go back.

When he arrived at Forest School, he was withdrawn and anxious. He wouldn’t sit with the group, and if we approached him he would run away, hit and spit. Over time, he would sit at the edge of camp at the base of an oak tree, and permit me to hover nearby. As we would sit there peacefully, we would spot birds and insects. He was incredibly observant, and began to learn their names.

Still he felt uncomfortable in the group, and would only sit on the peripheries of the circle. A few sessions in we introduced him to the hammock, which he loved, and in which he could spend hours. He would stare at the leafy canopy and tell me ‘faster, faster!’ I spent hours with him, rocking him in the hammock, and slowly began to get to know him.

After some time he would hold a butterfly identification guide in his hands and watch to see which butterflies flew by. He became calmer, and more trusting, and began to sit with the group during lunchtime.

One day we sat at the base of a cherry tree, and he spotted the resin seeping out and hardening. He asked about it, and I explained about resin, and about how it forms amber when compressed deep under the ground. I showed him my amber ring, and he said that he wanted to make one.

The boy who had never entered the tool circle, never picked up a tool, felt the intrinsic motivation to walk across camp and pick up the tool bag. Having taken time to observe the other children, he knew exactly what to do.

He used a small hack saw to remove a piece of resin. He used a bow saw to cut a disc of wood, and a palm drill to make a shallow hole inside it. He used wood glue to secure the resin to the disc, and tied a knot in the twine to tie it around his neck. He then showed the other children the source of the resin, and how to use the tools to make their own jewelry.

Over time I discovered that he was exceptional at maths – able to calculate the number of children in camp each day almost immediately. We saw him develop teamwork – whittling the bark from a length of hazel with another child, turning the log each time they’d completed one side. And I discovered the depth of his empathy the day that I sneezed, copiously, as the willow pollen blew across the woods. He asked me why I was sneezing, and I explained that it was allergies. He asked me, are you going to sneeze all day? He disappeared, and returned with a pocketful of tissues, saying: I think this will be enough for the whole day.

This is only one case study of many, that demonstrates the ways in which Forest School can be transformational for children in their developmental pathways. So often, children who struggle in a classroom come to believe that the problem lies with them, and that they simply cannot learn.

Often these children are problematised and blamed, by teachers who are themselves struggling with a class of 30 children with diverse needs. When these children are offered an alternative learning space in which they are given the tools to self-regulate, the support to take risks, and the space to build their self-esteem, they come to discover that they are both able, and in fact love, to learn.

Since the pandemic, teachers and Early Practitioners internationally have noted a significant rise in the number of children arriving at school with speech and language delays and social and emotional difficulties (4). For many, when access to school was limited to teaching online, and our access to the outdoors curbed to one walk per day, there was a deep realisation of how much we needed and valued both our learning communities, and our time in wild spaces.

‘Of more than 200 forest schools surveyed by the Forest School Association (FSA), about two-thirds said demand for their services had increased since March 2020.’(5). As part of this study, Forest School providers were asked why they believed that attendance had rocketed in this way. Amongst the reasons cited were ‘increased awareness of the benefits of the outdoors, especially in relation to stress and anxiety, Covid safety, and dissatisfaction with the school syllabus after months of pandemic homeschooling.’

In their discussion of Forest School as an alternative pedagogy, Goodenough and Waite consider the difficulties of integrating Forest School within the current English Education system; so often a system in which ‘children, parents and carers are positioned as customers, while progress is expected for all children and judged through outcomes rather than prescribed pedagogical approaches’ (6).

In such a context, it is challenging to integrate Forest School, particularly as you travel up from Early Years into Primary and Secondary School. Indeed, it is the attempt to integrate Forest School that so often sees the dilution of the key principles; a creeping need to cover curriculum adds a pressure to the sessions that distracts from the core principle that the sessions are child-led.

We must begin to consider which skills the children of today will require most in the coming years, and which educational methods can best give them the resilience, self-esteem and grounded-ness that they will need.

It is clear to me, from my time spent working in Forest Schools, that these spaces in which we are in community with one another, with the seasons, with the creatures of the forest and with the trees, offer children time and space to develop at their own pace. At Forest School, everything is relational.

Children learn alongside their peers, they help friends who are still learning, and they develop in the areas that they individually need most. It is astonishing to observe children arrive in the forest in September, so quickly show us their needs, and then gravitate to their own developmental pathway to address those needs. When we give children the space to do so, they can lead their own learning.

In this way, they discover an intrinsic motivation to learn, unfettered by praise or punishment, instead embracing learning for learning’s sake. For the children who experience this formative time in the woods, there will forever be a connection and a gratitude to the forest, giving these children the skills and the care to become the next generations’ environmental stewards.

1. What is Forest School? | Forest School Association. Forest School Association. https://forestschoolassociation.org/what-is-forest-school/. Published 2022. Accessed August 24, 2022.
2. Cree J, Robb M. The Essential Guide To Forest School And Nature Pedagogy. Routledge; 2021:16.
3. Skenazy L. How Children Lost The Right To Roam. Freerangekids.com. https://www.freerangekids.com/wp-content/uploads/2017/02/how-children-lost-the-right-to-roam-map.jpg. Published 2022. Accessed August 24, 2022.
4. Impact of COVID-19 on Early Childhood Education & Care. Post Parliament UK. https://post.parliament.uk/impact-of-covid-19-on-early-childhood-education-care/. Published 2021. Accessed August 24, 2022.
5. Forest schools flourish as youngsters log off and learn from nature. The Guardian. https://www.theguardian.com/education/2021/oct/31/forest-schools-flourish-as-youngsters-log-off-and-learn-from-nature. Published 2021. Accessed August 24, 2022.
6. Waite S, Goodenough A. What is different about Forest School? Creating a space for an alternative pedagogy in England. Journal of Outdoor and Environmental Education. 2018;21(1):25-44. doi:10.1007/s42322-017-0005-2

A strain is caused by overstretching a muscle and/or a tendon (1), usually caused by overstretching the fibres, leading to bruising, pain, spasms, weakness, oedema (swelling) inflammation, and cramping in the muscle, and even tears in the muscle fibres (2). A sprain, in contrast, is injury to a ligament, which connects bone to bone, and is often caused by a sharp twisting motion. The symptoms are often similar to those of a strain.

Treatment of sprains and strains should be approached carefully, particularly when in the acute stage, immediately following the injury.

The role of aromatherapy here is primarily to help reduce swelling and pain through the gentle application of anti-inflammatory essential oils, and to help move lymph around the area, through the use of astringent essential oils and herbal extracts. Since temperature also has a role to play with the reduction of pain and swelling, it is advisable to use a cool pack alongside the oil blend to aid the healing process. Although the injury is acute, applying neat or undiluted essential oils to the skin is not advised, since it may cause irritation or damage to the skin.

Instead, a strong blend of around 5% can be made and applied to the area, then occluded with a cold compress, and alternated with a hot compress if desired, to increase blood flow to the area and speed up the absorption of the remedy. A carrier oil will be needed to dilute the blend; a herbal-infused oil such as arnica is helpful for addressing bruising, for example. Alternatively, witch hazel (Hamamelis virginiana), which is astringent, can be blended with a dispersant such as Solubol, and the essential oils added and applied to the area with a cold flannel.

Safety note: Do not mix witch hazel and essential oils without the dispersant, since oil and water will not mix and thus the essential oils would effectively be neat, and undiluted, and could irritate the skin.

Suggested blend for sprains and strains

5% blend

• 10ml Arnica Arnica montana-infused carrier oil e.g. Sunflower (Helianthus annuus) (or 10ml of Witch Hazel / Solubol mixture as described above)
• 10 drops (total) of cooling, anti-inflammatory astringent essential oils, to include any of the following:
  • Grapefruit (Citrus paradisii): Lymphatic drainage, astringent (Safety note: Phototoxic. Avoid application before exposure to sunlight.)
  • Juniper (Juniperus communis): Lymphatic drainage, astringent
  • German Chamomile (Matricaria recutita): Anti-inflammatory
  • Roman Chamomile (Chamaemelum mobile): Anti-inflammatory
  • Peppermint (Mentha piperita): Cooling, analgesic (Safety note: do not use whilst pregnant, breastfeeding or with children under 2 years old.)
  • Lavender (Lavandula angustifolia): Anti-inflammatory, analgesic

Stir well to combine, and apply to the affected area using gentle massage. Cover with a cold flannel or ice pack if desired.

Please note: Only use on small, injured areas, not suitable for full-body

Many of my clients exercise regularly, but also have desk-based jobs. This means that they often arrive at the clinic with various low-level aches, pains and tension which they are unable to relieve through stretching at home.

Usually poor posture or overuse of the muscle are to blame for these kinds of aches and pain, and symptoms can include pain, inflammation, oedema (swelling), tightness or tension, and reduced motion in the affected area. Also tendonitis, plantar fasciitis, or carpal tunnel syndrome may be the result of repetitive strain injury (RSI). In such instances, there are several treatment options available to clients, both at home and on the massage couch.

Preventative measures include regular stretching as part of the working day (3), and post-exercise, to ensure the muscles are adequately moved and stretched, and tension build up is prevented. Supportive desk chairs, mouse mats, and armrests can prevent RSI in the wrists, for example, and support healthy back posture whilst seated (4).

Maintaining a regular physical practice such as gentler forms of yoga, e.g. yin yoga, can also be enormously helpful for maintaining flexibility, since they focus on releasing the fascia that connects the musculoskeletal system (5), reducing tension in the muscles and keeping joints mobile. Mixing up exercise regimes and not over-working one muscle group can also help to prevent muscle pain from overuse (RSI).

However, there are always times when we might overdo it on a run or in the gym, sit for too long at our desks, or lift something heavy. We then wake up the next morning with a crick in the neck, sore legs, or a painful shoulder. Perhaps we even suffer from a ‘pinched nerve’ due to the inflammation in the surrounding muscle tissues. In these cases, aromatherapy can be a gentle and enjoyable way to help alleviate pain and tension, and to help relax and release muscle tissue.

Since pains and tension of this type tend not to be as limiting or acute as sprains, strains and other injuries, they require a different approach to treatment. Ingrid Martin recommends the use of “strongly analgesic and cooling” (6) essential oils for pain caused by overuse of a muscle, however, oils that are considered warming are also useful for longer-term chronic stiffness (7) and tension.

Some useful oils for chronic pain, tension and RSI

Carrier oils

St John’s Wort (Hypericum perforatum): herbal infused oil, e.g. sunflower Helianthus annuus. A carrier oil infused with St John’s Wort is extremely anti-inflammatory, and is recommended for bruising, reddened skin, as well as being calming for neuralgia and sciatica (inflamed nerves). The herb gives its carrier oil a gorgeous blood red colour.

Jojoba (Jojoba sinensis): Actually a liquid wax, jojoba absorbs very easily into the skin, having a similar molecular structure to that of skin’s natural sebum. It is also anti-inflammatory and is often recommended for treating arthritis and other inflammatory conditions, so can be useful for relieving chronic joint pain.

Essential oils

Cooling, anti-inflammatory essential oils such as those mentioned above for the treatment of acute injuries can also be applied here, but sometimes a more “warming” approach is needed, particularly in cases of stiffness and stagnation in the muscles and joints. Some of these oils include:

Cinnamon (Cinnamomum verum): A warming, stimulating oil that has antirheumatic properties. A lovely addition to a muscle-warming blend.

Safety note: This oil should be treated with caution and not used above 0.1% in any blend due to its skin-sensitising properties (8).

Black pepper (Piper nigrum): Another stimulating, warming oil, with anti-inflammatory and analgesic properties (9). This oil promotes good blood circulation and is particularly recommended for overworked muscles, chronic inflammation, stiffness, and both osteoarthritis and rheumatoid arthritis (10).

Safety note: Use in low doses on sensitive skin.

Rosemary (Salvia rosmarinus): A stimulating, invigorating oil, which is an excellent vasodilator (11) and can alleviate muscle tension and pain through bringing blood to the area. “Stiffness and the related pain are usually relieved if local circulation is improved” (12) states Ingrid Martin.

Marjoram (Origanum majorana): Primarily a relaxant and hypotensive oil, which I use a lot in my clinic for clients with muscular pain and tension. Due to its ability to act on the nervous system as well as on smooth muscle tissue (13), it is a powerful oil for treating physical conditions such as muscle aches and rheumatism (14) caused by excessive tension in the body. It is an excellent accompaniment to some of the more stimulating, anti-inflammatory oils mentioned above.

I would normally combine these oils at no more than a 2% dilution in an appropriate carrier oil for use in massage during a treatment, however I regularly make muscle rubs and balms for clients to take home, as these can be useful to carry with them for use at home, work and more.

Usually, a product at a 4-5% dilution is prepared, using a mixture of carrier oils, essential oils and waxes to create a thick balm that is solid at room temperature. This is then applied three times a day to the affected area. A balm of this strength, however, would be too strong for a full-body massage, and is designed for localised, topical use only.

Muscle rub/balm recipe

Makes 1 ~60ml pot

Ingredients

• 7.15ml Beeswax (or soy wax)
• 50ml Carrier oil (e.g. herbal infused St John’s Wort oil)
• 57 drops (~2.85ml)  total essential oil (from list above)

Method

1. Use a bain-marie over a low heat to melt the carrier oils and wax together. Stir until completely melted and combined.
2. Take off the heat. Allow to cool to 50-60 degrees centigrade. If the essential oils are mixed in before the mixture is left to cool much of the essential oils will be evaporated and lost.
3. Add up to 57 drops of essential oils, from those listed above
4. Stir well to combine, pour into a 60ml sterilised tin and allow to cool
5. When solid, the balm is ready to use. Use within 6 months.
6. Apply topically to the affected area up to three times per day, massaging gently.

Fibromyalgia is a chronic health condition that can affect the whole body (15). Symptoms include increased sensitivity to pain, tenderness and soreness, fatigue, and stiffness. Brain fog, insomnia and digestive issues can also be accompanying symptoms. Whilst it has a strong muscular component, when treating fibromyalgia, an aromatherapist will take into consideration the symptoms as a whole, and create a blend of oils according to each individual’s unique needs.

Massage can be a wonderful way to treat fibromyalgia and other chronic muscular conditions, since it works not only on the site of the pain, i.e. the muscles, but on the emotional body and nervous system, too.

A 2014 systematic review concluded that “Massage therapy with duration ≥5 weeks had beneficial immediate effects on improving pain, anxiety, and depression in patients with [Fibromyalgia]. Massage therapy should be one of the viable complementary and alternative treatments for [Fibromyalgia]” (16) although more, large-scale research is needed to provide confirmation of the findings.

My favourite essential oils for treating fibromyalgia are those that work synergistically on the nervous system as well as the physical body, since my clients presenting with fibromyalgia often experience depression, anxiety, and frustration along with their chronic pain.

Inhalation as well as topical application of essential oils is key in treatment of conditions such as this, since inhalation is the most effective method of application of aromatherapy for psychotherapeutic effect (17).

Coriander seed (Coriandrum sativum)

Coriander seed is analgesic and antispasmodic, but also a powerful antidepressant oil. It is also excellent for digestive issues, and in Traditional Chinese Medicine, it is indicated for clearing ‘painful obstruction’ which refers to rheumatic pain (18).

Marjoram (Origanum majorana)

Marjoram is mentioned above, and is an excellent dual function oil, working to calm the nervous system whilst simultaneously relaxing the muscle tissue

Grapefruit (Citrus paradisii)

Grapefruit is also mentioned above; a “cooling, cleansing and decongesting” (19) oil that is helpful for clearing the mind, stimulating lymph and can help ease feelings of frustration and tension.

Safety note: Phototoxic. Avoid application before exposure to sunlight.

Cardamom (Elettaria cardamomum)

Cardamom is a digestive oil, helpful for treating IBS and other digestive complaints that are often associated with Fibromyalgia. It is also considered a “gentle tonic of the brain and nervous system”(20) and therefore complements the more stimulating oils with its gentler nature.

Melissa or lemon balm (Melissa officinalis)

Melissa is one of the most regularly-used oils in my clinic. Particularly as an inhalation oil, it works beautifully, though I often include it in massage blends, too. Analgesic and anti-inflammatory, it is also calming and sedative, so can be wonderfully effective for calming the nerves and the muscle tissues. The fresh or dried leaves can also be taken as an infusion in hot water.

Safety note: Safe for topical use at dilutions of 1% or less. Melissa should be avoided if pregnant or breastfeeding.

A balm or oil blend for fibromyalgia can be made in much the same way as in the other recipes suggested above, though for full-body application, the dilution of essential oils should be no more than 2% in total, with those essential oils which are potential irritants or sensitisers being used at their much lower, appropriate dilutions.

Alternatively, a bath oil at a 2% dilution could be prepared. Heat aids the absorption of essential oils into the bloodstream, and the steam will increase the evaporation, aiding inhalation and speeding up the therapeutic properties. Equally, the heat will help to increase blood flow to the sore muscles as well as releasing tension. For a further benefit, Epsom salts (Magnesium sulphate) may be added to the bath.

The magnesium in these healing salts is known for speeding up muscle recovery and reducing inflammation (21), as well as for reducing tiredness and fatigue more generally so it may be helpful for post-workout recovery too. It can cause dehydration, though, so make sure to top up on water before and after an Epsom salt bath.

It is clear that aromatherapy products such as massage oils, therapeutic baths and muscle rubs have a large part to play in the prevention and treatment of both chronic and acute musculoskeletal conditions. These recipes and oil blend suggestions have been specifically designed for treatment of the conditions explored here.

Do check allergy information and consult a health professional before using these products on children, if you have any health conditions, are pregnant or breastfeeding.

1. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 209.
2. Mulcahey, MD, FAAOS, M., 2020. Sprains, Strains and Other Soft-Tissue Injuries – OrthoInfo – AAOS. [online] Orthoinfo.aaos.org. Available at: <https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/> [Accessed 29 July 2022].
3. nhs.uk. 2019. Common posture mistakes and fixes. [online] Available at: <https://www.nhs.uk/live-well/exercise/strength-and-flexibility-exercises/common-posture-mistakes-and-fixes/> [Accessed 29 July 2022].
4. Pruthi, M.D., S., 2021. Office ergonomics: Your how-to guide. [online] Mayo Clinic. Available at: <https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-ergonomics/art-20046169#:~:text=If%20you%20 sit%20behind%20a,joints%20stay%20 comfortable%20at%20work.> [Accessed 29 July 2022].
5. Morris, N., 2022. 5 Common Questions About Yin Yoga. [online] Yoga International. Available at: <https://yogainternational.com/article/view/questions-about-yin-yoga> [Accessed 29 July 2022].
6. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211
7. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 211
8. Tisserand, R. and Balacs, T., 2000. Essential oil safety. London: Churchill Livingstone, pp.129-130.
9. Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997, pp 8.
10. Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997, pp 8.
11. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 121
12. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 121
13. Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007: 100
14. Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997, pp 49.
15. nhs.uk. 2022. Fibromyalgia. [online] Available at: <https://www.nhs.uk/conditions/fibromyalgia/> [Accessed 29 July 2022].
16. Li, Y., Wang, F., Feng, C., Yang, X. and Sun, Y., 2014. Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS ONE, [online] 9(2), p.e89304. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/> [Accessed 29 July 2022].
17. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 15.
18. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 64.
19. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 80.
20. Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005, pp 57.
21. Cleveland Clinic. 2022. Epsom Salt: Potential Benefits and How to Use It. [online] Available at: <https://health.clevelandclinic.org/7-things-you-probably-didnt-know-about-epsom-salt/#:~:text=Epsom%20salt%20is%20used%20to,recovery%20period%20after%20a%20workout.> [Accessed 29 July 2022].

Bibliography

• Caddy, R. Essential oils in colour (2nd ed.). Amberwood Publishing. 1997
• Cleveland Clinic. 2022. Epsom Salt: Potential Benefits and How to Use It. [online] Available at: <https://health.clevelandclinic.org/7-things-you-probably-didnt-know-about-epsom-salt/#:~:text=Epsom%20salt%20is%20used%20to,recovery%20period%20after%20a%20workout.> [Accessed 29 July 2022].
• Li, Y., Wang, F., Feng, C., Yang, X. and Sun, Y., 2014. Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS ONE, [online] 9(2), p.e89304. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/> [Accessed 29 July 2022].
• Martin, I. Aromatherapy For Massage Practitioners. 1st ed. Baltimore: Lippincott Williams & Wilkins; 2007
• Mojay, G. Aromatherapy for healing the spirit. London: Gaia. 2005
• Morris, N., 2022. 5 Common Questions About Yin Yoga. [online] Yoga International. Available at: <https://yogainternational.com/article/view/questions-about-yin-yoga> [Accessed 29 July 2022].
• Mulcahey, MD, FAAOS, M., 2020. Sprains, Strains and Other Soft-Tissue Injuries – OrthoInfo – AAOS. [online] Orthoinfo.aaos.org. Available at: <https://orthoinfo.aaos.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/> [Accessed 29 July 2022].
• nhs.uk. 2019. Common posture mistakes and fixes. [online] Available at: <https://www.nhs.uk/live-well/exercise/strength-and-flexibility-exercises/common-posture-mistakes-and-fixes/> [Accessed 29 July 2022].
• Pruthi, M.D., S., 2021. Office ergonomics: Your how-to guide. [online] Mayo Clinic. Available at: <https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-ergonomics/art-20046169#:~:text=If%20you%20sit%20behind%20a,joints%20stay%20comfortable%20at%20work.> [Accessed 29 July 2022].
• Tisserand, R. and Balacs, T., 2000. Essential oil safety. London: Churchill Livingstone
• https://www.herbalreality.com/conditions/musculoskeletal-system/

First up is a true medicinal powerhouse, calendula (Calendula officinalis). Calendula is by far one of the easiest herbs to grow, it displays beautiful orange blooms all summer long and the insects go absolutely bonkers for it. For these reasons, calendula will always take centre stage in my herb garden.

The vibrant tangerine flowers are jammed packed with antioxidant, anti-inflammatory, antiviral and anti-fungal compounds. Traditionally calendula flowers abundant in resin are infused with olive oil as a base for a skin soothing which is why calendula is so popular in many cosmetics products today.

When infused into oil, it becomes what herbalist call liquid gold that will make your skin glow. A simple way to prepare calendula is to make a tea from the dried flower heads. Calendula tea is said promotes the health of the skin, respiratory, lymphatic and digestive systems.

Gardeners will already know calendula to be a great source of pollen which makes for a very useful companion flower that will attract beneficial insects who assist with pollination and the control of pests. It’s pretty much a magnet for attracting biodiversity to the garden and comes in a whole host of colours. One of my favourite variates is the ‘Art Shades’ mix a popular strain with large blooms in unusual shades including tangerine, peach and apricot, it sounds more like a fruit salad than a flower bloom.

Growing tips

Sow Calendula undercover 2 weeks before the last frost and plant out once all risk from frost has gone. I like to cover young seedlings with horticultural fleece or netting during the plants early stage to prevent attack from slugs and birds. A quick tip to keep the plant in continuous bloom, remove the spent flower heads sometimes called deadheading remembering to keep them aside to dry and store for future use in teas and ointments.

Second on my list of flowers with holistic powers is Cornflower (Centaurea Cyanus). A lightly fragrant annual flower that produces brilliant colourful displays of white, blue, pink, red and purple. These old fashioned wild flowers are super easy to grow, they’re not fussy on soil type and are super drought resistant.

One of my favourite things about cornflowers is they grow nice and tall. Some varieties can even reach heights of 2.5ft plus. The long, narrow hairy stems with fringed flowers make cornflower an excellent choice for freshly cut flowers bouquets.

The most popular and famous of the Centaurea Cyanus is the vivid sapphire blue variety. This year I’ve interplanted blue cornflower with a striking orange Indian Prince calendula. The contrast of blue and orange looks visually stunning along my border of the garden and the bees and butterflies can’t keep away.

Cornflowers have a long history of being used in the medical and cosmetic industries. It’s primarily the dried flowerhead that have been used medicinally for its anti-inflammatory properties. I personally use the dried petals to brew herbal tea as I’m a big fan of its lightly floral flavour with a hint of spice.

Cornflower tea is thought to aid in soothing stomach ulcers, while using the tea as rinse or wash is used to speed the healing of bleeding gums. Cornflower tea can also be good for improving digestion as the herbs high antioxidant content aids in detoxing the liver.

Growing tips

Cornflower can be sown directly on the surface of freshly raked compost or soil. Scattering seeds on the surface mixed with other seeds like poppies, borage and chamomile is a great way to create a mini wildflower meadow. Taller varieties of cornflower can benefit from being stacked with a bamboo support to help them from toppling over.

Next up is a vigours vine like bushy plant that grow low to the ground. The leaves are a round and sometimes almost heart-like shaped, the flowers come in bright shades of oranges, apricots, yellows and creams with long spurs protruding out from behind them. It’s one of our favourites- nasturtium.

Beauty aside, one of the main reasons why I love to grow nasturtium is I’ve found it to be one of the most effect cabbage white caterpillar trap I’ve come across. Veggie growers will know that if you don’t cover your brassicas you’ll be spending all summer picking cabbage white caterpillar of your kales, broccolis and cabbages.

So how do nasturtiums help? Well… the peppery leaves of nasturtium are a delicacy for cabbage white caterpillars, growing them in or next to your brassica’s is a great form of natural pest control. The humble cabbage white get’s a lot of flack and growing some decoy plants is the perfect way to give them a safe place to breed.

It’s worth noting that I advise growing dwarf compact varieties of nasturtiums in the veg patch as the trailing varieties will have vigorous growth and can literally swallow a whole veg bed in just a few weeks.

In the kitchen nasturtium blossoms are great for bringing bursts of colour to the plate. The flowers contain as much vitamin C as parsley, and more lutein than tomatoes which is great for eye health. Even if all you do is toss them into a salad, nasturtium blossoms are good for you. I like to collect the newly open flowers early in the morning so they’re extra sweet and full of nectar.

For me, what makes nasturtium the complete plant for the garden is it has strong antiseptic properties found in its leaves that can be used on wounds to help fight infections. The seeds which are the size of large peas can be ground into pastes to fight fungal infections in toenails. It doesn’t stop there, when you chew nasturtium leaves pungent vapours are released which are said to help ease the effects of bronchitis and other infections in the lungs.

Growing tips

Nasturtium sometimes doesn’t respond well to being repotted so it’s a good idea to direct sow seeds in their final planting position. Dib a hole slightly bigger than the seed and around 5cm deep. I like to sow two seeds per hole for an extra bushy and abundant bloom.

Coming in at number 4 is Nepeta Grandiflora, also known as catnip (also known as cat mint), yes that’s the stuff your fluffy kitty goes silly for! Despite being famous for its effects on felines, cats aren’t the only ones who can enjoy catmint. The leaves and flowers can be steeped to make a soothing herbal tea with a cool minty taste and a sweet floral fragrance. Some people enjoy eating young cat mints leaves.

I think they have a delicate fresh minty flavour, making them a great aromatic salad topper. Older leaves can be used as a potherb in cooked dishes. Catmint tea is said to relieve tension and improve sleep quality. Much like many herbal teas, cat mint can aid digestive problems such as upset stomach and nausea. It is also particularly useful for treating fevers.  

One of the many benefits of growing Nepeta is that it has a long flowering season and its aromatic leaves and flowers are loved by bees and other pollinators. It’s an easy to grow perennial which will come up and flower reliably every year. Nepeta is notorious for sprawling, especially as the summer goes on it can almost develop a bald spot in the middle. A good way to avoid this is give the old Chelsea chop.

A pruning method which allows you to limit the size of plants and control the flowering season of many herbaceous plants. It gets its name The Chelsea Chop because it is usually carried out at the end of May, coinciding with the RHS Chelsea Flower Show.  The Chelsea chop has several functions. Firstly it makes the plant compact, while delaying flowering.  It is useful to use on plants that love to sprawl such as Nepeta. 

Growing tips

A plant best grown from cutting so you’re better off buying pot plants at any time of the year, although spring and autumn are ideal times to plant in the garden. Once growth dies back in autumn, cut back to the ground before spring.

The fifth and final flower with holistic powers that I will be writing about today (and I must say I personally feel we have saved the best ’til last!) is none other than the humble marigold or tagetes erecta.

Mexican marigolds are my favourite flower to grow in the veg garden for so many reasons, but please note that tagetes erecta and calendula officinalis are two different species that both share the common name marigold so be sure to check the Latin name before you buy any seeds.

Dwarf marigolds are my go-to companion flower, particularly for lettuce and tomatoes. Marigold roots release pheromones which deter cutworm, interplanting marigolds with lettuce is a great way to deter those pesky pests from nibbling away at the base of your lettuce plants. Alongside tomatoes marigolds act as a double-edged sword. Deterring pests like aphids and black fly with their strong odour they emit from their leaves and flowers.

They also attract beneficial insects who can assist with pollination of your tomato crop and control pests. Ants farming aphids on your tomatoes can be a real pain, lucky enough marigolds are great for attracting lady bugs and guess what a ladybugs favourite meal is? That’s right aphids.

Now the reason why I love the dwarf varieties so much is they can easily be planted on the corners of your beds without losing too much cropping space. Dwarf varieties also fit perfectly under cucumbers and tomatoes growing up string or canes.

Pest control aside, marigolds are incredibly useful in the medicine cabinet. Marigold flowers support skin healing, their petals contain natural antiseptic, anti-inflammatory and hydrating properties. The flowers are generally used in herbal medicine, fresh or dried. The flowers are often used to prepare ointments, oils and gels. Its relaxing and soothing qualities help promote wound healing for sunburns, scratches, eczema and dermatitis. 

Growing tips

Growing from seed is super easy. Sow 2 weeks before the last frost date and plant out after the risk of frost has completely gone. When the plant reaches 4 branches high pinch out the stem to encourage the plant to become more compact and bushy, resulting in more blooms.

• Short on space? Try growing these flowers in baskets, pots or containers, you’ll be surprised at how well the grow with limited space.
• Try growing in raised beds to ease the burden of bending down, alternatively a foam kneeling mat is a great way to make long periods kneeling more comfortable.
• There are lots of lightweight tool options available from plastic wheelbarrows to spades and watering cans.
• Wild flower meadows like the cornflower mentioned are not only beautiful, but they require less maintenance and bring the benefits of nesting habitat for wildlife for ladybirds to butterflies, hedgehogs and birds.

Happy growing!

The health of the body and the presence or absence of inflammation is dependent on the health and proper functioning of all systems and organs. Just because a knee joint is swollen and sore doesn’t mean that the knee joint can be treated alone. Any malfunctioning body systems or organs will also need to be treated and returned to health to treat the knee. This is always more obvious when there is inflammation throughout the body, such as in fibromyalgia or rheumatoid arthritis, but it applies to almost all chronic inflammatory processes.

The immune system is the key to inflammation, but it doesn’t work alone; it requires all body systems to play their role well in a complex interconnecting dance that will maintain a harmony of health when it functions as it should. A strong immune system will maintain a healthy body.

The gut plays a vital part in immune system homeostasis, as most immune cells are in the gut. If the gut is not healthy, the immune system won’t be healthy, and there will be chronic inflammation to one extent or another. This is something that the older traditional medicine systems knew, and those who practise herbal medicine today also know. The health of the body begins in the gut (1).

In most cases of chronic inflammation, the initial problem begins in the gut, generally with the diet. Either too many inflammatory foods such as sugar, trans fats or refined grains are present, or foods are eaten to which there is an intolerance, most commonly dairy or wheat.

The immune system can be seen as the housekeeping system of the body. It protects us from pathogenic organisms and removes or isolates dead or malignant body cells and foreign bodies.

Innate or non-specific immunity is the immunity we were born with and refers to the general protective function of the immune system. It includes the barrier functions of the skin and internal mucous membranes in the mouth, digestive system, lungs and urinary system. It also includes tears in the eye and ear wax.

Macrophages are also part of the innate immune system, and they can eat or phagocytose foreign particles to render them harmless. Fever is an innate immune response that creates a hostile environment for an invading microorganism and stimulates the immune response.

Adaptive or specific immunity develops over time in response to exposure to various antigens. It involves lymphocytes B cells and T cells – which produce specific antibodies against the invader (B lymphocytes) and has various cytotoxic mechanisms (T lymphocytes) to clear up dead or compromised tissue cells. These cells also have an ability to remember earlier invasions which means that future attacks are more efficiently dealt with.

A healthy immune system will recognise which cells it needs to attack and recognise healthy self-tissue. But if it is under too much pressure, for example, chronic inflammation, this is when the immune system can turn on the host body, attacking self cells and creating autoimmune disease.

Removal of dysfunctional, dead and dying tissue cells is also part of autophagy (literally, self-eating). This process can be seen as a spring clean of the body and may be important in protection from cancer (2)  and also involves both specific and non-specific immunity and can be made more efficient by exercise and fasting with the overall effect of cell regeneration and recycling cellular nutrients (3).

The process of autophagy has been shown to be optimised by a diet low in refined starch and sugar and high in omega-3 fatty acids (4,5).

Herbs and nutrition directly affect the immune system, but all body systems are vital here, so any attempt to improve the health of the immune system must also look at the whole. Emotional health also affects the immune system, hence the field of psychoneuroimmunology. Stress or social isolation will weaken immune function, whereas a relaxed nervous system creates a strong immune system. This connection has been demonstrated many times in studies (6,7,8).

Lack of sleep is strongly linked with a weak immune system and a much-increased risk of cancer. A study involving sleep restriction in healthy young men where sleep was only allowed between ten in the evening and three in the morning resulted in a seventy per cent reduction of natural killer cells plus reduced cellular immune response – both vital in a normal immune system which amongst other things also protects us from cancer.

After one night of recovery sleep, only part of the immune system returned to normal – the conclusion was that even a modest disturbance of sleep reduces the natural immune response (9).

A good and varied diet is important for a healthy immune system. Particularly important vitamins and minerals include vitamins D and C and zinc and selenium. Good sources of vitamin C include most fresh fruit and vegetables; vitamin D is best obtained from sunlight exposure or a supplement. Food sources of vitamin D include oily fish, mushrooms and eggs. Zinc is found in red meat, shellfish, legumes, nuts and seeds. Selenium is found in brazil nuts, fish, poultry and sunflower seeds.

The gut microbiome needs to be healthy for a strong immune system, so fermented foods such as sauerkraut or kefir are helpful. These must be unpasteurized so that the beneficial bacteria are still present.

Short term fasting will have a stimulant effect on the immune system, just as will raising the body’s temperature in a sauna or steam room. This type of stimulation is useful when an immediate effect is needed for an acute situation.

Herbs that affect the immune system can be subdivided into immune modulators or tonics – these are slower acting and can be used long term to improve immune function in those with chronic infection, autoimmune disease or lowered immunity; and herbal antimicrobials that practically attack and kill invading microorganisms.

Immune modulating herbs include echinacea (Echinacea purpurea and E. angustifolia), astragalus (Astragalus membranaceus), marigold (Calendula officinalis), wild indigo (Baptisia tinctoria), Siberian ginseng (Eleutherococcus senticosus), ginseng (Panax ginseng), ashwagandha (Withania somnifera), and all the medicinal fungi including (Trametes versicolour) and reishi (Ganoderma lucidum). Many immune-modulating herbs are also adaptogens, so they will support the endocrine and nervous systems, supporting immunity.

A herb that strengthens connective tissue, hence reinforcing the immune system’s barrier function, is horsetail (Equisetum arvense); this plant contains very high amounts of silicic acid or silica, which is water-soluble and required by all connective tissue (10).

Lymphatic herbs may also have a role to play in promoting autophagy. These might include cleavers (Galium aparine), heartsease (Viola tricolour), and figwort (Scrophularia nodosa).

Herbal antimicrobials include garlic (Allium sativum), thyme (Thymus spp), oregano (Origanum majorana), sage (Salvia officinalis) and walnut (Juglans nigra).

The digestive tract’s general health depends on the health of the gut, its microbiome, and the liver. Any treatment of inflammation anywhere in the body requires that the gut and the liver are healthy and functioning well.

There is a three-way interaction between the microbiome present in the digestive system, bile acids produced by the liver, and the immune system, which results in an inflammatory response, healthy or otherwise.

Bile acids are the main component of bile, produced by the liver and secreted into the small intestine via the gallbladder, where its main function is to digest fats and oils from the diet. However, they also have an important role in the inflammatory process.

After bile acids have processed fats, they travel down the digestive tract, where they are modified into immune regulating molecules by gut bacteria. One type of immune regulating molecule will activate effector helper T cells (Th17) which are pro-inflammatory. For example, when an infection needs dealing with, another type activates regulatory T cells (Tregs) that are anti-inflammatory and necessary when the infecting pathogen has been killed. These should balance each other out to maintain good intestinal health.

Low levels of Tregs have been seen in those with inflammatory bowel disease and are linked with low bile acids (11).

Cholestasis is where there is a decrease in bile flow and is associated with impaired immunity and ability to fight infection and increased inflammation. (12)

Improving the liver’s health will improve bile acid function, and most people will benefit from improving liver health.

Remove anything causing harm to the liver, such as alcohol or toxic chemicals. Medication may also be causing a problem, and if it cannot be removed, then work with diet to ameliorate the problem as much as possible.

Diet should be organically grown foods as much as possible in order to ensure minimal chemical residues. The Pesticide Action Network UK’s website an idea of how many pesticides and herbicides are used on many types of fruit and vegetables; therefore, it is possible to decide which foods should be bought as organic.

Some foods are good at supporting the liver; these include lemon and lime; bitter salad leaves such as dandelion, chicory and endive; dark green leafy vegetables, particularly the brassica family; olive oil and olives. Coffee is also a useful liver herb, if not overindulged.

The hepatic herbs for the liver need to be chosen carefully to support whatever is going on. If someone has an overactive, hot liver and is given liver stimulant herbs, they will become hot, flushed and emotional.

These people need calming and cooling liver tonics such as agrimony (Agrimonia eupatoria), burdock (Arctium lappa), chamomile (Matricaria chamomilla), dandelion (Taraxacum officinale), vervain (Verbena officinalis) or yarrow (Achillea millefolium). And those with a cold, stagnant liver need the more stimulating liver herbs such as angelica (Angelica archangelica), artichoke (Cynara scolymus), barberry (Berberis vulgaris), marigold (Calendula officinalis), milk thistle (Silybum marianum), or yellow dock (Rumex crispus).

The gut wall lining from mouth to anus is made up of many layers. The inner layer is the mucosa, in which there are mucous secreting cells and epithelial cells. This lining is permeable but very selectively, allowing only a few small molecules to pass through once digested and made safe to enter the bloodstream. The body secretes a protein called zonulin which increases intestinal permeability because sometimes this is required, but this is a controlled and immediately reversible permeability. But zonulin is also secreted when there is inflammation in the gut from food sensitivities, diet, infections, etc.

When this wall is subjected to prolonged inflammatory damage, the tight junctions between cells can widen, allowing larger molecules to pass through, creating more inflammation due to the activation of the immune system and more food sensitivities. So food sensitivities are a cause of, and a result of, increased intestinal permeability.

The increased intestinal permeability is termed leaky gut and is a major player in chronic inflammation and may also be a key process in the development of autoimmune diseases (13).

When the gut lining becomes less efficient and the digestive secretions of the stomach decrease due to poor health or ageing, the ability of the digestive tract to digest food and obtain nutrients will decrease. In this case, symptoms such as bloating, reflux, gas and feelings of fullness will appear, and food intolerances start to increase. These symptoms may also be due to eating the wrong foods. Still, they often indicate that digestive capability has been compromised, which, in turn, will impact the microbiome, the liver, and nutrient availability for the immune system. All of these have an impact on overall inflammation in the body.

Bacterial endotoxin is a lipopolysaccharide LPS found in the cell walls of gram-negative bacteria, which are found in large numbers in the gut, the gums, and other tissue when there is bacterial infection or dysbiosis. When they remain in the intestines, they don’t cause a problem, but when the bacteria die off and there is a degree of gut leakiness, then the released LPS can move through the intestinal wall and into the bloodstream, where they will initiate inflammation. Evidence shows that this process is important in the development of inflammation linked with obesity and diabetes and may be a major cause overall of chronic inflammation (14) and of brain microglial activation, which promotes neurodegeneration of the brain (15).

A diet high in trans fats or constant snacking can also cause a dysbiosis that increases LPS production (16), and a diet high in fructose causes LPS-induced inflammation (17).17 It has been shown that celery (Apium graveolens) contains aglycones which show potent inhibitory activity against LPS-induced nitric oxide production in macrophages.

Cardamom significantly decreases the secretion of inflammatory mediators secreted by lipopolysaccharide-stimulated macrophages.

Leaky gut and digestive ability are closely linked; once the correct diet for the individual has been found, the rest will follow. Healing a leaky gut must commence with a good diet with no inflammatory foods.

Removing processed foods and replacing them with healthy food can turn around an inflamed digestive system within a couple of months. Bone broths, when long-cooked, release collagen peptides that support the repair of the intestinal wall. Gum acacia is another supplement that appears to be able to heal damaged tissue, possibly by supporting that part of the microbiome that improves tight junctions in the intestinal lining (20). Herbs can help repair the gut wall, and those containing mucilaginous polysaccharides such as Aloe vera (Aloe barbadensis), marshmallow root (Althaea officinalis), and slippery elm (Ulmus fulva), and also many seaweeds are often used to improve mucosal health.

These herbs are easiest to take as powders in tablespoonful doses and can be mixed with stewed apples (peel and all), which contain large amounts of pectin, which is also a good gut healer.

Marigold (Calendula officinalis) and plantain (Plantago spp.) are both inflammation-mediating herbs excellent at wound healing. Simmering the dried or fresh herbs for 20–30 minutes makes a strong decoction. Ideally, this would be drunk on an empty stomach after at least a 12 hour fast. Make it the night before and drink the next morning. A dose of a handful of the dried herb in about 250ml of water daily would be fine.

Improving digestive function requires the involvement of bitter herbs and aromatic digestive herbs. These should be chosen to suit the person, making distinctions between warming and cooling bitters (see liver herbs above).

Most culinary herbs and spices such as black pepper, mustard, ginger, coriander and cumin will help digestion and can be taken before eating, with food or afterwards if needed.

If these are not enough, bitter herbs can be used, ideally before a meal but also useful afterwards. I have a formula for a digestive bitters tonic, which has been the most popular formula I have ever made, and hundreds of people have found it useful. The mix contains warming and cooling bitter herbs and aromatic herbs, which together really help digestion:

• 3 parts artichoke (Cynara scolymus)
• 2 parts (Angelica archangelica)
• 2 parts blessed thistle (Carbenia benedicta)
• 1 part fennel seed (Foeniculum vulgare)
• 1 part gentian (Gentiana lutea)
• 1 part bitter orange peel (Citrus aurantium fr.)
• 1 part ginger (Zingiber officinale)
• 1 part centaury (Centaurium erythraea)

Take anything from twenty drops to a teaspoonful of tincture in a bit of water as needed.

The combination works best as a tincture as it becomes quite unpleasant as tea. As a tincture, it is pleasant to take if a little bitter to those who are not used to bitter tastes. Everyone gets used to it after a few days.

The human body is an ecosystem, part of which includes a vast number of different microbial organisms which play a vital role in the proper function of our bodies. The role of the gut microbiome is well recognised in the inflammatory process, and the inflammatory process has been shown to have deleterious effects on the microbiome (21).

It has also been well recognised that pre-industrial peoples have a similar microbiome wherever they live in the world. Those living in industrialised areas have a very different, less healthy microbiome due to three main reasons: the presence of antibiotics, a diet of processed food, and a much more sanitised environment.

However, there is no such thing as a “normal” microbiome; it is always individual, so testing to determine a microbiome to see if it is “healthy” is not that useful. A microbiome will contain not only bacteria but also viruses, fungi and parasites, and its makeup will be affected by everything from conception onwards. It is considered that the most influence comes from the first one thousand days of life, including time in utero. However, it can be improved and repaired at all stages of life.

One hundred years ago, the killer diseases worldwide were pneumonia, tuberculosis and infectious gut diseases. Nowadays, these have been supplanted in the richer, western world by the killer inflammatory diseases – cardiovascular disease, cancer and diabetes. So as a population, we have learned how to manage bacteria but overmanaged them so that we killed all micro-organisms, beneficial and pathogenic, without the understanding that we actually needed the beneficial ones

For example, a study has shown that the presence of a bacterium Blautia obeum in the gut can protect against cholera by a number of different mechanisms, including its interaction with bile salts. The study found that B. obeum was prevalent in the microbiome of people studied in Bangladesh. Those from Bangladesh had a much more diverse microbiome than a similar number of people from the USA (22).

The functions of these beneficial microbiotas are numerous and very important to our health. Our understanding of the functions and health of the microbiota has only really developed in recent years, and more and more connections have been drawn between this new industrial microbiota and chronic inflammatory diseases. We still don’t know the full story yet, but it is developing (23).

There is evidence that dysbiosis weakens the immune defences “thereby predisposing to more severe SARSCoV-2 infection and contributing to ‘long COVID.’” (24).

The factor with the most effect on the microbiome is diet, and we need a good variety of foods to feed a large variety of microorganisms. The average modern western diet contains a tiny variety of different plant foods, in some cases less than ten. In contrast, the diet of older generations may well have contained at least one hundred different plant foods.

It is now understood that if we eat at least thirty different plant foods in a week, we will have a much healthier microbiome than if we only ate ten different ones. It’s actually not that difficult to eat such a variety, as plant foods include all grains, nuts, seeds, fruit and vegetables.

One important change in diet from the less developed to the developed world was the reduction of both soluble and insoluble plant fibre based complex carbohydrates found in plants such as legumes, whole grains and vegetables. These were replaced by simple carbohydrates, the refined and processed grains and sugar that make up the modern diet, which is much less useful to the microbiome and shown to have altered its structure and function, resulting in dysbiosis (defined as unnatural changes in the composition of the microbiome) and leading to chronic inflammatory disease.

Stress can also have a significant impact on the microbiome this can be physical or mental stress and can include overworking, sleep deprivation, pollution, local climate change and lack of exercise. Social interaction and physical activity also have an impact on gut and body health (25).

There are several ways to improve the microbiome, but it is most important first to improve the gut’s health, i.e. improve the terrain. If there is a leaky gut, then this needs dealing with first.

The bacteria in the gut microbiome need prebiotics to feed on for their health. The breakdown products of this digestion are short-chain fatty acids released into the blood circulation, which have beneficial effects on the whole body (26).

They are a particular kind of dietary fibre that the gut microbiota selectively uses and are vital to the microbiome’s health. Good prebiotic fibre containing foods include Jerusalem artichokes, apples, bananas, asparagus, leeks, onions, oats, barley, and linseeds. Acacia gum and slippery elm (Ulmus fulva) are also excellent prebiotic sources.

Probiotics, the bacteria that can support the microbiome and be ingested in capsules or drinks, are useful but are only temporary residents of the gut and only serve a purpose while they are being taken. In order to encourage the microbiome to flourish, the terrain needs to be right, so prebiotics, a healthy diet and a healthy gut wall are most important.

Garlic (Allium sativum) is useful as it is a prebiotic and antimicrobial to pathogenic microorganisms. Fermented foods and drinks such as sauerkraut, kimchi, kombucha and kefir are most useful here too, and as they are food and drink can be taken daily at a much lower cost than probiotic supplements. However, if these are purchased rather than homemade, it is important that they are unpasteurized so that the beneficial bacteria are still present. Eating avocados also seems to support healthy gut flora.

The nervous system comprises two main parts, the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which includes nerves branching off from the spinal cord and extending to all parts of the body.

These nerves carry messages or information in their nerve cells or neurons between the brain and the body, which control every action.

There is a strong bi-directional connection between the brain and the gut via the cranial and the vagus nerves and the entire peripheral nervous system. So anything that affects the gut will affect the brain and vice versa. When there is an inflammatory state in the gut, it will affect the brain – this is apparent in patients with inflammatory bowel diseases such as coeliac disease, where there is also a high incidence of brain inflammation visible on an MRI scan (27).

Or, if the gut is on fire, then the brain will also be on fire.

The action of the vagus nerve is very linked with inflammatory states in the body. The vagus nerve, so-called because it wanders through the body like a vagabond – originates in the brain, travels down the neck, through the chest, to the abdomen creating an interconnected network between the brain, digestive system, lungs, heart, liver and kidneys.

Its principal function is to send messages to the brain from the organs, so the brain is aware of how they are functioning. The vagus is also able to assess immune function too.

The vagus nerve controls the parasympathetic nervous system – so it is vital in winding down from any sympathetic nervous system activity. The sympathetic nervous system is activated by increased cortisol in the fight or flight response created by a stressful situation.

Keeping this balance between parasympathetic and sympathetic is vital for health. It was a matter of life or death to have that sympathetic response when we were out hunting or being hunted back in the stone age. Still, those who don’t deal well with stress and anxiety find themselves in the sympathetic mode more or less constantly and unable to revert to relax mode, which is parasympathetic dominance.

The sympathetic response releases hormones such as adrenalin and cortisol, resulting in a raised heart rate, tense muscles (ready to run), sweating, slowed digestion and a feeling of increased energy due to gluconeogenesis (the generation of new glucose by the liver). It also releases the hormone renin from the kidneys, increasing blood pressure and metabolism.

Understanding the stress response is simple if we consider the domestic cat – they are masters of relaxation (parasympathetic dominance). Still, when necessary, they can spring into fast action to hunt or to run from a dog (sympathetic dominance) and then straight back to sleep again afterwards as though nothing had happened.

Generally, the parasympathetic response is anti-inflammatory, and the sympathetic response is pro-inflammatory, especially if out of control. So chronic stress is a major cause of inflammation.

Stress results in the release of inflammatory cytokines through the effect on sympathetic and parasympathetic nervous system pathways. These cytokines have been found to interact with neurotransmitter metabolism and neuroendocrine function. Poor sleep results in lowered vagal tone, increased inflammation, and inflammation results in poor sleep.

Pro-inflammatory cytokines IL-6 and TNF alpha daytime secretion are increased in insomniacs which causes more inflammation and contributes to the chronic inflammatory diseases so common today – type two diabetes, cancer, osteoarthritis and cardiovascular disease.

Improving vagal tone will help the body to relax better after any stress. There are several methods of improving the tone, and the results will reduce inflammation. These need doing long term and daily for several weeks to get results:

• Cold exposure will activate the vagus nerve, and regular cold exposure can lower the sympathetic response and increase parasympathetic activity via the vagus nerve: cold showers, or at least cold face wash.
• Deep and slow breathing activates the vagus nerve, reduces anxiety and increases parasympathetic response. Aim at six breaths a minute as diaphragmatic breathing with the expansion of the stomach.
• Singing, humming, chanting, and gargling activate the throat muscles and stimulate the vagus nerve.
• Probiotics – healthy gut bacteria improve brain function by affecting the vagus nerve.
• Meditation – can increase vagal tone.
• Eye exercises – without moving the head facing forward, look to the right for one minute, then to the centre, then left for one minute, breathing slowly as you do it. This exercise can be done sitting or lying down (28).
• Omega-3 fatty acids – increase vagal tone and vagal activity. For example, oily fish, flaxseed oil, and walnuts.
• Exercise – stimulates the vagus nerve.
• Massage can stimulate the vagus nerve – also reflexology and the Bowen technique.
• Socialising and laughing stimulate the vagus – and stimulating the vagus often causes laughter.

Anything that causes inflammation in the gut will affect the brain, so in order to protect the brain and nervous system, it is vital to follow an anti-inflammatory diet. There are suggestions that non-coeliac gluten sensitivity may be of prime importance here, but all pro-inflammatory foods should be avoided (29).

Plastics, in particular the plasticisers bisphenol A BPA, and bisphenol S BPS, are also implicated in causing inflammatory damage to nerve cells, so avoiding all plastic wraps and bottles is a good move (30).

Herbs to improve nervous system health will be nervine tonics, nervine relaxants and adaptogens. Many of these double up as inflammation mediating herbs, and notable herbs which do this are chamomile (Matricaria recutita), lemon balm (Melissa officinalis), linden flower (Tilia europaea), St John’s wort (Hypericum perforatum), skullcap (Scutellaria lateriflora), ashwagandha (Withania somnifera), rose root (Rhodiola rosea) and schisandra (Schisandra chinensis).

Endothelial cell health is another important factor in the inflammatory process.

Endothelial cells form the lining of all blood and lymph vessels in the body. They are there to act as a barrier between blood and lymph and the rest of the body tissues. They are also selectively permeable to some chemicals to move into body tissues and permeable to carbon dioxide to move into the bloodstream from tissues. This permeability is a very important function that, among many other things, maintains the blood-brain barrier, which protects the brain from toxic chemicals.

Another main function of endothelial cells is maintaining the elasticity of blood vessels to allow them to constrict and dilate – vasoconstriction and vasodilation in order to control blood flow and blood pressure. Endothelial cells synthesise nitric oxide (NO), which acts as a vasodilator, and also catecholamines which act as vasoconstrictors.

Reduced NO production and/or bioavailability is considered the central mechanism responsible for endothelial dysfunction (31). NO also acts as an anticoagulant to prevent anything from sticking to the endothelial cell wall.

The endothelium also has a role to play in wound healing – controlling platelet aggregation and a clotting factor to prevent further bleeding, but also they are involved in fibrinolysis, which dissolves clots and prevents thrombosis.

If there is a chronic inflammatory process, then damage to the endothelium will result in a loss of elasticity, resulting in poor vasodilation, which results in hypertension; it also results in increased coagulation incidences as it tries to heal itself. This process results in thrombosis, heart and kidney disease, neurological disease and pulmonary disease. Insulin resistance and diabetes are inflammatory and will also damage the endothelium, hence the link between diabetes and cardiovascular disease. With age, diabetes, hypertension, smoking, and inactivity, endothelial cells lose function.

A recent study looking at mRNA COVID vaccines concluded that the mRNA vaccines dramatically increase inflammation on the endothelium and T cell infiltration of cardiac muscle and may account for the observations of increased thrombosis, cardiomyopathy, and other vascular events following vaccination (31).

• Avoid smoking, inactivity, obesity, sugar and refined carbohydrates.
• Eat more plants, especially whole grains, nuts and seeds, herb teas, green tea, cocoa, and dark chocolate, which all increase endothelial nitric oxide, one of the most helpful ways of supporting the endothelium.
• Spices improve endothelial function – turmeric, ginger, cinnamon and black pepper. Foods to improve microcirculation include chocolate, berries, garlic, beetroot and green tea.

Often the heroic methods of modern medicine – the surgery and medications – are required when heart disease becomes severe, but in the earlier stages, or when things are stabilised, there are plenty of herbal interventions that can help.

The main mechanisms of action of the most commonly used hypertension medications are calcium channel blockade, beta-adrenergic blockade and angiotensin-converting enzyme inhibition. Herbs have been shown to act by all of these mechanisms as well.

Herbs that will support endothelial function include ginkgo (Ginkgo biloba), hawthorn (Crataegus oxyacantha), red sage (Salvia miltiorrhiza), rose hips (Rosa canina), reishi (Ganoderma lucidum), ginger (Zingiber officinale). Gentian (Gentiana lutea) has been shown to prevent endothelial inflammation (32).

1. G.Vighi et al. “Allergy and the gastrointestinal system.” Clinical and experimental immunology vol. 153 Suppl
2. Suppl 1 (2008): 3-6. 2L.Galluzzi et al. “Autophagy in malignant transformation and cancer progression.” The EMBO journal vol. 34,7 (2015): 856-80.
3. P.Kuballa et al.Autophagy and the immune system. Annu Rev Immunol. 2012;30:611-46.
4. L.Shen et al. “Dietary PUFAs attenuate NLRP3 inflammasome activation via enhancing macrophage autophagy.” Journal of lipid research vol. 58,9 (2017): 1808-1821.
5. J. Bland The long haul of COVID-19 recovery: immune rejuvenation versus immune support. IHCAN April 21
6. Abdurachman,et al. “The role of psychological well-being in boosting immune response: an optimal effort for tackling infection.” African journal of infectious diseases vol. 12,1 Suppl 54-61. 7 Mar. 2018
7. Y. Barak The Immune system and happiness Autoimmunity reviews Vol 5, 8, Oct 2006 pp 523–527.
8. S. Brod et al ‘As above, so below’ examining the interplay between emotion and the immune system Immunology. June 2014.
9. M. Irwin et al. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J. 1996 Apr;10(5):643–53.
10. L.M. Jurkić, et al. Biological and therapeutic effects of ortho-silicic acid and some ortho-silicic acid-releasing compounds: New perspectives for therapy. Nutr Metab (Lond) 10, 2 (2013).
11. Harvard Medical School. “Bile acids may help regulate gut immunity and inflammation.” ScienceDaily. www.sciencedaily.com/ releases/2020/01/200103141047.htm accessed 3/12/20.
12. M.Wammers et al. “Reprogramming of proinflammatory human macrophages to an antiinflammatory phenotype by bile acids.” Scientific reports vol. 8,1 255. 10 Jan. 2018
13. Q.Mu et al. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017 May 23;8:598.
14. P.D.Cani, et al Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes. 2007 Jul;56(7):1761-72.
15. G.C. Brown The endotoxin hypothesis of neurodegeneration. J Neuroinflammation 16, 180 (2019).
16. C. Franceschi, et al. Inflammaging: a new immune–metabolic viewpoint for age-related diseases. Nat Rev Endocrinol 14, 576–590 (2018).
17. N.Jones et al. Fructose reprogrammes glutamine-dependent oxidative metabolism to support LPS-induced inflammation. Nat Commun 12, 1209 (2021).
18. L H Zhu et al, Constituents from Apium graveolens and their anti-inflammatory effects. J Asian Nat Prod Res. 2017 Nov;19(11):1079-1086.
19. M.Souissi et al. Antibacterial and anti-inflammatory activities of cardamom (Elettaria cardamomum) extracts: Potential therapeutic benefits for periodontal infections. Anaerobe. 2020 Feb;61:102089.
20. J.C.Clemente et al. The role of the gut microbiome in systemic inflammatory disease. BMJ 2018;360:j5145.
21. S.Alavi, et al. Interpersonal Gut Microbiome Variation Drives Susceptibility and Resistance to Cholera 22)
22. Infection. Cell. 2020. 22Vulnerability of the industrialised microbiota https://science.sciencemag.org/content/366/6464/eaaw9255/tab-pdf.
23. Gut Microbiota May Influence COVID-19 Severity, Immune Response – Medscape – Jan 11, 2021.
24. Stefani Lobionda, et al. “The Role of Gut Microbiota in Intestinal Inflammation with Respect to Diet and Extrinsic Stressors.” Microorganisms vol. 7,8 271. 19 Aug. 2019
25. Davani-Davari, Dorna et al. “Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications.” Foods (Basel, Switzerland) vol. 8,3 92. 9 Mar. 2019.
26. I.D. Croall et al. Cognitive Deficit and White Matter Changes in Persons With Celiac Disease: A Population-Based Study, Gastroenterology, Volume 158, Issue 8, 2020, Pages 2112-2122.
27. Rosenberg, Stanley (2017) Accessing the Healing Power of the Vagus Nerve.
28. Vasefi, Maryam et al. “Diet Associated with Inflammation and Alzheimer’s Disease.” Journal of Alzheimer’s disease reports vol. 3,1 299-309. 16 Nov. 2019
29. E. Schirmer,et al. Bisphenols exert detrimental effects on neuronal signaling in mature vertebrate brains. Commun Biol 4, 465 (2021).
30. Endothelium and cardiovascular diseases: vascular biology and clinical syndromes. Editors Protasio L. et al 2018.
31. Steven R Gundry, Correction to: Abstract 10712: Mrna COVID Vaccines Dramatically Increase Endothelial Inflammatory Markers and ACS Risk as Measured by the PULS Cardiac Test: a Warning, Circulation, 8 Nov 2021 2021;144:A10712
32. R.Kesavan et al.Gentiana lutea exerts antiatherosclerotic effects by preventing endothelial inflammation and smooth muscle cell migration. Nutr Metab Cardiovasc Dis. 2016 Apr;26(4):293-301.

By resonating with us at all speeds of vibration, from the spiritual to the material, plants have the potential to heal us on every level of our being. Yet this is not all; something about flowers is particularly special, as if they express the essential nature of all flowering plants and convey their messages to us in all their variation of purpose. They are vital to the plant’s survival and represent the peak of plants’ evolution.

The first organisms were single-celled bacteria living in the sea. Then came algae, which are believed to be the ancestors of all other plants, followed by fungi, mosses and lichens. Ferns, taller plants and then trees such as giant horsetails came next, followed about 200 million years ago by plants bearing seeds known as gymnosperms – of which the wonderful ginkgo tree is a living example, as are conifers.

Flowering plants, botanically known as angiosperms, evolved about 140 million years ago, the earliest of them probably resembling a magnolia tree. In botanical terms, a flower represents a reproductive structure made up of modified leaves which attract insects and a variety of other small creatures in order to ensure their cross-fertilisation and reproduction and hence their survival.

This was a far more sophisticated means of reproduction than had gone before. The cones of conifers have sperm cells packed tightly in pollen grains relying on the wind to blow them to the ovules of female cones. Spores of fungi and mosses are also vulnerable to the vagaries of the wind. More than 80 per cent of all green plants are flowering plants and every flower has the same purpose, to ensure that male pollen grains from the stamens of one flower come into contact with the stigma of a female pistil.

The intricacies of nature are amazing in their perfection. The stigma produces special secretions making sure that no pollen from other species than its own germinates, and once the right pollen has germinated, it extends a tube into the stigma down its style and makes contact with the ovary below, where two male pollen cells fertilise three female cells. An embryo is thereby produced with a food store wrapped up neatly in a seed capsule and primed to spark into life once it is in favourable conditions.

The beautiful colours and shades of flowers, their enormous variety of shape, size and pattern, as well as their wonderful perfumes, are all developed to attract specific pollinators – insects, birds, moths, beetles, even snails. The evolutionary links between the form, colour, nectar and scent of flowers and the sensory perceptions of their pollinators is truly fascinating.

One of the earliest pollinators was the beetle, which crawled into primitive flowers to eat pollen, distributing grains around the area and enabling self-pollination. More evolved species of flowers developed nectar-secreting glands to attract flying insects that would brush against the pollen and so carry it to other flowers.

Flowers with tubular shapes developed simultaneously with those insects and birds with a sucking proboscis or beak sufficiently long to reach the nectar. Some flowers, such as antirrhinums, will only open when the right size pollinator lands on its lower lip. In some flowers, patterns such as lines or spots on the petals, as seen in horse chestnut and eyebright, point the way to the nectar to a hungry insect. Scents wafting through the air will attract pollinating insects from huge distances, as will bright colours to those insects with good sight. Some flowers only emit their scents at night when their colour fades; many, including evening primrose, open only at night to attract night-flying moths.

It is clear that one of the vital roles of flowers is to ensure the continuation of their species and therefore their survival. Flowering plants make up 80 per cent of all plants on the planet, and we as human beings also depend on plants for our survival. Flowers are absolutely essential to all human life. Not only do flowers convey messages to their pollinators, but the early herbalists believed that flowering plants embodied messages regarding their healing virtues in their shape, colour, form and pattern.

The delicate drooping blooms of the purple Pasque flower certainly do intimate the sad drooping head of the nymph Anemone, forsaken by her lover, Zephyr the Greek god of the West wind. This points towards the flower’s famous healing powers for women feeling similarly forsaken and forlorn when taken as a homeopathic remedy.

By contrast, the bright blue, purple and yellow heart-shaped flowers of heartsease have a much more uplifting nature, with their ability to heal the heart and lift the spirits.

Heartsease has been used by healers for thousands of years as a love potion and to bring comfort to those feeling hurt, rejected, lonely or broken hearted as Shakespeare well knew,

Yet mark’d I where the bolt of Cupid fell: It fell upon a little western flower, Before, milk-white, now purple with love’s wound, And maidens call it love-in-idleness
– Midsummers Night’s Dream

The healing potential of flowering plants is an integral part of the deep bond that exists between humans and nature. That flowers have the ability to heal us, not only physically but also emotionally and spiritually, is something that has been recognised and utilised as far back as we know. Now in the 21st century with evidence of the healing role of flowers going back 60,000 years, we are still striving to understand the totality of their significance in our lives.

Flowers have been used in many different ways for healing, in a variety of herbal preparations, as essential oils, homeopathic remedies and flower essences. Each system of medicine claims a certain mode of action or vibrational level of healing for its own. One thing is clear to me from the flowers’ history of healing: the essence of the flower that permeates every remedy has the same healing potential that permeates the essence of our being.

The art of healing comes from nature and not from the physician.
Therefore, the physician must start from nature with an open mind
– Paracelsus (c. 1493–1541)

It is best to pick the flowers you are planning to use first thing in the morning on a fine dry day once the dew has dried, so they are as fresh as possible. Choose the healthiest looking plants, remove any soil and old leaves or flowerheads and check for insects. The sooner you make the flowers up into your preparations the better, so they don’t lose any of their vibrancy and medicinal effects.

There are many ways that you can take healing flowers to benefit from their remedial effect. The easiest way to do this is in food and drink by using edible flowers and culinary herbs and herbal teas, which many people may be doing without realising their medicinal benefits.

A man may esteem himself happy when that which is his food is also his medicine
– Henry David Thoreau (1817–1862)

Salads with basil, coriander, nasturtiums and chives, vinaigrettes with garlic, fish with dill or wild garlic, new potatoes with fresh mint, casseroles with thyme and pizza with oregano are all very familiar. Once your food is absorbed from the digestive tract, the nutrients and therapeutic constituents of the plants enter the bloodstream and then circulate around the body.

Your favourite culinary flowers and herbs all contain volatile oils that lend their wonderful flavours and scents. These oils have antioxidant and antimicrobial effects, helping to protect the body against stresses of all kinds and to ward off a wide variety of infections, which would have been vital for health as well as enhancing culinary skills in the days before fridges, when food may have been less than fresh.

Edible flowers don’t just heighten the visual impact and the flavour of our food, they can also contribute a wide range of nutrients and medicinal compounds. Almost all of them contain vitamins A and C and mineral such as calcium, phosphorous, iron and potassium.

They are also rich in antioxidants which give the flowers and leaves their colours. Pigments that make carnations red, chrysanthemums and calendula orange for example, are rich in antioxidant polyphenols including flavonoids which protect the body against oxidative stress and may help prevent chronic diseases such as heart disease and cancer.

Calendula flowers contain more flavonoids known as lutein and zeaxanthin (that help protect the eyes from age-related disorders) than cabbage, kale or spinach and nasturtiums are also rich in them. Violets are a good source of another bioflavonoid called rutin which protects the blood vessels from damage and reduces inflammation. Apparently, even though it is an ancient practice, there is a scientific name for people who eat flowers for food, it is called floriphagia!

Let your food be your medicine and your medicine be your food
– Hippocrates (c.460BC–c. 370BC)

Vitamins

• Vitamin A: Dandelion, squash flowers, basil, dill, peppermint, rosemary, sage, coriander, lavender, violets
• Vitamin B: Peppermint, sage, coriander, garlic, dandelion, sunflowers, feverfew, peppermint, hibiscus
• Vitamin C: Echinacea, borage, nasturtium, garlic, peppermint, rosehips, dandelion, dill, rocket, rosemary, basil, sage, coriander, oregano, roses, purslane, calendula, fennel, violets
• Vitamin D: Dandelion, rosehips, nasturtiums
• Vitamin E: Dandelion, skullcap, sage, rose, sunflowers
• Vitamin K: Basil, sage, coriander, dandelion

Minerals

• Calcium: Bergamot, chamomile, fennel, marshmallow, sage, dill, peppermint, rosemary, garlic, oregano, coriander, dandelion, lavender, borage, violets, hibiscus
• Iron: Peppermint, bergamot, nasturtium, begonia, French marigold, dianthus, rosemary, day lily, skullcap, peony, lavender, dill, sage, coriander, oregano, dandelion, echinacea, calendula, chamomile
• Magnesium: Rosemary, day lily, wood betony, basil, dill, peppermint, sage, oregano, coriander, dandelion, dianthus, sunflowers
• Manganese: Basil, dill, rosemary, peppermint, sage, chrysanthemum, coriander, garlic, oregano, dandelion
• Potassium: Dandelion leaf, peony, bergamot, day lily, dianthus, fennel, rosehips, dill, rosemary, peppermint, oregano, violets, wild pansy
• Zinc: Chamomile, day lily, skullcap, peony, bergamot, dandelion, marshmallow, rosemary, peppermint, sage, caraway, garlic, coriander leaf
• Chromium: Coriander, hibiscus, dandelion
• Copper: Skullcap, sage, day lily, fuchsia, bergamot, peony, dill, rosemary, peppermint, wild garlic, coriander, dandelion
• Selenium: Garlic, coriander, fennel, basil, chamomile, St John’s wort, oregano, sage, rosemary, lime flowers

You can also prepare a variety of different floral preparations including tinctures, elixirs, oxymels and honeys.

These floral preparations can be made with single plants and then when needed you can combine several together to address the health problem you are trying to resolve or you can make ready-made combinations all in the same preparation for treating common ailments such as colds and coughs, digestive troubles, stress and insomnia when they arise.

A good example of a popular and old fashioned cold and catarrh remedy is a combination of equal parts of peppermint, elderflowers and yarrow.

You can also make preparations to apply to the skin as it is very absorbent and covers a large surface area for absorption. Tiny blood capillaries under the surface of the skin take the medicinal compounds in the flowers into the bloodstream and from there they are circulated throughout the body.

Infusions of flowers can be used as hand and foot baths, infused or diluted essential oils can be massaged into the skin, tincture-based rubbing lotions can be applied to the skin as can ointments and creams, compresses and poultices. In addition, fresh flowers and leaves can be applied directly such as yarrow, marigold or lavender flowers to staunch bleeding from minor cuts and abrasions and relieve minor burns.

The conjunctiva of the eye will also absorb floral extracts. A calendula, elderflower or chamomile eyebath or compress can be used to relieve sore and inflamed eyes. The nose and the nerve endings lying in it can provide another therapeutic pathway which we use when we smell a flower or use oils for inhalations.

When we use a hot tea or a few drops of essential oil in hot water as an inhalation, the messages from the aromatic flowers are carried directly to the brain and are also taken into the lungs where they are absorbed with oxygen into the bloodstream and circulated throughout the body.

Physically

During menstruation the body is letting go of the un-fertilised egg and endometrial lining from the previous cycle. Whilst this is occurring, it is already starting to gear up for the next ovulation. The hypothalamus releases a hormone (GnRH) that tells the pituitary gland to release the follicle-stimulating hormone (FSH). 

This stimulates follicles (aka immature eggs) to start to mature in the ovary on one side of the womb (ovulation alternates sides each month). Those maturing eggs make oestrogen of their own and feed back to the hypothalamus to keep providing the support it is. 

During this phase you are losing blood, of varying quantities, and this can leave you feeling drained. So be mindful of this, take it slow and eat nourishing blood-building foods like raw cacao, red meat, red wine, dark leafy greens, molasses and apricots. Towards the end of this phase you might stop bleeding but it’s unlikely your cervical mucous will return till the next phase. Your waking body temperature will be relatively low during this phase. I used to find mine would drop on the morning my period came, I could actually use it as a heads-up that she was on her way that day. 

Emotionally

You may be feeling introspective, or hermit-like. If you can’t get this space and time to yourself, the outside world can get pretty tiring and annoying. Try to carve out as much me-time during your bleed as possible. Alternatively, you might be one of those people who, as soon as they bleed, feel relieved, and find their energy starts to build.

I was one of those people. If that’s you, still try to take it easy and slowly build yourself back up into out-going life. Try to rest just a touch longer, or spend the energy you have on yourself, rather than prioritising others. This is a good time for planning what you want to do in the coming month, and tuning into your emotions and intuition. 

Supportive herbs

This phase, if not supported correctly, can leave us in an energy deficit for the rest of the month. It’s a good idea to drink lots of nettle and raspberry leaf tea during this phase to build blood and tonify the womb. I actually put these two herbs in a drink I make called Aunt Flo. It’s a raw cacao drinking chocolate with those herbs combined within.

Physically

After a few days most of those follicles start to die off,  except the one that will go on to be the egg for that cycle. Once a peak surge of FSH is reached the pituitary gland releases luteinising hormone that triggers ovulation itself. You’ll notice your cervical mucous will start to change during this phase from non-existent to sticky or crumbly. Your waking temperature during this part of the cycle is relatively low. 

Emotionally

Your energy has built up since you bled and this is when you’ll start to want to go out and socialise again. It’s a good time to make plans, and communicate anything to your loved ones that you discovered during the menstrual or pre-menstrual phase. This is a time to plant seeds. It is also a highly creative time for many people, and this new burst of energy can be great if channelled well. However, for some they can be left feeling unfocused and ungrounded, so this is a good time for grounding and embodiment practises. 

Supportive herbs

It is a good idea to keep feeding and nourishing the body during this phase. It is a time of gentle blossoming of new ideas as energy rises. I think delicate flowers are beautiful during this phase such as rose bud tea. Helping us to open our hearts to the week ahead. 

Physically

The egg is released from the ovary and starts its journey down the fallopian tube. The body has the next 24-48 hours to fertilise that egg or pregnancy won’t occur that month. The egg leaves behind the capsule that it grew in; this is called the corpus luteum. The corpus luteum will release its own progesterone for the next few days in the hopes that pregnancy does occur.

This supports the endometrial lining for the next few days. You’ll find your cervical mucous is at its most abundant during this phase. Often it will get watery or even super elastic like egg white (which is called spinnbarkeit). Your temperature will suddenly rise by 0.2 degree centigrade and stay high like this till your next period. 

Emotionally

This is the peak of your energy for most people. It’s also when you’re feeling most sexy and sociable. Make the most of it by going out or booking in those important meetings. You will feel confident and be at your best for communication. Words will flow freely from your mouth. You’ll feel like you’ve had some of the luck potion, Felix Felicis, from Harry Potter! 

Supportive herbs

Usually people find ovulation to be the easiest part of the menstrual cycle. I personally find that the energy boost can make me a bit hyper. Taking ashwagandha helps me to just pace myself a bit better so I don’t accidentally over-work and burn myself out for the next phase. 

Physically

It takes a little while for the body to realise fertilisation hasn’t occurred, and as the corpurs luteum uses up its resources and disappears, progesterone takes a nosedive, initiating menstruation. During this phase you’ll find your energy dips, along with your immunity so tiredness and colds are more likely.

Your cervical mucous will go back to crumbly or sticky and perhaps you’ll have some dry days before the period begins again. But your waking body temperature remains high till then. 

Emotionally

It’s normal to feel easily irritated and moody during this time because your energy reaches a natural low point and balanced blood glucose levels are harder to maintain. Communication skills are at their lowest but your instincts are heightened. If there is a contradiction between your instincts and what you are able to do this causes friction and irritability, which you may not be very good at expressing in a considered way. It tends to all come tumbling out in moody, angry or tearful outbursts instead.

To be on the safe side, we usually pick a tiny, insignificant pet hate to lay into so we can express the feelings without actually making any real progress. It’s pretty impressive. I have found that if I’m able to actually have downtime to relax, lessen my workload and eat well, then my irritability and tearfulness just don’t occur.

I implore you to experiment with using this phase to transition into a time of self-reflection and solitude. It can also be a great time for more introverted work such as planning and taking stock of life – the perfect tasks for solitude, and the perfect preparation for the next phase of your menstrual cycle where you can tune into your intuition more. 

Supportive herbs

One herb that really encapsulates this phase of looking inwards and slowing down is passionflower (Passiflora incarnata). This herb helps you slip into that dream-like state that is just out of reach for so many people in the premenstrual phase. If you are able to let go of your responsibilities (even if it’s just for half a day) you’ll find there is a bliss-like state that you can grasp, passionflower will help you do this. 

By charting our cycles and knowing where we are in them at all times we can harness the strengths of every part of it. We can also avoid the bad sides too. A lot of our suffering with periods comes down to the indoctrination we’ve received in western culture that they’re a negative experience. But there is a wave of menstrual activists, such as myself, whose purpose is to turn that narrative up on its head. 

Viva la Menstrual Revolution!

After four years of having taken the contraceptive pill (microgynon 30 specifically) I was sick of the constant thrush/cystitis cycle I found myself in. I’d been getting informed and empowered about the amazing benefits of ovulation to mind and body and I wanted to experience it for myself.

When I was about 19 I was taught how to use the hormone-free fertility awareness method as a contraceptive by an NHS nurse. Little did I know how incredibly rare this service is!

Although my experience with the contraceptive pill was negative in the end, I had taken it for many years without issue before then.

While your contraceptive provider is there to help you, there is a chasm of difference between the side effects they think you need to know about and the ones that so often lead to people quitting their hormonal contraceptives. When I was researching the history of the contraceptive pill for my masters this became more obvious than ever (1).

The research papers which looked into the side effects of the contraceptive pill would list life-threatening illnesses such as blood clot risk. But the reasons why people would stop taking their contraceptives would range from hair loss to loss of libido. Hardly life-threatening, but incredibly important to the lives of those taking them.

As women and anyone with wombs get more informed and empowered about their bodies they’re less likely to put up with those life-changing side effects and are instead seeking out natural alternatives.

The most effective hormone-free contraceptive is the fertility awareness method. With an effectiveness rate of 99% when used correctly it works better than the most popular hormonal contraceptive with an effectiveness rate of 91%; the pill (2). 

The fertility awareness method works by teaching you how to read the signs of your body. If you keep track of two out of three things; your waking body temperature, cervical mucous and/or cervix position you will be able to tell when you’ve ovulated.

Because an egg only lasts up to 48hrs in the female reproductive system before dying you only have up to 48hrs where it can come into contact with sperm (3). However, because sperm lives for up to 10 days in fertile cervical mucous, if you’ve had sex in the 10 days beforehand, it’s possible you will get pregnant.

Having said that, this is a very conservative estimate, there is only a 5% chance sperm will survive more than 4.4 days and a 1% chance sperm will live more than 6.8 days in a fertile woman (4).

By knowing when you are producing the sort of cervical mucous which would keep sperm alive, versus the mucous which actually acts as a barrier to sperm you can know when to avoid and when to have sex. I learnt the method through an NHS registered FAM practitioner, but you can learn it through books and I teach it in my Periods 101 online course too. What’s nice about this method is that you can choose how cautious you wish to be.

When I was learning it, I continued to use a barrier method for six months and abstained during my fertile phase. Once I felt more comfortable then I dropped the barrier method during the non-fertile days with my long-term partner. At my most cautious I had three contraceptives in my defence system!

The first was FAM, the second was a condom, and the backup plan was the emergency contraceptive pill if a condom failed and I was near a fertile day. When the time came to try to conceive, I got pregnant on the very first month of trying (much to my husband’s surprise!). After over 10 years of using the method I don’t chart anymore, I just instinctively know when I’m ovulating.

Barrier methods vary in efficacy. A rate of 98% means that for every two out of 100 men having sex with a male condom will lead to pregnancy:

• Male condom is 98%
• Female condom is 95%
• Diaphragm and caps (when used in combination with a spermicide) have a 92–96% effectiveness (5)

The diaphragm and cap have really fallen out of popularity and aren’t completely side-effect free because the spermicides that make them so effective change the Ph of the vagina, can cause local irritation and can damage the epithelial cells too (6). If you want to use them, perhaps in combination with another method, you’ll need to request to have one fitted by your doctor/obgyn.

For me personally, there is another element to going hormone-free when it comes to contraceptives. When you become attuned to your body it becomes intolerant to artificial modification of your hormones. You notice how they change your mental state, your libido, your agility, your physical well-being and more.

I enjoy being on the natural rollercoaster of hormones now that I know how to work with them, rather than against them. My research into the history of the contraceptive pill looked at why people chose to use it in the first place.

The most common answer was to manage the regularity of their periods. Specifically that the irregular nature of their period was too much of an inconvenience. Why? Because most of the working world is constructed around male physiology which fluctuates less. It can also be extremely hectic, busy and high pressured and often doesn’t allow us time to rest, time to dream, or time to be.

One benefit coming from the pandemic is the flexibility of the working world now. I hope that women can spearhead a new cyclical way of working which sees the benefits of rest at the core of it and natural contraception use will most likely grow along with that.

1. Inoue K, Barratt A, Richters J. 2015. Does research into contraceptive method discontinuation address women’s own reasons? A critical review. Journal of Family Planning and Reproductive Health Care. 2015;41:292-299
2. Statista.com, 2019. Methods of contraception used by women in the United Kingdom (UK) in 2018. [online] Available at: https://www.statista.com/statistics/1063613/contraception-use-among-women-in-the-uk/ [Accessed 12 May 2022]
3. Knight, J. 2016. The Complete Guide to Fertility Awareness. Routledge: UK.
4. Ferreira-Poblete, A. 1997. The probability of conception on different days of the cycle with respect to ovulation: An overview. Advances in Contraception. 12, (2-3), p.83-95.
5. NHS.uk. 2022. Contraceptive diaphragm or cap. [online] Available at: <https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/> [Accessed 11 May 2022]
6. Bishop, K. 2022. It’s Your Power Portal: Take Control of Your Vaginal Health with Herbal and Holistic Care. Aeon publishing: London

Have you ever wondered why you have felt a particular way only for your period to arrive and you have an ‘ah ha’ moment and think “now it all makes sense!” Understanding our cycle is important for many reasons, keeping an eye on our overall health, tracking where you are in your menstrual cycle and having a bit more control to plan things when we are at best capacity to tackle them.

I like to use the seasons as an analogy for this because it is something so familiar to us it’s easier to remember than perhaps the more clinical descriptions. How we feel during our cycle directly correlates with the seasons too.

You might think – like I did when I first started learning about this – that it’s just oestrogen and progesterone that are the key players of your cycle. In fact, there are several hormones on the go, and I hope this gives you more of an idea about the intricate dance that plays out each month.

Our menstrual cycle is seen as something primarily for procreation, this is indeed a wonderful thing it does, but our bodies are more than that, we need all these moving parts to work regardless of whether or not a pregnancy happens. I hope in my work to shine a light on how damaging that narrative can be as it can hinder women receiving the help they need. 

Your menstrual cycle actually starts in your brain, the hypothalamus, it sends pulses of gonadotropin-releasing hormone (GnRH) to the pituitary gland, this then starts to release follicle stimulation hormone (FSH) and luteinising hormone (LH) which communicate to your ovaries and follicles.

The following is an overview, your cycle is pertinent to you, things might not completely align with a 28-day cycle, which is completely ok. A ‘normal’ cycle is anywhere from 22-35 days, and as long as you are roughly the same number of days each month by a day or two that is a happy menstrual cycle.

If it changes drastically say 24, 30, 25 days then this is indicative of something not being quite right with your cycle. It would be worth getting that checked out with your health care provider.

Your period is always day one of your next cycle, you want to make sure that it is in full flow, and you aren’t counting any spotting days that might happen before your period. Charting can be a wonderful way to get to know your menstrual cycle you can find out more about that on The Well Woman Project Blog.

The spring part of our cycle is where your hormones are climbing back up again after your period getting your body ready for ovulation. You might find your energy returning and just like spring you are ready to maybe put some brighter clothes on, and head back out in the world again.

You might find that your clarity comes back, you are feeling more confidant and just want to pick back up where you left off before your period. As spring sees life coming back again with all the buds and flowers, so too are you. Often people find they are full of ideas and creativity in this stage (sometimes a little too much and extra grounding is needed!).

The reason for this shift is that oestrogen is on the rise, and this is the action taker, mover, shaker and fiery hormone. Testosterone is also rising – this is thought to be a male hormone, it isn’t, it’s produced in all humans. It helps to maintain and build muscle, bone density and boost libido. We have several different types of oestrogen but our super-duper one is oestradiol and is only made in the ovaries.

FSH is also building at this point in your menstrual cycle, it does what is says on the tin, stimulates your follicles to get an egg ready and mature, as it stimulates the follicles, and an egg begins to form this lead follicle then produces oestrogen. Once the oestrogen has met its peak, FSH and LH take over once more to nudge the egg over the finish line and for it to be released.

It’s short and sweet this part of your cycle, very much like the summers can be in the UK! However, in terms of your menstrual cycle there is A LOT going on. ovulation is the peak of oestrogen and testosterone; you most likely feel your most confident, can spin all the plates and feel on top of your game.

Very much like summer, we are out and about, the days are longer we are wearing less, socialising more, its lighter so more things get done and the big blue skies lift us up and make it feel that much better.

If you have presentations, talks, or anything that requires you to be sharp as a tac this is the time to plan it into your diary! Your body is at the peak of its game so you might as well take advantage of that in other areas of your life! In the summer you walk with more swagger.

Ovulation seems a bit of a non-event to be honest as it only lasts a matter of a day or two, but it really is where it’s all at, it’s how we make hormones and if it isn’t happening for you that is a big problem for your whole health. This is where it all comes together, all the hard work your body has been doing to get you here, the dance of the hormones all weaves together and makes Ovulation the sensation it is.

When autumn kicks in the evenings draw darker and generally, we cling to the notion of the summer, we don’t want it to get colder and be indoors, we long for the lazy days of the summer months and want to keep going with that intensity which just isn’t possible, we must harvest and put things away until the next year.

Almost every woman I have worked with hates the autumn part of their cycle, everything about it is a struggle and the fight to keep on going rather than give into it is where most of us struggle. To be plain and simple our body just doesn’t have the capacity to keep functioning in the summer mode during autumn.

Summer is for summer and autumn is for autumn –when you think about it, you can’t do all the thing you did in summer in autumn and vice versa. Winding down in autumn, closely followed by a brief hibernation in winter, allow us to be fully rested making us have more energy for spring and summer.

I can’t stress enough how paring back on the expectation you have for yourself here is paramount, if we are trying to do all that we were capable of with a full tank why do we think we can do it when it’s half full or nearly empty?!

Immediately after ovulation in the second half of your cycle, FSH, oestrogen and testosterone fall away and LH and progesterone pick up, these are cooler, quieter and laid back hormones. As oestrogen peaks it stimulates the secretion of LH which together with  oestrogen and FSH make ovulation happen. LH take over in the second half, it also instructs the corpus luteum to formulate. The corpus luteum is the ONLY way we make progesterone, so it is very important ovulation happens because it sets off a chain of events that is vital to our health.

The corpus luteum is an extra endocrine gland grown every month, it supports a pregnancy until the placenta takes over, if no pregnancy it gets reabsorbed back into the body and a new one will form next month.

The dark depths of winter, curtains drawn, slouching on the couch watching TV, wanting all the carbs and feeling like we don’t want to talk to another soul. We are inside and don’t want to go out into the night again!

Resting is the key to this part of your cycle and not demanding too much from yourself, you are bleeding, this is a big deal, it depletes our body so we need to allow it to period in peace as much as we can. An early night, delegation and preparing ahead for your needs are ways you can help yourself during this time.

We aren’t meant to be roller blading no matter what the adverts suggest! However for many women this period is a time to tune into their intuition and move through emotions. Every season has its own needs and powers, they will become more apparent to you the more aware you are of them.

The quality of our period will be a culmination of many things diet, lifestyle, exercise, toxin overload (emotional and physical) stress, wellbeing and everything in between. Learning to understand your cycle helps you to understand your body as a whole. Periods that are very painful/heavy are NOT normal and could signify an underlying problem like endometriosis or edenomyosis.

Absent periods or cycles that go on for 35+ days are also not the norm this could be a sign of PCOS (polycystic ovarian syndrome) These conditions can take a long time to diagnose partly due to this normalisation of it being ok that periods are a nightmare, it’s always best to get this checked out.