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 

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.

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

Heartburn

This is one symptom of indigestion or ‘functional dyspepsia’. It is a burning sensation in the middle of the chest, usually after eating and worsened when lying down or stooping. It is often associated with

• increased visceral activity such as irritable bowel syndrome (IBS)
• ‘diaphragmatic spasm’ linked to stress, with hyperventilation (shallow breathing) and palpitations
• abdominal congestion such as pregnancy, obesity, or bloating.

Stress in heartburn is also associated with increased sensitivity of the lower oesophageal mucosa (1).  These and other predisposing factors are elaborated below.

Gastro-oesophageal reflux

This occurs when pressure in the stomach exceeds that in the lower oesophagus (eg from stooping, and with abdominal distension, pregnancy or obesity), or when the sphincter between the two relaxes, usually for short spells of between 5–30 seconds (Transient Lower Esophageal Sphincter Relaxation – TLESR). (2) Triggers for TLSERs include stomach distension, whether by swallowing air or taking large meals, (3) and again by stress manifested as heightened diaphragm activity.

Gastroparesis

Delayed gastric emptying is another digestive malfunction that exacerbates reflux and the frequency of TLESRs. Other symptoms include nausea, vomiting, abdominal pain, feeling full soon after beginning to eat and abdominal bloating. Causes of gastroparesis are elusive though it may be linked to immunological complications of viral infections, and interference in the vagus nerve in diabetes.

Hiatal hernia

This is marked by the lower oesophageal sphincter being forced upwards, to become separated from the diaphragm (which normally acts as the outer sphincter), the extent of this is directly linked to the levels of acid reflux and oesophagitis. HH appears to have no impact on TLESR rates but there is an extended acid pocket at the top of the stomach and reduced clearing of acid on swallowing. (4)

GORD (GERD)

When reflux is persistent it can lead to inflammation of the lower oesophagus (oesophagitis) which is widely referred to as Gastro-O/Esophageal Reflux Disease. GORD is a confusing syndrome, in fact usually diagnosed when symptoms are relieved by PPI acid-blockers like omeprazole! There are many different recognised subtypes. (5)

• Non-erosive reflux disease (NERD): An early stage of oesophagitis (often simply classified as heartburn), perhaps associated with hypersensitivity of the oesophageal mucosa.
• Erosive disease (classic GORD) increases in intensity (Los Angeles grade A, B, C or D) marked also by increasing damage to the oesophageal-gastric junction and likely hiatus hernia, more trouble when lying down, and association with gastroparesis.
• Barrett’s oesophagus: A condition seen as increasing the risk of oesophageal cancer, with endoscopy showing a spectrum, from non-dysplastic metaplasia through increasing grades of dysplasia. It is indicative of both acid and bile reflux and is associated with obesity, male gender, white ethnicity, smoking, and genetic factors.
• Reflux chest pain syndrome with pain indistinguishable from angina but resolved with antacid therapy.
• Regurgitation reflux disease with large volumes of reflux that is often difficult to manage.
• Reflux cough: Reflux is a common cause of chronic non-productive cough (and also asthma) and should always be checked for.

Stomach acid and gastrin

It is important to note that contrary to popular belief, stomach acid secretion is rarely abnormal in GORD. However as noted above for heartburn it is likely that the oesophageal mucosa becomes more sensitive to acid.  This is still enough rationale for the practice of reducing acid production to relieve GORD.

Indeed gaining benefit from PPIs like omeprazole is as we have seen the main way GORD is diagnosed. Studies comparing the relative effectiveness of PPIs conclude that the fraction of the day that they maintain intragastric pH above 4 is a reliable marker of effectiveness in high grade oesophagitis, with the target being 50-70% of a 24 hour period. (6)

Gastrin is a stomach hormone that induces acid as well as stomach histamine production, and its levels have been proposed as a non-invasive marker of GORD. (7) The primary stimulus for gastrin secretion is the presence in the stomach of certain foodstuffs, especially protein peptides, certain amino acids and calcium.

Also, as yet unidentified compounds in coffee, wine and beer can stimulate gastrin secretion. Gastrin levels can also rise in response to long-term suppression of acid production with antacids, and again as a rebound to coming off PPIs. They may also be raised in pernicious anaemia and when stomach-acid production capacity is reduced in atrophic gastritis.

After meals a layer of acid sits on top of the meal close to the oesophageal sphincter, ready to reflux. This is known as the “acid pocket” and is facilitated by the absence of peristalsis in the upper stomach.  The acid pocket is also more prominent in GORD and hiatus hernia.

Inflammation (or hypersensitivity?)

The conventional model of reflux esophagitis has been the “burn hypothesis” proposing that the caustic effects of stomach acid combined with enzymatic digestion by pepsin erodes the oesophageal epithelium. According to this paradigm, the easiest pathway for acid lies in the intercellular spaces, which are protected by proteins such as claudins, occludins, and E-cadherin. (8)

However, recent experiments have challenged this concept, instead proposing that much of the injury is chronic and chemokine mediated. (9) Among patients with GORD who discontinued PPIs 2 weeks before endoscopic biopsy, they found an increase in lymphocyte levels along with distended intercellular spaces in areas that were without surface erosions. (10)

Specimens also stained positive for hypoxia-inducible factor (HIF) 2α, a proinflammatory cytokine that is induced by bile salts. Under this alternative paradigm, acid and bile salts enhance HIF-2α, leading to increases in levels of T-cell chemokines that promote oesophagitis. (11)

Helicobacter pylori

Epidemiologic data demonstrate that erosive oesophagitis and Barrett’s oesophagus are inversely related to H. pylori infection. The proposed protective mechanism is that chronic H. pylori infection leads to atrophic gastritis and relative hypochlorhydria (low acid production), which in turn diminishes the acidity of gastro-oesophageal reflux. (12,13)

Role of vanilloid (spice) receptors

Spice constituents like capsaicin, gingerols, piperine and curcumin stimulate transient receptor potential vanilloid-1 (TRPV1) receptors. These are present on oesophageal sensory nerve fibres. TRPV1 activation here has been found to occur with exposure to capsaicin as well as heat and acid. TRPV-1 expression is upregulated in patients with both oesophageal erosion and NERD. (14)

The potential role of TPRV1 activation in inducing GORD symptoms was highlighted in a study in which submucosal injection of capsaicin and not acid triggered severe sensations of heartburn and chest pain in healthy volunteers. (15) With such activation, TRPV1 leads to nerve depolarization and may represent the primary nervous pathway for reflux symptoms.

There are several types of antacids available. These include

• alkalinising agents like sodium bicarbonate, or salts of aluminium, magnesium, calcium or bismuth;
• histamine (H2) blockers such as cimetidine and ranitidine (Zantac);
• Proton Pump Inhibitors (PPIs) such as omeprazole and esomeprazole (Nexium).

It is clear that the main justification for the use of antacids is symptom relief, and in the case of PPIs, diagnosis of GORD. They do not however address the causes of any of the conditions for which they are used: excess acid production is not a significant problem as such.

So what positive treatment options should be considered? We will consider some options and offer 5 herbs that fit. Before considering herbs however it is always important to look at other ways to reduce reflux pressures, for example with weight-loss regimes or reducing bloating (there is evidence for example of the benefits of cutting out gluten in susceptible individuals (16). There is before all one non-herbal approach that should always be considered.

GORD and hiatal hernia as well as other reflux problems can almost always be helped with approaches that relax the diaphragm. This large skeletal muscle (ie a voluntary muscle such as we have in the arms and legs) nevertheless has to act involuntarily, like the muscles in the viscera. This identity confusion means that the diaphragm is particularly likely to be affected by nervous tension and stress.

The result of this is that instead of a smooth deep movement through the breathing cycle the diaphragm tenses up leading to shallower breathing (hyperventilation). Because it acts as a wall between thorax and abdomen it can also transform these into resonating chambers, in which normally quiet organ functions become noisy.

This can lead to palpitations of the heart (mostly caused by resonance of the heartbeat within a rigid thorax cavity), as well as increased agitation in the abdominal organs. It can interfere also with normal swallowing functions and can be a major contributor to disturbances there, can exacerbate the cough from reflux and is sometimes also associated with other syndromes above.

The antidote to all these diaphragm-associated problems is to learn to breathe again. There are many exercises available. The best ones simply involve counting through the breathing cycle. A quick starter is the 7-11 exercise, counting 7 slowly as you breathe in and 11 as you breathe out.

It is always a slow outbreath that is the key to calming the diaphragm. Exercises like this need practising over many days and weeks until they become easy to slip into and can be used as required to ‘unknot’ your centre. If well done a good breathing routine can be enough to transform an acid or reflux problem.

Taking a mucilage-rich material immediately after a meal provides a ‘raft’ of mucus to float on top of the acid pocket that usually forms in reflux conditions. This raft can then protect vulnerable mucosa in the oesophagus as the stomach contents are pressed upwards. (17) There is evidence for this effect for alginate-containing topical solutions, (18) which are the basis of the proprietary product Gaviscon.

The most effective herbal product for this effect is powdered slippery elm (Ulmus fulva). Simply swallowing this, most conveniently in the form of a tablet or capsule, will provide often immediate relief of heartburn, hiatal hernia or GORD, without suppressing important acid production. Acacia and other gums may also be considered for this role.

GORD is often linked with IBS and both are syndromes associated with excessive gut motility and even hyperperistalsis. (19) Symptoms of reflux can certainly be helped with herbs that have carminative action such as the gentler spices like fennel and cardamom However individual responses to any such herbs vary extensively – for example peppermint, while calming the bowel in many people, is known to exacerbate reflux in others.

A consistent performer in calming the stomach in reflux is lemon balm (Melissa officinalis). This is almost perfectly pitched to calm symptoms in this area as well as others associated with diaphragmatic spasm. It is best tried as a strong hot or warm tea with fresh leaves.

Hypersensitivity of the oesophageal mucosa is increasingly accepted as a key feature of GORD, accounting for most of the symptoms popularly associated with ‘hyperacidity’. There are several herbal approaches that lend themselves to improving the integrity of the oesophageal lining. Their access to the affected tissues is helped by the brief time swallowed materials are held above the lower oesophageal sphincter before it opens into the stomach.

There are a number of candidates for this work. Aloe vera, gotu kola (Centella asiatica) are examples; however two herbs stand out for this duty. Meadowsweet (Filipendula ulmaria) is often seen as healing in the stomach itself. However an equal prospect is its direct effect before it gets there, helped particularly by the high levels of healing tannins, salicylates and its other prominent phenolic constituents.

Liquorice (Glycyrrhiza glabra) is a superb topical healing agent very well suited to reducing disturbed inflammatory and immunological activity on exposed surfaces. Its local effects on the upper gut also account for some of its calming expectorant effects in reducing coughs so it becomes an ideal solution where reflux is associated with cough.

Acid reflux symptoms are often linked to reduced digestive capacity, including digestive congestion, weight gain and especially bile reflux into the stomach. Many of these background factors may be helped with the judicious use of bitter digestive remedies. These do not suit everyone but it is often worth trying them out to see. An excellent all-rounder is the root of dandelion (Taraxacum officinale).

This is both a gentle entry-level bitter and critically one of the surest ways to dilute bile and help it move down the bowel where it should be rather than reflux upwards to contribute to oesophageal erosion. There are indications, though not confirmed in the literature, that in people who respond well to bitters that these also increase the production of protective mucus in the stomach.

Anything that can accelerate stomach emptying will reduce acid reflux. Although for some people hot spices can exacerbate reflux symptoms (see above) there is good evidence that there are benefits in the less fiery versions. Culinary spices like cardamom, cumin, cinnamon, fennel and aniseed are also classified as warming aromatic digestives and have traditionally been used to relieve acid dyspeptic conditions.

Notably, ginger (Zingiber officinale) has long been used for its benefits in reducing nausea and vomiting associated with motion sickness, chemotherapy and pregnancy.  It also has benefits in acid reflux problems as well. In healthy volunteers, ginger has been found to enhanced gastric and duodenal motility, (20) to accelerate gastric emptying (21) and improve burping without increasing reflux. (22)

1. Woodland P, Lee C, Duraisamy Y, et al. (2013) Assessment and protection of esophageal mucosal integrity in patients with heartburn without esophagitis. Am J Gastroenterol. 108, 4: 535-43. doi: 10.1038/ajg.2012.469
2. Dent J, Holloway RH, Toouli J, et al. (1988) Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastrooesophageal reflux. Gut. 29, 8: 1020-8. doi: 10.1136/gut.29.8.1020
3. Zachariah RA, Goo T and Lee RH (2020) Mechanism and Pathophysiology of Gastroesophageal Reflux Disease. Gastrointest Endosc Clin N Am. 30, 2: 209-26. doi: 10.1016/j.giec.2019.12.001
4. Zachariah ibid.
5. Katzka DA and Kahrilas PJ (2020) Advances in the diagnosis and management of gastroesophageal reflux disease. Bmj. 371: m3786. doi: 10.1136/bmj.m3786
6. Katz PO, Johnson DA, Levine D, et al. (2010) A model of healing of Los Angeles grades C and D reflux oesophagitis: is there an optimal time of acid suppression for maximal healing? Aliment Pharmacol Ther. 32, 3: 443-7. doi: 10.1111/j.1365-2036.2010.04367.x
7. Cesario S, Scida S, Miraglia C, et al. (2018) Diagnosis of GERD in typical and atypical manifestations. Acta Biomed. 89, 8-s: 33-9. doi: 10.23750/abm.v89i8-S.7963
8. Jovov B, Que J, Tobey NA, et al. (2011) Role of E-cadherin in the pathogenesis of gastroesophageal reflux disease. Am J Gastroenterol. 106, 6: 1039-47. doi: 10.1038/ajg.2011.102
9. Souza RF, Huo X, Mittal V, et al. (2009) Gastroesophageal reflux might cause esophagitis through a cytokine-mediated mechanism rather than caustic acid injury. Gastroenterology. 137, 5: 1776-84. doi: 10.1053/j.gastro.2009.07.055
10. Dunbar KB, Agoston AT, Odze RD, et al. (2016) Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes. Jama. 315, 19: 2104-12. doi: 10.1001/jama.2016.5657
11. Huo X, Agoston AT, Dunbar KB, et al. (2017) Hypoxia-inducible factor-2α plays a role in mediating oesophagitis in GORD. Gut. 66, 9: 1542-54. doi: 10.1136/gutjnl-2016-312595
12. Wang Z, Shaheen NJ, Whiteman DC, et al. (2018) Helicobacter pylori Infection Is Associated With Reduced Risk of Barrett’s Esophagus: An Analysis of the Barrett’s and Esophageal Adenocarcinoma Consortium. Am J Gastroenterol. 113, 8: 1148-55. doi: 10.1038/s41395-018-0070-3
13. Dunbar KB, et al.
14. Bhat YM and Bielefeldt K (2006) Capsaicin receptor (TRPV1) and non-erosive reflux disease. Eur J Gastroenterol Hepatol. 18, 3: 263-70. doi: 10.1097/00042737-200603000-00006
15. Lee RH, Korsapati H, Bhalla V, et al. (2016) Esophageal Submucosal Injection of Capsaicin but Not Acid Induces Symptoms in Normal Subjects. J Neurogastroenterol Motil. 22, 3: 436-43. doi: 10.5056/jnm15166
16. Usai P, Manca R, Cuomo R et al. (2008) Effect of gluten-free diet on preventing recurrence of gastroesophageal reflux disease-related symptoms in adult celiac patients with nonerosive reflux disease. J Gastroenterol Hepatol. 23(9): 1368-1372. doi: 10.1111/j.1440-1746.2008.05507.x
17. Rohof WO, Bennink RJ, Smout AJ, et al. (2013) An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 11, 12: 1585-91; quiz e90. doi: 10.1016/j.cgh.2013.04.046
18. Woodland P, Lee C, Duraisamy Y, et al. (2013) Assessment and protection of esophageal mucosal integrity in patients with heartburn without esophagitis. Am J Gastroenterol. 108, 4: 535-43. doi: 10.1038/ajg.2012.469
19. de Bortoli N, Tolone S, Frazzoni M et al. (2018) Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann Gastroenterol. 31(6): 639-648. doi: 10.20524/aog.2018.0314.
20. Lohsiriwat S, Rukkiat M, Chaikomin R et al. (2010) Effect of ginger on lower esophageal sphincter pressure. J Med Assoc Thai.  93(3): 366-372. PMID: 20420113
21. Hu ML, Rayner CK, Wu KL, et al. (2011) Effect of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 17(1): 105-10. doi: 10.3748/wjg.v17.i1.105
22. Shariatpanahi ZV, Taleban FA, Mokhtari M, Shahbazi S. (2010)  Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients hospitalized in an intensive care unit. J Crit Care. 25(4): 647-50. doi: 10.1016/j.jcrc.2009.12.008

Have you ever felt overwhelmed by choices, frozen and unable to figure out what to eat? You are not the only one. Research indicates that increased choice leads to decision fatigue while shopping for food and ultimately decreased satisfaction with the food itself (3).

Our current food environment is a complex one, with an abundance of information and choices to navigate. To add to this, we are constantly bombarded with visual stimuli of food, with hundreds of food adverts daily.

We eat not only with our mouths, but with our eyes too and this visual information overload increases the likelihood of making poor food choices.

A meta-analysis published in Obesity Reviews found that exposure to pictures and videos of food results in increased eating behaviour and was associated with a higher risk of weight gain (4).

Another factor in our current lifestyle that impacts our food choices more than we realise is multitasking. There is rarely a moment when we are only doing one thing, with the pace of our lives, multi-tasking seems to be a necessity. But excessive multitasking is known to have detrimental effects on health over time. When we are processing too much information at once, it leads to a cognitive overload and is associated with feelings of increased stress and poorer health (5).

Our environment is also filled with information, furthering our need to multitask, and this affects our food choices as well. When we are doing too much while choosing what and how much to eat, we experience a brain-freeze moment, which impacts our decision making when it comes to food.

An experiment done in the University of Surrey showed some interesting results pertaining to food choice while multitasking (6). 81 women were asked to take a taste test while performing tasks which distract from eating. The tasks included – driving, watching TV, interacting socially or being alone.

Their hunger, fullness and motivation to eat was measured before and after these tasks. It was found that those who were eating alone felt full faster compared to those driving, or watching TV. Certain tasks induced more eating behaviour than others, and TV watching was associated with the and the latter was associated with the most hunger.

Eating alone resulted in feeling full faster, and thus eating less. Distraction leads to poor food choices as it inhibits our conscious decision making, we are overloaded with sensory information, and continue to eat “mindlessly” long after we are full.

Improving our food environment, and decluttering our minds while eating can help with making better food choices. Though our surroundings are often out of our control, there are many small things we can do to better our food environments:

• Reducing media use during eating and buying food: Limiting the use of screens, and eating in silence increases mindfulness towards the food (8).
• Planning our shopping beforehand: Going with a fixed list, and adhering to it helps reduce the likelihood of cognitive overload and poor food choices.
• A moment of silence before eating: A few seconds of silence, and a deep breath before the meal helps us to reconnect and anchor the mind to the current moment. This ensures we observe the food, and determine how much we really need to eat. Eating slowly and mindfully helps with satiety cues (9). 
• Shopping at smaller stores and at off-hours: Shopping in a smaller setting can help reduce the sensory overload.
• Tonic herbs like gotu kola can increase the concentration, memory power and ability of the brain to handle multiple tasks at once (10). Adaptogenic herbs like ashwagandha can help with stress management, and improves cognition (11).

Our food environment, much like the rest of our lives, is a multitasking one. This is, in turn, affecting our food choices adversely, with too much choice and sensory overload, there is a higher chance of reaching towards something unhealthy. Though we cannot directly change our food environment, we can deal with it more effectively by inculcating mindfulness, stress management into our eating. 

1. Caswell JA, Yaktine AL, Allotments C on E of the A of FR and S, et al. Individual, Household, and Environmental Factors Affecting Food Choices and Access. National Academies Press (US); 2013. Accessed November 1, 2021. https://www.ncbi.nlm.nih.gov/books/NBK206912/
2. Fuentes Pacheco A, Carrillo Balam G, Archibald D, Grant E, Skafida V. Exploring the relationship between local food environments and obesity in UK, Ireland, Australia and New Zealand: a systematic review protocol. BMJ Open. 2018;8(2):e018701. doi:10.1136/bmjopen-2017-018701
3. Reutskaja E, Lindner A, Nagel R, Andersen RA, Camerer CF. Choice overload reduces neural signatures of choice set value in dorsal striatum and anterior cingulate cortex. Nat Hum Behav. 2018;2(12):925-935.
4. Food cue reactivity and craving predict eating and weight gain: a meta‐analytic review – Boswell – 2016 – Obesity Reviews – Wiley Online Library. Accessed November 1, 2021. https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.12354
5. Misra S, Stokols D. Psychological and Health Outcomes of Perceived Information Overload. Environ Behav. 2012;44(6):737-759. doi:10.1177/0013916511404408
6. Ogden J, Coop N, Cousins C, et al. Distraction, the desire to eat and food intake. Towards an expanded model of mindless eating. Appetite. 2013;62:119-126. doi:10.1016/j.appet.2012.11.023
7. Carroll KA, Samek A, Zepeda L. Food bundling as a health nudge: Investigating consumer fruit and vegetable selection using behavioral economics. Appetite. 2018;121:237-248. doi:10.1016/j.appet.2017.11.082
8. Kononova A, McAlister A, Oh HJ. Screen overload: Pleasant multitasking with screen devices leads to the choice of healthful over less healthful snacks when compared with unpleasant multitasking. Comput Hum Behav. 2018;80:1-11. doi:10.1016/j.chb.2017.10.042
9. Meule A, Kübler A. A Pilot Study on the Effects of Slow Paced Breathing on Current Food Craving. Appl Psychophysiol Biofeedback. 2017;42(1):59-68. doi:10.1007/s10484-017-9351-7
10. An Acute, Double‐Blind, Placebo‐Controlled Cross‐over Study of 320 mg and 640 mg Doses of Bacopa monnieri (CDRI 08) on Multitasking Stress Reactivity and Mood – Benson – 2014 – Phytotherapy Research – Wiley Online Library. Accessed November 1, 2021. https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.5029?casa_token=MugUmeKNra8AAAAA%3AWZ7gHcdUpJW_at1aAqPkkUyAjDBPSERwFSeCDygDqO1XZps3lyu82FU22vt5p7kHfCoQpAzoH4huEw
11. Chandrasekhar K, Kapoor J, Anishetty S. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. Indian J Psychol Med. 2012;34(3):255-262. doi:10.4103/0253-7176.106022

On a daily basis, we are eating more than we did fifty years ago, with calories in the US and Western Europe topping 3,500 kcal per day (2). One underlying factor is greater consumption of high calorie ultra-processed foods. In the UK these are estimated to account for 57% of our total energy intake and provide two thirds of the total free sugars in our diets (3).  

These foods are processed and can be characteristically sugary or salty to make them more palatable. We all enjoy tucking into burgers or chocolate, and population-based studies have found that consumption of ultra-processed food is associated with almost every chronic disease (4).

The ‘omic’ studies are showing us that these foods alter the balance of our gut microbiota from helpful Bacteroides species that metabolise non-digestible polysaccharides, leading to a loss of healthy bi-products like butyrate.

By unbalancing the system this allows less helpful bacteria to occupy niches in the intestine (5). In almost every other instance of our modern lifestyles, we see a similar pattern of dysregulation of our microbiota. Exposing it to environmental pollutants initiates a protective response by the gut that releases inflammatory compounds that damages the gut wall – the delicate single layer of epithelial cells on the inner most surface (6).

A commonly used insecticide diazinon disrupted the microbiome in animals for up to 13 weeks following a single dose (7). Multiply that up by the thousands of pesticides used globally (8), even if our agricultural and food systems can adhere to safe levels, the impact on our planetary microbiota – be it the bugs within our soils or our life-giving human and animal microbiomes – is not fully known.

Another area of our modern living that may have a detrimental impact on our microbiomes is our choice of healthcare. In one study, a quarter of commonly used pharmaceuticals were found to prevent the growth of our microbes, potentially adversely affecting our health and also contributing to the risk of antibiotic resistance (9).

Antibiotics are known to create competition within microbial communities and upset the balance of mutually beneficial co-habitation (10). Whilst it might be the case that in adults they can recover from a course of antibiotic treatment, in infants there may be lasting changes along with the risk of building the pool of antibiotic-resistance genes in our residing communities (11).

At this half-way point, there is a picture emerging from the research that how we treat our gut through our foods and medicines causes disturbances that can have lasting ill-effects. However, I believe the gut is not called the “little brain” for nothing (from Michael Gershon MD) and it is well poised to offer us help using herbs and spices.

What we do know is that positive lifestyle changes such as eating more nutritiously can improve health at any stage of life (12). Research is putting the benefits of herbs and spices into the spotlight, with turmeric increasing beneficial butyrate-producing gut bacteria and other herbs also modifying our microbiota (13).

The wide-ranging effects of herbs and spices may reflect the array of polyphenols and plant compounds that we ingest and are consequently metabolised by our bugs.

There is also much more intrigue beyond the gut microbiota. Why is it that our gut walls contain a myriad of receptors for plant-based compounds? I can’t help but think why are they there, and what is their importance? We evolved to eat a diverse plant species that were seasonally available, and this has dwindled in our modern diets. So, can we use herbs and spices to kick-start our physiology again?

Firstly, it is recognised that bitter receptors are located throughout the mouth, throat and gastrointestinal system and enhance digestive processes (increasing secretions and supporting the cardiovascular system in diverting blood flow to the gut). Bitter herbs – ‘bitters’ – like gentian and wormwood have longstanding use as aperitifs as digestive aids (14). Within the gut are also an abundance of cannabinoid receptors which regulate gut function and barrier integrity, located throughout the epithelial cell lining and extensive enteric nervous system (15).

Capsaicin which is a plant compound from chilli peppers binds to vanilloid receptors and also stimulates gut function (16). It is suggested that our body’s processes are now at odds with our unhealthy lifestyles. Just as we need vitamins and minerals in our diets, the presence of these receptors suggests that consumption of herbs, spices and green leafy vegetables, might be just as essential to reset our systems.

The notion of diversity increasingly seems to hold the key to the future, whether we are talking about diversity in our diets, diversity of gut microorganisms, or the diversity of receptors in our gut.

Concepts like the dietary phytochemical index may help us understand the importance of diverse plant compounds like polyphenols and phytoestrogens in our foods and how these relate to our gut processes and body’s health (17).

The latest research is helping us understand the significance of our bug’s bugs – the viruses known as bacteriophages that interact with our bacteria. In this intriguing area of science, the phages become more diverse shortly after birth, and they manipulate our gut bacteria to have both good and bad effects on our health (18).

We know that our modern lifestyles do not allow the orchestral capabilities of our microbiomes or gut receptors to be fully played. The science points towards plant compounds within our herbs and spices as being important elements within these systems. More research is needed to see how we can encourage lifestyle changes to off-set some of our poor habits, and how we can spice up our lives so that our digestive systems can flourish and bring our bodies into better health.

1. Agrawal A, Yadav C, Meena M. Physiological aspects of Agni. AYU (An International Quarterly Journal of Research in Ayurveda). 2010;31(3):395. doi:10.4103/0974-8520.77159
2. Daily supply of calories. Our World in Data. https://ourworldindata.org/grapher/food-supply-kcal?tab=chart&time=1961..2013&country=OWID_WRL~Europe%2C+Western~Eastern+Europe~Africa~Asia~South+America~Northern+America. Published 2021. Accessed October 29, 2021.
3. Rauber F, Louzada M, Martinez Steele E et al. Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study. BMJ Open. 2019;9(10):e027546. doi:10.1136/bmjopen-2018-027546
4. Consumption of ultra-processed foods and health outcomes: a systematic review of epidemiological studies – Nutrition Journal. Nutrition Journal. https://nutritionj.biomedcentral.com/articles/10.1186/s12937-020-00604-1. Published 2020. Accessed October 29, 2021.
5. Martínez Leo E, Segura Campos M. Effect of ultra-processed diet on gut microbiota and thus its role in neurodegenerative diseases. Nutrition. 2020;71:110609. doi:10.1016/j.nut.2019.110609
6. Defois C, Ratel J, Garrait G et al. Food Chemicals Disrupt Human Gut Microbiota Activity And Impact Intestinal Homeostasis As Revealed By In Vitro Systems. Sci Rep. 2018;8(1). doi:10.1038/s41598-018-29376-9
7. Gao B, Bian X, Mahbub R, Lu K. Sex-Specific Effects of Organophosphate Diazinon on the Gut Microbiome and Its Metabolic Functions. Environ Health Perspect. 2017;125(2):198-206. doi:10.1289/ehp202
8. Pesticide Residues in Food. Report of the 1974 Joint Meeting of the FAO Working Party of Experts on Pesticide Residues and the WHO Expert Committee on Pesticide Residues. Food Cosmet Toxicol. 1976;14(5):491. doi:10.1016/s0015-6264(76)80206-4
9. Maier L, Pruteanu M, Kuhn M et al. Extensive impact of non-antibiotic drugs on human gut bacteria. Nature. 2018;555(7698):623-628. doi:10.1038/nature25979
10. Seelbinder B, Chen J, Brunke S et al. Antibiotics create a shift from mutualism to competition in human gut communities with a longer-lasting impact on fungi than bacteria. Microbiome. 2020;8(1). doi:10.1186/s40168-020-00899-6
11. Gibson M, Crofts T, Dantas G. Antibiotics and the developing infant gut microbiota and resistome. Curr Opin Microbiol. 2015;27:51-56. doi:10.1016/j.mib.2015.07.007
12. Calder P, Carding S, Christopher G, Kuh D, Langley-Evans S, McNulty H. A holistic approach to healthy ageing: how can people live longer, healthier lives?. Journal of Human Nutrition and Dietetics. 2018;31(4):439-450. doi:10.1111/jhn.12566
13. Peterson C, Rodionov D, Iablokov S et al. Prebiotic Potential of Culinary Spices Used to Support Digestion and Bioabsorption. Evidence-Based Complementary and Alternative Medicine. 2019;2019:1-11. doi:10.1155/2019/8973704
14. McMullen M, Whitehouse J, Towell A. Bitters: Time for a New Paradigm. Evidence-Based Complementary and Alternative Medicine. 2015;2015:1-8. doi:10.1155/2015/670504
15. Hasenoehrl C, Taschler U, Storr M, Schicho R. The gastrointestinal tract – a central organ of cannabinoid signaling in health and disease. Neurogastroenterology & Motility. 2016;28(12):1765-1780. doi:10.1111/nmo.12931
16. Du Q, Liao Q, Chen C, Yang X, Xie R, Xu J. The Role of Transient Receptor Potential Vanilloid 1 in Common Diseases of the Digestive Tract and the Cardiovascular and Respiratory System. Front Physiol. 2019;10. doi:10.3389/fphys.2019.01064
17. Sotoudeh G, Abshirini M, Mahaki B, Bagheri F, Siassi F, Koohdani F. Higher intake of phytochemical-rich foods is inversely related to prediabetes: A case-control study. Int J Prev Med. 2018;9(1):64. doi:10.4103/ijpvm.ijpvm_145_18
18. Townsend E, Kelly L, Muscatt G et al. The Human Gut Phageome: Origins and Roles in the Human Gut Microbiome. Front Cell Infect Microbiol. 2021;11. doi:10.3389/fcimb.2021.643214

The extracts used in liquid bitters are often in a base of alcohol, though one can find them made with vinegar, or as powders meant to be mixed in a little water. This liquid form allows for the full experience of the bitter flavour on the tongue – an essential part of how bitters work, and why they seem less effective when taken in capsule form (2).

But alcohol also makes for an excellent solvent and preservative, drawing out bitter and aromatic components from the herbal ingredients and stabilizing the final solution. Alcohol-based bitters are also a very traditional part of mealtimes. But the bitter liqueurs we see today (like Cynar, Fernet, Underberg, Unicum, and so many more) may not have been the first documented medicinal bitters in the European tradition.

That honour may belong to a blend from a now-lost herbal written and illustrated over 2,000 years ago in northern Turkey by a physician known as Crateuas. He helped to develop the formula as an antidote to poison, and it included over 40 different botanicals (3).

The remedy proved popular, and countless variants were passed on through the generations. These became known as “theriac” (the physician Galen coined this name, which roughly means “remedy for the bite of wild beasts”).

Though their ingredients evolved over time, they followed a similar template: strong bitter herbs like centaury (Centaurium erythraea Raf.), costus (Saussurea costus (Falc.) Lipsch), and the wild poppy (Papaver rhoeas L.) were blended with pungent, aromatic herbs like ginger, pepper, and asafoetida (Ferula assafoetida L.). Herbal resins and gums came next – both as flavour, and to soften and harmonise the formula. Finally, the herbs were ground into powder and mixed with a little honey as a binder and sweetener (4).

This same template is still followed today: strong bitter herbs, a custom cocktail of aromatic and pungent spices, and finally gummy, starchy, or sugary ingredients to bind the formula together and offer a (relatively) sweet counterpoint. The indications for these formulas are similar to what they were 2,000 years ago: bitters assist and modulate the process of digestion and assimilation and encourage gentle daily detoxification. These are crucial physiologic functions – no wonder the theriac of antiquity was so revered. At the heart of its power is the bitter taste itself. What might be happening when it hits our tongue?

Our taste buds contain a few types of specialized receptors, each tuned to a broad flavour category. Receptors for sweetness, saltiness, and delicious “umami” (a savoury quality linked to amino acids found in protein, especially glutamate) give us a sense of pleasure and encourage us to eat more of the simple sugars, important electrolytes, and nourishing protein that elicit these flavour experiences (5). There may be a receptor for fats as well (6), another important source of nutrition.

Sour taste receptors have a more neutral role: if coupled with sweetness (think fruit), sourness can be pleasant. In other cases (think spoiled meat, or rancid fat), acidity feels wrong, and leads us to stop eating (7). But bitterness always acts as a deterrent: folks report that they just don’t like the flavour and tend to avoid bitter-tasting foods (8).

This is obvious in children, who may have a higher concentration of bitter taste receptors compared to adults (9): even the small amounts of bitter compounds in vegetables like broccoli send them running. But if you look at the modern Western diet, you will find that we’ve systematically removed bitter ingredients from our food supply (10), and even altered our vegetables to contain fewer bitter constituents (compare the wild versions of carrots and lettuce to their domesticated, supermarket varieties) (11). Indeed Western culture seems to have a child-like palate.

The reason we turn away from the bitter flavour is the same reason children are more sensitive to bitterness: toxic, poisonous substances are often very bitter, and the receptors that detect their presence (known as T2R, or “taste type 2 receptors”) are there to protect us (12). This is important at any age, but even more so for the sensitive metabolisms of children.

T2Rs on the tongue, like other taste receptors, are linked to the brain’s flavour perception centres via nerve fibres (13). There are more than 25 different types, sensitive to hundreds of different bitter compounds from the natural world (14).

This broad spectrum includes simple polyphenols, such as the flavonoids in goldenrod herb (Solidago species); strongly bitter lactones found in roots from dandelion to gentian (Gentiana lutea L.); and alkaloids, from caffeine to atropine, which are rare, intensely bitter, and often deadly. While the protective effect of T2R stimulation makes sense for a poison like atropine (from Atropa belladonna L., the deadly nightshade), you might wonder why we need protection from the non-toxic dandelion root (or broccoli for that matter).

In fact, we don’t – but whether goldenrod or dandelion, plants that are not toxic to humans may still be toxic to many insects, and a deterrent to browsing (15). Insects have primitive taste receptors that are thought to be the evolutionary precursors of T2Rs: similar in structure, they activate a primal, aversive response (16). The insect gets the message, and eats less.

This message alters behaviour in mammals, too. An interesting area of clinical research on the bitter taste involves appetite modulation. In an apparent paradox, bitters have been used to stimulate appetite in conditions like anorexia, or when appetite is suppressed during illness or convalescence (17).

This gentle effect can help folks maintain or recover a healthy weight and may be related to the increase in digestive juice production and stomach muscle tone that accompanies a dose. But for those whose appetites are normal (or excessive), recent clinical research suggests that experiencing a bitter taste before or during a meal reduces overall consumption of food between 20% and 30% (18).

The effect lasts throughout the day and can be valuable for those attempting to control their weight or reduce their intake of carbohydrate-rich foods (19). Bitters may affect our appetite much the same way bitter compounds affect insect browsing.

The protective effect that comes from stimulating T2Rs with bitter compounds starts by slowing down our overall intake of food. But it does not stop there: many of the classic effects we associate with bitters, from improved digestion to enhanced liver function and bile production, are part of an overall protective effect, too.

Bitters inspire the production of digestive juices across the entire GI tract (20): as a result, food is bathed in secretions that neutralise bacteria and break down potential toxins with digestive enzymes. Furthermore, bitters may increase the activity of molecular “pumps” in the intestine that keep harmful substances from entering the bloodstream, favouring their expulsion via the colon (21).

And finally, by supporting the metabolic function of the liver, bitters help ensure that our bodies break down, neutralise, and eliminate unwanted substances (22). When you put it all together and take a step back, the role of T2Rs becomes apparent: these receptors engage multiple physiologic processes that act in concert to protect us from toxicity, enhance digestion, and keep detoxification and elimination working smoothly (23). They are triggered by the bitter taste.

When you taste something bitter, the T2Rs on your tongue send a signal to your brain, and you perceive the flavour. Perhaps there is a brief shudder, but soon you can feel an increase in saliva – a harbinger of things to come, as digestive juice production increases and your body gets ready for a meal.

These are reflex effects: the sensation of bitterness triggers a cascade throughout the gut, mediated by a signal sent via the vagus nerve (a key nerve “superhighway” that regulates the function of our internal organs) (24). But this nerve reflex is just one way bitters activate our digestive and detoxification processes: over the last twenty years, researchers have discovered T2Rs all over the body, not just on the tongue.

Stimulating intestinal T2Rs, for example, triggers the release of hormones that make us feel full (this may help explain the clinical research showing we eat less when tasting bitterness before a meal) (25). T2Rs are also found in the airways, both lungs and sinuses, where they open the passages and stimulate the secretion of antibacterial compounds (bacterial waste, it turns out, tastes bitter) (26). Some immune cells may have T2Rs on their surfaces (27). T

he thyroid gland carries T2Rs (28). Even the heart can “taste” bitterness: cardiac T2Rs may help modulate blood vessel diameter and blood pressure (29). This line of research hints at applications for everything from asthma and sinusitis to high blood pressure. While these effects are not evident when we take liquid bitters by mouth, they still reinforce the understanding that the bitter taste elicits a suite of protective activity from the body.

In the herbal clinic, we turn to bitters to manage and prevent digestive complaints, particularly for simple issues like gas, bloating, and indigestion. Liquid bitters can be taken in moderate doses to address these concerns and, over time, will help them appear less frequently. They do this by encouraging our own bodies to rise to the occasion: as such, they are a more tonic strategy when compared to digestive enzyme pills, antacids, or laxatives.

A few millilitres (about 60-90 drops) is a fine place to start. To address concerns in the lower belly, such as bloating, cramping, or occasional constipation, take bitters before a meal. For indigestion and overfullness, try them after eating.

We also recommend a week or two of thrice-daily bitters during the change of seasons, particularly in early spring and fall, when our diets shift and when many folks experience digestive upset. It is important to remember that, however they are used, bitters are not a “herbal detox”: yes, we feel better after taking bitters. But this is because of their protective, enlivening effects and not because they are “cleaning” us: our liver does a great job of that every day.

Bitters just help support that work. Finally, folks who have active peptic ulcers, or liver disease (including gallstones), should use bitters with caution and only after consulting a competent herbalist. The stimulating effect bitters have on digestive juice production and bile secretion from the liver could complicate those conditions. And because some of the herbs used in bitters can have strong effects, pregnant people should use extra care and try gentle preparations, like dandelion root tea, first.

In conclusion, bitters are supreme allies for digestion and metabolism. Because these functions are foundational, bitters often improve overall health. They help reduce overconsumption of food: the antidote to “super-size” meals. In fact, digestive complaints, metabolic dysregulation, and difficulty with maintaining healthy weight (all of which are so common in the Western world) may be partly due to the child-like diet so many follow: our digestion is drowned in sweet treacle, missing the crucial signal for effective function that the bitter flavour provides. The promise of bitters is the restoration of the theriac in our lives: the antidote to poison, the flavour of the wild, the crisp, clear signal that allows us to maintain moderation, to nourish ourselves with grace.

1. Hoffmann, David. Medical Herbalism: The Science and Practice of Herbal Medicine. United States: Inner Traditions/Bear&Co., 2003:498-500
2. McMullen MK, Whitehouse JM, Towell A. Bitters: time for a new paradigm. Evidence-Based Complementary and Alternative Medicine. 2015;670504.
3. Norton S. The Pharmacology of Mithridatum: a 2000-year-old Remedy. Molecular interventions. 2006;6(2):60.
4. Karaberopoulos D, Karamanou M, Androutsos G. The theriac in antiquity. The Lancet. 2012;379(9830):1942-3.
5. Breslin PA, Huang L. Human taste: peripheral anatomy, taste transduction, and coding. Advances in oto-rhino-laryngology. 2006;63:152-90.
6. Liu D, Costanzo A, Evans MD, Archer NS, Nowson C, Duesing K, Keast R. Expression of the candidate fat taste receptors in human fungiform papillae and the association with fat taste function. British journal of nutrition. 2018;120(1):64-73.
7. Breslin PA, Huang L. Human taste: peripheral anatomy, taste transduction, and coding. Advances in oto-rhino-laryngology. 2006;63:152-90.
8. Drewnowski A. Taste preferences and food intake. Annual review of nutrition. 1997 Jul;17(1):237-53.
9. Correa M, Hutchinson I, Laing DG, Jinks AL. Changes in fungiform papillae density during development in humans. Chem Senses. 2013;38:519–27.
10. Roy GM. The applications and future implications of bitterness reduction and inhibition in food products. Critical Reviews in Food Science & Nutrition. 1990;29(2):59-71.
11. Fenwick GR, Curl CL, Griffiths NM, Heaney RK, Price KR. Bitter principles in food plants. In: Rouseff RL,ed. Bitterness in foods and beverages; developments in food science. 1990;25:205-50.
12. Glendinning JI. Is the bitter rejection response always adaptive?. Physiology & behavior. 1994;56(6):1217-27.
13. Schoenfeld MA, Neuer G, Tempelmann C, Schüssler K, Noesselt T, Hopf JM, Heinze HJ. Functional magnetic resonance tomography correlates of taste perception in the human primary taste cortex. Neuroscience. 2004;127(2):347-53.
14. Meyerhof W, Batram C, Kuhn C, Brockhoff A, Chudoba E, Bufe B, Appendino G, Behrens M. The molecular receptive ranges of human TAS2R bitter taste receptors. Chemical senses. 2010;35(2):157-70.
15. Napal GN, Palacios SM. Bioinsecticidal effect of the flavonoids pinocembrin and quercetin against Spodoptera frugiperda. Journal of pest science. 2015;88(3):629-35.
16. Weiss LA, Dahanukar A, Kwon JY, Banerjee D, Carlson JR. The molecular and cellular basis of bitter taste in Drosophila. Neuron. 2011;69(2):258-72.
17. See, for example, the monograph on gentian root in: Blumenthal M, Goldberg A, Brinckmann J. Herbal medicine. Expanded commission E monographs. Integrative Medicine Communications; 2000.
18. Andreozzi P, Sarnelli G, Pesce M, Zito FP, D’Alessandro A, Verlezza V, Palumbo I, Turco F, Esposito K, Cuomo R. The bitter taste receptor agonist quinine reduces calorie intake and increases the postprandial release of cholecystokinin in healthy subjects. Journal of neurogastroenterology and motility. 2015;21(4):511.
    Kim HM. Modulation of the Bitter Taste to Reduce Calorie Intake. Journal of neurogastroenterology and motility. 2015;21(4):457-8.
19. Mennella I, Fogliano V, Ferracane R, Arlorio M, Pattarino F, Vitaglione P. Microencapsulated bitter compounds (from Gentiana lutea) reduce daily energy intakes in humans. British Journal of Nutrition. 2016;116(10):1841-50.
20. Bone K, Simon Mills MC, Fnimh MA. Principles and practice of phytotherapy: modern herbal medicine. Elsevier Health Sciences; 2012:40
21. Jeon TI, Seo YK, Osborne TF. Gut bitter taste receptor signalling induces ABCB1 through a mechanism involving CCK. Biochemical Journal. 2011;438(1):33-7.
22. Raka F, Farr S, Kelly J, Stoianov A, Adeli K. Metabolic control via nutrient-sensing mechanisms: role of taste receptors and the gut-brain neuroendocrine axis. American Journal of Physiology-Endocrinology and Metabolism. 2019 Oct 1;317(4):E559-72.
23. Harmon CP, Deng D, Breslin PA. Bitter taste receptors (T2Rs) are sentinels that coordinate metabolic and immunological defense responses. Current Opinion in Physiology. 2021; 20:70-6.
24. Darby SA. Neuroanatomy of the autonomic nervous system. Clinical Anatomy of the Spine. Spinal Cord, and ANS. 2017:466-469.
25. Sternini C, Anselmi L, Rozengurt E. Enteroendocrine cells: a site of ‘taste’ in gastrointestinal chemosensing. Current opinion in endocrinology, diabetes, and obesity. 2008;15(1):73.
26. Maina IW, Workman AD, Cohen NA. The role of bitter and sweet taste receptors in upper airway innate immunity: recent advances and future directions. World journal of otorhinolaryngology-head and neck surgery. 2018;4(3):200-8.
    Deshpande DA, Liggett SB. Regulation of Intracellular Calcium by Bitter Taste Receptors on Airway Smooth Muscle. Calcium Signaling In Airway Smooth Muscle Cells 2014;409-421.
    Devillier P, Naline E, Grassin-Delyle S. The pharmacology of bitter taste receptors and their role in human airways. Pharmacology & therapeutics. 2015 Nov 1;155:11-21.
27. Gopallawa I, Freund JR, Lee RJ. Bitter taste receptors stimulate phagocytosis in human macrophages through calcium, nitric oxide, and cyclic-GMP signaling. Cellular and Molecular Life Sciences. 2021;78(1):271-86.
28. Clark AA, Dotson CD, Elson AE, Voigt A, Boehm U, Meyerhof W, Steinle NI, Munger SD. TAS2R bitter taste receptors regulate thyroid function. The FASEB Journal. 2015;29(1):164-72.
29. Bloxham CJ, Foster SR, Thomas WG. A bitter taste in your heart. Frontiers in Physiology. 2020;11:431.

Type 2 diabetes mellitus is most often preceded and is accompanied by an increasing resistance to the action of insulin in moving glucose from the blood into the cells.

This condition has been referred to as metabolic syndrome, insulin resistance syndrome, or syndrome X. It is a disorder of energy utilisation and storage, diagnosed by a co-occurrence of three out of five of the following medical conditions:

• Abdominal (central) obesity
• Elevated blood pressure
• Elevated fasting plasma glucose
• High serum triglycerides
• Low high-density cholesterol (HDL) levels

Metabolic syndrome increases the risk of developing cardiovascular disease, particularly heart failure, and diabetes itself. Some studies have shown the prevalence in the UK to be over a third of the adult population (1) and this increases with age.

We will see there are a number of ways in which we can use plants to reduce insulin resistance.

An immediate impact of increased insulin resistance is on the integrity of the endothelium, the cell wall lining of the blood vessels, and the single interface between blood and tissues at the capillaries.

The endothelium is the frontline in inflammation: this is where the white blood cells are activated and switch on inflammatory cytokines and other initiators. Many long-term complications of diabetes can be laid directly to the direct inflammatory pressures of insulin resistance.

Endothelial dysfunction leads to the following:

• Increased vascular endothelial growth factor (VEGF)
• Capillary basement membrane thickening
• Increased inflammatory cell adhesion
• Increased leptin and inflammatory adipocytokines (from increased fatty tissue)
• Increased inflammatory activity and cytokine concentrations
• Yet more insulin resistance

This in turn leading to the following pathological developments:

•  Oxidation-induced reduction in vasodilation
•  Reduced tissue perfusion and hypoxia
•  Impaired tissue oxidation – fatty infiltration and its pathological consequences
•  Adiposity

There was a recent dramatic illustration of the importance of this endothelial interface in early observations of the incidence of severe complications of Covid-19: that these were associated with health conditions (obesity, cardiovascular disease, diabetes) associated with insulin resistance and endothelial dysfunction.

We will see that there are promising plant based approaches to improving endothelial function.

The most distressing consequences of poorly managed diabetes follow from endothelial dysfunction and disruption in blood supply.

• Retinopathy: Damage to capillary blood supply to the retina, with the development of microaneurysms, retinal haemorrhages, and exudates; this progresses to a ‘proliferative’ phase with the presence of new blood vessels. Blindness is a possible outcome.
• Nephropathy: A persistent proteinuria which can progress to a decline in renal function and end-stage renal disease.
• Neuropathy: Various nerve pathologies with symptoms determined by the nerves involved.

Such macrovascular problems are associated with atherosclerotic plaque formation, affecting blood supply to the heart, brain, limbs, and other organs. Later stages involve complete obstruction of these vessels, which can increase the risks of wider cardiovascular disease, including myocardial infarction, stroke, and gangrene (leading to amputation).

As in the previous section there is considerable evidence that a number of important plant constituents can improve endothelial integrity, and there are indications that this may reduce the incidence of diabetic complications.

Fatty tissues are inherently inflammatory. Adipose cells secrete a variety of cytokines, known as adipokines, including leptin, tumour necrosis factor (TNF)-α, and plasminogen-activator inhibitor type 1 (PAI-1). Fat tissue is also a key regulator of C-reactive protein.

Adipokines generate a state of low-grade generalised inflammation resulting in pathological defects in metabolism and blood flow. These inflammatory agents have been shown as a major mechanism for inducing insulin resistance and diabetes (2).

We shall see that there is promising research pointers to benefits of spices in reducing adipokine activities and in reducing the consequent rises in insulin resistance.

It has long been confirmed that the most effective way to reduce diabetic complications is to bring down the raised levels of blood sugar that accompany the resistance to insulin.

The most useful first approach is to cut the rate at which glucose is produced and absorbed from food. This means at its simplest the reduction in amount of simple sugars, refined carbohydrates and alcohol in the diet and replacing them by complex, slow-release carbohydrates and proteins. To reduce complicating obesity and high cholesterol levels it also makes sense to cut back consumption of saturated fats.

A quick guide to the likelihood of a food pushing up blood glucose levels is its glycaemic index. This is defined by the American Diabetes Association as ‘a ranking of carbohydrates on a scale from 0 to 100 according to the extent to which they raise blood sugar levels after eating.’ Foods with a high GI are those which are rapidly digested and absorbed and result in marked fluctuations in blood sugar levels. Low-GI foods, by virtue of their slow digestion and absorption, produce gradual rises in blood sugar and insulin levels, and have proven benefits for health.

Low GI diets have been shown to improve both glucose and lipid levels in people with diabetes (type 1 and type 2). They have benefits for weight control because they help control appetite and delay hunger. Low GI diets also reduce insulin levels and insulin resistance.

A good GI Index is produced by the Harvard Medical School.

We shall see there are further ways in which we can reduce blood glucose levels using plant foods.

There are several categories of fibre.

• β-glucans such as cellulose in cereals, fruit, vegetables (in all plants in general)

and the mushroom glucans

• Hemicelluloses in cereals, bran, legume
• Lignin invegetables, fruits and cereals
• Resistant starch in barley, wheat, legumes, bananas, etc.
• Fructans such as inulin in onions, bananas, leeks, Jerusalem artichokes, and asparagus
• Polyuronides such as pectin in the fruit skins and vegetables, and alginic acids in agar and other algae

Various fibres are known to have laxative effects, and assist with cholesterol lowering (3). Specific glucose management effects include

• attenuated blood glucose responses (4,5,6)
• prebiotic benefits on gut microbiome (increased Bifidobacteria, Lactobacilli, Faecalibacteria) (7)
• increased production of glucose-sparing short-chain fatty acids (SCFAs) (8)
• increased incretins: glucagon like peptide (GLP-1), peptide YY (PYY) (9)
• reduced body weight (10)
• reduced lipogenesis, adipogenesis, adipocyte numbers and size, inflammation, oxidative stress (11)

Apart form increasing the amount of wholegrains, vegetables, pulses and fruit in the diet, high fibre remedies include linseed (flaxseed), psyllium seed and husk, ispaghula, guar gum, and agar agar.

Bitters have been used for their immediate effect in reducing sugar cravings associated with hypoglycaemic episodes.  They have also been components of traditional formulations in diabetes, accompanied by hyperglycaemia. It has even been possible to speculate from these experiences that such an ‘adaptogenic’ effect is linked with a capacity to modulate insulin release.

Bitter principles in plants activate a family of around 30 receptors (TAS2Rs) tuned to each detect multiple bitter substances (perhaps as a defence mechanism against poisons) and with a wide range of physiological consequences, including changes in digestive activity (12,13) and an increase in blood flow to the digestive tract (14).

They are found throughout the GI tract, airways, and other tissues (15), including pancreatic beta-cells. This latter location adds to the speculation that there is an explanation for the insulin modulating capacity of bitters.

Bitters have been shown to help manage glucose levels (16,17) with effects including the regulation of the hunger hormone ghrelin (18,19) increase in cholecystokinin (20) and regulation of key agents PYY and GLP-1 (21).

Classic bitter remedies associated with managing blood sugar levels include andrographis, neem, gentian root, wormwood, barberry bark (22) and golden seal.

There is increasing evidence that polyphenols, including flavonoids, anthocyanidins (the colours of fruits and vegetables), have a significant effect in glycaemic control (23), and on various aspects of metabolic syndrome (24,25).

In one trial daily cranberry juice (240 mL) consumption for 12 weeks and blueberry extract or powder supplementation (= 9-10 mg of anthocyanins) for 8 to 12 weeks showed a beneficial effect on glucose control in late-onset diabetic subjects (26).

In a major study (PREDIMED-Plus) involving observations over several years of 7447 elderly participants at high cardiovascular risk, polyphenol intakes were calculated from food frequency questionnaires. Analyses were stratified by sex and BMI groups (overweight and obese).

Consumption of polyphenols were inversely associated with incidence of type 2 diabetes, especially on women and those overweight (27). In a subgroup of 3430 elderly persons at higher cardiovascular risk in this same study, a high intake of total polyphenols was also associated with a reduced risk of diabetes (28).

There are several possible mechanisms for such benefits (29). A number of clinical trials point to an improvement of endothelial function in patients whose diets were supplemented with cocoa (30), green tea (31) and anthocyanin-rich berries (32,33,34).

Polyphenols are also prebiotic (35,36) and it may be that changes in gut microbiome can be a significant factor (37,38). The microbiota also process polyphenols (by cleavage into simple phenols) so that large molecules that are poorly absorbed become active modulators of inflammation (39).

Foods that are likely to be helpful in providing useful levels of polyphenols include berries, green tea and high-cocoa, low-sugar chocolate (which has been shown significantly to improve insulin sensitivity and lipid profile (40)), as well as a range of herbal products (41).

Common kitchen spices are showing increasing signs of being very important in the management of metabolic syndrome, blood sugar levels, and particularly vascular complications (42,43).

Cinnamon has been shown to directly regulate blood sugar levels (44,45), to reduce insulin resistance (46,47).

A beneficial effect of various spices on endothelial factors in diabetes is very likely (48).

Turmeric has been shown directly to interact with adipocytes to suppress adipokines. These curcumin-induced alterations reverse insulin resistance, hyperglycaemia, hyperlipidaemia, and other symptoms linked to obesity. Other structurally similar constituents derived from red chili, cinnamon, cloves, black pepper, and ginger, also exhibit effects against obesity and insulin resistance (49).

Turmeric, ginger and other spices also reduce inflammatory activity originating from adipose tissue (50,51)

Ginger has been shown to regulate blood sugar levels by increasing thermogenesis and lipolysis, suppressing lipogenesis, inhibiting intestinal fat absorption, and controlling appetite (52), as well as by reducing insulin resistance (53,54).

The Asian paradox

The rampant increase in the incidence of diabetes in India (55) and China suggests that a high daily spice intake is not sufficient protection against the condition. However the prevalence of peripheral vascular disease in these countries is lower than that reported in European populations (56,57). Levels of retinopathy approximately half that found in the west have been seen in India, Pakistan, Sri Lanka, China (58). This reduces the likelihood that this is due to genetic differences and reinforces the idea that there are dietary reasons, and that it is increased spice intake that reduces vascular complications of diabetes.

After basic exercise and low GI diet:

• Increase consumption in the diet of spices, especially cinnamon, turmeric and ginger.
• Increase polyphenol consumption: green tea, black currant, blueberry, pomegranate, with rewards of 70% chocolate, with any alcohol ration restricted to red wine!
• Ensure high fibre consumption, with supplementation by seaweed and seed sources.
• Consider supplements with spice extracts such as turmeric, and ginger (especially if extra heating appropriate) and also careful use of bitters.

All these measures are on the assumption that the diabetes is being managed without the use of insulin or other medical prescriptions. In these cases there needs to be more care, especially if glycaemic management is not stabilised, as too abrupt a change in regime might precipitate a glycaemic crisis. For the same reason it is not advisable to attempt to add to the management of Type 1 diabetes without careful coordination with medical professionals and monitoring of blood sugar levels.

1. Mainous AG, Tanner RJ, Baker R, et al (2014) Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study. BMJ Open 2014; 4: e005002.
2. Kwon H, Pessin JE. (2013) Adipokines mediate inflammation and insulin resistance. Front Endocrinol. 12 (4): 71.
3. Liu F, Prabhakar M, Ju J, et al. (2017) Effect of inulin-type fructans on blood lipid profile and glucose level: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Nutr. 71(1): 9-20.
4. Silva FM, Kramer CK, de Almeida JC, et al. (2013)  Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutr Rev. 71(12): 790-801.
5. Al-Mana NM, Robertson MD. (2018) Acute Effect of Resistant Starch on Food Intake, Appetite and Satiety in Overweight/Obese Males. Nutrients. 15;10 (12): 1993.
6. Lin Y, Huybrechts I, Vereecken C, et al. (2015) Dietary fiber intake and its association with indicators of adiposity and serum biomarkers in European adolescents: the HELENA study. Eur J Nutr. 54(5): 771-82.
7. Holscher HD. (2017) Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes. 8(2): 172-184.
8. van der Beek CM, Canfora EE, Kip AM, et al. (2018)  The prebiotic inulin improves substrate metabolism and promotes short-chain fatty acid production in overweight to obese men. Metabolism. 87: 25-35.
9. Klosterbuer AS, Thomas W, Slavin JL. (2012) Resistant starch and pullulan reduce postprandial glucose, insulin, and GLP-1, but have no effect on satiety in healthy humans. J Agric Food Chem. 60(48): 11928-34.
10. Clark MJ, Slavin JL. (2013) The effect of fiber on satiety and food intake: a systematic review. J Am Coll Nutr. 32(3): 200-11.
11. Rizkalla SW, Prifti E, Cotillard A, et al. (2012) Differential effects of macronutrient content in 2 energy-restricted diets on cardiovascular risk factors and adipose tissue cell size in moderately obese individuals: a randomized controlled trial. Am J Clin Nutr. 95(1):49-63.
12. Sternini C. (2007) Taste receptors in the gastrointestinal tract. IV. Functional implications of bitter taste receptors in gastrointestinal chemosensing. Am J Physiol Gastrointest Liver Physiol. 292 (2): G457-61.
13. 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. Horm Res Paediatr. 83(1): 1-10.
14. McMullen MK, Whitehouse JM, Towell A. (2015) Bitters: Time for a New Paradigm. Evid Based Complement Alternat Med. 2015: 670504.
15. Behrens M, Meyerhof W. (2006) Bitter taste receptors and human bitter taste perception. Cell Mol Life Sci. 63(13): 1501-9.
16. Palatini, K., Wilson, M., Alley, J., et al. (2015), Diverse Classes of Bitter Phytochemicals Modulate Carbohydrate Metabolism and Immune Responses through Gastrointestinal Bitter Taste Receptors. The FASEB Journal, 29: 405-5.
17. Dotson CD, Zhang L, Xu H, et al. (2008)  Bitter taste receptors influence glucose homeostasis. PLoS One. 3(12): e3974.
18. Janssen S, Laermans J, Verhulst PJ, et al. (2011) Bitter taste receptors and α-gustducin regulate the secretion of ghrelin with functional effects on food intake and gastric emptying. Proc Natl Acad Sci U S A. 108(5): 2094-9.
19. Calvo SS, Egan JM. (2015) The endocrinology of taste receptors. Nat Rev Endocrinol. 11(4): 213-27.
20. Jeon T-I, Seo Y-K, and Osborne TF (2011) Gut Bitter Taste Receptor Signaling Induces ABCB1 through a Mechanism Involving CCK. Biochem J. 15; 438(1): 33–37.
21. Posovszky, C, and 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.
22. Zhao Y, Yang YY, Yang BL, et al. (2021) Efficacy and safety of berberine for dyslipidemia: study protocol for a randomized double-blind placebo-controlled trial. Trials. 22(1): 85.
23. Rienks J, Barbaresko J, Oluwagbemigun K, et al. (2018) Polyphenol exposure and risk of type 2 diabetes: dose-response meta-analyses and systematic review of prospective cohort studies. Am J Clin Nutr. 108(1): 49-61.
24. Amiot MJ, Riva C, Vinet A. (2016) Effects of dietary polyphenols on metabolic syndrome features in humans: a systematic review. Obes Rev. 17(7): 573-86.
25. Raman G, Avendano EE, Chen S, et al. (2019)  Dietary intakes of flavan-3-ols and cardiometabolic health: systematic review and meta-analysis of randomized trials and prospective cohort studies. Am J Clin Nutr. 110(5): 1067-1078.
26. Rocha DMUP, Caldas APS, da Silva BP et al. (2019) Effects of blueberry and cranberry consumption on type 2 diabetes glycemic control: A systematic review. Crit Rev Food Sci Nutr. 59(11): 1816-1828.
27. Tresserra-Rimbau A, Castro-Barquero S, Vitelli-Storelli F, et al. (2019) Associations between Dietary Polyphenols and Type 2 Diabetes in a Cross-Sectional Analysis of the PREDIMED-Plus Trial: Role of Body Mass Index and Sex. Antioxidants (Basel). 8(11): 537.
28. PREDIMED study investigators. (2015) Intake of Total Polyphenols and Some Classes of Polyphenols Is Inversely Associated with Diabetes in Elderly People at High Cardiovascular Disease Risk. J Nutr. 146(4): 767-777.
29. Munir KM, Chandrasekaran S, Gao F, Quon MJ. (2013)  Mechanisms for food polyphenols to ameliorate insulin resistance and endothelial dysfunction: therapeutic implications for diabetes and its cardiovascular complications. Am J Physiol Endocrinol Metab. 305(6): E679-86.
30. Sun Y , Zimmermann D , De Castro CA , Actis-Goretta L . (2019) Dose-response relationship between cocoa flavanols and human endothelial function: a systematic review and meta-analysis of randomized trials. Food Funct. 10(10): 6322-6330.
31. Alexopoulos N, Vlachopoulos C, Aznaouridis K, et al. (2008)  The acute effect of green tea consumption on endothelial function in healthy individuals. Eur J Cardiovasc Prev Rehabil. 15(3): 300-5.
32. Amiot MJ, Riva C, Vinet A. (2016) Effects of dietary polyphenols on metabolic syndrome features in humans: a systematic review. Obes Rev. 17(7): 573-86.
33. Martini D, Marino M, Angelino D, et al. (2020) Role of berries in vascular function: a systematic review of human intervention studies. Nutr Rev. 78(3): 189-206.
34. Fairlie-Jones L, Davison K, Fromentin E, Hill AM. (2017) The Effect of Anthocyanin-Rich Foods or Extracts on Vascular Function in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients. 9(8): 908.
35. Igwe EO, Charlton KE, Probst YC, et al. (2019) A systematic literature review of the effect of anthocyanins on gut microbiota populations. J Hum Nutr Diet. 32(1): 53-62.
36. Bond T, Derbyshire E. (2019) Tea Compounds and the Gut Microbiome: Findings from Trials and Mechanistic Studies. Nutrients. 11(10): 2364.
37. Ejtahed HS, Angoorani P, Soroush AR. (2020) Gut microbiota-derived metabolites in obesity: a systematic review. Biosci Microbiota Food Health. 39(3): 65-76.
38. Houghton D, Hardy T, Stewart C, et al. (2018) Systematic review assessing the effectiveness of dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia. 61(8): 1700-1711.
39. Nash V, Ranadheera CS, Georgousopoulou EN, et al.(2018)  The effects of grape and red wine polyphenols on gut microbiota – A systematic review. Food Res Int. 113: 277-287.
40. Lin X, Zhang I, Li A, et al. (2016) Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Nutr. 146(11): 2325-2333.
41. Ejtahed HS, Soroush AR, Siadat SD, et al. (2019) Targeting obesity management through gut microbiota modulation by herbal products: A systematic review. Complement Ther Med. 42: 184-204.
42. Panickar KS. (2013) Beneficial effects of herbs, spices, and medicinal plants on the metabolic syndrome, brain, and cognitive function. Cent Nerv Syst Agents Med Chem. 13(1): 13-29.
43. Skulas-Ray AC, Kris-Etherton PM, Teeter DL, et al. (2011) A high antioxidant spice blend attenuates postprandial insulin and triglyceride responses and increases some plasma measures of antioxidant activity in healthy, overweight men. J Nutr. 141(8): 1451-7.
44. Namazi N, Khodamoradi K, Khamechi SP, et al. (2019) The impact of cinnamon on anthropometric indices and glycemic status in patients with type 2 diabetes: A systematic review and meta-analysis of clinical trials. Complement Ther Med. 43: 92-101
45. Deyno S, Eneyew K, Seyfe S, et al. (2019) Efficacy and safety of cinnamon in type 2 diabetes mellitus and pre-diabetes patients: A meta-analysis and meta-regression. Diabetes Res Clin Pract. 156:107815
46. Sheng X, Zhang Y, Gong Z, et al. (2008) Improved Insulin Resistance and Lipid Metabolism by Cinnamon Extract through Activation of Peroxisome Proliferator-Activated Receptors. PPAR Res. 2008:581348.
47. Qin B, Panickar KS, Anderson RA. (2010) Cinnamon: potential role in the prevention of insulin resistance, metabolic syndrome, and type 2 diabetes. J Diabetes Sci Technol. 4(3): 685-93.
48. Azimi P, Ghiasvand R, Feizi A, et al. (2016 Effect of cinnamon, cardamom, saffron and ginger consumption on blood pressure and a marker of endothelial function in patients with type 2 diabetes mellitus: A randomized controlled clinical trial. Blood Press. 25(3):133-40.
49. Aggarwal BB. (2010) Targeting inflammation-induced obesity and metabolic diseases by curcumin and other nutraceuticals. Annu Rev Nutr. 30:173-99.
50. Woo HM, Kang JH, Kawada T, et al. (2007) Active spice-derived components can inhibit inflammatory responses of adipose tissue in obesity by suppressing inflammatory actions of macrophages and release of monocyte chemoattractant protein-1 from adipocytes. Life Sci. 80(10): 926-31
51. Ebrahimzadeh Attari V, Ostadrahimi A, Asghari Jafarabadi M, et al. (2016) Changes of serum adipocytokines and body weight following Zingiber officinale supplementation in obese women: a RCT. Eur J Nutr. 55(6): 2129-36
52. Ebrahimzadeh Attari V, Malek Mahdavi A, Javadivala Z, et al. (2018) A systematic review of the anti-obesity and weight lowering effect of ginger (Zingiber officinale Roscoe) and its mechanisms of action. Phytother Res. 32(4): 577-585
53. Li Y, Tran VH, Kota BP, et al. (2014) Preventative Effect of Zingiber Officinale on Insulin Resistance and its Mechanism of Action. Basic Clin Pharmacol Toxicol. 115 (2): 209-215.
54. Mahluji S, Attari VE, Mobasseri M, et al.(2013) Effects of ginger (Zingiber officinale) on plasma glucose level, HbA1c and insulin sensitivity in type 2 diabetic patients. Int J Food Sci Nutr. 64(6): 682-6.
55. Ramachandran A, Snehalatha C. (2009) Current scenario of diabetes in India. J Diabetes. 1(1): 18-28.
56. Premalatha G, Shanthirani S, Deepa R, et al.(2000) Prevalence and risk factors of peripheral vascular disease in a selected south Indian population. Diabetes Care. 23: 1295–300.
57. Ramachandran A, Snehalatha C, Satyavani K et al. (1999) Prevalence of vascular complications and their risk factors in type 2 diabetes. J Assoc Physicians India. 47: 1152–6.
58. Narendran V, John R K, Raghuram A. (2002) Diabetic retinopathy among self reported diabetics in southern India: a population based assessment. Br J Ophthalmol 86(9): 1014–1018

Oestrogen is a catabolic sex hormone that has a large array of roles and influences including reproduction, digestion, mood, fat-balance, fluid ratios, skin pigmentation, breaking down muscle mass that leads to an increase in body fat and aromatase. Testosterone, and to a slight degree progesterone, are anabolic sex hormones that promote lean body mass.

Aromatase is an enzyme that is found in oestrogen-producing cells located in the adrenal glands, ovaries, placenta, testicles, brain and fat tissue. Higher levels of aromatase in the body convert more testosterone and progesterone into oestrogen. With the increased prevalence of Environmental Endocrine Disruptors, we are exposed to multiple triggers for endocrine disruption.

Elevated aromatase activity and oestrogen dominance are some of the most common factors associated with breast, uterine and ovarian cancers in women. Prostate, colon and breast cancer in men are associated with oestrogen dominance. Other symptoms include PMS symptoms, cervical dysplasia, uterine fibroids, endometriosis, decreased libido, fatigue, fibrocystic breasts, headaches, infertility and weight gain.

Cruciferous veggies

Cruciferous vegetables such as broccoli, cauliflower Brussel sprouts and cabbage contain several powerful nutrients that help metabolise oestrogenic molecules. These nutrients include Indole-3 Acetate, Indole-3 Carbonyl and Diindolylmethane. These cruciferous veggies also contain sulfur containing nutrients such as Sulfurophane and Phenyl Isothiocyanates that enhance liver detoxification processes and destroy cancer cell formation.

Broccoli sprouts 50-100g/day are a good way to get this.

Healthy fat-rich foods

These are foods that are rich in saturated and omega-3 fatty acids. It includes plant based fats such as coconut oil, hemp seed oil, extra virgin olive oil and avocados. Raw nuts (other than peanuts) and seeds contain oestrogen balancing plant sterols. Organic poultry, wild-caught salmon, wild game and 100% grass-fed beef are the best animal-fats for healthy hormone function.

Allium family

The alliums include garlic, onions, scallions, chives and leeks. These are all rich in sulfur-containing amino acids and the powerful flavone anti-oxidant quercetin that both help the liver detoxify and reduce the production of oestrogen.

Flavone rich herbs

Dietary flavones and flavonones have been demonstrated to be the most potent aromatase-inhibitory flavonoids. The most powerful flavones include chrysin which is found in passionflower and apigenine which is found in chamomile.

Flavonones

These are found in citrus fruits and in particular lemons and limes. They are classically called citrus bioflavonoids and they include diosmin, hesperidin, rutin, naringin, tangeretin, diosmetin, narirutin, neohesperidin, nobiletin and quercetin.

Antioxidant-rich herbs

Herbs such as oregano, thyme, rosemary, sage and turmeric are loaded with volatile oils that promote liver detoxification. Turmeric has a potent ability to destroy oestrogen receptor positive cancer cells which are the most commonly found cells in breast, uterine, ovarian and prostate cancer.

Chlorophyll

One of the most powerful life-giving substances on the planet is chlorophyll. This is the pigment that gives green foods their color. Chlorophyll-rich foods have a very deep green color and they are extraordinarily useful in purifying the body of toxins.



Fermented foods

These contain organic acids, anti-oxidants, enzymes and probiotics that enhance gut function and eliminatory channels. Fermented veggies include sauerkraut, kimchi and fermented soy.

Lignans

Using 2 tablespoons of freshly-ground flaxseed everyday helps to establish a healthy oestrogen balance.

Herbal teas

Green tea and Licorice specifically balance oestrogen levels. 

Mushrooms

All mushrooms regulate aromatase and regulate oestrogen levels. Use shitake, maitake, button, cep.

Lentils

All lentils contain appreciable amounts of phyto-oestrogens that help to balance oestrogen-progesterone levels. Soy is well known for this but all pulses are helpful.

Growing the Matcha under shade increases the volume of healing chlorophyll as well as the L-Theanine, amino acids and polyphenols such as EGCG (epi-gallo-catechin-gallate). These natural compounds add to the sweet and savoury-mineral flavour, known as umami- umami, helping to reduce the bitterness of the iridescent green Matcha.

The rare amino acid L-Theanine helps to nourish neurotransmitters in the brain having a positive influence on our mood and sense of inner peace. L-Theanine works synergistically with the low levels of caffeine in green tea and Matcha; it is one of the reasons why it brings such a deep sense of calm as well as alertness. (L-Theanine is five times higher in Matcha than green tea). It actually increases serotonin, dopamine and GABA – all essential neurotransmitters associated with the feel-good factor bringing happiness, inner peace and the general all-round clarity of shanti-ness.

We all know that these qualities help us feel at our best in the midst of our over-stimulated world because they help us focus and feel centered. These more subjective experiences flow into measurable affects such as lowering blood pressure, reducing anxiety and influencing alpha-waves (associated with a relaxed state of mind and also regulated by deep meditation).

We get these effects because humans and plants have evolved so closely together. We can benefit from eating plants that have developed these special compounds because they evolved the ability to protect themselves from invasion by microbes as well as adapting to stressful environments to be successful reproducers.

For example, many of the colourful pigments in plants that protect them from extreme climates help protect us from extreme stresses. It’s now well known that the traditional Indian diet full of healthy spices such as turmeric, cinnamon and ginger help to protect from inflammatory disorders such as heart disease and cancer that are the scourge of modern healthcare.

And green tea is a powerful addition to this protective diet with matcha being the king of all green tea protectors; one cup of Matcha has 100 times the antioxidants compared to green tea (and green has about double the levels in black tea).

Gram for gram it is about 15 times more antioxidant than pomegranates and 100 times more than spinach. So a little goes a long way.

In fact a little can help you to become a little more little because Matcha also helps to burn body fat through a process known as thermogenesis. By enhancing metabolic processes the nearly calorie-free Matcha helps you burn fat four times faster than your usual metabolism.

It’s also important to ensure your Matcha and your green tea (and black for that matter) are organic. Conventionally grown tea has had numerous reports of its pervasive contamination with fat-stored and life-depleting pesticides and herbicides.

This has recently been highlighted by a report by Greenpeace India ‘Trouble brewing: Pesticide residues in tea samples from India.’

Green tea and Matcha don’t have a long history of use in India as the British introduction of the sweet-milky chai has had a more prominent place. Whilst a masala-chai from our favourite chai-wallah is a delight, it’s now questionable if so much sugar and milk are actually healthy.

Perhaps it’s worth reflecting on the goal of Ayurveda; ‘swasta samatva’ or ‘to be established in yourself with balanced health’ and consider how you can include some delicious, uplifting and even spiritual Matcha in your daily experience of drinking some green gold.

• Brunswick Laboratories, Lipophilic and Hydrophilic Antioxidant Capacities of Common Foods in the United States, Journal of Agricultural Food Chemistry 2004, 52, 4026-4037 // ORAC Analysis on Matcha Green Tea.
• Ferrucci et al, Measurement of spices and seasonings in India: Opportunities for cancer epidemiology and prevention, Asian Pac J Cancer Prev . 2010; 11(6): 1621–1629.
• Greenpeace India 2014, Trouble Brewing: Pesticide residues from tea sample in India.
• Hutchins-Wolfbrandt et al,Dietary Turmeric Potentially Reduces the Risk of Cancer, Asian Pacific J Cancer Prev, 12, 3169-3173.
• Mason, R. 200 mg of Zen. L-Theanine Boosts Alpha Waves, Promotes Alert Relaxation. Alternative and Complementary Therapies 2001.
• Weiss, D.J. et al. Determination Of Catechins In Matcha Green Tea By Micellar Electrokinetic Chromatography. Journal of Chromatography. 2003; 1011(1-2): 173-180.

Doses for sweet

• Low: Restores homeostasis
• Medium: Nourishes vata nervous system, has a mild laxative action and cools pitta via its anti-inflammatory effect
• High: Calms the CNS, alleviates vata and relieves pain whilst also aggravating kapha

Doses for sour

• Low: Stimulates the appetite but may aggravate pitta acidity
• Medium: Moistens dryness and benefits undernourished vata but aggravates pitta inflammatory tendency
• High: Contracts the organs

Doses for salty

• Low: Stimulates digestion and can aggravate pitta acidity
• Medium: Moistens dryness but can aggravate kapha tendency to fluid retention and is a mild laxative thus benefiting vata‘s tendency to dryness and constipation
• High: Breaks accumulations, can cause vomiting and diarrhoea and aggravates all three doshas

Doses for pungent

• Low: Stimulates digestion and increases digestive fire agni
• Medium: Stimulates circulation, penetrates the tissues and can aggravate pitta acidity
• High: Causes sweating, dries sticky ama and dries fluids, therefore aggravating vata and pitta

Doses for bitter

• Low: Stimulates digestion, clears stagnant kapha and awakens the nervous system
• Medium: Detoxifies the liver and blood
• High: Drains downwards through the bowel and bladder, cools the system, clears pitta, slows digestion and aggravates sensitive vata

Doses for astringent

• Low: Cleans the mucus membranes and clears kapha and pitta
• Medium: Holds tissues and organs in place
• High: Binds and constricts the movement of blood, liquids and prana in the channels, thus aggravating vata

Adults (12-60 years old)

Medicinal tea hot infusion (Phantha): 30-60ml of a 1:8 infusion 3 x daily. This means 5g of herbs in 40ml hot water infused with a lid on for an hour. Another method is a 1:16 ratio; soak 30g dried herbs in 500ml freshly boiled water and leave to infuse for 4+ house. Very good for nutrient dense herbs such as Nettles, Red clover, Clovers etc. For a regular cup of supportive herbal tea the ratio is 1:100 (2g in 200ml).

Medicinal tea cold infusion (Hima): 30-60ml of a 1:6 infusion 3 x daily. This is useful for mucilagenous plants such as marshmallow root and some aromatics.

Medicinal tea hot decoction (Kvatha): 30ml of a 1:16 reduced to 4 parts 3x daily. This method is best for roots, resins – and generally ta good way to take herbs. Main method used in Traditional Chinese Medicine and Ayurveda.

Pills / tablets / gugguls: 250-500mg 2-3 x/day

Tincture: Average dose of 1-15ml of a 1:5 ratio 3x/day or 1-9ml of a 1:3 ratio 3x/day. A good method to extract a broad range of the polar and non-polar compounds from flavonoids to volatile oils to fatty-resins. Most common method used by Western herbalists and phytotherapists.

Children (5 – 12 years old)

There are some specific rules for determining dosages for children. Age is one consideration, weight is another, and physical constitution is another. Slight or frailer vata-like children require less. Heavy or robust more kapha-like children can use more. Use your intuition and their weight as guides. Dr. Clark’s Rule is very helpful:

To determine the appropriate fraction of an adult dose, divide the weight of the child in kilos by 75. Example: 25Kg child divided by 75 = 1/3. Therefore the child’s dose is 1/3 of the adult dosage.

Another method is Cowling’s dose: Divide the age at the next Birthday by 24 to determine the fraction of dose.

Rules of thumb doses for children:

• 12-year-olds get an adult dose
• 6-year-olds get ½ an adult dose
• 3-year-olds get a ¼ adult dose

Fats are divided into saturated and un-saturated fats.

Saturated fats

Saturated fats are made from short, medium and long chain fatty acids (also known as triglycerides). Short and medium chain fatty acids are easy to digest whereas long chain fatty acids are not. The short and medium chain fatty acids are absorbed in the upper part of the small intestine, not requiring the liver or gall-bladder for digestion and are used immediately for energy.

Long chain fatty acids have to go through a much more complex process involving being broken down by bile acids and pancreatic lipase into glycerol and free fatty acids. These are absorbed and then reconstitution into triglycerides which need to be bonded with a lipoprotein before they are transported to a site that can use them. This process takes up to 8 hours before they are stored as fat before becoming energy.

Excessive consumption of long chain fatty acids is associated with blood clotting, thrombosis and cancer. Medium chain fatty acids are known to increase metabolism and promote weight loss. Short chain fatty acids help to promote the production of hormones and strengthening cellular membranes. Ghee is high in short chain fatty acids, whilst coconut oil is high in medium chain fatty acids. Commercial margarines, lard and butter are high in long chain fatty acids.

What is the fad with fat?

Saturated fats have a bad public image as excessive consumption of them has become associated with an increased risk of high cholesterol, atherosclerosis, stroke and coronary heart disease. The Seven Countries Trial which began in the late 1950s, was set up to determine the causes of Coronary Heart Disease (CHD). It associated CHD with saturated fats and this has led to a host of ‘low-fat fads’ and an entire low fat industry.

This study is now largely discredited as is the association between saturated fat intake and CHD. Just think what the Eskimos eat…lots of saturated seal and whale blubber. Before westernisation the incidence of CHD amongst traditional Eskimo communities was virtually zero. Another example is Japan, where the rate of saturated fat is increasing but CHD is falling.

The causes of heart disease are much more complex then the ‘fat-heart disease’ hypothesis and involves a balance between the forces of degeneration and the energy of protection including genetic tendency, life-style factors, anti-oxidant status, stress, hostility, hypertension, exercise, sugar metabolism, correct LDL/HDL balance and, of course, dietary factors ensuring sufficient vitamin C, E, soluble fibre, EFAs, flavonoids and carotenoids.

One of the reasons for the controversy regarding the ‘fat-heart disease theory’ is that much research has not differentiated between true saturated fats and synthetically generated saturated transfatty acids. However, this is a misunderstanding of the nature of the saturated fats as some, containing high levels of short and medium chain fatty acids are healthy, such as ghee and coconut oil.

Also many of the saturated fats that people eat come from animals raised in intensive farming where they are grain fed. This leads to a reduction in the heart healthy Omega-3 Essential Fatty Acids made available to grass fed animals. This confusion that all ‘fats’ lead to high cholesterol has led people to embrace a ‘low-fat’ diet which may result in low cholesterol.

Low cholesterol levels and fat free diets have been associated with depression, and violence. Cholesterol helps us ‘feel good’ as it is an important component of serotonin receptors. Cholesterol also helps us to produce essential hormones such as Vitamin D, oestrogen and adrenaline.

So, saturated fats are important to health, benefiting certain specific metabolic functions, cellular interactions and immune responses. Used at an appropriate quantity and with good quality polyunsaturated essential fatty acids they are beneficial to health. My favourite saturated fats are coconut and ghee as they are easy to digest and have numerous health benefits. (Knopp 2004, Lancet 1992)

Unsaturated fats

Unsaturated fats are divided into monounsaturated fats (olive, mustard) and polyunsaturated fats (sesame, sunflower, flax, corn, hemp). Both are required for healthy life. Polyunsaturated fats (PUFAs) are ‘unstable’ oils. If they are not handled properly they can pose a health risk as their cell structure leaves many ‘bond’ sites that are potential sites for oxidisation to occur. They easily go rancid. Essentially this means that under poor processing and storage conditions (i.e. heat and light) they can become oxidised, a process similar to metals rusting, which allows for the release of free radicals in the body. This leads to accelerated ageing and other degenerative diseases.

Interestingly, sesame oil does not become oxidised under heat as its linoleic acid content actually improves its anti-oxidant status but hemp seed does oxidise easily under heat and light which is why it should not be used for cooking.

So, polyunsaturated fats that are handled properly (cold pressed, kept cool, stored away from light) are extremely beneficial for health. If they are not, i.e. when they are processed and stripped of their inherent protective anti-oxidants, then they can create Lipid Oxidation Products (LOPs). As they are toxic to cells, they can damage the lining of the arteries which increases the risk of heart disease and they use up valuable anti-oxidant reserves leaving us exposed to free radical damage.

Because of the way they are processed and handled most commercial, non-organic, PUFAs (sunflower, corn etc.) contain levels of LOPs and so should never be used for frying as this will create more oxidation. Olive oil as a mono-unsaturated fatty acid contains minimal amounts of LOPs and is safe for cooking. However, no oil should ever be re-used as it will harm your health.

Fats and carbs

If carbohydrate or fat consumption exceeds your needs then the glucose-like molecules are stored as glycogen reserves for potentially needed energy release in the muscles and liver. If the glycogen bank is full then the overflow gets laid down as fat molecules in the fat cells. As you reduce your dietary intake and/or increase metabolic needs, fat gets converted back to glycogen. As glycogen gets broken down water is also lost in a ratio of 1 part glycogen to 9 parts water. This is why fasting can bring about rapid weight loss but as food is resumed then glycogen levels go back up and an increase in water retention returns.

Calories

Counting calories is one method of monitoring how much ‘energy’ you are putting into yourself. Men require approximately 2,500 calories/day and women 2,000. One pound of fat is created from 4,000 calories. Whilst calorie counting may be useful for raising awareness of the nutritional components of the food you eat it does not consider the individual metabolic rate which is at the crux of all healthy weight diet and life-style regimes.

Glycaemic Index (GI)

The Glycaemic Index describes how the body’s sugar levels respond to certain foods. It has become an important indicator of how certain foods will affect weight loss and diabetic control. Foods with a low GI release sugar into the bloodstream slowly whilst those with a high GI can cause a rapid increase. Glucose and refined sugars have the highest GI and whole grains and lentils the lowest.

Insulin resistance

Insulin is the hormone that allows for the absorption of various nutrients including glucose and amino acids and keeps the blood sugar within ‘normal’ limits. Whilst insulin production is stimulated by eating carbohydrates it can also reduce the metabolism of fats and proteins thus leading to greater storage of fats. It is estimated that 8 out of 10 overweight people have a blood sugar imbalance including possible insulin resistance.

The term “insulin resistance” means that your body cells are more resistant to the action of insulin than normal. If you are insulin resistant, your pancreas has to make more insulin to keep your sugar normal. As long as your pancreas can meet the excess demand placed upon it, you are OK. If your pancreas cannot keep up with the increased demand, your blood sugar will rise and you will become diabetic.

Evidence points to an inherited abnormal form of insulin that is inefficient at regulating blood sugar levels. There also appears to be a problem with the insulin receptor not allowing insulin to facilitate the entrance of glucose into the cell.

It is fairly easy to determine whether someone is insulin resistant. One of the most common ways to find out is simply to measure the fasting blood sugar and fasting insulin level in the morning. It is also possible to undergo a Glucose Tolerance Test, measuring both blood sugar levels and insulin levels. If the insulin levels are higher than they ought to be, this indicates insulin resistance.

Insulin resistance is affected by:

• A high GI diet as these foods promote the release of high levels of insulin
• A high fat diet helps to lower the GI by slowing digestion and delaying the entrance of sugars into the blood stream
• Excessive insulin secretion creates a negative cycle through over-stimulation. When a cell is exposed to high levels of insulin it starts to alter its relationship with insulin and reduce the number of insulin receptors. This leads to lower levels of fat breakdown and leads to obesity
• Mineral deficiency in chromium and magnesium (also zinc and B vits)
• Obesity creates insulin resistance and insulin resistance creates obesity

Insulin resistance leads to ‘hyperinsulinemia’. It is another vicious cycle. As a tissue becomes increasingly insulin resistant, the uptake of blood glucose becomes more inefficient. As a result, blood glucose levels begin to rise and continue to be raised over ever increasing periods of time. The pancreas, in its efforts to effectively store the glucose, responds by secreting progressively higher levels of insulin. When this pattern occurs insulin levels are higher for longer such that the total hours of insulin exposure in the body may be increased to 50-100% beyond that of normal.

Hyperinsulinemia can cause:

• Sodium metabolism disruption, increased water retention and hypertension
• Oxidative damage and initiation of atherosclerosis and neoplasia (cancer)
• Decrease in the total daily secretion of growth hormone with negative effects throughout the body.One notable effect of this is to inhibit the conversion of the inactive thyroid hormone (T-4) to its active form (T-3). This creates a “functional hypothyroidism,” which is difficult to detect because a routine thyroid blood test will display an otherwise normal level of circulating thyroid hormones
• Compensatory hypercortisolemia (high blood cortisol levels), poor tolerance to stress, depressed immunity, and eventually, adrenal exhaustion
• Chronic, high levels of insulin secretion will eventually exhaust the beta cells of the pancreas, increasing the likelihood of a functional deficit of these tissues, resulting in adult-onset diabetes

The dreaded transfatty acids have become synonymous with poor quality foods and bad health. They are formed when certain polyunsaturated oils are intentionally saturated with hydrogenation under high temperature to make solid fats (an oil is liquid at room temperature and a fat is solid).

The technique of creating transfats was developed in the early 1900s in order to extend the shelf-life of unstable fish and vegetable oils. Widespread introduction of transfats into commercial foods began just after the 1920s with disastrous effects. Because of their harmful effects on health the recommendation to remove them from foods is now being legislated around the world.

Transfatty acids are associated with an accumulation of the potentially harmful LDL, the increased risk of heart disease, prostate cancer, diabetes, fertility and liver dysfunction. Transfats are ‘oxidised’ fats and create harmful free radical generating substances called lipid peroxides. Lipid peroxides (oxidised lipids) actually take up residence on cell walls and obstruct the correct working metabolisms of cells. As they interfere with the delta-6-desaturase enzyme conversion of Omega-3 and Omega-6 fatty acids into inflammation modulating prostaglandins they obstruct this crucial protective process.

Transfatty acids can:

• Increase cancer risk factors by disrupting liver detoxification of carcinogens, change B and T immune cell ratios, interfere with the functions of cancer protecting fatty acids
• Elevate cardiovascular risk factors by increasing total cholesterol levels and potentially harmful LDL cholesterol, lowering protective HDL cholesterol, make platelets more likely to stick to together to form a clot, increase the strongest known risk factor for cardiovascular disease (lipoprotein)
• Interfere with insulin function hence increasing the risk of diabetes
• Disrupt fertility by decreasing testosterone and increasing abnormal sperm
• Be associated with low birth weight babies and lower human breast milk quality
• Interfere with essential fatty acids metabolism
• Interfere with nutrient absorption by reducing Vitamin K absorption

PUFAs contain the fragile Essential Fatty Acids (EFAs) which are found in high concentration in the cells of our brain, nervous system and skin. The cell membranes of the 63 trillion cells we have in us all contain EFAs.

There are three types of EFAs:

1. Omega-3 fatty acids, including alpha-linolenic acid
2. Omega-6 fatty acids, including linoleic acid and gamma-linolenic acid
3. Omega-9 fatty acids, including oleic acid

Examples of some Omega containing oils are;

• Fish oil is all Omega-3
• Flax oil is 60% Omega-3 and 20% Omega-6
• Hemp seed oil is 20% Omega-3, 60% Omega-6, 12% Omega-9 oleic acid and 3% GLA totaling more than 90% unsaturated fatty acid.

We need the EFAs Omega 3 to 6 in a certain ratio. The ratio of 1:3 is considered ideal for health (the ratio is debated, but this is the current most accepted figure). This is the ratio that hemp seed has. Flax has the opposite ratio, which can be beneficial for redressing imbalances in the short-term but not for long-term health as it can lead to omega-6 deficiencies. Commonly people have a ratio of 1 to 10 or 20 Omega 3 to 6! This is because animal fats and many commonly used vegetable oils (soy, corn, safflower, peanut and sesame) are high in Omega 6.

Cells that have a rapid evolution, such as those in the skin, immune and nervous systems, and in growing babies and children, need lots of essential fatty acids to stay healthy. It is vitally important that the correct ratio of Omega 3 to 6 is received or imbalances will occur.

Mental health

60% of the weight of our brain, the fat-richest organ in our body, is fat, and one third of that is EFAs. The ratio of omega 3s to omega 6s in the brain is 1:1. EFAs have been shown to help ADHD, Schizophrenic symptoms, Alzheimer’s disease and senile dementia, Parkinson’s, Lou Gehrig’s disease (ALS), and multiple sclerosis.

Skin health

EFAs help to moisten and nourish the skin preventing dry and flaky skin. As EFAs help form cell membranes they help to keep moisture in the skin and keep cell membrane function at optimum levels. This can positively influence eczema, psoriasis and other inflammatory skin conditions.

Women’s health

EFAs help to reduce Arachidonic Acid levels which can help to reduce menstrual pain. Its mood balancing qualities can also help with PMS.

Fertility

Pregnant women need a larger intake of EFAs to nourish their child, and this need increases with each extra child. Low EFA levels are also associated with post partum depression and some diseases that have a higher incidence in women; multiple sclerosis, thyroiditis, fibromyalgia and lupus. EFAs also help build male fertility through boosting sperm quality and quantity.

Blood

An important function of EFAs is that they make red blood cells more flexible, which means that they can find their way through capillaries more easily. The result is that tissues and cells receive their supply of nutrients and oxygen more effectively, and stamina therefore increases. EFAs also assist in the transport of oxygen and essentially draw oxygen into the cells.

Weight

Getting up to 12% of your diet from EFAs can actually help you to loose weight as EFAs help with our metabolism.

Cardiovascular health

EFAs can reduce blood lipid triglycerides by 65% and have been shown to increase HDL and lower LDL in some people. However they are not sufficient on their own to achieve this in everybody and should be used as a part of a cholesterol reducing programme if this is indicated. They also make platelets less sticky which can reduce the chance of blood clots arising.

Immunity

EFAs are involved in the correct functioning of the DNA and so may help prevent cancers, enhance wound healing and protein metabolism that are so essential for correct immune function. Another important role is that EFAs make hormone-like prostaglandins. There are different forms of prostaglandins, which can either reduce inflammation or be pro-inflammation depending on the source and quality of oil and how it is metabolised in the body. Beneficial prostaglandins (PGE 1 and 3) work to;

• Protect the skin and joints from inflammation
• Reduce cholesterol levels, dilate blood vessels and reduces blood pressure
• Protect integrity of blood vessels and prevent platelet aggregation
• Reduce auto immune inflammation; psoriasis, lupus, crohn’s disease
• Help to reduce menstrual pain
• Reduce the complications of diabetes
• Keep cells functioning properly and reducing cancerous behaviour 

If there is not enough Omega-3 in the diet then the prostaglandin metabolites will convert Omega-6 into a pro-inflammatory Arachidonic Acid process. (Simopoulos 1999, Cullis 1991, Grimble 1998, James 2000)

Omega-3 oils are medium chain fatty acids that are metabolised to long-chain eicosapentaenoic acid (EPA) and decosahexaenoic acid (DHA). EPA, is an Omega-3 derived fatty acid that is a precursor to the eicosanoids; prostaglandin-3, leukotrine-5 and thromboxane-5.  It is associated with a healthy inflammatory, nervous and emotional balance. DHA is another Omega-3 derived fatty acid associated with brain health, retina health, foetal development and immunity.

Omega-3 deficiency leads to dry skin, growth retardation, weakness, impaired learning ability, poor motor coordination, behavioural changes, impaired vision, high blood pressure, sticky platelets, oedema, mental deterioration, low metabolic rate, and immune dysfunction

Nothing in itself, it’s just that we have too much of it in our diets. Although Omega-6 is an EFA, and we need a certain amount of it, unfortunately Omega -6 linoleic acids in excess to Omega-3 can create Arachidonic Acid which can cause an inflammatory cascade disrupting the health of the skin, brain, nervous system, fertility, joints and circulatory system. Excess poor quality Omega-6 linoleic acids in our diet are potentially a causative factor in the increase in heart disease in ‘developed countries’ over the last 90 years.

Some authorities believe that we should be aiming for a 1:1, Omega-3:6 ratio in our diet to redress the imbalances we face from long-term destabilisation in our fatty acid profile.  Others recommend a ratio of 1:3.

Some suggestions for achieving this are (Wallace 2002):

1. Restrict intake of animal-based foods: Meat, dairy, poultry as they are dietary sources of Arachidonic Acid and are precursors to inflammatory PGE2, LTB4, 5-HETE, and 12-HETE
2. Substantially increase dietary sources of omega-3 polyunsaturated fatty acids (PUFAs) ensuring sufficient levels of eicosapentaenoic acid and docosahexaenoic acid that block metabolism of Arachidonic Acid
3. Limit intake of plant-source omega-6 PUFAs, targeting a 1:1 ratio of w3 to w6 PUFAs in severe disease. This helps to prevent enzyme competition and reduce the inadvertent shunt to Arachidonic Acid and inflammatory eicosanoids
4. Increase dietary antioxidants: 7 to 9 servings a day of deeply pigmented fruits and vegetables. This reduces oxidative biosynthesis of inflammatory eicosanoids and isoprostanes
5. Eliminate hydrogenated and trans-fatty acids, alcohol, simple sugars, and refined carbohydrates, and reduce elevated cholesterol levels as these are inhibitors of the desaturase enzyme responsible for converting EFAs to EPA/DHA
6. Ensure adequate intake of zinc, magnesium, ascorbate, niacin, and pyridoxine as these are coenzymes for desaturase metabolism of omega-3 PUFAS
7. Optimize blood glucose regulation: Address hyperinsulinemia as excess insulin shifts dihomogammalinolenic acid toward PGE2 synthesis
8. Provide a combination of several anti-inflammatory botanical agents that help to modulate the inflammatory cascade through multiple and synergistic actions, including COX and LOX inhibition.
9. Monitor inflammatory markers (e.g. C-reactive protein, ceruloplasmin) at baseline and interval and adjust protocol as required

Some authorities (in the fish oil industry?) have said that vegetarian sources of Omega-3 alpha-linolenic acid cannot be efficiently converted into EPA and DHA. However, two studies published in the British Journal of Nutrition which measured the conversion of alpha-linolenic acid (ALA) into EPA, DPA, and DHA have shown otherwise. The first study, carried out with six women, showed that these women converted an average of 36% of the ALA they were given into long-chain Omega-3 derivatives (21% EPA, 6%DPA, 9%DHA).

The second study, done with six men, showed that the men converted an average of 16% of the ALA they received into long-chain Omega-3 derivatives (8%EPA, 8%DPA). In this study, the men produced no DHA. However, another study showed that men convert ALA to DHA as well. It is considered that men can convert 1% of ALA to DHA (Burdge 2002, Emken, Brenna 2002).

It is surmised that women have a better conversion rate as they need to metabolise EPA and DHA for their children as well.

What can influence conversion?

• Too little ALA or Omega-3 intake
• High Omega-6 intake interferes with conversion of Omega-3
• Lack of the vitamins B3, B6 and C and the minerals zinc, calcium, biotin and magnesium necessary for assisting conversion of ALA to EPA and DHA
• Toxic influences
• High carbohydrate diets slow down conversion
• Diets higher in proteins enhance conversion.
• Diets high in saturated or transfats blocks conversion
• Too low a ratio, such as 1 to 10 Omega-3:6 (the average found in Western diets) can lead to symptoms of Omega-3 deficiency. Omega-3 deficiency increases the risk of increasing cardiovascular, immune, autoimmune, diabetic, and inflammatory disease, and leads to sub-optimal intelligence, concentration, mood, and performance. In the two conversion studies published in the BNJ, the diet contained only 1/7^th as much Omega-3 as Omega-6. A better ratio would consist of more Omega-3 and less Omega-6 to redress this imbalance

The global fish stocks are hugely depleted and as it takes 1000Kg of fish to make 1Kg fish oil using fish oil as a health product is not advisable due to the damage it inflicts on our ocean fish stocks. Secondly, our seas are highly polluted. Taking fish oils increases the chance of industrial pollutant toxicity from mercury, dioxins and polychlorinated biphenyls (PCBs). As these toxins tend to accumulate in the fatty parts of fish they are concentrated in the fish oils. They are implicated with a range of diseases from increased aging to neural disorders to cancer.

It is also interesting that the Omega oils and there derivatives ALA and LA are not actually found is fish oils. However EPA and DHA are, but these are metabolised from the ALA and LA found in micro-algae present in the sea. There are all sorts of risks associated with the processing and storage of EPA and DHA due to their tendency to oxidise as they are 5 times less stable than ALA.

So, vegetarian sources are more ethical, more stable and very effective sources of Omega oils.

The National Institute of Health in the US published a report that on average we should have 3% Omega-6 and 1% Omega-3 and 0.3% EPA and DHA as a total of our calorific diet. Pregnant women are recommended to have 650mg/day of EPA and DHA/ day. Other sources recommend 600mg EPA and 400mg DHA per day.

I am giving the following recommended dose based on the profile in hemp seed oil as it contains the perfect balance of Omega oils.

Recommended dose for women

Women with an average weight of 50 kg: Recommended dose 2-3 tablespoons

In order to receive the recommended dose of EPA and DHA from a vegetarian source:

• 1 tablespoon per day of hemp seed oil = 9g (9,000mg)
• 9g hemp seed oil has 6.6g LA and 2.2g ALA

The 36% conversion rate of ALA mentioned in the British Journal of Nutrition means that 1 tablespoon hemp seed oil will give you 792mg of long chain Omega-3 with 21% or 166mg EPA, 6% or 48mg DPA and 9% or 71mg DHA.

If you take the recommended 2 tablespoons per day it will give you a total of 1584mg long chain Omega-3s or 388mg EPA, 96mg DPA and 142mg DHA.

Recommended dose for men

Men with an average weight of 50 kg: Recommended dose 3-4 tablespoons per day

At a conversion rate of 16% ALA to EPA will get 352mg long chain Omega 3s made up of EPA and DPA from 1 tablespoon hemp seed oil. Taking the recommended 3 tablespoons per day will give him 1056mg/day.

This will lead to benefits including lower cardiovascular risk, smoother skin, higher energy levels, better stamina, improved performance and recovery, better insulin sensitivity, lowered cancer risk, lowered inflammation, greater heat production, and improved mood, learning, IQ and calmness, and better ability to handle stress.

• Arnesen H N-3 fatty acids and revascularization procedures. Lipids. 2001;36 Suppl:S103-6. Review.
• Brenna JT. Efficiency of conversion of alpha-linolenic acid to long chain n-3 fatty acids in man. Curr Opin Clin Nutr Metab Care. 2002 Mar;5(2):127-32.
• Burdge G, Conversion of alpha-linolenic acid to eicosapentaenoic, docosapenta-enoic and docosahexaenoic acids in young women. British Journal of Nutrition 2002 Oct;88(4):411-20.
• Burdge G , Jones A, Wootton S , Eicosapentaenoic and docosapentaenoic acids are the principal products of alpha-linolenic acid metabolism in young men, British Journal of Nutrition 2002 Oct;88(4):355-63.
• Cullis P, Hope MJ. Physical properties and functional roles of lipids in membranes. In:V ance DE, Vance JE, eds. Biochemistry of Lipids, Lipoproteins and Membranes. Amsterdam:Elsevier; 1991.
• Emken EA et al Dietary linoleic acid influences desaturation and acylation of deuterium-labelled linoleic and linolenic acids in young adult males. Biochimica et Biophysica Acta 1213, 277-88.
• Grimble RF, Tappia PS. Modulation of pro-inflammatory cytokine biology by unsaturated fatty acids. Z Ernahrungswiss. 1998;37 (suppl 1):57-65.
• James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000;71(1 suppl):S343-S348.
• Knopp R and Retzlaff B,Saturated fat prevents coronary artery disease? An American paradox American Journal of Clinical Nutrition, Vol. 80, No. 5, 1102-1103, November 2004.
• Pereira C et al, 2001. The Alpha-Linolenic Acid Content of Green Vegetables Commonly Available in Australia. Int. J. Vitam. Nutr. Res.;71(4):223-228.
• Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999;70(3 suppl):S560-S569.
• Storelli MM et al, 2002. Total and Methylmercury Residues in Tuna-Fishfrom the Mediterranean Sea. Food Add. And Contam.;19(8):715-720.
• Wallace J, Nutritional and Botanical Modulation of the Inflammatory Cascade—Eicosanoids, Cyclooxygenases, and Lipoxygenases—as an Adjunct in Cancer Therapy, Integrative Cancer Therapies Vol 1, Number 1, 2002.

A healthy weight is a balanced proportion of body weight to body height. There is no one ideal weight as we are all uniquely different but a general guide has been devised and is described via the Body Mass Index (BMI). A healthy weight is 20-25, overweight is 25+, obesity is defined as a BMI of 30 or more and gross obesity as 40+. Your BMI can be worked out by taking your weight in kilograms and divide it by your height in metres and then divide the result by your height in metres again.

With obesity being described as a global epidemic by the World Health Organisation (WHO) a balanced perspective to eating, exercise and life-style is evidently required.

In the UK, 68% of adults are overweight with 22% of these being obese and 20% of children are overweight. Unhealthy weight levels are a real problem. However, there is also a cultural gender bias with regards to attitudes towards weight loss; 37% of men are overweight whilst only 22% of women but twice as many women diet as men!

The simple fact is that taking in more energy than you use creates an excess that accumulates as fat. There is also a genetic factor that can increase your tendency for a large appetite and also affect metabolism, but the quantity and types of foods consumed in relation to exercise has the greatest effect on your weight. Of course behind these external factors of food consumption and exercise are the internal emotional reasons why we ‘over’ eat and ‘under’ exercise. Resolving these patterns are at the heart of achieving a healthy weight.

Obesity sets up vicious malevolent circles that degrade health. For example, obesity increases insulin resistance which prevents the metabolism of sugars which are stored as fats and increase obesity. The upward spiral of weight gain becomes a downward spiral of health quality.

The proliferation of diets (Atkins, Zone, F Plan, South Beach, Mayo clinic, Mediterranean, Low carb etc.) clearly shows the need for our modern society to regulate its weight. It also displays the high level of confusion associated with the issue of body weight. The bottom line is that there is no right diet for everybody but Ayurveda offers some very personal and insightful advice.

Fats and carbs

If carbohydrate or fat consumption exceeds your needs then the glucose-like molecules are stored as glycogen reserves for potentially needed energy release in the muscles and liver. If the glycogen bank is full then the overflow gets laid down as fat molecules in the fat cells.

As you reduce your dietary intake and/or increase metabolic needs, fat gets converted back to glycogen. As glycogen gets broken down water is also lost in a ratio of 1 part glycogen to 9 parts water. This is why fasting can bring about rapid weight loss but as food is resumed then glycogen levels go back up and an increase in water retention returns.

Calories

Counting calories is one method of monitoring how much ‘energy’ you are putting into yourself. Men require approximately 2,500 calories/day and women 2,000. One pound of fat is created from 4,000 calories. Whilst calorie counting may be useful for raising awareness of the nutritional components of the food you eat it does not consider the individual metabolic rate which is at the crux of all healthy weight diet and life-style regimes.

Glycaemic Index (GI)

The Glycaemic Index describes how the body’s sugar levels respond to certain foods. It has become an important indicator of how certain foods will affect weight loss and diabetic control. Foods with a low GI release sugar into the bloodstream slowly whilst those with a high GI can cause a rapid increase. Glucose and refined sugars have the highest GI and whole grains and lentils the lowest.

Insulin resistance

Insulin is the hormone that allows for the absorption of various nutrients including glucose and amino acids and keeps the blood sugar within ‘normal’ limits. Whilst insulin production is stimulated by eating carbohydrates it can also reduce the metabolism of fats and proteins thus leading to greater storage of fats. It is estimated that 8 out of 10 overweight people have a blood sugar imbalance including possible insulin resistance.

The term “insulin resistance” means that your body cells are more resistant to the action of insulin than normal. If you are insulin resistant, your pancreas has to make more insulin to keep your sugar normal. As long as your pancreas can meet the excess demand placed upon it, you are OK. If your pancreas cannot keep up with the increased demand, your blood sugar will rise and you will become diabetic.

Evidence points to an inherited abnormal form of insulin that is inefficient at regulating blood sugar levels. There also appears to be a problem with the insulin receptor not allowing insulin to facilitate the entrance of glucose into the cell.

It is fairly easy to determine whether someone is insulin resistant. One of the most common ways to find out is simply to measure the fasting blood sugar and fasting insulin level in the morning. It is also possible to undergo a Glucose Tolerance Test, measuring both blood sugar levels and insulin levels. If the insulin levels are higher than they ought to be, this indicates insulin resistance.

Insulin resistance is affected by:

• A high GI diet as these foods promote the release of high levels of insulin
• A high fat diet helps to lower the GI by slowing digestion and delaying the entrance of sugars into the blood stream
• Excessive insulin secretion creates a negative cycle through over-stimulation. When a cell is exposed to high levels of insulin it starts to alter its relationship with insulin and reduce the number of insulin receptors. This leads to lower levels of fat breakdown and leads to obesity
• Mineral deficiency in chromium and magnesium (also zinc and B vits)
• Obesity creates insulin resistance and insulin resistance creates obesity

Insulin resistance leads to ‘hyperinsulinemia’. It is another vicious cycle. As a tissue becomes increasingly insulin resistant, the uptake of blood glucose becomes more inefficient. As a result, blood glucose levels begin to rise and continue to be raised over ever increasing periods of time.

The pancreas, in its efforts to effectively store the glucose, responds by secreting progressively higher levels of insulin. When this pattern occurs insulin levels are higher for longer such that the total hours of insulin exposure in the body may be increased to 50-100% beyond that of normal.

Hyperinsulinemia can cause:

• Sodium metabolism disruption, increased water retention and hypertension.
• Oxidative damage and initiation of atherosclerosis and neoplasia (cancer).
• Decrease in the total daily secretion of growth hormone with negative effects throughout the body. One notable effect of this is to inhibit the conversion of the inactive thyroid hormone (T-4) to its active form (T-3). This creates a “functional hypothyroidism,” which is difficult to detect because a routine thyroid blood test will display an otherwise normal level of circulating thyroid hormones.
• Compensatory hypercortisolemia (high blood cortisol levels), poor tolerance to stress, depressed immunity, and eventually, adrenal exhaustion.
• Chronic, high levels of insulin secretion will eventually exhaust the beta cells of the pancreas, increasing the likelihood of a functional deficit of these tissues, resulting in adult-onset diabetes.

• Excess fat around the buttocks, breasts, abdomen, hips and extremities
• Decreased activity, tiredness
• Shortness of breath on exertion
• Excessive sweating
• Low back pain
• Joint pain

Involving the complications of:

• Diabetes (NIDDM)
• Arthritis and Osteoporosis
• Ischaemic Heart Disease
• Hypertension
• High cholesterol
• Congestive heart failure
• Gall bladder disease
• Various cancers; breast, uterus, prostate (caused by excess adipose tissue aromatase and increased free sex hormones)
• Hypothyroidism
• Low libido
• Impotence
• Infertility
• Menstrual irregularities
• Depression
• Snoring, sleep apnoea

Rule out pregnancy, cyclic premenstrual oedema, ascites, kidney disease in the diagnosis of obesity.

• Excessive intake of heavy, fatty and sweet foods
• Alcohol
• Lack of exercise
• Excessive sleeping during the day
• Excessive steroid use causing increased weight

Described by the Caraka Samhita* as one of the “eight despicable diseases” as it is hard to treat and because patient willpower is essential for any management plan to be effective.

Ayurvedic view

Obesity is characteristically a disease of low digestive fire and an excess of kapha. The qualities of kapha become predominant in the person’s diet and life-style; cold, damp, heavy, slow, oily, static, sticky, cloudy.

Foods such as dairy, wheat, sugars, cold drinks, ice, refrigerated foods have these qualities. They also weaken the digestive fire. Activities such as sleeping in the day time, sleeping straight after a meal, regular snacking, lack of exercise, living in a damp climate all promote these qualities and increase kapha.

The digestive fire in the fat tissue is sluggish and this leads to an accumulation of fat throughout the adipose system; central abdomen, hips, thighs. Fatty tissue accumulates around the abdomen and blocks the natural flow of digestive energy downwards. This obstructs vata dosha (the bodily humour responsible for all movement in the body). 

This causes vata to reverse backwards and to accumulate in the stomach which – because vata’s predominant element is air – fans the digestive fire leading to a hyperactive digestive system.  Any food ingested thereafter “cooks” too quickly causing rapid stomach emptying with a resultant excessive hunger and the patient to continually over-eat. However the food is not utilised and the result of this over-eating builds up in the fat tissue.

Eventually all three dosas become imbalanced and improper nourishment of the tissues leads to a chronic depletion of the body’s natural immunity leading to multiple complications and premature death.

So fat metabolism is weak, the channels are obstructed, digestive fire is low but the appetite is large.

Conventional treatments

• Xenical (orlistat) is a lipase inhibitor. Lipase is an enzyme that helps to metabolise fats to become available for the body. By obstructing the activity of lipase about 30% less fat is available to the body. Its use may result in various digestive disorders such as cramping, diarrhoea, flatulence and fatty stools.
• Meridia (sibutramine) is an appetite suppressant. It appears to have serious effects on the heart and may increase blood-pressure, irregular heartbeat, congestive heart failure and headaches.
• Surgery: Various techniques have been evolved to induce a feeling of satiation and hence prevent over eating. Complications such as pulmonary embolisms, liver disorders, kidney disease, cancer of stomach, bowel and pancreas.

Please note that pharmaceutical medication should only be altered with the advice of a registered medical doctor.

* The definitive Ayurvedic text written circa 2000 BC

• Empowering the individual towards a life-long healthy eating pattern that regulates weight and brings good health.
• Engender willpower and motivation.
• The diet must be simple, delicious and nourishing but also help you loose weight.

Diet

• Avoidyeast, salt, cheese, yoghurt, chocolate, alcohol, refined sugars, oils and flours as these reduce digestive fire and increase weight. It is also advisable to avoid saturated fats in meat and fried foods.
• Include ginger in your daily diet: take a pinch of fresh ginger root with a few drops of lemon juice before each meal.
• Favour foods that are light, dry, and warm as these reduce mucus (e.g. soups, basmati rice).
• Reduce foods that are heavy, oily, and cold as these increase weight and mucus (e.g. pizza, ice cream, bananas).
• Favour foods that are spicy, bitter, and astringent (e.g. ginger, asparagus, tea) as these help to dry excess fluids in the body.
• Reduce foods that are sweet, salty, and sour (e.g., cakes, crisps, vinegar) as these increase fluids in the body.
• Eat foods which are heavy, and therefore “filling”, but which have a lightening effect e.g. barley, green mung and black urad lentils, honey and buttermilk. This will quell feelings of hunger while promoting weight-loss.
• Eating complex carbohydrates encourages an even hunger and a slow release of energy that allows for a balanced use of the food without any excess being turned into fat.
• Include natural fibre from vegetables, wholegrains, lentils and nuts to assist a slow release of energy helping to control blood sugar levels.
• Drink plenty of tepid water mixed with honey morning and evening (4:1 water:honey). Honey helps to satiate the appetite and removes fat.
• Drink plenty of warm water and Revitalising tea throughout the day.
• Maintain the rules of healthy eating e.g.
• Wait until the previous meal is digested before eating again.
• Eat slowly with concentration.
• Do not overeat (ideal ratio is 1/3 liquid: 1/3 solid food: leave 1/3 portion of the belly empty to allow for circulation to promote proper digestion).
• Eat lightly at night.
• Do not eat when you are not hungry. 
• Do not eat between meals.
• Do not eat cold foods and ice.
• Avoid too much water (especially cold from the ‘fridge).
• A primarily vegetarian diet is highly recommended.

A note on ghee: Clarified butter is praised in Ayurveda for its ability to nourish all the tissues. It has been shown that as part of a whole-grain vegetarian diet (using up to 2 tsp per day) it can actually increase the HDL cholesterol (the positive aspect) and reduce the LDL cholesterol (the negative aspect). However if the person has high cholesterol ghee (and other saturated fats) should be avoided. However, as we have seen above, low fat diets can increase the GI and lead to weight increase as well, so some high quality fats should be included in the daily diet.

Lifestyle

• Gradually increase mental and physical activity.
• Practice anaerobic activity that builds muscle rather than stamina. Practice for 20 minutes 5 times per week.
• Yoga; dynamic sun salutation, bellows breath, twists, backward bends, cobra, bow, locust.

Trikatu, triphala, turmeric, fenugreek and guggul

For weight loss these herbs help to increase metabolism, clear excess fluids, reduce fat, regulate digestion and aid the body in its natural elimination of excess wastes. They can also be used to reduce cholesterol and prevent clogging of the arteries.

• Guggul, turmeric and fenugreek to clear excess weight. Guggul literally ‘scrapes’ excess fat deposits from the body.
• Trikatu stimulates the digestive tissues. The black pepper in this blend of ginger and long pepper contains chromium forming part of Glucose tolerance factor (GTF) essential for normalising blood sugar levels and food cravings.
• Triphala clears toxins, regulates the liver and stimulates bowel movements.

Gymnema, guduchi, amla, turmeric, fenugreek, triphala, neem and black pepper

These herbs balance blood sugar levels, increase insulin resistance and can help manage diabetes. They can also reduce sugar cravings and help with weight management programmes.

Triphala, rhubarb root, psyllium seed, linseed, liquorice and fennel

These herbs act as a combination of purgative and bulk laxatives to help eliminate accumulated waste and toxic congestion.

Trikatu formula (Long pepper, ginger, black pepper)

Trikatu can be used as part of a weight loss regime to increase metabolism, digest fats and balance appetite. It is traditionally taken with honey. It will correct digestive sluggishness.

Effects of Sweetness Perception and Caloric Value of a Preload on Short Term Intake (BRALA, P.M. AND R. L. HAGEN. Effects of sweetness perception and caloric value of a preload on short term intake. PHYSIOL BEHAV 30(1) 1—9, 1983).

To determine the effects of calories and sweetness perception on intake, fasted normal weight subjects drank a preload sweetened with sucrose (1.1 g/kg) or L-asparthyl-L-phenylalanyl-methyl ester (Aspartame, 0.011 g/kg), or with no added sweetener.

Sweetness perception of the load was reduced in half of the subjects by oral application of Gymnema sylvestre extracts. One hour after the preload, a meal of snack foods was presented and amounts of nutrients eaten were calculated. Subjects whose perception of sweetness had been decreased for the preload ate less total and sweet calories than did those with normal perception. Calories did not affect intake. The effect of calories and perception of the load was also assessed on variables presumed to correlate with satiety.

Sucrose pleasantness ratings were not related to calories, perception or intake. Subjects’ estimates of the amount of milkshake that they would drink if given the opportunity to do so and hunger ratings were related to overall intake and carbohydrate intake, respectively. The findings indicate that hedonistic aspects of taste are of greater importance than calories in determining short term intake.

GUGULIPID: A natural cholesterol-lowering agent (Urizar NL, Moore DD. Annual Review of Nutrition. 2003;23:303-13. Epub 2003 Feb 26).

The resin of the Commiphora mukul tree has been used in Ayurvedic medicine for more than 2000 years to treat a variety of ailments. Studies in both animal models and humans have shown that this resin, termed gum guggul, can decrease elevated lipid levels. The stereoisomers E- and Z-guggulsterone have been identified as the active agents in this resin. Recent studies have shown that these compounds are antagonist ligands for the bile acid receptor farnesoid X receptor (FXR), which is an important regulator of cholesterol homeostasis. It is likely that this effect accounts for the hypolipidemic activity of these phytosteroids.

Environmentally vegetarianism is more sustainable Its that simple. The livestock industry is one of the largest contributors to environmental damage. It takes 7 Kg of grain to produce 1 Kg of red meat and 2 Kg grain to produce 1Kg of poultry. One quarter of the earth’s surface is now pastureland to support livestock.  

¾ of all grains and beans grown in the US are destined for animal feed which would feed 800million people. The livestock industry uses 50% of all US water resources. These easily could be used to satisfy humans nutritional needs.

It is estimated that 50% of the world’s rainforests have been cleared to support livestock for the meat industry. And 70% of the world’s fish populations are threatened by over fishing.  The livestock industry (meat, dairy, poultry, fisheries) contributes towards 17% of greenhouse gases (Transportation is 13.5%).

All these figures means that it takes ten times more resources to get our nutrition from meat as from grains. Whilst not an absolute answer to the earth’s environmental problems (as modern farming techniques as a whole need to be addressed) becoming a vegetarian is THE single most influential impact that an individual can have on the environment.

I don’t think that being a vegetarian makes you ‘absolutely’ a better or more moral person, but I do think it makes you relatively better. I mean, why would we kill another animal when we can get plenty of nutrition from plants? Of course, if you think we are superior to other animals then maybe that is your answer. Why would we impose such fear and pain on another animal if we don’t have to?

If you have ever visited a battery chicken farm or seen cattle slaughtered at an abattoir you will know what I mean. However hard they try all meat eaters end up eating this sort of mass processed meat because that is what is generally available in restaurants. Fortunately I have chosen to be vegetarian.  I don’t live in the Khalahari desert and ‘need’ animal flesh to support me and my family. I live in the UK where vegetarian options are plentiful.

It’s about a choice. The very nature of our existence means that we kill all the time; washing our hands destroys millions of bacteria, driving a car kills lots of insects, digging the earth kills lots of worms. So to live we must kill. But to live consciously we do not need necessarily have to eat another being. It’s a balance.

For me, this is the intention. To try and live a life that causes no other beings intentional pain. This is the yogic attitude known as ahmsa  or non-violence. Of course I trip up. Ask my calm but chicken loving-wife about my occasional lapse of sense of humour. But in essence the intention of vegetarianism induces a moral code by which I can attempt to live.

The health reasons to be vegetarian are legendary. Of course, it is about what is appropriate for each individual but generally speaking vegetarians suffer less heart disease, diabetes, cancer (breast, bowel, prostate, pancreatic), hypertension, gall bladder problems, obesity and osteoporosis than non-vegetarians.

Vegetarians also make less visits to their GPs and spend less time in hospital (about 22% less than the meat eater). Sounds like a good opportunity for a tax break and an insurance premium! Although it is very easy to eat an ‘unhealthy’ vegetarian diet of white bread, loads of cheese and processed foods. You can still be a meat eater and include high levels of these healthy foods (in fact I would recommend it).

Eating a healthy vegetarian diet means that you comply with the government recommended levels of fruit, vegetable, whole grain, fibre and low saturated fat consumption. These volumes of vegetarian foods also contain a high amount of various ‘super-nutrients’ such as protective anti-oxidants, healing phytochemicals and essential micronutrients.

Ayurveda considers that different foods have different qualities that effect the make-up of our mind and body. You are what you eat and all that. Ayurveda divides all of nature into three qualities called sattva, rajas and tamas. Sattva  refers to qualities of balance, equality, stability. It is light and luminous and holds the capacity for happiness. It is conscious and intelligent, moving inwards and upwards.

Think Gandhi, Mother Teresa, sunrise, hugs and meditation. Rajas generates activity, change and disturbance. It is mobile and excitable. It is the motivator and expressor. It has a centrifugal force causing dispersion and disintegration. Think Led Zeppelin, volcanoes, arguing and Saturday night in the pub.

Tamas is the immobile, still and stuck quality. It is heavy and causes obstruction or lack of perception. It moves down and is responsible for degeneration. Through the force of tamas there is delusion and confusion. Think  being lazy, night time, hangovers and Boxing day.

Generally speaking vegetables, fruits, nuts, grains and milk (organic) are considered to be sattvic and increase awareness, meat is considered to be rajasic and increasing the passions and processed foods are considered to be tamasic.

There are a few good reasons not to be vegetarian. Anyone who is undernourished or recovering from a debilitating illness is a candidate for a bit of chicken soup. New mums often need a bit of extra protein. If you do eat meat keep the portions low to about 30g a couple of times a week and insist on organic.

Indian culture has been associated with vegetarianism (Hinduism, Buddhism and Jainsim all support vegetarianism) from antiquity and it was prevalent in Greece around 6th century BCE. The rise of Christianity wiped vegetarianism from Europe and its green shoots did not reemerge with significance until the 19^th century.  From the traditional medical point of view Ayurveda is primarily but not wholly vegetarian. Ayurveda is a science in pursuit of health. It is not a moralistic system, although morality does creep into its practices.

If someone’s health can benefit from the properties of eating some animal meat, then this is recommended. Ayurveda would understand that there is some karma, or effect, from using animal products, but argues that the health of the individual is paramount. That being said it does recommend a primarily vegetarian diet that is easy to digest. In accordance with Ayurvedic principles it would also encourage an awareness of one’s actions and there is little doubt that the massive impact of the meat industry on the environment, economy and health of society would influence the opinion of the original propounders of Ayurveda.

Any vegetarian who has visited a Chinese medicine practitioner will know what they think. Chinese medicine likes people to eat meat to build the strength of the blood, qi and tissues. Whilst it can help some people regain certain aspects of health when needed it reveals Chinese medicine’s interest in the quantitative approach (how much one is getting) versus Ayurveda’s qualitative (the essence of what one gets) approach to health.

I have seen too many unhealthy vegetarians in my clinic. It is essential for vegetarians to eat an especially healthy diet and supplement their diet with super tonics. This takes a fair bit of effort; soaking, boiling and kneading….but its fun and has results. You MUST eat lots of whole grains, pulses and nuts. Include seaweeds and herbs in your diet.

Ginger, turmeric and coriander are essentials. In both India and China it is a tradition to make herbal decoctions and boil rice and vegetables in them. Try making teas of astragalus and boiling rice in this, add goji berries to porridge, mix amla berries into soups.

Definitely take chywanaprash which is a super herbal tonic jam. Where appropriate, use rejuvenating herbs such as ashwagandha, shatavari, Aloe vera juice and the ginsengs. Make sure you are getting the correct balance of healthy oils, especially Omega-3 to Omega-6s (it should be a 1:2 proportion). Vegetarian sources of Omega-3 do not convert to DHA and EPA very well and so keep your levels of hemp and flax seed high. Ayurveda recommends taking ghee (clarified butter) with food (2 tsp/day) to nourish the tissues. I would recommend supplementing with a wholefood multi-vitamin as well.

Ingredients

• 100g rice pudding rice (You can also try with black or red rice)
• 1 I litre of cow’s, almond, coconut or rice milk
• 3 tbs almond powder
• 7 strands of saffron
• 5 cardamom pods
• Rose jam or water
• Ghee, hemp seed or honey, optional

How to make a nourishing vegetarian breakfast

• Place the rice in a heavy pan and add the milk. Bring to boil and simmer for 1 hour. Add the almond powder. Add more milk as desired. (coconut milk is an interesting change).
• Soak the strands of saffron in a tablespoon of milk for 10 minutes to extract its golden pigment and then add to rice pudding. Add cardamom and rose jam.  Serve and add ghee or honey as desired.
• You can also add grated carrots or beetroots to this recipe for a colourful and nourishing variation. Also try with roasted walnuts, hazelnuts or raisins or goji berries.

This is a very nourishing food for strengthening the tissues and building deep strength.

At the very heart of being a vegetarian is its spiritual quality. Spiritual in the sense of connecting with that part of life that honours all beings as being an expression of the unconditional love that we all are.

Spiritual in the sense of slightly removing oneself from the material world to a more contemplative place where you can reflect on who you are and what you are doing here. Spiritual in distinction to material flesh. I am sure that many enlightened yogis have eaten meat so lets not get too high and mighty about this ‘spiritualism of vegetarians’ but some of us need all the help we can get! If you want it to be vegetarianism can be a part of your spiritual practice.

Blessings to you all. Blessings to the plants. Blessings to the animals. Blessings to the earth.

• Burr, M & Butland, B. (1988) Heart disease in British vegetarians. Am Jnl Clinical Nutrition v.48 p.830-2.
• Claude-Chang, J et al. (1992) Mortality pattern of German vegetarians after 11 years of follow-up. Epidemiology v.3 (5) p.395-401.
• Cummings, J & Bingham, S. (1998) Diet and the Prevention of Cancer BMJ v.317 p.1636-1640.
• Doll, R. (1990) Symposium on diet and cancer. Proc of the Nutrition Society v.49 p.119-31.
• Dwyer, J T. (1988) Health aspects of vegetarian diets. Am Jnl Clinical Nutrition v.48 p.712-38.
• Gale, Catharine R; Ian J Deary, Ingrid Schoon, G David Batty, G David Batty (2006-12-15). “IQ in childhood and vegetarianism in adulthood: 1970 British cohort study”. British Medical Journal 333 (7581).
• Key, T J. et al. (1999) Health Benefits of a vegetarian diet. Proceedings of the Nutrition Society v.58 p.271-5.
• Margetts, B M et al. (1986) Vegetarian diet in mild hypertension: a randomised controlled trial. BMJ v.293 p.1468-71.
• Marsh, A G et al. (1988) Vegetarian lifestyle and bone mineral density. Am Jnl Clinical Nutrition v.48 (3) p.837-41.
• Sellmeyer, D E et al. (2001) A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women.
• Am J Clin Nutr 2001; 73:118-22. Spencer, Colin: The Heretic’s Feast. A History of Vegetarianism, London: Fourth Estate 1993,
• Thorogood, M et al. (1994) Risk from death from cancer and ischaemic heart disease in meat and non meat-eaters.
• BMJ v.308 p.1667-1671.
• Thorogood, M et al. (1987) Plasma lipids and lipoprotein cholesterol in people with different diets in Britain.
• BMJ v.295 p.351-3.
• Vesterby, Marlow and Krupa, Kenneth S. 2001 Major Uses of Land in the United States, 1997 Statistical Bulletin No. (SB973) September 2001. 
• LEAD digital library: Livestock’s long shadow – Environmental issues and options.
• Walters, K and Portmess, L, Religious Vegetarianism From Hesiod to the Dalai Lama, Albany 2001.
• Willett, W C et al. (1990) Relation of meat, fat and fibre intake to the risk of colon cancer in a prospective study among women.
• New England Jnl of Medicine v.323 p.1664-72.
• World Health Organisation (1990). Diet, nutrition and the prevention of chronic diseases. WHO, Geneva.

The Sanskrit word for taste is rasa, and it is a very pregnant word: as well as meaning taste, it can mean ‘essence’, ‘juice’, ‘sap’, ‘lymphatic fluid’, ‘flavour’ and ‘delicious’. Just saying the word sounds ‘juicy’ … raa-ssa, rasa, RASA. Flavour is the essence of life – it affects everything.

Ayurveda identifies six tastes: sweet, sour, salty, pungent (spicy), bitter and astringent, which we will discuss later. Remarkably, how we ‘taste’ life affects our health and mood. If your experience of life is ‘sweet’ you are usually happy, whilst ‘bitter’ episodes are less savoury. Because our taste of life becomes our rasa, our essence, it is helpful to learn how taste affects us.

Taste (rasa)	Element (tattva)	Quality (guna)	Effect on dosha
Sweet (madhura)	Earth, Water	Heavy, Wet, Cold	K+, P-, V-
Sour (amla)	Earth, Fire	Heavy, Wet, Warm	K+, P+, V-
Salty (lavana)	Water, Fire	Heavy, Wet, Warm	K+, P+, V-
Pungent (katuka)	Fire, Air	Light, Dry, Warm	K-, P+, V+
Bitter (tikta)	Space, Air	Light, Dry, Cold	K-, P-, V+
Astringent (kasaya)	Air, Earth	Dry, Cold	K-, P-, V+

Ayurveda states that every substance, including taste, has all of the five natural elements – Space, Air, Fire, Water and Earth – within it, but that usually only one or two are dominant. For example, the pungent flavour is dominated by Fire and Air and, like a fire and the wind, is hot, drying and light. In addition to possessing elemental qualities, taste has a number of effects on the body and mind.

Temperature (hot or cold)

Each specific taste affects the thermo-regulatory and metabolic qualities in the body (i.e. heating it up or cooling it down). For example, cinnamon is pungent and hot, which raises body temperature; grapes are sweet and cooling, which can help to cool you down.

Quality (heavy or light, wet or dry, penetrating or soft)

Taste also defines the qualities of whether a particular herb or food is light or heavy to digest, and wet or dry on the mucus membranes. It also defines if the herb is penetrating or soft. For example, black pepper is spicy and also hot, light, dry and penetrating: it is easy to digest, dries the mucus membranes and penetrates deeply into the tissues. Chew on a peppercorn and these qualities will become clear.

Direction (where the food goes in the body)

Tastes also have an affinity for certain parts of the body. We all know that garlic goes to our lungs as we can smell it on our (and other people’s) breath. Asparagus is renowned for making our urine smell – Ayurveda knows asparagus is a bitter and cooling food that clears internal heat via the urinary system. Ginger has multiple ‘sites’, clearing mucus from the lungs, warming the skin, invigorating the blood and relaxing the muscles.

Taste also has an effect on the movement of energy in the body, by influencing the direction that vata (the dosha responsible for movement) travels in. For example, the pungent taste (e.g. in chillies) ascends and spreads energy outwards, causing sweating, whilst the bitter taste (e.g. in coffee) descends, causing energy to move downwards, sometimes with a laxative effect.

Dosha (effect on the constitution)

Tastes also influence your dosha. For example, the sweet flavour builds earthy kapha, cools hot pitta and reduces airy vata. As it is a nourishing taste, it increases the volume of all the tissues. Hence, it is no surprise that we live off sweet-tasting foods, like wheat and rice, as they keep us strong.

The sweet flavour is made from the elements of earth and water. This means that it has the qualities of these two building blocks; ie earth is heavy and descending and, like water, it is wet and cold (when water is subjected to heat it becomes hot but in its ‘primordial’ state it is cold). Sweet is the flavour of love, of sharing and of compassion. We give sweets to friends as an act of sharing and companionship. It is considered the most spiritually sattvic of flavours and is used to heighten experience of clarity and awareness of the spiritual aspect of life.

We all know the sweet flavour. Its main receptors are at the front of the tongue. Sweet comes from sugars; glucose, sucrose, fructose, maltose. They are made up of short (mono) and long (poly) chains of saccharides. It is the flavour of energy. Many carbohydrates, fats and proteins are sweet and their potential energy is measured in kilajoules. Foods and herbs with the sweet flavour are considered to be tonics. They build and nourish all seven tissues.

Liquorice (Glycyrrhiza glabra), beetroot (Beta vulgaris) and shatavari (Asparagus racemosa) are sweet and nourish the deeper reproductive tissues. The sweet flavour increases ojas and the integrity of the immune system. Many renowned immune tonics have a sweet flavour and are full of immune-modulating saponins and polysaccharides.

Sweet substances and experiences increase fluid-kapha and reduce hot-pitta and nervous-vata. As a demulcent, soft, soothing and wet flavour it reduces some of the dryness and weakness associated with vata. It is a tissue healer and sweet herbs are often used for hastening wound repair (e.g. aloe vera or liquorice).

Sweet benefits the mucus membranes lining the mouth, lungs, digestive, urinary and reproductive systems. The sweet taste can help to clear a dry throat and lungs by enhancing expectoration. Its cooling anti-inflammatory tendencies help to remove the intense heat of pitta or ‘-itis’ conditions (e.g. bronchitis). This is also helped by its softening mild laxative effect. It benefits the complexion, improves hair and nail quality and is the best flavour for a smooth voice.

Following the principle of ‘like increases like’ you want to increase your sweet experiences and flavours in life to be truly nourished, loved and cherished. This will create a cycle of ever increasing benevolence.

Used in concentrated excess, such as with refined sugar/pastries/ice creams, it can increase mucus and promote congestion. It can cause toxins, ama, fever, chest and breathing problems, swollen lymph glands, flaccidity, heaviness, worms, fungal infections, obesity, and diabetes. Exceptions to this rule of sweet substances increasing kapha are honey, mung beans and barley; they are actually considered to balance excess moisture.

The sour flavour is made from the elements of earth and fire. Its qualities are hot, oily and light. It creates both dampness and heat in the body and mind. It stimulates digestion and clears dryness. Sour foods make the mouth moist and increase the flow of saliva. When taken in excess it draws the tissues inwards and ‘puckers’ the lips, making the body horripilate all over. This contraction creates an emotional reluctance to share things. Eating too much sour flavoured food encourages envy and can make your experience of life feel like ‘sour grapes’.

The sour flavour is found in acids; citric, lactic, malic, oxalic and ascorbic. The receptors for the sour flavour are found on taste buds on the sides of the tongue. The acids have a direct effect on digestion by promoting liver function through various mechanisms; as sour flavours can reduce stomach acid it also means that the liver needs to produce less acid neutralising alkaline fluids.

Sour flavours also increase the flow of bile that helps to encourage digestion of fats. Unripe fruits are sour and are commonly used as digestive chutnies in India. Sour fruits such as amalaki (Emblica officinalis) are high in vitamin C and are considered to be anti-oxidant, rejuvenating and tonic herbs.

As the sour flavour aggravates pitta and liquifies kapha it is not usually beneficial in hot and damp conditions. It is also considered to vitiate the blood and it is recommended that the sour flavour is avoided in skin diseases. Most fermented foods are sour; fermented yoghurt, sour dough breads, vinegar, pickles and alcohol are sour foods that increase heat and mucus in the body.

Sour nourishes all the tissues bar the deepest reproductive tissue (shukra). It alleviates vata and aggravations of the nervous system; it draws scattered energy back in. It is a specific carminative useful to promote digestion whilst also removing gas and indigestion. Amalaki, lemons and pomegranate seeds (Punica granatum) are the exception to the rule that the sour flavour aggravates pitta as they actually reduce heat and inflammation.

In excess sour can cause dizziness, thirst, burning sensations, fever, itching, anaemia and skin diseases.

Salt is predominantly made from the water and fire elements. It creates moisture and heat and is heavy and sinking. A grain dropped onto the tongue is instantly moistening. A sprinkle on food enkindles digestion. It is an easily recognisable flavour and its receptors are at the front of the tongue. Its sinking and heavy effect is very grounding for the nervous system and this encourages stability. People who are solid and reliable become known as ‘the salt of the earth’.

The use of salt is a good lesson in the importance of dosage. In correct quantities it is vital to our very existence and is as essential to our health as water and food. It can save life when there is dehydration. In contrast to this a sprinkle too much will cause an ulcer and aggravate stomach acidity.

Excess salt consumption also causes water retention with the concomitant results of oedema and High Blood Pressure. This physical holding is reflected in its emotional effects as it causes greed and encourages the desire for more flavour. To repeat the famous Ayurvedic adage, it is all about who is taking how much, of what and when.

Salt is found in minerals and there are different types of salt classified in Ayurveda; rock, sea, black, pink and sonchala. Rock is considered the best as it is very high in minerals and, unlike the other salts, does not cause such water retention and it is not detrimental to the eyes. Salty is the rarest flavour in the Ayurvedic materia medica, not found in many herbs. It is found in Shilajit, a natural mineral rock exudate, full of numerous nourishing minerals. Seaweeds and celery are other examples of the salty flavour.

Salt aggravates pitta and kapha. It also disrupts the blood and is contraindicated in skin diseases as well as bleeding problems. Its use in marinades reflects its softening quality and it is used to soften masses and as a demulcent to liquefy kapha. It alleviates any excess of vata by stimulating the appetite, moistening dryness and nourishing the nervous system. It is a mild laxative at a medium dose (3g) and an emetic at higher dose (5-10g).

In excess it causes ulcers, skin diseases, grey hair, baldness and thirst.

The pungent flavour is a combination of the fire and air elements. Its qualities are hot, dry and light as well as penetrating and ascending. The acrid heat of hot foods and spices spreads throughout the whole system. Too much heat, whether climatic or dietary, is known to cause ‘hot’ emotions ranging from passion and excitement to anger and irritation. It is the most rajasic and volatile of the tastes.

It is primarily found in the aromatic volatile oils, resins, oleo-resins and mustard glycosides. All these compounds are used to stimulate, invigorate, dry and clear the accumulation of wet, stagnant and congestive conditions.

The essential oils of ginger (Zingiber officinale) and black pepper (Piper nigrum) are often used for clearing mucus congestion or warming a cold condition. Pungent resins such as guggul (Commiphora mukul) and frankincense (Boswellia serrata) also invigorate the flow of blood, scrape out toxins and reduce cholesterol. The aromatic cardamom (Elettaria cardamomum) is an excellent digestive for encouraging sluggish digestion. Unlike the other tastes it does not have a specific taste bud receptor site but works through irritation of local tissue and nerve endings.

Pungent herbs and foods are a panacea for kapha as they dry the excess moisture and mucus so prevalent in this humour. Pungent herbs are vital for any weight-loss programme as they stimulate the metabolism and reduce fat. They directly cook and burn ama as well as also clearing it via diaphoresis.

The heat encourages vasodilation of the pores of the skin and encourages the body to sweat, therefore throwing off unmetabolised toxins through the skin. The pungent flavour usually increases vata but, in moderation, it can also help to remove the cold stiffness of vata whilst also encouraging the elimination of wind and digestive cramps. The heat of pungent herbs irritates pitta and should not usually be used where there is inflammation, especially with aggravation of the plasma (rasa) and blood (rakta) tissues. Its drying effect on bodily fluids can cause constipation.

In excess it creates burning, dizziness, thirst and excessive dryness. Ginger (Zingiberis officinalis) and cooked garlic (Allium sativum) are the exceptions to the rule that pungent flavours aggravate vata; in fact they benefit it as they increase digestion and reduce intestinal gases.

This therapeutically priceless taste is created from a combination of space and air elements. Its dominant qualities are cooling, drying and light. It creates space in the body by draining and drying excess fluids. Too many bitter herbs can literally ‘space you out’ and leave you feeling disorientated. Many psychotropics are bitter; e.g. Psilocybe spp.

It has a particular affinity for the blood (rakta). Bitters are usually classified as ‘alteratives’ as they alter the chemical balance of the blood by clearing toxins. As they encourage the flow of bile and the activity of the liver this may account for some of bitter’s detoxifying activity. Too much bitter flavour can weaken the kidneys, cause excess urination and emotionally encourages fear and anxiety. The bitter flavour has a negative effect on the strength of avalambaka kapha and ojas which reside in the heart. Again, it is all about an accurate diagnosis and using an appropriate dose for each individual person.

Whereas in Western herbalism bitters are associated with a tonic effect, in Ayurveda they are considered depleting. The tonic association comes from the low dose, digestive stimulating and liver promoting perspective. The depleting and cleansing view comes from the experience that relatively larger doses of bitter herbs are cooling, reducing, detoxifying, laxative and diuretic. Studying and applying the insights of herbalism is a constant reminder to be specific.

Everything is unique; how you apply the medicine, when you apply it, to whom it is applied and where it is administered. Ayurveda clearly teaches that any substance can be a food, a medicine or a poison depending on how much is given, who is eating it, when it is eaten and where it is taken.

The reason that the bitter flavour is found in plants is often attributed to its ability to defend itself; if you taste nasty noone will eat you! The bitter taste receptors are at the back of the tongue; they are the body’s way of giving us a last line of defence. The bitter flavour is found in sesquiterpenes, anthraquinones, alkaloids and some glycosides.

Plants with these properties are renowned for their anti-inflammatory, anti-bacterial, anti-pyretic and digestive secretion enhancing activities. These compounds are usually found intermixed with pungent and aromatic or astringent tasting plants; all drying flavours. Neem (Azadiracthta indicia), andrographis (Andrographis paniculata) and chamomile (Matricaria recutita) are well-known bitters famed for their ability to clear infection, heal skin problems and purify the blood.

Bitter herbs clear kapha and pitta whilst aggravating vata. Excess dampness and heat are reduced as the bitter flavour drains them out of the system. Bitters also promote peristalsis and urination. They are often indicated in lung conditions, especially with infections manifesting with green and sticky mucus. They excel at clearing itching, swelling and oozing on the skin. A little is used as a stimulant to the appetite as the light quality can enhance the appetite and clear the palate. Higher doses are used to kill worms and parasites in the intestines and blood. Bitter herbs also benefit overweight conditions as they can dry and scrape away the adhesions and fatty accumulations.

When misused or incorrectly prescribed they can cause too much dryness and wasting in the body and mind; this can upset the nervous system causing constipation, dizziness, weakness, reduction in semen and dryness of the whole body. Guduchi (Tinosporia cordifolia) is a bitter herb that is an exception to the above contraindications as, along with the bitter benefits, it is also an aphrodisiac.

Astringent is the driest flavour. Made from a predominance of the earth and air elements it is heavy, cold and dry. As it draws inwards it dries and reduces them. On eating something astringent your whole mouth contracts and draws the mucus membranes closer together. Having too many ‘dry’ and unfulfilling experiences can leave you with a lack of taste for life and even resentful at its lack of zest.

The astringent flavour is found in tannins. These polyphenols are particularly concentrated in the bark, leaves and outer rind of fruits of plants and trees. They appear to offer some form of outer protection by repairing wounds and neutralising bacteria. They are especially soluble in water; hence the drying nature of a strong cup of tea left to steep for too long. Astringency is often found in combination with plants that also taste sweet or sour.

Bibhitaki (Terminalia belerica), haritaki (Terminalia chebula), arjuna (Terminalia arjuna) and guggul (Commiphora mukul) are especially astringent.

Therapeutically the astringent flavour clears kapha and pitta whilst aggravating vata. It is very useful where there is any leakage of body fluids; bleeding (externally and internally), excessive sweating, enuresis, diarrhoea, excess catarrh, leucorrhoea and premature ejaculation. It holds tissues together and astringent herbs are often used as a wash to help heal wounds.

This holding effect also prevents loose and flaccid tissue from accumulating. Using astringent herbs is appropriate to treat sinking problems such as prolapses. Its effect on the digestive system benefits diarrhoea by astringing the bowel and stopping excessive downward flow. This also helps absorption by drawing fluids and nutrients inwards. Astringents are used for pitta inflammations to draw the swelling inwards, cool the heat and also drying any damp suppuration.

These dry, rough and light qualities are similar to vata. Because astringent tastes contract the tissues and obstruct the flow of prana and nervous energy in the system it is detrimental to vata. In excess it can cause vata diseases like rigidity, pain in the heart, convulsions and retention of gas, urine and faeces.

Our fat, or ‘lipid layer’ protects us, comforts us as well as helps to carry fat-soluble nutrition into our body and brain. According to Ayurveda our fat tissue is made from a combination of the Water and Earth elements that bring protection to our organs, bones and tissues.

However, if we have too much or too little or poor quality fat tissue then health can become imbalanced. Too little fat tissue then we can be too thin with cracking joints, joint weakness, tired and brittle hair, bones, nails and teeth.

Too much and there can be obesity, excess fat tissue around the breasts, abdomen and buttocks, sexual debility, asthma, poor mobility, fear, hypertension and diabetes. If the fat is of poor quality and the doshas (Ayurvedic constitutions) invade it then there can be multiple symptoms from hard and small lumps, excessive sweating, kidney infections, diabetes, fibroids and other growths dependant on the causative factors.

Ayurveda can help people to balance their fat tissue and regulate the lipid layer. If the digestive fire (metabolism) in the lipid tissue (medas-dhatu-agni) is low then fatty tissue accumulates in the body, especially around the abdomen. This is often due to excessive intake of sweet, poorly digested, low quality fatty foods that block the vata dosha (the bodily humour responsible for all movement in the body). This causes vata to accumulate in the stomach which – because vata’s predominant element is air – fans the digestive fire leading to a hyperactive digestive system. 

Any food ingested thereafter “cooks” too quickly causing excessive hunger and the patient to continually over-eat.  This causes a vicious circle of increased hunger but reduced metabolism. Eventually all three doshas become imbalanced and improper nourishment of the tissues leads to a chronic depletion of the body’s natural immunity and an increase in weight. It is worth noting that obesity is described in the Charaka Samhita as one of the “eight despicable diseases” as it is so hard to treat because the enduring willpower of the client is essential for any management plan to be effective.

Modern science has determined that one of the main causes of weight imbalance and hence imbalanced medodhatu, is insulin resistance. The term “insulin resistance” means that your body is more resistant to the action of insulin than normal. Insulin is the hormone that keeps your blood sugar within “normal” limits.

It helps to open the keyhole for the glucose to lock onto so that it can be metabolised in the liver and muscle ready to be used as energy. ‘Insulin resistance’ makes you less sensitive to insulin and less able to absorb glucose and this results in higher blood sugar levels.  It is a complex process involving, amongst other things, thyroid function, oestrogen levels, leptin resistance and glycosylation.

When there is excess sugar in the blood stream it gets deposited as stored energy, otherwise known as fat. The body’s genetic wisdom is ‘to make hay whilst the sun shines’ and it stores that potential energy for a time when it really needs it. If this cycle of high blood sugar being converted to fat stores continues, it leads to weight increase, obesity and the associated health implications of high blood sugar levels including weakened immunity, repetitive infections, inflammation and blood clots.

The high blood glucose levels cause the red blood cells to become coated in excess sugar that damages the protein leading to something known as ‘glycosylated heamoglobin’. This causes the formation of Advanced Glycation End products- known as AGE- damaged molecules that literally cause ageing.

Glycosylation is a natural process where sugar molecules bind with another molecule through a process known as cross-linking, and impair its function. It’s more common in diabetics and people with insulin resistance but happens to us all as we age.

When crystalline proteins in the eye are ‘glycosylated’ it leads to cataracts; when collagen and elastin are ‘glycosylated’, and sugar molecules attach to these extra cellular matrix proteins, it can disrupt the integrity of the connective tissue which can harden and become less flexible; in the arteries this causes arteriosclerosis, or hardening of the arteries and in the skin it causes wrinkles. Even insulin can become glycosylated, leading to more deep-set insulin resistance. 

Looking at treatments from a purely plant chemistry perspective, flavonoids are the remedy par excellence for addressing glycosylation. It is why foods, such as colourful berries (think blueberries, amla and acerola), with the highest levels of sweetness in foods, often have high levels of protective flavonoids, as nature has an in-built protective mechanism to help offset any of the potential damage of exposure to excess natural sugars. Other vibrant and colourful spices, such as Turmeric, are also excellent and reducing glycosylated cross-linking and just half a teaspoon a day (1-2g) is protective.

When continually exposed to sugars, the high insulin levels trying to manage the high blood sugar levels also leads to excessive tissue growth, particularly due to something called Insulin-like Growth Factor-1 (IGF-1), which is implicated in some forms of cancer. IGF-1 also leads to a high release of free radicals that cause more tissue oxidation, which disrupts the integrity of the dhatus. In fact, it is this high insulin level causing oxidation of LDL cholesterol that is now associated as one of the causes of the high levels of heart disease that we have in many industrialised countries.

Conversely, high levels of free radicals have also been implicated in causing insulin resistance. This eventually leads to pancreatic burn-out. After years of over-activity, the insulin producing pancreas eventually tires of all the extra insulin it has had to produce to ‘force’ the glucose into the cells and it ‘packs up’ and diabetes develops. Insulin resistance is also associated with depression, cognitive decline and some forms of cancer (notably, breast and colon).

It is thought that 35% of the population have some form of insulin resistance, otherwise known as dysglycaemia. More than 50% of women with Poly Cystic Ovarian Syndrome (PCOS) have insulin resistance. Evidence points to an inherited abnormal form of insulin that is inefficient at regulating blood sugar levels. There also appears to be a problem with the insulin receptor not allowing insulin to facilitate the entrance of glucose into the cell. Mixed with poor eating habits, low exercise and plenty of stress you have a dangerous cocktail.

Fortunately nature and Ayurveda have an answer. Mixed with a kapha-reducing diet, high quality Omega-3 oils and sensible amounts of short and medium-chain-fatty-acid-easy-to-digest oils (such as flax, hemp, coconut oil and ghee), regular exercise, reduced stress and a by using certain plants that have been shown to assist with glucose and lipid metabolism, you can help to regulate your body to find your perfect balance of medodhatu.

Cinnamon (Cinnamonum verum var zeylanicum)

Cinnamon regulates blood sugar, increases digestion, reduces weight and helps normalise intestinal flora by reducing pathogenic Candida. A study in 2003, gave three groups of diabetics 1, 3 or 6 grams of cinnamon per day. All responded to the cinnamon within weeks, with blood sugar levels 20 per cent lower on average than those of a control group.

Some of the volunteers taking cinnamon even achieved normal blood sugar levels. Reports suggest that improvements can be seen after just 20 days. Cinnamon on its own will not remove insulin resistance but as part of a healthy diet and exercise programme it can be of great benefit due to its ability to strengthen agni (digestive fire) and regulate kapha with its warming, light and astringent qualities.

Fenugreek seed (Trigonella foenum-graecum)

The pungent, bitter and astringent seed of fenugreek has been used in Ayurveda to improve digestion and help reduce weight for centuries. Its spicy and bitter flavour have been shown to increase digestion, reduce lipid levels and removes fats. It has a positive effect on the digestive fire in medas-dhatu helping the agni to metabolise food into useful nutrition. It also increases the efficiency of the water circulating channel (ambuvahasrotas) and the urinary channel (mutravahasrotas) helping to regulate fluid retention and proper moisture levels in the tissues.

Ginger (Zingiber officinale)

Considered to be the universal healer in Ayurveda, and known as vishvabheshaja, ginger has been used in food and medicine for thousands of years. It is a wonderful warming spice that is superior at assisting digestion and circulation. It specifically helps with the assimilation of nutrients, quickens circulation and warms the body. By increasing the digestive agni in all the tissues it helps to assimilate the other herbs in any formula whilst also strengthening digestion and thermogenically increasing metabolism.

Green tea (Camellia sinensis)

Though not a traditional Ayurvedic plant the Camellia plant is indigenous to India. As India is now a large producer of green tea it would also be a great addition to the Indian diet as a replacement for all that deliciously sweet masala-chai.Green tea is a potent antioxidant whose slightly stimulating nature brings a lift to your energy.

Green tea is made by lightly steaming the fresh leaves to inhibit enzymes that breakdown the important polyphenol compounds, known collectively as catechins. The water soluble properties of green tea have been shown to help reduce cholesterol, regulate weight, increase metabolism, correct gene function, reduce bacterial and viral overload as well as help absorb oxidative molecules that damage cells and encourage aging. It helps to regulate the body’s detoxification mechanisms in the liver. It is slightly bitter and astringent helping to remove lipid accumulations and stimulate the agni in medas-dhatu.

Guggul (Commiphora mukul)

Guggul is a pungent and acrid oleo-gum-resin that has a very special property appropriate for regulating medas-dhatu, and more specifically as a medhogna, a herb that reduces fatty accumulations. It increases the digestive fire in the lipid tissue and through its ‘scraping’ (lekhaniya) properties clears toxic ama that coats cells, tissues and organs to reduce insulin resistance, imbalanced cholesterol levels and weight accumulation.

Its effect on metabolism has been verified by its ability to help with the conversion of T4 to the more active T3 and increasing iodine uptake in the thyroid, enhancing its homeostatic regulatory function. It is usually used after being ‘purified’ in a decoction of triphala (amla, bibhitaki, haritaki) and then used as a powder at doses from 50-500mg 2-3x/day. It is combined with other remarkable regulating plants such as kanchanara (Bauhinia variagata) that has potent effects on lymphatic congestion, glandular swellings and growths and with trikatu and triphala.

These combinations incorporating guggul are so important to treatments that a large range of ‘guggul’ containing products have been developed in the Ayurvedic pharmacy including kancanara guggil, kaishore guggul, punarnava guggul, triphala guggul, yogaraj guggul and gokshuradi guggul, to name just a few.

Bitter melon (Momordica chiranta)

A common food in Asia, this member of the cucumber family helps to regulate blood sugar, reduce insulin resistance and reduce fats. It is extremely bitter but has a pungent effect after digestion (and therefore a metabolic enhancing action that does not aggravate vata) and is very useful for helping to regulate weight. Bitter melon has a specific action, known as bhedaniya, which means to remove accumulations, and in Karavella’s case, specifically from the digestive, fat and water systems.

Seaweed (Ascophyllum nodosum)

Also known as Arctic wrack and Ascophyllum nodosum, this sea vegetable is renowned for its diverse range of essential macro and micro-nutrients that provide the nutritional foundation to health. Not a traditional plant used in Ayurveda, but a crucial part of every island-faring nation’s diet, seaweeds are in fact the most nutritious form of vegetation on the entire planet.

They are full of nutrients that help facilitate the absorption of vital proteins and other nutrients. This includes 14 times more calcium, 200 times more iron, 8 times more magnesium and 100 times more iodine than any land vegetable. They are also filled with detoxifying polysaccharides that can help to bind with toxic heavy metals. There is a substantial body of research showing how seaweeds can improve the thyroid function, heart health, cancer and high blood pressure.

The improved thyroid function can benefit metabolism and help reduce excess weight, fat and blood sugar control. Use at least 1g per day with food, and it makes an excellent salt replacement.

Turmeric (Curcuma longa) has a long tradition of use in Indian Ayurvedic medicine over at least the last 4,000 years. Having a sweet, bitter and astringent flavour with the ability to drive out toxins turmeric balances the fundamental principles of health bringing equilibrium to all three constitutional dosha.

Modern medical descriptions include diverse biological activity including antioxidant, anti-inflammatory, anticancer, antigrowth, anti-arthritic, anti-atherosclerotic, antidepressant, anti-aging, antidiabetic, antimicrobial, wound healing, hepatoprotective and memory-enhancing activities.It has many names in India (over 45!) including ‘Haridra’ (The Yellow One) and my preferred, ‘Kanchani’ (The Golden Goddess). The word ‘turmeric’ comes from medieval Latin ‘terra merita’, meaning ‘blessing of the earth’.

Turmeric has over 300 compounds including volatile oils (e.g. tumerone and zingiberone), sugars, proteins and resins and owes its bright yellow colour to polyphenolic pigments also known as curcuminoids, including demethoxycurcumin and bisdemethoxycurcumin.

It is believed that turmeric’s effectiveness may, at least partially, be attributed to its immunomodulatory properties and the ability to affect multiple signalling pathways initiating inflammatory and neurological modulation via multiple pathways including COX-2, LOX-5, Nrf2, NF-KB etc. Turmeric has compared positively when compared with statins, corticosteroids and aspirin revealing it as nature’s answer to the side-effect free treatment of inflammation.

When you consider that whole turmeric contains at least 20 phytochemicals that are anti-biotic, 14 that are known cancer preventatives, 12 that are anti-tumour, 12 are anti-inflammatory and there are at least 10 different anti-oxidants it makes you realize that turmeric is rather a lot more than curcumin. It makes me think that I want to use a whole turmeric formula that brings out the best of the curcumin as well as the volatile tumerone, the resins and other yellow pigments.

It’s worth noting that in Traditional Chinese Medicine turmeric has long been selected from the ‘Invigorate Blood’ category and is used as a water extract (decoction) showing that as curcumin is not water soluble, the other 299 compounds are also able to deliver a therapeutic benefit. Recent studies indicate that curcumin-free turmeric (CFT) possess numerous biological activities including anti-inflammatory, anticancer, and antidiabetic activities.

In a previously published review of Aggarwal et al., 2013, the anticancer and anti-inflammatory activities of CFT and the individual components of turmeric, including turmerin, turmerone, elemene, furanodiene, curdione, bisacurone, cyclocurcumin, calebin A, and germacrone are exhibited.

Murakami et al. published an article showing that curcumin combined with turmerones, the essential oil component of turmeric, abolishes inflammation-associated colon carcinogenesis. These beneficial compounds – the tumerones – are only one example of the various bioactive compounds beyond curcumin in the whole turmeric root. Practitioners should note that this broad range of turmeric compounds are rarely present in the solvent extracted curcumin products on the market.

Whilst it has entered the natural medicine vernacular that curcumin is poorly absorbed it is less well known that you only need very small amounts for effectiveness; studies point to its chemotherapeutic and chemopreventive activity even at low concentrations ranging from 5-50µm.

Turmeric’s traditional use with black pepper, ginger, milk or ghee reveals an ancient insight into how we can enhance the bioavailabilty and efficacy of the turmeric; take your whole turmeric with spice and fat. It also shows how the positive epidemiological benefits of using turmeric powder in the Indian diet (at around 1g/day) may contribute to lower cancer rates, alzheimer’s and diabetic complications seen on the India subcontinent.

Most curcumin on the market today is extracted with hexane, ethyl acetate, acetone or methanol. All have questionable environmental credentials and as this process strips the other synergistic compounds out of the turmeric it often requires curcumin products to then be further processed into liposomes or miscelles to have any significant absorption (as well as requiring toxicological studies in animals to prove safety).

More cutting-edge methods such as wholistic extracts that combine super critical extraction (using carbon dioxide) with tincture extraction (using water and alcohol) are leading the way in capturing the holy grail of herbal extraction; concentration of the parts while still representing the whole spectrum of plant compounds that, in turmeric’s case, is to capture the curcumin as well as the resinous and essential oil turmerone compounds.

Every clinician is faced everyday with complex degenerative illness. Its become the norm in our society. And we need solutions that offer multi-organ and multi-dimensional protection. And this is where whole herbs, notably turmeric come into their element.

Let’s look at turmeric’s effect on Nuclear factor erythroid 2-related factor 2 (Nrf2). Nrf2 is a protein involved in the cellular response to oxidative damage caused by injury or inflammation. It is pivotal in the regulation of various cellular processes, such as antioxidant defences, redox equilibrium, the inflammatory process, the apoptotic processes, detoxification, and cellular proliferation (Morales-González et al. 2015) and furthermore offers a strategy for cancer chemo-preventive phytochemicals (Becks et al. 2010).

Numerous studies have shown this Nrf2-conferred, multi-organ protection phenomenon protects many cell types and organ systems from a broad spectrum of toxic insults and disease pathogenesis (Lee et al. 2005).Nrf2 moderates gene regulation and the Antioxidant Response Elements to protect neurological pathways making it especially relevant to focus on for treating Parkinson’s, ALS and Alzheimer’s.

It was found that Nrf2 has an antagonistic effect on the NF-κB pathway (Cuadrado A. et al. 2014). When Nrf2 is activated, NF-kB pathways are also mediated, such multiple interactions allow bioactive compounds, including turmeric, to exert their beneficial preventive and therapeutic effects.

Studies comparing isolated curcumin extracts, turmeric powder and wholistic extracts show that Nrf2 activation is most potent in wholistic extracts (75% more effective at enhancing Nrf2 compared to a 95% curcumin product and 93% more than conventional turmeric). From this it can be suggested that compounds other than the curcuminoids activate the multi-organ protector and a synergistic effect may occur. These results are in line with the outcome of the antioxidative potential determined by ORAC analysis where a super critical/tincture combined turmeric showed outstanding activity of antioxidant scavenging compared to a combination of fresh fruits and vegetables.

The microvascular bed comprises of countless small arterioles, capillaries and venules. It regulates the contractile relationship between blood vessel walls and circulating blood, regulating haemostasis and is a gateway to our immune cells. Its health affects hypertension, diabetes, cholesterol, atherosclerosis, Alzheimer’s, liver disease, erectile dysfunction and cancer. Because of turmeric’s fundamental ability to enhance circulation through influencing platelets and thinning the blood it serves as a key-stone species in the treatment of today’s epidemic of diseases stemming from microvascular, inflammatory and neurodegenerative disorders.

The history, the science and the experience of turmeric stand as testimony to its deserved position as one of the most relevant herbs for today’s health challenges. It is the herb of choice for inflammation, injuries, neuronal degeneration, digestive disorders and cellular irregularities. Just remember that each and every one of turmeric’s 300 phytochemicals are there to help you achieve success in your clinical practice.

We are increasingly aware that many of the very compounds that protect plants from attack may also have an immensely beneficial and protective effect on the humans that ingest them. We often refer to these compounds as phytonutrients. They help prevent damage to cells throughout the body, they regulate inflammatory responses in the body and genetic expression, and they protect our all-important genetic code, DNA.

Compounds found in plants as diverse as turmeric root, grape skins and seeds, broccoli (and other cruciferous vegetables), leafy vegetables, garlic, carrots and many herbs and spices, have been shown to reduce the risk of cancer, heart disease, stroke, osteoporosis, Alzheimer’s and Parkinson’s disease. Experts believe that eating plenty of nutrient-dense, phytonutrient-rich foods promotes healthy ageing.

Hundreds of thousands of phytonutrients have been identified across our vegetable, fruit and herb crops. Many of them have multi-target functions, unlike most synthetically-manufactured drugs. Well researched phytonutrients include:

• Carotenoids: These provide the yellow, orange and red colours in fruits and vegetables, such beta-carotene and other carotenoids in carrots (antioxidant), lutein in marigolds (helpful against macular degeneration and cataracts) and lycopene in tomatoes (protective against heart disease and some cancers).
• Curcuminoids: Found in turmeric root, a powerful antioxidant, immune modulator and anti-inflammatory and neuro-protective agent.
• Flavonoids: Such as catechins from green tea that may prevent some forms of cancer, hespiridins from citrus fruits that help to reduce inflammation and thereby chronic disease; and flavonols found in apples and berries as well as kale and onions that may be used to reduce the risk of asthma, some forms of cancer and coronary heart disease.
• Resveratrol: A well-known and popular one found in red grape skin and red wine, linked to reduced levels of heart disease
• Glucosinolates: From cruciferous vegetables like broccoli, cabbage and kale that have been to reduce cancer risk and high blood pressure.

Different varieties of the same crop can often contain quite different levels of secondary metabolites depending on where they have grown and when they were harvested.  Unripe fruits and vegetables may often contain fewer secondary metabolites than ripe ones, and artificial ripening may prevent the development of the same, full complement of phytonutrients as compared with sun-ripened crops.

You can often taste the difference, the taste buds on your tongue being particularly sensitive to phytonutrients. If a fruit or veg is lacking in flavour or taste, chances are it’s got a low quotient of phytonutrients. If the flavour is full, the reverse may be true.  This is particularly evident with crops like tomatoes.

With some crops, younger plants can have higher levels of phytonutrients.  Broccoli sprouts, for example, contain much higher levels of the sulforaphane (a glucosinolate derivative) than mature broccoli heads.

So, what are adaptogens? Well, the clue is their name. They help the body to adapt, adjust and recalibrate itself depending on our emotional and physical surroundings. So, for example, they can foster a sense of calm in times of stress; bring peace to a racing mind in the middle of the night; offer clarity amidst turmoil; and imbue us with energy in the face of exhaustion.

The term adaptogen was introduced into scientific literature by Russian toxicologist Nikolay Lazarev in 1957 to refer to “substances that increase the state of non-specific resistance” in stress.

Broadly, an adaptogen must have the four ‘Ns’:

• Nourishing: Bring nutritive strength.
• Normalising: Raise what is low and lower what is high (e.g. energy, stress).
• Non-specific: Act on multiple parts of the body at the same time.
• Non-toxic: Safe when used over extended periods of time.

Adaptogens relieve stress by modulating the release of stress hormones from the adrenal glands. As biological response modifiers, adaptogenic herbs restore the body’s innate immune function and help the body adapt to different stressors. This gives them preventative and protective as well as curative activity in compromised immunity.

By replenishing our deeper immunity and regulating our response to stress, adaptogenic herbs replenish the wellspring of health and vitality and are true rejuvenating tonics helping to:

• Improve overall wellbeing
• Increase energy
• Optimise organ function
• Reduce stress response
• Improve blood sugar levels
• Optimise protein synthesis
• Reduce inflammatory cortisol levels
• Improve cholesterol ratios
• Regulate the hormonal balance

I often marvel at the fact that there are plants that can do all, yes, all of these things. And, there are plenty. Here are three of my favourites.

Ashwagandha

Ashwagandha is the 21st century perfect herb as it both calms and energises, helping us to adapt to the stresses of everyday living. It’s helpful for assisting deep sleep and calming nervous tension.

Its ability to replenish the blood, enhance nutrients and build bone strength make it indispensable in disorders of degeneration and ageing. Its affinity for the adrenal, endocrine and nervous systems point to its use in any imbalances affecting our energy or vitality.

Holy basil

This leafy member of the mint family is known in Hindu mythology as an incarnation of the Goddess Tulsi, offering divine protection. As well as increasing circulation, aiding digestion and helping to protect against seasonal malaise, holy basil is also good for calming busy minds. 

Turmeric

Turmeric is the superspice par excellence. High in flavonoids and with over 6,000 clinical studies attesting to its ability to protect and nourish the body, it improves circulation, reduces inflammation, heals wounds and protects the liver and bowels. It has gained the reputation of one of nature’s most potent remedies for many of today’s health challenges.

Finally, perhaps our greatest rejuvenating friend is letting our hair down and peeling with laughter. There is a great Hindi adage that goes: “There is medicine for 100 problems, but laughter is my best healing friend!” 

So, is tea drinking good for you? As is so often the case when it comes interpreting the health sciences and the benefits, or risks, of natural products, consensus isn’t easy to come by. Tea drinking is no exception.

There are a multitude of reasons for the discrepancies in view, among them:

• The results from different studies are often inconsistent and don’t always show benefits.
• The natural products under investigation are often not sufficiently well characterised to allow meaningful comparisons to be made.
• Different population groups experience different benefits and risks.
• There are discrepancies between the findings from lab studies versus those on human populations.
• There are simply not enough high quality human studies covering the gamut of effects that different teas can have on the body.

Despite this seeming quagmire of evidence, conflicting results and divided opinion on tea drinking, there is some key information that can be teased out. This article serves to address some of the key questions relevant to tea drinkers, including: how and why tea drinking can help to keep you healthy, which teas might be better for you than others, and when and how much tea you should consider drinking daily?

To avoid any confusion, all references to tea in this article refer to use of the leaves of the tea plant, Camellia sinensis. Both green tea and black tea come from leaves of the same plant, although different parts of the leaves are used for different teas, and post-harvest treatment can vary hugely.

Green tea is not fermented; the leaves are simply withered and steamed before being dried. Black and oolong teas are both crushed and fermented in various ways. Matcha is simply a powdered green tea, so instead of only benefiting from the compounds that are infused into water during the brewing process, the powdered tea is consumed in its entirety, so increasing the amount of beneficial phytochemicals, vitamins, minerals and amino acids consumed in a given volume of tea.

Oxidation happens when oxygen atoms (radicals) bind to elements or compounds, be they complex organic molecules or simple elements. Rust is an oxidation product that develops on the surface of iron or steel when exposed to oxygen. Our bodies are also susceptible to oxidation, and the result is the production of radical oxygen species (ROS), sometimes also referred to as ‘free radicals’, that if not scavenged by antioxidants produced naturally within our bodies or consumed in our diets, can lead to excessive oxidative stress.

Many metabolic processes rely on a degree of oxidation to trigger a particular beneficial response, such as an immune response or wound healing. But oxidation is generally short-lived and counteracted by antioxidants which scavenge or quench the ROS. Uncontrolled oxidative stress, which can be thought of as ‘rusting from the inside out’, has been shown to increase our risk of many chronic diseases, including heart disease and cancer, as well as contributing to premature ageing.

Making sure there is an adequate supply of antioxidants in the body is one of the best ways of guarding against oxidative stress, as well as managing related processes like a healthy inflammatory response and a resilient immune system.

In essence, we have two main antioxidant systems, an endogenous one in which we produce our own antioxidants internally, and en exogenous one, which relies on us consuming antioxidants in our diets and through drinks and beverages.

While tea supplies some essential nutrients, such as certain vitamins and minerals, and amino acids, the most important group of compounds in teas found to deliver beneficial effects are the flavonoids and other polyphenols that can act as antioxidants in the body.

Different studies quote differing ‘horse power’ ratings for the antioxidant capacity of teas. Many of these are the result of laboratory or ‘test tube’ studies in which the antioxidant capacity of a given tea, or tea extract, has been measured according to its ability to ‘quench’ particular ROS (notably peroxyl, hydroxyl, peroxynitrite, superoxide anion, singlet oxygen or hypochlorite radicals).

The most common kind of test is one called an ‘ORAC’ assay which stands for ‘oxygen radical absorbance capacity’. The assay was developed by one of the leading antioxidant testing facilities in the world, Brunswick Laboratories in Southborough, MA, USA.

The ORAC assay evaluates the antioxidant capacity of a test material under laboratory (in vitro) conditions notably against peroxyl radicals. It measures the value as Trolox equivalents (TE), usually expressed by weight of a given food or ingredient or per serving, and includes both inhibition time and the extent of inhibition of oxidation. There are various different types of ORAC assay, including hydrophilic (H-ORAC) and lipophilic ORAC (L-ORAC) assessments for water soluble and fat soluble antioxidant compounds respectively. Total-ORAC (Table 1) takes into account the ROS scavenging capacity of both the hydrophilic and lipophilic components.

Most recently, Brunswick has developed a Cellular Antioxidant Assay (CAA) which measures antioxidant capacity of a test material within a human cell culture. While this test still doesn’t equate to a human clinical study, it is an important step closer to deriving a more realistic perspective of how a natural product might act as an antioxidant within the human body.

Despite its shortcomings, the ORAC test has long been regarded as a laboratory standard for determining the relative antioxidant capacity of natural products, although it has also been misused or misinterpreted by some given that ORAC values cannot be regarded as having a direct bearing on human health because antioxidant compounds are absorbed to differing extent (i.e. have different bioavailability), others are subject to chemical transformation in the body, there are genetic differences between individuals (so affecting both benefits and risks) and there may be a host of other interactions with other compounds present or consumed concomitantly.

Some so-called antioxidants, when consumed at very high doses, may I some circumstances act as pro-oxidants, having the exact opposite effect to that which is expected. This has been shown for sustained very high doses of vitamin C.  All these issues are very relevant when it comes to tea and its benefits.

In short, an ORAC lab test provides information about the theoretical antioxidant potential of a substance outside the body.  This can be very useful for phytochemical profiling or quality control. The ORAC value does not, however, tell you anything about how the antioxidant substances are absorbed through the digestive tract or how they may subsequently interact in the bloodstream, in different tissues or in particular organs. 

A number of other antioxidant assays are also quite often used to test antioxidants, including ferric reducing antioxidant power (FRAP) assay and the Trolox equivalence antioxidant capacity (TEAC) assay. These assays generate very specific data linked to specific antioxidant properties and so cannot be compared with each other or with ORAC values.  

Table 1, based on analyses reported by the US Department of Agriculture (USDA), shows that brewed green and black teas have modest antioxidant capacities when measured in a laboratory. For a given volume, they are greater than beverages like apple juice, on par with unsweetened (but not blended, sweetened) cranberry juice, but somewhat less than well-known antioxidant ‘superfoods’ such as pomegranate, goji berries and even red wine.  Additionally, ready-made teas were found to have substantially lower antioxidant capacities compared with brewed teas.

Foodstuff	Total-ORAC (μmol TE/100g) (Mean/Min/Max)	n	Reference
Black tea, black, ready-to-drink (plain and flavoured)	Mean: 31/3 Min: 170 Max: 59/0	9	Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422.
Black tea, brewed, prepared with tap water	Mean: 11/28 Min: – Max: –	1	Welch Foods, Inc. 2006. Unpublished Data.
Green tea, brewed	Mean: 12/53 Min: – Max: –	1	Welch Foods, Inc. 2006. Unpublished Data.
Green tea, ready-to-drink	Mean: Min: Max:	1 1	Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422.
Black tea, with milk powder, ready-to-drink	Mean: 52/0 Min: 320 Max: 61/0	7	Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422.
Apple juice, unsweetened, without added vitamin C	Mean: 26/4 Min: 100 Max: 48/0	7 5	Prior et al. J. Agric. Food Chem., 2003, 51:3273-3279; Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422; Welch Foods, Inc. 2006. Unpublished Data
Blueberries raw	Mean: 46/69 Min: 2746 Max: 92/45	4 7	Cho et al. J. Sci. Food Agric., 2005, 85:2149-2158; Wang et al. J. Agric. Food Chem., 2008, 56:5788-5794; Wolf et al. J. Agric. Food Chem., 2008, 56:8418-8426; Wu et al.  J. Agric. Food Chem., 2004, 52:7846-7856.
Cranberry juice, unsweetened	Mean: 14/52 Min: 852 Max: 20/14	9	Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422.
Goji berry, raw	Mean: 32/90 Min: – Max: –	1	Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422.
Black cherry juice	Mean: 23/70 Min: 2070 Max: 29/70	9	Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422.
100% cranberry juice blend	Mean: 86/5 Min: 2341 Max: 86/5	5	Welch Foods, Inc. 2006. Unpublished Data.
Raw pomegranate juice, bottled	Mean: 26/81 Min: 2341 Max: 44/44	1 3	Prior et al. 2006. Unpublished data on pomegranate juice; Seeram et al., J. Agric. Food Chem., 2008, 56: 1415-1422; Welch Foods, Inc. 2006. Unpublished Data.
Pomegranate, raw	Mean: 44/79 Min: – Max: –	3	Wolf et al. J. Agric. Food Chem., 2008, 56:8418-8426.
Cocoa-mix, powder	Mean: 48/5 Min: – Max: –	2	Welch Foods, Inc. 2006. Unpublished Data.
Red wine, Merlot	Mean: 26/70 Min: 2670 Max: 26/70	3	Seeram et al. J. Agric. Food Chem., 2008, 56:1415-1422.
Red table wine, Zinfandel	Mean: 24/00 Min: 2400 Max: 24/00	3	Seeram et al. J. Agric. Food Chem., 2008, 56:1415-1422.
White table wine	Mean: 39/2 Min: 318 Max: 48/4	1 2	Dávalos et al. J. Agric. Food Chem., 2004, 52: 48-54; Welch Foods, Inc. 2006. Unpublished Data.

Tea contains a variety of constituents including the alkaloids caffeine, theobromine, and theophylline, polyphenols, tannins, trace elements and vitamins. Tea polyphenols, are the key antioxidant components, while the alkaloids, including caffeine, are nervous system stimulants.

The chemical composition of green or black teas vary according to the leaf size, the nature of processing, fermentation and drying, the infusion time. Even a particular type of tea can vary considerably, depending on factors like the prevailing climate during the growing season, the time or conditions during plucking, horticultural practices and the age and position of the leaf on the harvest shoot.  The major polyphenols include catechins, epicatechin, epicatechin gallate, epigallocatechin-3-gallate (EGCG) and proanthocyanidins.

There is accumulating evidence for the role of tea as means of reducing the risk of serious chronic diseases such as heart  and neurodegenerative diseases, cancer, metabolic syndrome and type 2 diabetes. Most of these beneficial effects appear to be related to the potent  antioxidant and anti-inflammatory activities of EGCG, which typically comprises around 50% of the polyphenols present. Recent studies suggest EGCG may act by modulating the effects of the energy-producing organelles in cells, the mitochondria, as well as altering the cell cycle and mitochondria-related cell death (apoptosis).

Data from the Zutphen Elderly Study in the Netherlands revealed that tea drinking reduced the heart attack, but not stroke, risk among the elderly, the authors relating this to the high EGCG content especially in green teas (30% of the dry weight, as against just 9% of the dry weight of black tea). Both EGCG and other catechins have been implicated as the most significant antioxidants in tea. The bud leaf and the first leaves, as found in teas such as orange pekoe, tend to be richest in EGCG.

High-grade matcha green tea — as used in traditional Japanese tea ceremony — has the highest levels of L-theanine, thought to promote a state of alert relaxation.

There has been considerable scientific debate about how easily catechins in tea are absorbed by the body. Most studies suggest bioavailability is far from complete, one study estimating key flavonol absorption being around 40% of those ingested. Bioavailability also appears to be reduced (up to 3.5 times) when tea is consumed along with food compared with when it is consumed on an empty stomach.

While we so often find ourselves asking for more, believing that ‘more is better’, in the case of antioxidants, this isn’t necessarily the case. There are two important aspects to consider. First, how long does the antioxidant effect last after consuming a single cup of green or black tea, and second, what is the extent and nature of the effect. On both counts, the results are impressive and remind us just how valuable tea drinking can be to our health.

While the caffeine levels typically peak within an hour of tea consumption, the catechin levels for someone having 4 cups of tea over a 6 hour period will typically peak in the bloodstream at 5 hours, with the super-catechin, EGCG, peaking after 24 hours. This means that regular tea drinking contributes to sustained levels of antioxidants in the bloodstream — a great way to reduce your long-term chronic disease risk and maintain neurological health.  

For the over 90% of people who consume tea with milk, the good news is that the addition of milk to tea doesn’t compromise the bioavailability of catechins.

On that note, given you’ve got to the end of this article, perhaps you might consider making yourself a cup of matcha, green or even black tea before you resume your next task?

In Ayurveda, understanding your own personal health concerns is centred around recognising your ‘dosha’, or constitution. In some ways, your ‘dosha’ is a little like your ‘health star sign’. Understanding your dosha will help you to understand how your body works and, therefore, how you can help it. There are three core Ayurvedic ‘dosha’, Vata, Pitta and Kapha.

Put simply, everyone will have a little bit of all three, but there is often one that is more dominant than the other. Vata types are highly creative and a little like a whirlwind of ideas, Kapha types are your steady, strong grounded individuals’ that often hold everything together. Your Pitta types are fiery, passionate, competitive and determined. Already you can probably recognise which one you might be.

But, how does this relate back to the menstrual cycle? Interestingly, in Ayurveda, the menstrual cycle has its very own Vata, Kapha and Pitta stage. How can this help? If you can recognise which phase affects you most, there are differing strategies in terms of how you can support yourself.

Here is how the Ayurvedic menstrual cycle works:

• The Vata phase lasts from approximately day 1-5 (from the first day of bleeding)
• The Kapha phase lasts From the end of bleeding until ovulation (approx. days 4-14)
• The Pitta phase lasts from ovulation until your period starts (days 14-18)

And, here is how each phase is characterised with tips on what you can do to help:

Vata types

Vata is the force that regulates all downward movements in the body, pushing the menstruum down and out of the body. Vata, therefore predominates during the period itself. If your Vata is out of balance, it will manifest as digestive upset, constipation, pain on intercourse, fatigue, anxiety and/or insomnia indicating the need for some Vata balancing practices.

How do we balance Vata? This is a time to keep warm, rested and safe. Manage your diary so that you have some calm space during this time to recharge and keep life on your terms. This is an opportunity for an extended me-time. Calming, nourishing herbs that will strengthen and support your adrenal glands are key here. For example, liquorice and ashwagandha. Steer clear of anxiety inducing stimulants and create space for mindfulness and meditation.

Kapha types

Kapha types naturally nourish and strengthen others. They are your mother-earth. So, the Kapha stage of the cycle is all about building the endometrium (the mucous membrane that lines the inside of the uterus). Oestrogen is the hormone that builds and increases at this time. It is the phase of restoring strength to the body and preparing for conception.

If your Kapha is out of balance it will manifest as imbalances such as fluid retention, breast distension, weight gain, discharge, fatigue, back ache and general ‘heaviness’ may appear at this time. Kapha types also store not just energy, but memory and emotion. If you notice you feel teary and a little low, it could be an indicator of imbalanced Kapha.

How do we balance Kapha? This is a time so often filled with energy and vitality when you can rebuild your nutritive strength, take tonifying herbs and spread your wings. Building herbs that support oestrogen balance are key here. Oestrogen dominant conditions are characteristic of a Kapha imbalance. Shatavari is your primary herbal remedy alongside cleansing, decongesting herbs such as aloe vera.

Pitta types

Pitta types are naturally hot and fiery. Fire is transformative and this is stage where the body prepares itself for new life; the endometrium for implantation of the fertilized egg and the breasts for milk production. Essentially, Pitta fires our body in readiness for conception. It is the hormone progesterone that peaks during this phase.

Severe PMS is a classic sign of imbalanced pitta, due to hot pitta accumulating in the blood and liver. As the blood channels and menstruation are connected, there can be extra heat in the system, leading to skin irritations, headaches, diarrhoea, feelings of irritation and emotional overload. This is when Pitta types can really manifest as fire!

How do we balance Pitta? This is an important time to help the liver metabolise the high hormone levels; increase the amount of colourful vegetables, do your exercise and let your spirit soar. Use heat-clearing and liver-regulating solutions such as turmeric and classic greens like spirulina.

There is a great deal of media and advertising coverage surrounding various ‘detox’ and cleansing regimes, but very little of this coverage really examines what detoxification means. One place to start might be a definition of detoxification. The Oxford English Dictionary describes it as a process that ‘removes toxic substances or qualities’.

It is well documented in medical literature that the body uses the liver, kidneys, bowels, skin and lungs as organs of elimination as well as detoxification. Traditional systems of healthcare have used purification and cleansing techniques for centuries. But what are the ‘toxins’ that are being ‘detoxified’?

A toxin is anything that is potentially poisonous, causing damage or death to an organism. A toxin may be endogenous or exogenous. By endogenous, we mean that the toxins grow or originate from within the body. We create endogenous free radical toxins all the time.

Free radicals are a part of normal biological processes such as cell signalling and are created from molecular oxygen. They are the waste products of normal cellular metabolism but can also be generated in response to environmental sources. Some sources of free radicals from cellular metabolism are prostaglandin synthesis, phagocytosis and enzyme activities.

If excessive free radicals are produced they can compromise the body’s normal defence mechanism as they overwhelm our elimination systems. Free radicals are known to produce adverse changes throughout the body by causing chemical bonds to occur between molecules that are programmed to operate independently. These bonds, known as cross-linking, reduce the ability of the cell to adjust to change. By affecting the molecular bonding of cells, free radicals can damage the formation of the cell wall and the nucleus.

They may also set off a chain reaction that damages cells, eating away at their membrane and corrupting their genetic DNA. This ability to influence cellular behaviour by disrupting the exchange of information and nutrients across the cell membrane makes the cell sick. A free radicals’ ability to damage DNA and impair its information managing function causes the DNA within the cell to mutate. This mutation implicates free radicals in numerous degenerative disorders.

Exogenous toxins are those that originate outside of the body but, in some way, make contact with our internal environment to cause potential damage. Examples include mycotoxins, neurotoxins, aflatoxins, venomous toxins, environmental toxins and many more. In Ayurveda toxins are called ‘ama’ and refer to anything that is undigested. We all know about poisonous mushrooms such as ‘The Poison Deathcap’ mushroom, Amanita phalloids., causing poisoning and death.

Aflatoxins, a type of fungus commonly found on peanuts and grains, are one of the leading causes of liver cancer in the world. Alcohol is a renowned toxin, causing liver damage through repeated exposure. Acetaldehyde is a toxic substance produced in the body from alcohol and is one of the impurities found in cheap wine spirits.

Some researchers believe that an acetaldehyde build-up is the cause of hangovers. If the liver’s detoxification pathways are impaired, aldehydes can, instead of being converted to the next intermediate product, build up to harmful levels and cause damage as they are often more toxic than the original substances from which they are derived.

It is probably the metabolism of methanol to formaldehyde and formic acid that caused the symptoms of the hangover. People who are efficient methanol metabolizers suffer more. This is reinforced by the fact that the types of drinks associated with more severe hangovers contain higher levels of methanol (Calder, 1997).

All types of alcoholic drinks contain some methanol, a substance blamed for the worst hangovers. Whiskey, cheap red wine, fruit brandy and other dark spirits contain the most methanol, sometimes as much as 2% by volume. Vodka and other clear drinks contain the least. In the liver, methanol takes 10 times longer than ethanol to break down.

Human generated poisons are now omnipresent in our environment. The chemical, pharmaceutical, agriculture and food industries have created a host of poisons that have infiltrated our air, water and soil. We are exposed to these products every day. They have penetrated our food chain, our homes and are a part of our eco-system in the guise of insecticides, pesticides, herbicides, flame retardants, heavy metals, petrochemicals, pharmaceutical drugs and radiation. Numerous studies attest to the direct relationship between the increase in poisons in our environment, their detrimental effect on our ecosystem and both adult and children’s health (Schwartz, 2004).

Fortunately, the body has its own in-built protection system. Many toxins and free radicals are metabolized and de-toxified through the liver via the Phase 1 and Phase 2 detoxification pathways. The liver clears many pharmaceutical drugs, hormones, and industrial pollutants. The Phase 1 pathway is comprised of a range of systems, including the cytochrome P-450 enzyme system, that can convert poisons via certain chemical reactions (such as oxidation, hydrolysis or reduction) into a less toxic state.

The Phase 2 process then binds or ‘conjugates’ cysteine, glutathione or sulphur with these metabolites from Phase 1 and they are excreted by the bile via the bowel or as a water-soluble compound via the bladder.

However, if Phase 1 is overly ‘induced’ it can create an overload of free radicals which can damage the liver and swamp Phase 2. An overactive Phase 1 and underactive Phase 2 is a recipe for illness. The ‘toxins’ that the liver cannot metabolise often end up stored in fatty tissue, including the brain, nerves and endocrine glands. Hence toxicity being associated with neurological, fertility, metabolic and energy issues. Herbs such as rosemary and milk thistle may be used to support Phase 1 and 2 detoxification pathways (Morgan and Bone, 2011).

There are many natural supplements that can support a body’s detoxification and eliminative processes. It is perhaps useful to look at some of these in turn and consider their application.

Turmeric

Turmeric (Curcuma longa) is a member of the ginger family and contains a number of active compounds including curcumin and essentials oils such as tumerones. The curcuminoids have attracted the most media and research attention for their anti-inflammatory and anti-cancer properties but are also valued by herbalists for several other applications. In clinical trials, turmeric has been found to protect the liver from many toxic substances, including alcohol (Rukkumani et al, 2004).

Additionally, turmeric may be used therapeutically to reduce cholesterol, help manage blood sugar levels and improve the flow of bile from the liver (Jentzsch et al, 1959). This latter action on bile also supports its role in aiding elimination as bile is used by the body as a natural laxative.

Nettle

Nettle leaf (Urtica dioica fol.) is a perennial plant native to the UK but found in temperate zones worldwide. Nettle is regarded in traditional medicine as an ‘alterative’, meaning a substance that improves detoxification and promotes elimination to increase the excretion of metabolic waste products from the body (Bone, 2003).

Its major application in this traditional sense was to alleviate skin conditions such as acne, eczema and psoriasis that were seen to be caused by congestion within the body. In more modern medicine (and particularly in Germany), nettle is approved for the treatment of benign prostatic hyperplasia, infections of the lower urinary tract and rheumatic conditions (Fisher, 2009). However, western herbalists will commonly use nettle to support elimination and support the cleansing process in inflammatory conditions of all kinds.

Celery seed

Although historical uses of this celery seed (Apium graveolens) include indications such as ridding the body of worms and alleviating insomnia, more recently it has been used in conditions requiring detoxification and cleansing. It has an ayurvedic use in treating liver dysfunction and in Germany is regarded as a medicine for improving bowel function. Where western herbalists often see a strong value in celery seed is as a herb that aids the excretion of waste metabolites, such as uric acid, through the renal system. For this reason, it is strongly indicated for gout and other rheumatic or arthritic conditions (Australian Patent, 1995).

Ginseng

Korean ginseng (Panax ginseng) is a plant with a fascinating history of use both in medicine, where it was regarded as a panacea for illness, and in cultural festivals. It is native to mountainous regions in Russia, Korea and China where it prefers the cool climates and is harvested for its valuable roots.

Due to extensive research into Korean ginseng, we know that it contains numerous active compounds called ginsenosides, which are triterpene saponins in structure. It is a potent antioxidant (Zhang et al, 1996), which assists the body with detoxification, but also has adaptogenic action. By exerting an adaptogenic influence, it helps the cope with stressors more effectively and achieve a more favourable state. This effect is widespread throughout the body and may be seen in both hormonal and reproductive mechanisms, nervous system effects and in digestion (Fisher, 2009).

Tulsi

Although not regarded as the most obvious of detoxification or cleansing herbs, tulsi (Ocimum tenuiflorum) has a broad spectrum of activity which includes strong antioxidant actions. More colloquially known as ‘holy basil’, tulsi has a long and proud history of use as a sacred and medicinal plant in its native habitat of Sri Lanka, India and China.

A large part of its antioxidant action appears to be attributable to two particular enzymes, superoxide dismutase and superoxide catalase (Gupta et al, 2002). However, tulsi also demonstrates support in detoxification and cleansing through a variety of other means such as helping to clear lung congestion, support effective digestion and helping to clear the ‘mental fog’ that often arises where a body in overly taxed. In the Ayurvedic tradition, tulsi is regarded as having an action of deepana, which rekindles the digestive fire.

• Australian Patent 99469910-A. January 1995, Mobius Consultancy Pty Ltd.
• Bone, S, A clinical guide to blending liquid herbs, 2003, Churchill Livingstone
• Calder, I, Hangovers: Not The Ethanol, Perhaps The Methanol, British Medical Journal, Vol.14, pp.2-3
• Fisher, C, Materia Medica of Western Herbs, 2009, Vitex Medica
• Gupta et al, Validation of traditional claim of Tulsi, Ocimum sanctum Linn. As a medicinal plant, 2002, Indian J of Exper Biol., Vol.40, pp.765-773
• Jentzsch et al, Paper chromatographic and pharmacological investigations on curcuma pigments, Pharm acta Helv., 1959, Vol.34, pp.181-188
• Morgan, M and Bone, K, Herbs for enhancing Phase I/II hepatic detoxification, 2011, No.56 Mediherb
• Rukkumani et al, Comparative effects of curcumin and an analog of curcumin on alcohol and PUFA induced oxidative stress, J Pharm Pharm Sci., 2004, Vol.7(2), pp.274-283
• Schwartz, J, Air pollution and children’s health, 2004, Paediatrics, Vol.113 (4 Suppl.), pp.1037-1043
• Zhang et al, Ginseng extract scavenges hydroxyl radical and protects unsaturated fatty acids from decomposition caused by iron-mediated lipid peroxidation, Free Radic Biol Med., 1996, Vol.20(1), pp.145-150

According to Ayurveda, skin has seven layers, corresponding to the seven dhatus. Similarly, in modern physiology, skin has been found to have seven layers, stratum corneum, on the surface, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale, the basement membrane and the dermis.

At the same time, the epidermis of the skin, as whole, is seen as an secondary (upadhatu) of plasma tissue (rasa dhatu), and the dermis as part of muscle tissue (mamsa dhatu). Skin belongs to bahya marga, the external pathway of disease, and as such is very vulnerable to toxins carried by plasma rasa) and blood (rakta dhatus) during the spreading (prasara) stage of disease, accounting for the relatively common nature of skin inflammations. 

Let us turn our attention first to atopic dermatitis (AD). Also called eczema, this condition is due to a hypersensitivity reaction in bahya marga, leading to long-term skin inflammation which creates itchy and scaly skin. Long-term irritation and scratching may cause the skin to thicken and develop a leathery texture. If the ear canal is affected there may be discharge from the ears (for pictures of atopic dermatitis, for atopic dermatitis on ankles, for atopic dermatitis on arms, for atopic dermatitis in infancy).

Atopic dermatitis is most common in infants, often clearing by the age of three, while in adults it becomes a yapya condition that persists or recurs throughout the lifetime. In infants, lesions of AD begin on the cheeks, elbows and knees, while in adults the lesions are more commonly found on the knees and elbows alone.

Typically, AD occurs on the flexor surfaces (the parts of the skin that touch when a joint bends). It arises most often where there is a family history of atopic conditions such as hay fever, asthma and eczema. Because skin belongs to bahya marga, AD is typically the first condition in the atopic picture, later followed by asthma or allergic rhinitis as the atopic process moves from the prasara stage to localize in prana vaha srotas (1).

A combination of genetic factors (adi bala pravrutta), doshic skin type (dosha bala pravrutta), exposure to environmental allergens (parya varana) and immunological reactivity (pittaja), come together to create the tendency to AD. (1) Vata skin is more prone to AD because of dryness and pitta skin because of its greater irritant response. Manasaja or psychogenic causes also play a part, as stress can trigger an outbreak of AD in both children and adults. Annaja or dietary causes are extremely important in AD, and so are agantu causes or infective agents.

In one study, 56% of children with AD were found to have food allergies that could trigger the condition. (3) Major food allergens associated with AD are eggs, cow’s milk, wheat, soy and peanuts (1, 3). Most patients with AD are colonized with Staphylococcusaureus instead of healthy, normal skin flora (1). Hence secondary (anubandha) Staphylococcus aureus overgrowths or infections are typical and can create AD relapses (1, 4).  Although AD is not in itself infectious, lesions infected with Staph. aureus can be passed on to others.

Dermatitis treatment

Because AD is a multi-factorial condition, it can only be addressed effectively in a holistic manner, taking into account emollients for doshic skin type, removal of environmental toxins, pacification of pitta and cleansing of pitta ama with a herbal blends such as guduchi and neem or Neem and Sarsaparilla, dietary modifications to address annaja causes and ointments to address infective agents. Neem or coconut oil will act as excellent pitta emollients and can be mixed with neem powder as an anti-infective agent. For psychogenic causes, counselling, stress management, yoga and meditation will be beneficial.

Case studies: Patient A

A thirteen year old pitta prakruti girl presented in great distress with AD that affected her arms and face. As a teenager, she found an assault on her appearance to be unbearable. Fortunately for the practitioner, her exasperation rendered her a highly compliant patient. She agreed to use Neem and Sesame oil and to take triphala and an herbal formula containing guduchi, turmeric, neem and manjista with aloe vera as an carrier (anupan). She was even willing, in her desperation, to follow a one month exclusion diet, eliminating eggs, cow dairy products, wheat, soy and peanuts from her diet completely.

We explained to her that exclusion diets are only effective if followed meticulously. “This is an experiment. You don’t have to eat this way for the rest of your life.” Within two weeks of the exclusion diet, her skin had cleared completely. She then began challenging the allergens, one allergen per week. The challenge process used was to eat a significant amount of the suspected item, wait two days and then eat it again.

During this process, she learnt that dairy products were the trigger food for her unwanted symptoms. She thus became a staunch devotee of the casein-free diet.  She continued her herbal regimen for three more months to ensure that pitta was pacified and pitta toxins removed, after which she remained symptom free by following her prescribed diet.

Case studies: Patient B

A forty two year old pitta woman presented with eczema localized to the fourth finger of her left hand. The symbolism of this location was not lost on us and we explored emotional causes in detail. She had a history of relationships with unavailable men and had remained unmarried as result. Currently, she was in her first promising relationship, with a man who wished to marry her and adopt a family. It is worth noting that her AD remained intractable when treated with a similar herbal regimen to the one which proved highly effective for patient A. 

In her case, emotional toxins were of more significance than physical ones. Accordingly, we started her on brahmi tea to help move the emotional toxins.  On her third follow up she had an epiphany, realizing that she feared intimacy and had created the eczema, “To make sure I can’t wear a wedding ring.”  Following this realization, her eczema rapidly cleared. I last met her in the grocery store. She was proudly wearing a wedding ring and carrying her adopted son in her arms.

Turning now to psoriasis; this is a condition opposite in many ways to AD. Psoriasis is a non-contagious, genetically based condition that typically appears as inflamed, oedematous skin lesions. The lesions are red and are covered with distinctive silvery white scales.

It is a lifelong illness for which there is no known cure, although it can be quite effectively managed Ayurvedically. Severe cases often move into asthi dhatu, presenting with pitted nails and painful joints. Unlike AD, psoriasis typically manifests on extensor surfaces, is not associated with atopy and does not result in frequent staphylococcal skin infections. 

It also begins in an older age group, with typical onset between the ages of ten and forty rather than in infancy. Although psoriasis is one of the most common skin conditions, affecting over 7 million Americans, its aetiology has long been poorly understood. It is now widely accepted as an auto-immune disorder sharing the same disease pathways as rheumatoid arthritis and inflammatory bowel disease (6, 7, 8).

In psoriasis, the journey of the keratinocytes from stratum basale to stratum corneum is shortened from 311 to 36 hours (5). The epidermal layer of the skin becomes thicker and cells are distributed abnormally (5).

Psoriasis treatment

As an auto-immune condition, psoriasis requires a rather different treatment protocol than AD. It is not sufficient to clear pitta toxins and return pitta to its seat. In addition, anti-inflammatory herbs are needed, while pancha karma is necessary to reverse the disease pathways involved in auto-immunity.

Case studies: Patient C

A forty five year old pitta woman presented with psoriasis on her scalp and extensor surfaces.  She was vata provoked and under great stress as she was conflicted in her marriage and currently involved in an extra-marital affair. She was given a medicated ghee containing ashwagandha, neem and manjista to apply topically, and an herbal formula which also included ashwagandha and manjista, but not neem, on account of her vata provocation.  It is important to note the value of ashwagandha in dry, scaly skin conditions such as psoriasis, and also the role vata provocation may play in flaring up the condition. She took Brahmi tea to help her depression and stress and a formulation of guduchi and guggulu as an anti-inflammatory helpful in many auto-immune conditions. With this herbal regimen and a pitta-soothing diet, her psoriasis began to improve gradually. 

She then did seven days of pancha karma treatments using Refresh Pitta Massage Oil with a few drops of added cold pressed neem oil for therapeutic massage (abhyanga), amalaki for its mild laxative effect (virechan) and decoctions of Dashamoola and Guduchi for basti. After this process, the psoriasis went into complete remission for the first time since its onset at the age of fifteen. She continued to maintain this level of improvement except for a small patch on her scalp, which would flare up whenever she stepped out of integrity with herself in terms of relationships. It was as if this remaining patch on her head acted as a kind of visible moral compass, calling her back to the journey of truth and compassion for self and others. 

Both AD and psoriasis are quite prevalent inflammatory skin conditions which are very responsive to the holistic approach of Ayurveda. By combining topical and systemic herbs, appropriate diet and lifestyle, pancha karma therapies and emotional awareness, these conditions can be effectively cured or brought into remission.

1. Donald Y.M. Leung, Mark Boguniewicz, et al, New insights into atopic dermatitis J. Clin. Invest. 113(5): 651-657 (2004).
2. Gupta, Gupta (1998) Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. British Journal of Dermatology 139 (5).
3. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients J Pediatr. 1985 Nov;107(5):669-75.
4. James J. Leyden¹¹Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, U.S.A., Richard R. Marples¹¹Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, U.S.A. and Albert M. KligmanStaphylococcus aureus in the lesions of atopic dermatitisBritish Journal of Dermatology Volume 90 Issue 5 Page 525-525, May 1974.
5. Gerald D Weinstein, Jerry L McCullough and Priscilla A Ross Cell Kinetic Basis for Pathophysiology of Psoriasis Journal of Investigative Dermatology (1985) 85, 579–583; doi:10.1111/1523-1747.ep12283594.
6. Davidson, A, Diamond, B: Autoimmune diseases. N Engl J Med 2001 345: 340–350.
7. Frank O Nestle and Michel Gilliet, Defining Upstream Elements of Psoriasis Pathogenesis: An Emerging Role For Interferon Journal of Investigative Dermatology (2005) 125, xiv–xv; doi:10.1111/j.0022-202X.2005.23923.x.
8. Joshi R. Immunopathogenesis of psoriasis. Indian J Dermatol Venereol Leprol [serial online] 2004 [cited 2008 Jun 15];70:10-2.

Let’s start with sugar. Sugar has not always been used as a sweetener or preservative, it actually has a strong medicinal history. In Ayurveda, the sugar cane plant was used to treat skin and urinary tract infections in addition to relieving constipation and a low blood pressure.

A paste made from the plant was also used to pack wounds and promote healing. Although it may seem somewhat obvious, sugar was traditionally used to sweeten foods, whereas now, sugar is seen as a valuable preservative increasing the shelf-life of foods that wouldn’t traditionally contain sugar. It is increasingly difficult to locate foods that do not have added sugars.

Sugar cravings

But, what has made these two plants so popular in our modern world?

A lot of it has to do with how they make us feel. All sugars are broken down by the body into glucose and fructose and are processed in the liver. Sugars are converted into glycogen or fat for storage, or kept as glucose in the blood as potential energy for use by our body’s cells. Our body recognises ‘sweet’ and cannot immediately differentiate between un-natural and natural sources of sweetness.

Sucrose is a carbohydrate also broken down into glucose and fructose. The body and brain processes glucose and fructose in different ways, and it may be this differentiation that is contributing to our modern sugar craving. When glucose is processed by the body it reduces blood flow and activity in the regions of the brain that regulate feelings of satisfaction, leaving us feeling ‘full’.

Fructose, however, appears to have the opposite effect, increasing our natural ‘food-seeking’ behaviours. It may not be such a surprise to learn that the majority of added sugars and sweeteners now being used in our food and drinks industry are in fact fructose based, including the rather infamous ‘fructose corn syrups’. What this explains is why we are never satisfied after consuming high levels of refined sugars, whether it’s in foods or drinks. It appears to be a bit of a vicious cycle, where the more ‘un-natural’ sugar we consume, the more we crave.

Sugar has actually been found to induce addictive behaviour. Specifically, sugar dampens the suppression of the hormone ghrelin, which signals hunger to the brain. It also interferes with the normal transport and signalling of the hormone leptin, which helps to produce the feeling of satiety and satisfaction.

One other important point of consideration are the links between sugar and the onset of metabolic syndrome. Sugar consumption raises plasma glucose, which can influence hypertension due to fructose increasing uric acid levels. It also influences high levels of triglycerides and insulin resistance through the synthesis of fat in the liver. Similarly, these increases in liver fat are also associated with the onset of diabetes. So, we can clearly see why there are so many current concerns over the increased levels of added sugars in food and drinks.

And what about coffee? The coffee bean, Coffea arabica, was traditionally recognised as a stimulating and diuretic medicinal herb but its unique roasted-bitter taste has fashioned it into one of the world’s most popular drinks. Caffeine is the most well-known component of coffee with caffeine being the primary pharmacologically active compound to which the majority of coffee’s therapeutic effects are attributed. Coffee is the world’s principal source of caffeine, accounting for 54% of our caffeine intake, and is the most widely consumed psycho-physiologically active substance in the world. Just try an espresso and see for yourself.

The love for caffeine

And what about coffee…?

The link between caffeine and its stimulatory effects has developed the belief that coffee influences human cognitive processes such as thinking learning and memory. Caffeine has a direct affect upon the sympathetic neurotransmitter known as adenosine found in the sympathetic nervous system. Caffeine blocks adenosine receptors and, when uninhibited, adenosine reduces physiological activity, for example by reducing heart muscle contraction Therefore, when adenosine receptors become blocked by caffeine, a stimulant effect is produced. Caffeine also increases the rate of synthesis and turnover of noradrenaline, an excitatory neurotransmitter in the sympathetic nervous system. Noradrenaline is implicated in maintaining levels of alertness in the human brain.

Habitual coffee drinkers are chronically exposed to caffeine as a result of consuming the beverage at intervals throughout the day. Evidence exists that coffee consumption after periods of caffeine abstinence may increase its stimulant effects but that there is nothing to gain from habitual consumption. As a consequence, it has to be questioned whether habitual consumption of coffee is due to a psychological association between coffee ingestion and cognitive stimulation. What’s also worth remembering is that caffeine is a psycho-physiologically active substance with the documented withdrawal effects of fatigue and migraine, one significantly reported withdrawal symptom of coffee is the onset of hyperacidity in the form of heartburn and/or acid reflux. So, habitual consumption of highly caffeinated drinks may also be a result of avoiding the effects of the withdrawal.

So, what can we deduce from this? The motto, ‘everything in moderation’ comes to mind.

Can we combat our regular sweet cravings and what can use as an alternative to highly caffeinated drinks to help nourish our energy? Well, of course, there are herbal alternatives. This is where herbal medicine becomes the star of the show. There are some fantastic herbs that can help our body regulate our excessive sugar cravings and provide alternatives to excessive caffeine consumption. Here are Herbal Reality’s favourites:

Cinnamon (Cinnamomum zeylancium and aromaticum)

Cinnamon has a direct balancing effect on the blood sugar. Cinnamon impacts on insulin resistance through increasing the body’s sensitivity to insulin, so that we are more reactive to changes in blood sugar levels; constituents in cinnamon such as cinnamaldehyde mimic insulin and improve glucose uptake in the body.

Cinnamon also decreases the amount of glucose that enters the bloodstream after a meal through its impact on numerous digestive enzymes slowing the breakdown of carbohydrates in the digestive tract. Cinnamon’s warmth improves overall digestive metabolism and nutrient absorption. It stokes a sluggish digestion, firing up our digestive ‘agni’.

Licorice (Glycyrrizha glabra)

Liquorice is the perfect natural replacement for sugar without the added calories. The primary constituent, glycyrrhizic acid, is naturally sweet in taste and is responsible for the characteristic taste associated with this herb. Liquorice is also a natural adaptogen that nourishes the adrenal glands, helping to support and sustain energy levels.

Green tea (Camellia sinensis)

The therapeutic properties of green tea are attributed to its antioxidant capacity which protect cells from the damage caused by free radicals. The presence of (epi-gallo-catechin-gallate) EGCG’s in the plant make it incredibly supportive to the cardiovascular system as a whole, protecting the integrity of the heart and blood vessels. Constituents such as caffeine, which is naturally present in this plant, works synergistically with compounds such as L-Theanine to increase serotonin, dopamine and gamma-Aminobutyric acid (GABA) in the brain.

This significantly boosts mood without causing the characteristic ‘crash’ you may experience after drinking a strongly caffeinated drink. EGCG has also demonstrated the ability to reduce atherosclerosis and the build-up of cholesterol by reducing serum cholesterol, triglycerides and high density lipoproteins (HDLs), all of which can be an issue with excessive sugar consumption. Green tea is an excellent herb for improving overall metabolic rate without influencing ‘crashes’ in energy.  

Ashwagandha (Withania somnifera)

Ashwagandha is the perfect herb for encouraging endurance and boosting core energy levels. Ashwagandha is unusual in that it brings both energy and calm. It brings strength by helping you to rest more efficiently and helps you rest by making you stronger. It will enhance endocrine communication, strengthening the adrenal glands whilst also calming a hyperactive nervous system through moderation of cortisol, the thyroid and the reproductive organs. It is particularly useful in nervous exhaustion.

Nutritional research during the early and mid-20th century was heavily engaged in establishing which nutrients were essential to life, which had to be ingested via the diet and which could be made in the body.

By definition, essential vitamins and minerals of which there are 14 and 15 respectively, and essential amino acids, of which there are 9, need to be ingested via the diet.

We now know more about essential fats, and call these essential fatty acids (or EFAs) and they include certain omega-3 and omega-6 fatty acids.

As more and of these essential nutrients were discovered, it became evident that they had the ability to resolve many illnesses. Therefore, diseases like scurvy, beriberi, pellagra and rickets, caused by vitamin C, thiamine (vitamin B1), niacin (vitamin B3) and vitamin D deficiency respectively, were soon largely consigned to the history books.

What we now recognise as the pharmaceutical industry also emerged in Germany, France and Switzerland shortly post-WWII. The huge growth of this industry was driven both by developments in organic chemistry—the chemistry of carbon—as well as recognition that new-to-nature molecules could be patented. These patented molecules, or drugs, had to be different from natural products to be eligible for patents. While this remains the principle business model of today’s Big Pharma, the fact our bodies have not had millennia to adapt to patented drugs means they often disrupt aspects of our physiology—hence the common side effects and poor safety record of pharmaceutical medicine. In fact, the unintended side effects of properly prescribed drugs makes them one of the leading causes of death in modern society.

In its infancy in the pre-WWII period, the embryonic pharmaceutical industry was busy finding ways to produce vitamins, amino acids and other essential nutrients synthetically. The two main perceived advantages were low cost and high stability, which also has a bearing on keeping shelf lives long, reducing distribution costs, increasing profit margins — and generally contributing another vital piece to the highly viable business model of the rapidly growing pharma industry.

With the wind in its sails after global sales of broad spectrum antibiotics like penicillin and pain relievers like aspirin, 1965 saw pharma’s first big shock. It was the thalidomide disaster. This spawned the first attempt to comprehensively regulate drugs and, in Europe, regulation took the form of its first pharmaceutical directive, Directive 65/65/EEC. Existing EU medicines law is still based on this first Europe-wide medicinal code.

Our modern day desire to want to ingest concentrated nutrients in the form of food supplements is quite likely a survival mechanism, one triggered by the increasingly simplified and processed diets to which so many of us are exposed. Not only has food supplementation always existed to see us through leaner times, today, it’s arguably a necessity. This is especially so if we’re to endeavour to live long and vital lives in which our final decades are untarnished by debilitating chronic disease.

Symptoms of pravahika include frequent elimination, often of small quantities of faeces, mucus in stools and tenesmus. The small quantity is accounted for by the fact that mucus is extremely irritating and can trigger an urgent call to stool simply to pass some mucus or a small amount of mucus-filled stool.

As described in the classical texts, pravahika is characterized by bahusam (frequency), alpalapam (small quantity), sashulam (with pain), sapravahikam (straining i.e. a very intense urge again caused by the irritant effect of mucus), saraktam (blood in stool), sapicham (jelly-like mucus), upveshayte (urgency of defaecation) (2).

Vataj pravahika is characterized by frequent defaecation accompanied by pain, a typical symptom of Crohn Disease. Pittaja pravahika is accompanied by burning sensation, kaphaj pravahika by mucus in stools, common in amoebic dysentery and raktaj pravahika with blood in the stools, as in the case of ulcerative colitis (2).

Crohn disease is a typical form of vataj pravahika, since its main symptoms are dysentery and pain. In addition, the course of the illness is unpredictable (3), a typical vata quality.

The disease affects the small intestine, particularly the terminal ileum, as well as the ascending colon (3). Thus as it progresses it can lead to malabsorption as well as to small bowel obstruction and abscess formation. Secondary conditions resulting from fat malabsorption include steatorrhoea (fatty diarrhoea), fat-soluble vitamin deficiency, gallstones, kidney stones, clotting disorders and osteoporosis (4).

The causes include a genetic khavaigunya in the digestive tract along with dietary and lifestyle factors, notably a high fat diet and smoking. In our clinical experience, a combination of a high-fat junk-food diet of pizza, burgers and fries, accompanied by smoking, is often a prelude to Crohn Disease in susceptible subjects (5). Crohn Disease typically begins in young people between the ages of fifteen and thirty. (4) It occurs with increased frequency in Ashkenazi Jews (6).

Ulcerative colitis (UC) is a type of raktaj pravahika, characterized by rectal bleeding, mucus discharge from the rectum and frequent stools. Tenesmus may also occur. Unlike Crohn disease, it is confined to the large intestine, beginning in the rectum and spreading into the rest of the colon. UC is three times more common than Crohn disease (7).

It frequently begins in young people aged 15-25 although onset can occur at any age (8). Like Crohn disease, it is more common in Ashkenazi Jews. An autoimmune condition, UC may be associated with autoimmune disorders outside the digestive tract. Up to 6.2% of patients with UC have such manifestations, which include autoimmune eye disease (uveitis), ankylosing spondylitis, inflammatory back pain and sclerosing cholangitis (9).

Primary sclerosing cholangitis is a severe autoimmune liver disease leading to jaundice and liver failure and is found mainly in patients with IBD (10). Genetics (11), diet and stress (12) play a role in the development of UC. A pittagenic diet high in sulphur, as found in heavy consumption of red meat and alcohol, is associated with increased likelihood of relapse (13).

Micropscopic colitis includes both collagenous colitis and lymphocytic colitis (14). This milder form of colitis presents as atisar or diarrhoea and lacks the typical features of pravahika. Indeed, microscopic colitis is often misdiagnosed as diarrhoea dominant irritable bowel syndrome, although it is actually a mild form of IBD. The colloidal colitis form of microscopic colitis is twenty times more common in women than in men (15).

Microscopic colitis occurs more commonly over 40, peaking in the sixth and seventh decades of life, and should be considered in the differential diagnosis of atisar (diarrhoeal disease) in older women (16). Most if not all patients with microscopic colitis have lived for decades with undiagnosed coeliac disease (17). These patients respond extremely well to a gluten free diet, usually getting complete remission of symptoms when this diet is used in tandem with Ayurvedic herbs.

Treatment of pravahika is carefully described in both Sushrut and Vagbhat. Diet is of course of great importance since the condition arises due to use of unsuitable diet. During an acute episode, diet begins with rice gruel seasoned with cumin (18).

Ghee

When solid food can be taken, the first food is rice with curds or yoghurt (19). After this, soups, kitcheri and boiled rice with rock salt and ghee can be given. Once the condition is in remission, patients with Crohn disease (vataj pravahika) can take a vata soothing diet while carefully avoiding trans fats and deep-fried foods.

They should also be counseled to quit smoking. Patients with UC should adopt a vegetarian or semi-vegetarian pitta-soothing diet, avoiding alcoholic beverages. They should be instructed in relaxation and meditation techniques to manage their stress. Patients with microscopic colitis should adopt a gluten free diet regimen tailored to their constitution.

Herbs to improve pravahika

Herbs can be used both rectally and orally. Sushrut mentions the use of picchila vasti with liquorice powder, unpastueurized boiled milk, Salmali stems (silk cotton tree), kusha grass and ghee (20). Today, licorice ghee vasti can be used as a simplified version and in our clinical experience has proved highly effective in ulcerative proctitis and UC, due to the ropan or wound-healing properties of licorice (21). Vasti with a decoction of dashamoola will relieve pain in the case of painful tenesmus (20).

Takram or buttermilk is the ideal vehicle for oral herbs during episodes of pravahika (22). When rectal bleeding is present, arjun, both haemostatic and ropan (wound healing) can be used in takram (23). Other astringents herbs favoured for dysentery include bilva ( 24) and kutaja (25).

Ajwain, black pepper and ginger are used to stimulate normal agni (25). Triphala in small amounts (pinch size) is also effective in dysentery because of its astringency (22). As well as these herbs and remedies for use during the acute phase, guggulu is extremely valuable for maintenance and relapse prevention. Guggulu blocks pro-inflammatory gene expression, thus addressing IBD at the profound level of epigenetics (26).

Because Guduchi (Kaishore) is anti-inflammatory and anti-spasmodic (27), the best guggulu formulation for IBD is kaishore guggulu. Therefore, in the absence of contra-indications, Kaishore guggulu should be continued long term in patients with IBD. Due to the autoimmune aetiology of IBD, shodhan therapies such as pancha karma should be effective to maintain remission and prevent relapse (28).

Diet

As we have seen, IBD is a disease of Western lifestyles, linked to consumption of high-fat, high meat diets, junk foods and stress (29). The Ayurvedic texts have considered mainly tropical diseases under the heading of pravahika. Yet Crohn disease, UC and microscopic colitis fit well into the descriptions of vataj pravahika, rakta pravahika and atisar, respectively. Furthermore, the traditional treatments for these conditions offered in the texts remain highly effective today, accompanied by lifestyle modifications. Due to the persistent and relapsing nature of IBD, maintenance therapies are also necessary in the long term.

1. Bishagratna KL tr, Sushrut Samhita, Chowkhamba Sanskrit Series, Varanasi, 1981 ut XL 82-83
2. Srikantha Murthy KR tr. Madhava Nidhanam, Chaukhambha Orientalia ,Varanasi Ch 3 v 21-22.
3. Farmer RG, Hawk WA, Turnbull RB Jr. Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology. Apr 1975;68(4 Pt 1):627-35.
4. Kornbluth A, Sachar DB, Salomon P. Crohn’s disease. In: Feldman M, Scharschmidt BF, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. Vol 2. 6th. Philadelphia, Pa: WB Saunders Co; 1998:1708-34.
5. Kornbluth A, Sachar DB, Salomon P. Crohn’s disease. In: Feldman M, Scharschmidt BF, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, and Management. Vol 2. 6th. Philadelphia, Pa: WB Saunders Co; 1998:1708-34.
6. Duerr RH. Update on the genetics of inflammatory bowel disease. J Clin Gastroenterol. Nov-Dec 2003;37(5):358-67.
7. Garland CF, Lilienfeld AM, Mendeloff AI, Markowitz JA, Terrell KB, Garland FC. Incidence rates of ulcerative colitis and Crohn’s disease in fifteen areas of the United States. Gastroenterology. Dec 1981;81(6):1115-24
8. Jang ES, Lee DH, Kim J, Yang HJ, Lee SH, Park YS. Age as a clinical predictor of relapse after induction therapy in ulcerative colitis. Hepatogastroenterology. Sep-Oct 2009;56(94-95):1304-9.
9. Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. Apr 2001;96(4):1116-22.
10. Cox KL, Cox KM. Oral vancomycin: treatment of primary sclerosing cholangitis in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. Nov 1998;27(5):580-3.
11. Xavier RJ, Podolsky DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature. Jul 26 2007;448(7152):427-34.
12. Levenstein S, Prantera C, Varvo V, Scribano ML, Andreoli A, Luzi C, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. May 2000;95(5):1213-20
13. S L Jowett, C J Seal, M S PearceInfluence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study Gut 2004;53:1479-1484
14. Baert F, Wouters K, D’Haens G, Hoang P, Naegels S, D’Heygere F, et al. Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut. Sep 1999;45(3):375-81
15. Margret Agnarsdottir, Olafur Gunnlaugsson, Kjartan B. Orvar,Collagenous and Lymphocytic Colitis in Iceland Digestive Diseases and Sciences Volume 47, Number 5, 1122-1128
16. Fernandez-Banares F, Salas A, Forne M, Esteve M, Espinos J, Viver JM. Incidence of collagenous and lymphocytic colitis: a 5-year population-based study. Am J Gastroenterol. Feb 1999;94(2):418-23
17. Matteoni CA, Goldblum JR, Wang NCeliac disease is highly prevalent in lymphocytic colitis.J Clin Gastroenterol. 2001 Mar;32(3):225-7.
18. Bishagratna op cit ut XL 90
19. ibid 87
20. Bishagratna op cit ut XL 84-86
21. Tuhin Kanti Biswas,Biswapati Mukherjee Plant Medicines of Indian Origin for Wound Healing Activity: A Review The Journal of Lower Extremity Wounds 2003 2, 1, 25—39
22. Ashtanga Hridayam chi IX 25-28
23. Rethinam Sundaresan Devi, Shoba Narayan, Ganapathy Vani, Gastroprotective effect of Terminalia arjuna bark on diclofenac sodium induced gastric ulcer Chemico-Biological InteractionsVolume 167, Issue 1, 5 April 2007, Pages 71-83
24. Ashtanga Hridayam chi IX v 23- 25
25. Bishagratna op cit ut XL 92
26. Cheon JH, Kim JS, Kim JM, Kim N, Jung HC, Song IS (2006) Plant sterol guggulsterone inhibits nuclear factor-kappaB signaling in intestinal epithelial cells by blocking IkappaB kinase and ameliorates acute murine colitis. Inflamm Bowel Dis 12:1152–1161.
27. Avnish K. Upadhyay, Kaushal Kumar, Arvind KumarTinospora cordifolia (Willd.) Hook. f. and Thoms. (Guduchi) – validation of the Ayurvedic pharmacology through experimental and clinical studies Int J Ayurveda Res. 2010 Apr-Jun; 1(2): 112–121.
28. Ram Harsh SinghExploring Quantum Logic in Ayurveda with special reference to Srotovijnana of AyurvedaAyu-Vol.30,No.4(October-December)2009, pp.360-368
29. Yang, S.-K., Loftus, E. V. and Sandborn, W. J. (2001), Epidemiology of inflammatory bowel disease in Asia. Inflammatory Bowel Diseases, 7: 260–270. https://pubmed.ncbi.nlm.nih.gov/11515854/

Nutritive food protects health and prevents disease. It is as simple as that. It is estimated that at least 30% of all cancers are diet related and it is also known that 70% of these cancers are connected with typical diets that are high in animal fat, low in fruit, vegetables and fibre (1). Prostate, breast and colon cancer are frequently connected with diet. Why is this? Perhaps it is to do with dietary changes?

Since 1950 there has been a global reduction of calorific intake in the consumption of complex carbohydrates by 38% and an increase of 12% for meat and 46% for vegetable oils. In the same period in the UK there has been a fall in fresh vegetable consumption by 24% and in the EU and US there has been a 35% increase in sugar and refined starch consumption.

In the USA 35% of all fruit and vegetables consumed are consumed as ‘french fries’! Our shift in nutritional habits over the last 60 years has evidently had a negative impact on society’s health as the same time period has seen cancer rates double and also sharp increases in heart disease, alzheimers, diabetes and other chronic degenerative diseases. Despite there being a surplus of food quantity there has been a decline in food quality to the extent that Type-B malnutrition is now prevalent in the industrialised world with up to 60% of hospital admissions displaying nutritional deficiencies (2,3,4).

An increase in nutrition received from meat is a good example of how more can be less. Well-cooked meat, especially barbequed meat contains aromatic amines, including 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (2, 3), more accessibly known as PhIP, which is associated with bowel, breast and prostate cancer in human cell line studies. The increase in meat consumption is directly correlated with an increased incidence of death from cancer, as seen by statistics showing New Zealand as having the highest meat consumption and the highest levels of colon cancer. Conversely, vegetarian diets are known to extend life and reduce degenerative diseases (see below) (6).

Other qualitative and quantitative nutritional factors are altering society’s health. Obesity has clear links with some forms of cancer as well as heart disease, diabetes, infertility and bone disorders (5). Low selenium levels are specifically implicated in prostate cancer (6). In contrast to this, the increased use of protective oils containing Omega 3 and Omega 6 fatty acids is linked to a reduced rate of cancers.

Certain plant nutrients, known as ‘phytochemicals’, such as lycopene (the red pigment in tomatoes), carotenoids (the orange in carrots) and flavonoids (found in onion) have proven to be protective against prostate cancer. Studies have shown that increasing essential nutrients can give essential protection against degenerative diseases such as Alzheimer’s, arthritis, coronary heart disease, macular degeneration, depression and cancer. Changing one’s diet to a health promoting diet has been shown to reactivate certain genes known as Tumour Suppressor Genes, especially p53, that can keep tumours in check and force their cells to die (7, 8, 9,10,11).

Interestingly, but not surprisingly, organically grown food has been shown to have higher levels of nutrients and anti-oxidants than non-organic products. Studies comparing the nutritional value of organically grown and conventionally grown fruits, vegetables, and grains conclude there are significantly more nutrients in organic crops. These include: 27% more vitamin C, 21.1% more iron, 29.3% more magnesium, and 13.6% more phosphorus, 70% higher omega 3 content and certain vegetables have been shown to have 100% higher levels of cell protective flavonoids.

In addition, organic products have 15.1% less toxic nitrates than their conventional counterparts. Interestingly, the government recommended five daily servings of vegetables (lettuce, spinach, carrots, potatoes and cabbage) provided the recommended daily intake of vitamin C for men and women when they are organically grown but their non-organic counterparts did not. Eating organic affects the amount of flavonoids, quercetin, and anti-oxidants that are protecting and nourishing you. You are also avoiding exposure to excessive levels of immune damaging pesticides and organophosphates (12, 13, 14, 15).

“It is obvious that the body tissues cannot be nourished and developed when food is not properly digested by the digestive fire.” – Charaka Samhita

Ayurvedic Nutrition is a deep science. It is not a one-diet-fits-all approach. And that is the beauty of Ayurveda, the traditional medical system of India. It recommends what is right for you. It also reminds us that what is right for us one day may not be right for us the next. It teaches a deep awareness and connection with our digestive system. If you practice Ayurveda, you begin to fall in love with your belly…’if music be the food of love, play on!’ The negative impact that a poor diet can have on our health, as we have seen above, shows that there has never been such a need for some salient nutritional advice. Ayurveda can help add to this nutritional advice.

Ayurveda has a theory that anything can sometimes be a food, sometimes be a medicine or sometimes be a poison depending on ‘who’ is eating, ‘what’ is eaten, and ‘how much’ is eaten. For example, fresh ginger root is delicious in cooking as a food to flavour and help digestion. It is a stimulating medicine that can help clear a cold and induce a sweat when taken as a strong hot tea. However, if too much is taken it can make you sick causing acidity and vomiting, hence acting as a poison in the wrong circumstances.  This refers to Ayurveda’s focus on the ‘quality’ of what we eat as well as the ‘quantitative’ nature of the food. So, there is no strict ‘Ayurvedic diet’ per se, only sage recommendations to help you find the tastiest and healthiest diet for your personal optimum health.

Eating is considered to be the most important activity that can affect health. Whilst eating is an essential habit, and for some an addiction, it can be empowering to transform your eating habits to only include healthy foods that are rejuvenating and life-giving. This is a healthy habit. Whilst herbal remedies, massage, exercise and spiritual practice can balance and repair health it is a ‘good’ diet that gives us an every day opportunity to take control of our health. We are stuck with our genes, family and climate but we can change our diet; when it comes to what we put in our bodies, we are in charge.

Generally speaking, Ayurveda considers that the most beneficial foods are rice, wheat, barley, mung beans, asparagus, grapes, pomegranates, ginger, ghee, milk and honey. These are all tonics to the tissues and digestion. It also generally recommends that it is best to avoid habitual use of heavy meats, cheeses, yoghurt, refined salt, processed foods, refined sugar, coffee, tomatoes, bananas, citrus fruits and black lentils. These can create stagnation and undigested toxins, the scourge of all of our health problems.

Of course, many people have now become ‘intolerant’ to wheat and dairy. In my experience this is a result of a combination of a weak digestive fire with ‘unnatural’ foods.

For example, I call bread ‘unnatural’ as modern baking techniques require that it is leavened with synthetic yeast in a couple of hours. For a proper healthful fermentation bread should leaven over an 8 hour period using a natural sour-dough fermentation; this neutralises phytic acid which helps make the nutrients in the bran more bio-available and does not block calcium and iron absorption; it creates gut-healthful lactobacillus bacteria (as opposed to Candida albicans-promoting synthetic yeast) which assist with assimilation and the health of the digestive tract and also increasing the B vitamin content of bread. Add a powerful digestive system and you get optimum absorption of the best quality food.

Commercially yeasted bread causes bloating, gas and aggravates the nutritional state of the tissues and the micro-flora in the digestive tract. No wonder so many people are intolerant to it. Ayurveda says that yeast is a negative ingredient that aggravates every constitution.

This sort of understanding pervades Ayurveda. After all it is literally translated as ‘the Science if Life’. It has detailed practical theory covering all aspects of living a positive and health generating life-style. It literally gives you the clear information to live healthily and fulfill your potential. I have seen its innate wisdom empower and transform hundreds of people’s lives.

I clearly remember one 48 year old woman with ulcerative colitis who had been on various courses of steroids that helped whilst she remained on the medication but all the symptoms flared when she came off the drugs. Minimal dietary advice had been given by her primary carer. She ate a typical British diet including coffee, cereals, milk, sandwiches, frequent meat, low vegetables  and occasional alcohol.

Through simply applying some of the principles mentioned in this article to strengthen her digestive fire, adjust her diet to a more wholegrain (rice, quinoa, barley), high vegetable, low sugar diet along with some herbs to clear intestinal inflammation (triphala, neem, turmeric) she has remained almost symptom free and has not needed steroids for over 3 years. It was by allowing her digestive energy to flourish that her health was able to heal.

Now let’s look at how we can all look after our digestive altar. Remember that digesting your food properly depends on:

• A strong digestive fire called agni in Ayurveda
• Eating appropriate foods in the correct quantity and of the correct quality
• Healthy food combining based on Ayurvedic principles

The Indian Vedic culture revered agni or fire, which gave them light, warmth and cooked their food. Agnideva is the Fire god who acts as a messenger between the mortal world and the heavens. In Vedic rituals humans offer oblations (the act of offering something such as worship or thanks to a deity) to the sacred fire. The fire takes a portion for himself and then vaporises the rest for the benefit of the gods. The gods imbibe this nutritious fragrance and in return give life-giving waters and favourable environmental conditions from which crops flourish and humans can feed themselves. This benevolent cycle continues as long as both parties are happy.

It is a metaphor of our own digestive system. We eat and ‘offer’ food into the fire of our bellies. Agni digests this food and the control centres in the brain are nourished by these fragrant nutritional ‘vapours’. This nourishment feeds the nervous impulses, which release enzymes and hormones. This stimulates systemic metabolic activity so that the whole body-mind complex functions efficiently.  Hence eating is seen as a sacred act that should be given its full attention away from stress, disturbance and distractions.

Agni is seen as the metaphor for all metabolic functions in the body. It includes the digestive function, sense perception, cellular metabolism and mental assimilation. The agni’s ability to transform also gives it a pivotal role in absorbing life’s experiences as it works through the heart and mind to help process emotional and cognitive experiences. It is said to carry the inherent cosmic intelligence into our tissues.

Agni is involved in many functions:

• Absorption
• Assimilation
• Metabolism
• Digestion
• Perception
• Taste
• Touch
• Hearing
• Vitality
• Clarity
• Alertness
• Regular appetite
• Immunity
• A sparkle in the eyes
• Lustre to the whole body

The qualities of digestive agni are:

• Hot
• Light
• Sharp-penetrating
• Pungent
• Luminous-clear

When it is balanced it causes emotions that are beneficial to health: courage, happiness, cheerfulness, lucidity, optimism, enthusiasm and intelligence. It also provides energy, vitality and a system able to maintain homeostasis.

When it is out of balance it causes emotions that are destructive to health: fear, anger, confusion, idiocy, depression. This also leads to low energy, congestion and an accumulation of wastes. Modern research also shows that gut health is closely linked to energy levels, mental clarity and wellbeing.

There are four types of digestive fire that generally categorise people’s digestive tendencies. Which one are you?

Ayurveda recommends specific foods for each type of digestive fire.

1. Irregular digestion

This is an irregular appetite and digestive system with signs of variable hunger, bloating, indigestion, intestinal cramps, constipation, dry stools, gurgling and gas. It is common in nervous people (known as vata types in Ayurveda).

Using spices that have a carminative, warming and relaxing action can be useful. Ayurveda has a formula called Asafoetida Plus (made from asafoetida, fennel, cumin, nigella seed, ginger, black pepper) taken 30 minutes before meals can help balance this erratic type of digestive system.

2. Intense digestion

Intense hunger but with poor digestion is a sign of a hyperactive digestion. There may also be symptoms of thirst, parched mouth, dry throat, loose stool and a burning sensation in intestines are common concurrent symptoms. It is more common in ‘fiery’ people known as pitta types in Ayurveda.

Using herbs that can dilute the acidity in the stomach can help.  Amla and Peppermint formula mixes certain bitter and cooling herbs to help balance this intensity of pitta in the digestive system.

3. Weak digestion

Weak hunger is a sign of low metabolism and sluggishness. These types of people also commonly have slow digestion, heaviness after eating a meal, sluggish bowels, bulky stool, feeling cold, sweet cravings and they crave stimulants. It is more common in kapha types of people in Ayurveda.

Stimulating spices such as in the formula Trikatu (Ginger, black pepper and long pepper) before a meal it can help alleviate this tendency and works a bit like proteolytic enzymes.

4. Balanced digestion

Balanced hunger and digestion; food is digested within 4 hours with no excess craving or lack of interest in food. These people can just use Ayurveda’s premium digestive regulator Triphala to help maintain a healthy digestive system.

If you really know your digestive system and how it reacts to the different challenges of your diet and the day then you can understand how to live right for your own needs. It is the best way to perfect health.

In fact, the simplest and best suggestion of any diet is just to follow your hunger. Only eat when you are hungry. This way your digestive fire will express its own innate wisdom and let you know when it is time to eat, when it is time to drink and when it is time to rest. It really is that simple. Learning to really understand true hunger gives you an insight into the deeper workings of your self, your attachments to food, how you are nurtured by what you eat and how you care for yourself by what you eat. A beautiful way to love yourself is by giving yourself the food you really need. We all love a bit of chocolate cake and so you should enjoy it. It tastes great and chocolate is a wonderful mood enhancing food. Just make sure that the remaining 99% of the time you are giving yourself what you truly need.

Ayurvedic food combinations

It is not just the food you eat that affects digestion but how you put them together that affects your health. When it comes to food, not everything is equal. Foods have different tastes, heating or cooling qualities, moistening or drying qualities and building or cleansing effects. According to Ayurveda, if foods with different energetic qualities are combined then they can cause incompatibilities which can upset digestion leading to indigestion, gas, diarrhoea, constipation and ama. This ultimately leads to food intolerances and other health imbalances such as sinus congestion, lowered immunity and skin problems.

Ayurveda has these lovely balancing tricks. Its not a puritanical system dictating what is ‘good’ and what is ‘bad’. It is an experiential system based on creating what is right for you. If we can agree that foods have effects: e.g. beans are good for your heart via their plant sterol cholesterol lowering function but beans are also hard to digest, then we can agree that foods can have opposing effects. These can be balanced with careful food combining and Ayurveda recommends cumin, coriander and asafoetida to help with the digestive disrupting side effects of beans.

Incompatible foods can cause problems because they digest at different speeds and can cause fermentation or excessive mucus.

Overview of foot compatibilities

Food type	Compatible with	Exceptions
Fruit	Other food. It should be eaten at least 2 hours away from other foods	Dates together with milk are ok.
Milk	Bananas, bread, yoghurt, fish, meat, melons, cherries, sour foods
Yoghurt	Fruit, milk, meat, solanacea family, eggs, fish
Eggs	Milk, fruit, yoghurt, cheese, fish, meat
Grains	Fruit
Beans	Fruit, cheese, eggs, yoghurt, milk, fish, meat
Lemons	Milk, yoghurt, tomatoes, cucumbers
Honey	Ghee (by weight) 1tsp honey = 3tsp ghee Honey should not be heated	Adding honey to a warm drink is ok.
Radishes	Bananas, raisins, milk
Melons	Any other food
Raw food	Cooked food
Fresh food	Leftovers

Incompatible foods and antidotes for balance

Food	Antidotes	Effect
Dairy	Black pepper	Reduces mucus
Coffee	Cardamom	Reduces nervous system aggravating effect of caffeine
Potatoes	Ginger or black pepper	Makes them easier to digest and less heavy
Potatoes	Ghee, olive oil	Makes less dry and reduces gas
Cucumber	Black pepper	Makes less cold and easier to digest

• Start each meal with chutney of ginger, lime and a pinch of rock salt (or just chew a piece of fresh ginger)
• Eat warm food that is freshly cooked (Ayurveda promotes the use of warm food as this is easier to digest)
• Avoid processed, cold-refrigerated and stale foods
• Chew properly to ensure that digestive enzymes get to work in the mouth
• Sip warm water with each meal but do not drink lots of fluids within an hour after finishing your food as this can weaken the digestive fire
• Avoid iced water
• Eat in peace
• Do not eat when stressed, angry or depressed
• Eat with awareness; be aware of how your digestive fire is every day and eat appropriately for your constitution.
• Stop eating when you are half full of food and a quarter full of liquid, leaving a quarter of your digestive capacity free for life-giving prana to circulate and help digestion
• Eat your food with respect for nature and the gift of nutritious food she has bestowed upon you. Give thanks to the creator of your meal
• Eat sitting down. Do not eat standing up. (16)
• Have a short walk after each meal, however do not take excessive exercise, sleep or have seat for an hour after eating
• Do not eat a heavy meal at night and leave at least two hours from eating before going to bed

Although Indian culture is often associated with vegetarianism, Ayurveda is not wholly vegetarian. Ayurveda is a science in pursuit of health. It is not a moralistic system, although morality does creep into its practices. If someone’s health can benefit from the properties of eating some animal meat, then this is recommended. For example, this might happen if someone is extremely weak after an illness. Ayurveda would understand that there is some karma, or effect, from using animal products, but argues that the health of the individual is paramount. That being said it does recommend a primarily vegetarian diet that is easy to digest. In accordance with Ayurvedic principles it would also encourage an awareness of one’s actions and there is little doubt that the massive impact of the meat industry on the environment, economy and health of society would influence the opinion of the original propounders of Ayurveda.

Environmentally vegetarianism is more sustainable. One quarter of the earth’s surface is now pastureland to support livestock! ¾ of all grains and beans grown in the US are destined for animal feed (17).

Economically vegetarianism costs the world less. As demand grows, intensification practices rush to support the market. This means that many animals are kept in conditions that increase the risk of disease, requiring persistent treatment with anti-biotics. Of all food poisoning incidents in the UK 95% are due to animal products.

Vegetarians have been shown to have longer and healthier lives than meat eaters as well as less cancer, obesity and heart disease. Interestingly, New Zealand has the highest per capita levels of meat consumption and the highest levels of bowel cancer in the world. Globally calorific intake from meat has increased by 36% since 1950 and vegetable consumption has dropped by 24% in the same time period in the UK. The shift in our nutritional habits is clearly having a negative impact on society’s health as the WHO state that 30% of all cancers are diet related and that 70% of all cancers are connected with typical diets that are high in animal fat, low in fruit, vegetables and fibre (18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 32, 33, 34).

Whatever your dietary predilection Ayurveda would recommend eating with awareness.

The following are tried and tested delicious recipes.

Kicharee

Serves 2-3

Ingredients and preparation

• 1/3 cup or 100 gms split mung dal, 2/3 cup 200gms or basmati rice (or other grain) simmered in 3-4 cups of water (a ratio of 1:3 or 1:4).
• Add 1/4 tsp organic turmeric, ginger, roasted cumin and coriander.
• Add seasonal vegetables: spinach, peas, carrots or seaweeds and simmer on low heat in the lentil-rice mix for 30-40 minutes for an all round healing, healthy and agni enkindling meal.
• It’s best not to stir this once all the ingredients are in as it can go ‘mushy’. Mix it once, put a lid on, turn the heat down and enjoy the fragrant aromas filling your house. Leave it to sit for 10 minutes at the end.
• Add a teaspoon of ghee or hempseed oil at the end.
• Salt and pepper to taste.

 Other kicharee tips

• Whilst fasting on kicharee it can be useful to sip hot drinks; try spicy teas of black pepper, cinnamon and cardamom to burn ama, clear toxins and relax your contracting stomach.
• For a ‘medicinal’ meal add powders of shatavari, bala, ashwagandha, pippali, amla, almonds, walnuts; approx 1 tsp/person.
• Try adding fresh rose, marigold, borage petals.
• Try adding rose petal jam or rose water.

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Rice pudding elixir

Ingredients

• 100g rice pudding rice (You can also try with black or red rice)
• 1 litre of cow’s, almond or rice milk (option of more)
• 3 tbs almond powder
• 7 strands of saffron
• 5 cardamom pods
• Rose Jam
• Ghee or honey, optional

How to make rice pudding elixir

1. Place the rice in a heavy pan and add the milk. Bring to boil and simmer for 1 hour.
2. Add the almond powder. Add more milk as desired. (coconut milk is an interesting change)
3. Soak the strands of saffron in a tablespoon of milk for 10 minutes to extract its golden pigment and then add to rice pudding. Add cardamom and rose jam.  Serve and add ghee or honey as desired.
4. You can also add grated carrots or beetroots to this recipe for a colourful and nourishing variation.
5. This is a very nourishing food for reducing vata and pitta, strengthening the tissues and building reproductive tissues.

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Hot milk recipe

Serves 1

Ingredients

• 1 cup of cow’s, almond or rice milk
• 2 tsp organic almond powder
• 2 cardamom pods
• 5 strands saffron   
• Pinch of nutmeg

How to make a delicious hot milk

1. Put all the ingredients into a pan and heat until boiling.
2. Allow to cool and add 1 tsp honey (optional). Take with 1-2gs or caps of organic ashwagandha at night to help nourish the nervous system, reproductive system and it helps you sleep.

I hope that some of this wisdom that Ayurveda offers you for dietary balance helps you towards healthier and more delicious eating.

1. WHO, World Cancer Report 2003.
2. Gallagher-Allred CR, Voss AC, Finn SC, McCamish MA.  Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc 1996 Apr;96(4):361-6, 369.
3. Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. .Prevalence of malnutrition in general medical patients. JAMA 1976 Apr 12;235(15):1567-70.
4. Naber TH, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr 1997 Nov;66(5):1232-9.
5. Cerhan JR, Torer JC, Lynch CF, et al. Association of smoking, body mass, and physical activity with risk of prostate cancer in the Iowa 65+ Rural Health Study (United States). Cancer Causes and Control 1997; 8(2):229–238.
6. Cui Z, Liu D, Liu C, Liu G. Serum selenium levels and prostate cancer risk. Medicine (Baltimore). 2017;96(5):e5944. doi:10.1097/md.0000000000005944
7. Giovanucci E., et al ‘95. “Intake of carotenoids and retinal in relation to risk of prostate cancer.” Journal of National Cancer Institute; 87:1767–76. 
8. Lewin M, Bailey N, Bandaletova T, Bowman R, Cross AJ, Pollock J, Shuker D, Li, H, et al. A prospective study of plasma selenium levels and prostate cancer risk. Journal of the National Cancer Institute, vol. 96, May 5, 2004, pp. 696-703.
9. Taylor, PR, et al. Science peels the onion of selenium effects on prostate carcinogenesis. Journal of the National Cancer Institute, Vol. 96, May 5, 2004, pp. 645-47 (editorial).
10. Drewnowski, A. Fat and Sugar: An Economic Analysis J. Nutr. 133:838S-840S, March 2003.
11. Drewnowski, A. & Popkin, B. M. (1997) Dietary fats and the nutrition transition: new trends in the global diet. Nutr. Rev. 55:31-43
12. Worthington V, Nutritional Quality of Organic Versus Conventional Fruits, Vegetables, and Grains, The Journal of Alternative and Complementary Medicine, Vol. 7, No. 2, 2001 (pp. 161-173).
13. Heaton , Organic Farming, Food Quality and Human Health: A review of the evidence, The Soil Association, United Kingdom, 2001.
14. Grinder-Pedersen, Salka E. Rasmussen, Susanne Bügel, Lars V. Jrgensen, Lars O. Dragsted, Vagn Gundersen, and Brittmarie Sandström, Effect of Diets Based on Foods from Conventional versus Organic Production on Intake and Excretion of Flavonoids and Markers of Antioxidative Defense in Humans, J. Agric. Food Chem., 51 (19), 5671 -5676, 2003.
15. Zheng T, Zahm SH, Cantor KP, Weisenburger DD, Zhang Y, Blair A. (2001) Agricultural exposure to carbamate pesticides and risk of non-Hodgkin lymphoma.J Occup Environ Med. 43(7):641-9. 
16. Pole, S, Ayurvedic medicine, the principles of traditional practice, Elsevier, 2006.
17. Vesterby, Marlow and Krupa, Kenneth S. 2001 Major Uses of Land in the United States, 1997 Statistical Bulletin No. (SB973) September 2001 LEAD digital library: Livestock’s long shadow – Environmental issues and options.
18. Bingham SA. Red meat enhances the colonic formation of the DNA adduct O6-carboxymethyl guanine: implications for colorectal cancer risk. Cancer Res. 2006 Feb 1;66(3):1859-65.
19. Burr, M & Butland, B. (1988) Heart disease in British vegetarians. Am Jnl Clinical Nutrition v.48 p.830-2.
20. Claude-Chang, J et al. (1992) Mortality pattern of German vegetarians after 11 years of follow-up. Epidemiology v.3 (5) p.395-401.
21. Cummings, J & Bingham, S. (1998) Diet and the Prevention of Cancer BMJ v.317 p.1636-1640.
22. Doll, R. (1990) Symposium on diet and cancer. Proc of the Nutrition Society v.49 p.119-31.
23. Dwyer, J T. (1988) Health aspects of vegetarian diets. Am Jnl Clinical Nutrition v.48 p.712-38.
24. Gale, Catharine R; Ian J Deary, Ingrid Schoon, G David Batty, G David Batty (2006-12-15). “IQ in childhood and vegetarianism in adulthood: 1970 British cohort study”. British Medical Journal 333 (7581).
25. Galeone C, Pelucchi C, Levi F, et al. Onion and garlic use and human cancer. Am J Clin Nutr 2006;84: 1027-32.
26. Margetts, B M et al. (1986) Vegetarian diet in mild hypertension: a randomised controlled trial. BMJ v.293 p.1468-71.
27. Marsh, A G et al. (1988) Vegetarian lifestyle and bone mineral density. Am Jnl Clinical Nutrition v.48 (3) p.837-41.
28. Sellmeyer, D E et al. (2001) A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Am J Clin Nutr 2001; 73:118-22.
29. Spencer, Colin: The Heretic’s Feast. A History of Vegetarianism, London: Fourth Estate 1993.
30. Thorogood, M et al. (1994) Risk from death from cancer and ischaemic heart disease in meat and non meat-eaters. BMJ v.308 p.1667-1671.
31. Thorogood, M et al. (1987) Plasma lipids and lipoprotein cholesterol in people with different diets in Britain.
    BMJ v.295 p.351-3.
32. Walters, K and Portmess, L, Religious Vegetarianism From Hesiod to the Dalai Lama, Albany 2001.
33. Willett, W C et al. (1990) Relation of meat, fat and fibre intake to the risk of colon cancer in a prospective study among women. New England Jnl of Medicine v.323 p.1664-72.
34. World Health Organisation (1990). Diet, nutrition and the prevention of chronic diseases. WHO, Geneva.

However, Summer doesn’t last forever. Autumn is a beautiful season seeing an extravaganza of golden colour but also a keen increase in cooler winds. The characteristic windy, cold and dry weather in Autumn naturally aggravates the vata dosha, which is unsurprisingly governed by the element air. The qualities of vata are cold, light, rough, mobile, subtle, clear, dry and astringent.

After the heat of the summer and with the change of the season these qualities can increase, thereby aggravating vata. Vata regulates the nervous system, moisture in the body, how relaxed we feel and how well we digest food. So, keeping our vata in check during this seasonal change is key to feeling fit and healthy.

Interestingly, vata is responsible for all communication and movement in the body; the flow of breath and blood, elimination of wastes, expression of speech for example. It can be described as a current of electricity responsible for regulation of all electrical impulses in the body and mind. Optimal balance of the vata in all of us is crucial. In fact without vata the other dosha are inert. Especially during those times of the year where it is at risk from becoming out of balance, such as in Autumn. As it is said in the ancient writings Sharangadhara Samhita without vata, “pitta is lame, kapha is lame”. So, how can we keep our inner vata in balance? Here are a few top tips:

• Rise early when the world is still calm
• Daily 5-10 minute morning self-massage with a warming and relaxing oil like sesame oil. This offsets seasonal tendencies to dryness, joint cracking, stiff muscle pain and poor circulation.
• Diet to consist of warm, sweet, mildly spicy, sour and salty foods. Here are just a few that suit vata: Soups, casseroles, warming spices such as ginger, turmeric, fennel, root vegetables, ghee, hemp seed oil and kicharee.

Autumn is also a common month to perform a seasonal cleanse to prepare for the winter ahead and to clear the excess heat accumulated during the winter months. Kapha types are particularly prone to accumulation, and a seasonal cleanse can be especially beneficial for them. A successful fast leaves you feeling lighter, refreshed and energised.

The first and most important point to consider when undertaking a cleanse is to pick one that suits your personal constitution. There are many types of fasts; water fasts, fruit juice fasts, rice fasts, soup fasts, kicharee fasts. Here are some top tips for each of the three dosha:

• Kapha types store energy and a tendency to be too static. They can tolerate longer fasts and benefit the most from them. Their fasts can be more light soup/broth based or just hot water and spicy teas.
• Pitta types are good at managing energy but accumulate excess heat and inflammation. They benefit from a fast of one to three days and can manage on fruit or vegetable juices as their high levels of digestive fire at the best at breaking down raw fruit and veg.
• Vata types have difficulty holding on to energy and have a tendency to be ungrounded. Fasting must be undertaken with caution and should only fast for a short time of between one and three days. Their fast should always contain some nourishment and could be a mono fast of brown rice, mung soup or kicharee.

Here are some top tips to keep in mind for anyone undertaking a seasonal fast:

• Drink lots of warm water and replace caffeinated drinks for spicy teas that help to burn toxins
• You’re not eating your regular diet, so your body will need time to adjust. Rest and take plenty of sleep.
• There is a saying ‘Any fool can fast but it takes a wise one to break it’. It is very important to break a fast slowly, one day fast requires one day of re-introduction to normal diet.

Another very useful way to build the strength of your digestive fire that is in some way a light fast is to follow an incremental diet. Its very useful to help people with IBS, Crohn’s, Ulcerative colitis, acidity, recovery from fever, for removing toxinc ‘ama’. It is based in a traditional Ayurvedic practice known as ‘samsarjana karma’ that gradually cleanses and buolds digestive strength.

• Use basmati rice or quinoa and follow each stage for a day or two depending on your digestive strength.
• Drink lots of ginger tea during this time.

Phase 1: Rice water (manda)

• 14 parts of water to 1 part of rice simmered for 30-40 minutes: Strain the grains out.
• Add a pinch of salt and cumin powder to taste.
• This is a milky-coloured liquid, and is the easiest of all the foods to digest, usually given just once at the outset of the practice.
• Then follow the below having each one for a day or two.

Phase 2: Rice water with rice part 1 (peya)

• 8 parts of water to 1 part of rice simmered for 30 minutes: Leave the grains of rice in.
• Add a pinch of salt, cumin and ginger powder to taste.

Phase 3: Rice water with rice part 2 (yavagu)

• 6 parts of water to 1 part of rice simmered for 30 minutes: Leave the grains of rice in.
• Add a pinch of salt, cumin and ginger powder to taste.

Phase 4: Rice water with rice part 3 (vilepi)

• 4 parts of water to 1 part of rice simmered for 30 minutes: Leave the grains of rice in.
• Add a pinch of salt, cumin, coriander, ginger powder to taste. Also add1/2 tsp ghee.

If your digestion is feeling strong add some steamed vegetables such as carrots or spinach.

Phase 5: Rice water with rice part 4 (odana)

• 2 parts of water to 1 part of rice simmered for 20 minutes.
• Add a pinch of salt, cumin, coriander, ginger powder to taste.
• Also add1/2 tsp ghee.

Eat this with some yellow split mung lentils: Simmer 1 part lentils in 14 parts of water for 40 minutes with some spices and ghee in.

Then start to eat kicharee. Try eating kicharee regularly. It is easy to digest and very nourishing.

• 1/3 cup split mung beans, 2/3 basmati rice (or other grain) simmered in 3-4 cups of water (a ratio of 1:3 or 1:4).
• Add 1/4 tsp each of organic turmeric, ginger, roasted cumin and coriander.
• Add seasonal vegetables: spinach, peas, or seaweeds, shitake mushrooms for an all round healing, healthy and digestion enkindling meal.
• The best practice is to cook it on a very low heat in a covered saucepan and it is best not to stir it after all the ingredients are added or it will go mushy.
• Add a teaspoon of ghee or hemp seed oil at the end with some salt to taste.