Adrenal glands, also known as suprarenal glands, are small, triangular-shaped organs on top of both kidneys. They produce hormones that help regulate metabolism, immunity, responses to stressors, fluid balance and blood pressure, and other essential functions. Importantly, there are two distinct parts: the adrenal cortex and the adrenal medulla.

The adrenal cortex is the outer region. It is divided into three zones, each responsible for producing specific hormones.

• Cortisol is a glucocorticoid hormone that plays many important roles in the body. It helps control the body’s use of fats, proteins and carbohydrates; suppresses inflammation; regulates blood pressure; increases blood sugar; and can also affect bone formation. This hormone also controls the sleep/wake cycle. It is released during times of stress to help the body get an energy boost and better handle an emergency situation so it also generates a sense of euphoria.
• Aldosterone is a mineralocorticoid hormone that plays a central role in regulating blood pressure, acidity and the key electrolytes sodium and potassium. It sends signals to the kidneys, resulting in them absorbing more sodium into the bloodstream and releasing potassium into the urine.
• DHEA and the androgens are weak precursor hormones that are converted by the ovaries and testes to augment their own production of oestrogens and testosterone. This link and overlap with the functions of the sex glands is significant (see below).

The adrenal medulla is located at the core of the gland. It is essentially an extension of the sympathetic nervous system and produces ‘fight-fright-flight hormones’ including adrenaline and noradrenaline. This is an almost instant response to alarming situations, especially where urgent extreme physical activity is important, and these hormones increase heart rate and the force of heart contractions, blood flow to the muscles and brain (though in other areas can constrict blood vessels so as to increase blood pressure). They also relax airway smooth muscles to increase breathing efficiency.

So an adrenal stress response has two parts. The immediate reaction to a threat is a flood of adrenaline and noradrenaline from the medulla. The first tissue to be affected by this is the adrenal cortex, which responds in its own way by producing a more sustained response to stress, mainly with cortisol. It is the combination of the two responses that constitutes our adaptation to stress.

Pathologies of the adrenal medulla (e.g. pheochromocytoma) are very rare. There are a number of also relatively rare diagnosable disruptions in function of the adrenal cortex, either primary to the gland or secondary to disorders of the pituitary or hypothalamus.

They include Cushing’s Syndrome, where the adrenals overperform (and can also be a feature of over-prescription of steroids), and Addison’s Disease, which is a severe condition of adrenal insufficiency marked by weight loss, poor appetite, nausea and vomiting, fatigue, darkening of skin and abdominal pain, and can be a feature of potentially fatal ‘adrenal crisis’. The concept of ‘adrenal fatigue’ is not included in the catalogue of medical disorders of the adrenal glands.

Modern clinical concepts of ‘stress’ can be traced back to a brief article written in 1936 by the Austro-Hungarian scientist Hans Selye (2). The article set out what appeared to be a three-phase pattern of nonspecific physiological responses to injury: the ‘general adaptation syndrome’: this is made up of 1) an initial alarm phase 2) a stage of accommodation, resistance or adaptation, leading eventually to 3) a stage of exhaustion and even death.

This was a radical and sometimes controversial idea: that many different diseases could have a common cause in the failure of adaptation to stressors, which as well as the physical, such as cold, hunger and infections, could also include emotional and psychological ‘stress’.

It suggested that the body had an exhaustible capacity for coping, that initially it responded to stressors with vitality, learned to manage them for a while, but if the stressors persisted became increasing fatigued.

For Selye steroid hormones lay at the heart of the body’s capacity to adapt to the stress of life: “not only sex,” he wrote in 1949, “but the development and metabolism of the entire body, as well as its resistance and adaptability to exposure and disease, are influenced by the steroid hormones of the gonads, the adrenal cortex and the placenta.”

Although the separate discovery of cortisone as a medicine for the relief of rheumatoid arthritis (which won a Nobel Prize in 1950) were made without reference to Selye’s work, it contributed to a new enthusiasm for the role of steroids and the adrenal cortex in health. It was the linking of the third phase of Selye’s General Adaptation Syndrome with the adrenals that generated the concept of ‘adrenal fatigue’.

However Selye was at least as interested in the wider endocrine system, actually the basis of his most authoritative published works. In particular he led the way in understanding what we now know as the ‘hypothalamic-pituitary-adrenal axis’ (HPA). It is this circuit of the three glands, each producing hormones that regulate and affect the other, that is the real determinant of our adaptation to stress.  A well-functioning HPA is an indicator of resilience and coping capacity. Taking into account the hypothalamus and pituitary, and their location as integral parts of the central nervous system, and noting the complex interplay of signals back and forth between the three players (3), is much more useful than focusing just on the ‘adrenals’

Chronic fatigue is one of the syndromes often linked with ‘adrenal fatigue’. A common feature of chronic fatigue syndrome (CFS) appears to be reduced hypothalamic activity with less corticotropin-releasing hormone (CRH); this directly reduces the pituitary’s production of adrenocorticotrophic hormone (ACTH), that in turn reduces adrenal cortex activity (4).

The consequences of underperformance of the HPA axis include disrupted sleep patterns (leading to a vicious cycle of increasing fatigue that exacerbates all CFS symptoms as well as ‘adrenal fatigue’) (5).

There are also pointers to the disruptive role of inflammatory cytokines on the HPA axis (6). This could certainly link adrenal performance to infections, post-viral conditions and chronic inflammation.

However even the HPA role in fatigue is complex and it would be misleading to confine the argument to this endocrine factor alone (7). It is important in making biomedical assessments to remember that there are always wider factors at play. We will return to the ideas of networks later.

A popular synonym for adrenal fatigue syndrome is ‘kidney depletion’, a term appropriated from Traditional Chinese Medicine. The notion is that somehow the kidneys are the body’s powerhouse and that their depletion is analogous to flattened batteries. Not surprisingly, this attribution is even more thoroughly mocked in scientific circles, so before this conversation loses connection with modern experience altogether it is worth taking a look at what the ‘kidney’ means in traditional Chinese thought. The most glaring point is that it means something very different from the modern kidneys!

A general distinction between traditional and modern medical concepts is that the first were induced from cumulative subjective experiences, rather than the dissective, deductive approach that is the foundation of the scientific method. (In the traditional Chinese view dissection was more lowly work, eg. of butchers deconstructing dead bodies, rather than the work of physicians understanding living beings.)

Thus what are assumed as fixed organs in scientific medicine are understood in Chinese tradition as functions (zang fu). In classic texts going back up to 3000 years – like the huang di nei jing su wen -The Yellow Emperors Classic of Internal Medicine (8,9) the Chinese Kidney (shen) is a functional entity (10)  that is best understood by reference to our widest experiences of the world.

So the Kidney (shen) is

• linked to the Water phase in the Chinese universal 5-phase cycle and mediates the qualities of water within the living being (sinking, cold, yielding and fluid, tending to stillness, deep and dark, hidden, latent, full of potential, dissolving, necessary for buoyancy/vitality);
• at once the most yin or substantive function in the body: the ‘root of life” (it stores the constitutional energy received from one’s parents), manifest in the deepest tissues: bone and the marrow (which in Chinese observations including the brain and spinal cord);
• but also as the ultimate receptor of inspired vital energy (qi) from the Lungs(fei) it is the source of both yin and yang, water and fire, in the living being, with its yang aspect (ming men huo) the source of body heat and power, the ruler of birth, reproduction and development, the source of our will, and of jing (the vital energy that fuels reproduction and our capacity for action).

One can observe shen as the feeling of fear (which stimulates it to most activity)

• in the health of hair on the head
• in the ears (and hearing)
• in the sound of moaning (or a sad dull voice)
• in sputum
• in the radial pulse: 3rd position on the left (also right) side
• in the bones, teeth, joints and marrow
• when upset as a black hue to the complexion and around the eyes
• in that activity which is supported by moderate levels of bitterness, damaged by excess sweetness and in excess is relieved by moderate saltiness.

So the Chinese Kidney is very much the body’s central resource and powerhouse, manifest in its deepest places and most fundamental functions, including reproduction, birth, and development. There was a certain fatalism about the concept: a large part of Kidney energy is a birthright, to be cultivated by healthy practices, rather than squandered though an excessive lifestyle, and diminution of Kidney energy was seen as mark of ageing itself.

In this context Kidney Deficiency could be seen as potentially terminal and there is no doubt that repleting these energies is the toughest challenge in traditional Chinese therapy.

Although these concepts seem wholly alien to modern medicine there is a fascinating potential correlation between the Chinese Kidney and modern observations, as well as a link to our ‘adrenal fatigue’ theme.

In the human embryo, starting around 4 weeks after conception when it is around a centimetre long, there emerge several important structures in the back of the abdomen. There are primitive and temporary kidney structures, including the mesonephros, which fades away before the final kidney, the metanephros, emerges.

Alongside there is an accumulation of cells that forms the genital (or gonadal) ridge.  This ridge develops eventually to form two sets of endocrine glands, the gonads (ovaries or testes) and the adrenal cortex – the only tissues in the adult body that produce steroid hormones.

It is tempting to see a correlation between the embryonic genital ridge and the Chinese Kidney. The experiences that generated the concept of shen are mediated physiologically by the glands that originate in that ridge, which similarly sustain potency and resilience as well as sex and reproduction.

It is a happy coincidence that the course of the genital ridge in the embryonic abdomen is close to the Kidney meridian in the adult. (I am indebted to Richard Cone, Johns Hopkins Emeritus Professor of Biophysics for sharing the conversation that inspired this insight).

Although not biomedically supported the term ‘adrenal fatigue’ does describe an experience that is not uncommon, and which can be very distressing and disabling, not least because it is poorly explained and there are no useful prescriptions to treat it. This review has picked out different ways to understand the condition, but physiological mechanisms remain elusive. In some ways adrenal fatigue overlaps with chronic fatigue syndrome (see Fatigue) and can be seen as one aspect of this equally challenging condition.

There is one similar but relatively well and authoritatively described syndrome: ‘Critical Illness-Related Corticosteroid Insufficiency (CIRCI)’ associated with severe illnesses. It includes a complex dysregulation of the HPA axis, the suppression of cortisol-metabolizing enzymes in the liver and kidney, leading to raised cortisol levels, and tissue resistance to glucocorticoids (11). Heightened inflammatory activity is identified as a major driver for these disruptions and there may be some overlap with the more chronic conditions we have been discussing here.

Rather than looking for particular biomedical (or psychological) causes of adrenal fatigue syndrome (or any other chronic fatigue pattern) perhaps a more effective approach is to view it as a system breakdown, a failure in the normal self-organising adaptive network of functions in the body. Here a healthy emergent self-organising network of functions becomes chaotically disruptive (12).

The advantage of such a perspective is that rather than chasing elusive single causes, the search is on for ways to reprogram (‘reboot’) the whole system and to identify factors driving the disruptions. For example it has been found that it is helpful to switch the narrative in the management of fibromyalgia from damage and pain to the idea that the body is ‘a very, very clever computer’ where fibromyalgia is caused by a software rather than a hardware problem, by the body adapting when people have to ‘keep going’ despite ‘stop signals’, such as pain and fatigue.

This provides a rationale for engaging in interventions to reprogram the body’s software (13). Taking the opportunity of herbal treatment sessions to construct a ‘rebooting’ programme in which herbs support a strategic reconstruction of coping performance remains one of the best approaches to ‘adrenal fatigue’.

There is ample evidence that syndromes like these involve disturbances in the HPA axis (14), but a wider and more consistent pattern, such as described in CIRCI above, is the increased evidence of inflammatory and immunological activity (15), especially when this also becomes neuroinflammation (16), and in depression also (17). There is some indicative evidence of the benefits of anti-inflammatory diets in managing fatigue syndromes generally (18).

Given the absence of useful pharmaceutical approaches to syndromes identified as adrenal fatigue (although one unintended potential benefit of using antidepressants is that they actually down-regulate inflammatory processes (19) there is plenty of opportunity to consider more wholistic herbal solutions that can emerge from traditional insights, and take into account adaptive network ideas.

Certainly a first aim must be to hunt down any possible sources of inflammation, as the most likely driver of the system breakdown. There may already be evidence of chronic inflammatory conditions but these themselves may not be the origin. It is always a good start to assume that inflammatory pressures start in the gut, with increasing evidence of microbiome involvement and there are other Insight pieces in Herbal Reality that pick up on these themes. Look for possibilities of stealth pathogens as causes of chronic inflammatory pressures, those that evade defences and prescriptions and which best be managed by upregulating immune defences.

Setting up a proper convalescence programme is almost always productive as it gives the patient the opportunity to learn how to get on top of the conditions that worsen the exhaustion, like managing sleep, rest, activity, and diet.

Herbal tonics are the obvious first call. They have been poorly defined, with different meanings in different contexts. In this text they refer to remedies that support healthy functions. On one hand remedies used as tonics overlap wholly with foods: different parts of the oat, wheat, barley, rye, asparagus and artichoke, for example, have been used as both foods and medicines. In modern times dietary supplements like evening primrose oil and grape seed have further blurred the distinction.

Other tonics are more dynamic, notably some of those used in Chinese medicine, particularly the yang tonics like fenugreek and eucommia and the qi tonics like Panax ginseng (Asiatic ginseng): these can become a bit stimulating in the very debilitated. A particular application of tonics is to encouraging sleep, lack of which is notoriously part of a fatigue vicious cycle. Tonics like valerian, St John’s wort and notably ashwagandha (see also below) can often help break that cycle by helping charge up the particular sleep batteries.

However by definition the most appropriate herbal approach to supporting adaptation is the ‘adaptogen’. In currently the most definitive review (20), Alexander Panossian and his illustrious co-authors define adaptogens as ‘a category of herbal medicinal and nutritional products promoting adaptability, resilience, and survival of living organisms in stress’.

They emphasise that the term is related to a physiological process—adaptation to environmental challenges, including diverse mechanisms of extracellular and intracellular interactions that fit in well with the network theory above. The paper reviews many adaptogen candidates starting with Schisandra chinensis which inspired the concept in the USSR in the 1950s, initially to improve attention and endurance among the Soviet Armed Forces and the new cosmonauts.

Other adaptogens quickly became official medicines in the USSR: Aralia elata, Eleutherococcus senticosus, Panax ginseng, Oplopanax elatus, Rhodiola rosea, and Rhaponticum carthamoides.

Key points of the adaptogenic concept are in line with basic principles of traditional Asian medical systems like TCM, Japanese Kampo, and Ayurveda, for instance, an assumption is that their tonics, restorative remedies or rasayanas share normalizing effects, irrespective of the nature of the disease.

Ayurvedic rasayanas that are considered as having adaptogenic properties include

• Amla (Emblica officinalis)
• Ashwagandha (Withania somnifera)
• Guduchi (Tinospora cordifolia)
• Haritaki (Terminalia chebula)
• Kalmegh (Andrographis paniculata)
• Pipul (Piper longum)
• Shatavari (Asparagus racemosus)
• Tulsi (Ocimum tenuiflorum. O. sanctum)
• Yasthimadhu (Glycyrrhiza glabra)

Among around a hundred remedies in total listed in the Panossian paper traditional Chinese tonics that particularly fit the adaptogenic definition include

• Bai shao (Paeonia lactiflora)
• Bai zhu (Atractyloides macrocephala)
• Chai hu (Bupleurum falcatum)
• Chuan xiong (Ligusticum wallichii)
• Dang gui (Angelica sinensis)
• Di huang (Rehmannia glutinosa)
• He shou Wu (Polygonum multiflorum)
• Huang qi (Astragalus membranaceus)
• Ren shen (Panax ginseng)
• Suan zao Ren (Zizyphus jujuba)
• Yuan zhi (Polygala tenuifolia)

There are also holistic tools and lifestyle choices which can ease adrenal fatigue. In this article on fatigue, under holistic solutions the knowledge is shared on how to care for oneself beyond herbal treatment. 

Morris G, Anderson G, Maes M. (2017) Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways. Mol Neurobiol. 54(9): 6806-6819.

Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged periods of stress.

It manifests as low resilience, depression, cynicism, emptiness, feeling trapped, feeling ineffective, detached from the world, apathetic, insomnia and feelings of overwhelm.

As a term, it was originally used to describe the fallout from long-term stress caused by work, but a semantic shift and improved understanding means that we may apply it to any areas of life that cause such feelings of hopelessness.

Burnout goes beyond stress, it is a diminished capacity to deal with life’s stressors and needs urgent addressing for healing – it is essentially end-stage stress, cannot be sustained and, unlike stress, may feel never-ending and insurmountable to the sufferer.

There are no official figures of burnout sufferers as whilst the WHO have recognised it as an official “syndrome” (related to workplace stress only), it is yet to make it to the DSM-5 as a medical diagnosis. It can only be a matter of time for it to be officially recognised as there is no doubt that burnout is on the rise, and incredibly impactful on the lives of sufferers.

There are many contributing factors to the rise in burnout:

• Poor sleep
• Reliance on devices/never switching off
• Changes in how we nourish our bodies
• Poor work/life balance
• Adverse childhood events
• Inability to say “no” and the glorification of busyness
• Money issues and lack of access to resources

In more recent times, Covid and the seemingly never-ending pandemic was (and is) one of those challenges that rendered us with little control. The reality for many is that their mental health has been challenged. In fact, the Centre for Mental Health UK predicts that up to 10 million people (almost 20% of the population) will need either new or additional mental health support as a direct consequence of the pandemic. This has, without doubt contributed to the sudden rise in burnout sufferers in recent times.

• Onset and maintenance insomnia, and excessive daytime sleepiness
• Fatigue
• Food intolerances
• IBS
• Dysregulated blood sugar
• Low immunity/susceptibility to infection
• Headaches
• Unexplained pain
• Panic attacks
• Hypo arousal of the HPA (hypothalamic-pituitary-adrenal) axis – flattened cortisol curve
• Acne, psoriasis, eczema, and other skin disorders
• Brain fog and cognitive decline

Our diet has a huge impact on our physiology and nervous system response, thus our mental health. Whilst it’s not possible to simply eat oneself out of an anxious or burnt-out state, the potential for what we eat, or importantly what we don’t eat, and when and how we eat it, to influence our mental health is often seriously overlooked.

How we eat is indicative of what is going on in our lives, and a lot of people’s eating habits have changed over the past two years of lockdown. The way we feel about food and our ability to nourish ourselves affects our mood and sense of self.

Allostatic load is defined as “wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress, anxiety, or burnout. As food can affect burnout, so can burnout can affect how we absorb and respond to the food that we eat.

Increased output of our stress hormones and continued HPA-axis activation leads to systemic inflammation which can (amongst other things) drive food intolerances through altered tight junctures in the gut lining. Furthermore, dysregulated cortisol levels have been shown to affect the composition of bacteria in the gut.

Whilst structurally the same as the brain, our gut-derived serotonin has localised effects on the digestive system, such as the perception of nausea, pain and drives peristalsis (the rhythmical movement of the gut muscles to transport food through the tract). Whilst there is still much to be understood about the effect of peripheral serotonin on mood, what has been determined is that the production and release of serotonin from the enterochromaffin (EC) cells in the gut can be controlled by our gut bacteria.

Long term stress and burnout may impair our cell-mediated acquired immunity, leaving us more susceptible to viral, bacterial and yeast infections.

Staying up late

We have a wealth of streaming services at our fingertips, providing more incentive to stay up late. Screens emit blue light which interfere with our melatonin production, which means that when we do make it to bed after a series binge it takes us longer to fall asleep, and when we do drop-off, our sleep has less of the vitally restorative REM sleep stages. Sleep is so crucial to our mental and physical well-being that even the smallest sleep deprivation can have a deep impact.

Hooked on our devices

In this modern world we are always connected via our devices. Endless scrolling of Instagram feeds, designed to hook us in, and boundary-less colleagues and clients who see no harm in popping a “quick email” at midnight keep us in an aroused and stressed state. This is incredibly stimulating to our nervous system, putting us into flight-or-flight mode, which upregulates the production of stress hormones. Continued and chronic hyperarousal of our fight-or-flight response over time can lead to a freeze state, which some proponents of polyvagal theory believe to be similar to “burnout”.

Inability to say “no” and the glorification of busy

We now equate busyness to productivity and a characteristic of a successful life – often we have created this busyness to distract from our unfulfilled needs. We have designed our life to distract us from those uncomfortable feelings – we keep ourselves busy on social media, social engagements, in our work, and in our inability to say no, and it is stressful. The truth of the matter is that busyness does not result in greater productivity, and that busyness is contributing to a culture of continuous anxiety and stress.

Reaching for quick and easy foods

A typical western diet is nutrient-void and inflammatory to the body, and the mind. The western diet is rich in refined sugars, white and processed flours and simple carbohydrates, processed meats, and food additives, and contains low amounts of fibres, vitamins, minerals, complex carbohydrates and other plant-derived phytonutrients and antioxidants.

When we are busy, stressed or suffering burnout, what’s on our plate and how we nourish our body might become an afterthought, or we may not have the capacity to think about how to eat to improve our well-being. Fast foods can become a go-to as it requires little thought, despite the detrimental effect it can cause.

Whilst we cannot merely eat ourselves out of burnout, we can certainly modulate what we eat and the way we eat it to lessen the physiological impact of burnout on the body, and by giving our brains all it needs to repair, provide ourselves with all the tools to begin healing. Highlighting specific foods that may have an impact on brain chemistry can be useful, yet when a person has reached burnout stage it may be more helpful to look at how they are eating as opposed to concentrating on nutrients specific to a handful of foods.

Marrying your macros

When carbohydrates are broken down and have been eaten alone or without sufficient fats and proteins, they cause a spike in blood sugar, the body uses this quick energy as accessible and immediate, followed by a quick drop. We are not only quickly hungry again as the insufficient energy has not sustained us, but this is an incredibly inflammatory process for the body.

This is blood sugar imbalance or the “Blood Sugar Rollercoaster” and it’s not a ride we want to be on. Our body tries to reach homeostasis, and to do so releases cortisol – our stress hormone. So, ensuring you are pairing carbohydrates (preferably complex) with good fats and proteins will slow the rate of absorbency, and breakdown of sugars.

Avoiding fasting/eating regular meals

Our body doesn’t know why there’s a lack of food by design, it just knows that it must prioritise the search for it and scarcity of food is a stressor for our body. Too much circulating cortisol diminishes our ‘non-essential’ functions such as hair growth, libido, our reproductive system and sleep, because our body doesn’t know it’s truly safe to conceive or sleep under all this threat and escaping the stressor is priority.

A diverse range of foods

An ‘ecosystem’ of varied bacteria greatly impacts our mental. Different bacterial strains perform diverse beneficial functions, and each strain thrives off the consumption of different foods. Complex carbohydrate plant foods provide fibre as an important cornerstone of our diet. Our bodies do not have the enzymes to digest these – that is a job for our gut flora. These prebiotic foods nourish the good bacteria in our gut which are responsible for producing many of our mood-supportive neurotransmitters.

A Mediterranean diet

The Mediterranean diet has long been associated with a reduction in the risk of depression, and now emerging research shows that it may be a useful tool in the prevention or treatment of burnout.

A diet rich in a variety of vegetables (including dark leafy green), fruits (including berries for their antioxidant power), legumes, nuts, seeds, whole grains, olive oil, oily fish and a low intake of highly processed food and red meat, reduces inflammation and provides nutrients that are depleted when mental health is challenged. Stress is nutritionally very expensive on the body, so replenishing these stores is vital in healing.

Staying hydrated

Dehydration can mimic feelings of anxiety or panic; our bodies can feel fatigued and our brains sluggish. Our blood is 92% water, and so the smallest decrease can cause blood pressure to drop. Our bodies like homeostasis, so will create alarm (increased stress hormones) to alert us to the imbalance. Staying hydrated is the quickest and easiest win for our mental and physical health, and easy to forget when in a burnt-out state.

• Improved boundary setting and learning to say “no”
• Prioritising deep rest to heal
• Ensuring that at least 2 out of 3 meals per day are nutritionally dense
• Setting limits on our device usage
• Daily movement, even just a short walk
• Forest bathing and getting out in nature to increase GABA
• Assess and act upon any nutritional deficiencies in the body
• Improve gut health
• Daily movement, even just a short walk
• Taking time to eat undistracted to improve digestion
• Practice good sleep hygiene
• Avoid reliance on alcohol and limit intake

Self-forgiveness is key here. Whilst nutrition is a very important part of the healing process, it is not the only component of recovery. Not everyone loves to cook, or has the time, means or access to resources to create nutritious meals from scratch every day – a lot can be done with convenience foods and combining cheaper products.

Asking for help, from either partners, friends, or local resources such as food banks and charities may prove beneficial. The rise in austerity has meant that there are some wonderful free food sharing apps that have emerged in recent years and contacting your local welfare group may point you in the direction of valuable resources in your community.

The adage “prevention is better than cure” is certainly true when it comes to burnout. Recognising the warning signs of stress and taking preventative measures to mitigate its impact can prevent the transition to burnout. This isn’t always possible, often times we cannot remove ourselves from a chronic stressor before it is too late. When one has reached burnout, recognising that healing is not linear but rather undulating over time, is very important.

Often when we are at rock bottom, we can feel impatient to be better, and steps back can feel like colossal failure. Reminding oneself of the process and trusting in it will give the impetus to continue even when it feels hard. Understanding that as humans we are designed to heal and are always in a state of flux – whilst not everyone has the capacity to be fully cured (trauma will always leave its mark), everyone has the capacity to heal.

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Allergies (also known as “hypersensitivities”) are due to overreactions of the immune system to substances that do not necessarily elicit immune responses in the majority of people. Hypersensitivities are grouped into four types: I, II, III and IV. These groupings are based on which white blood cells (WBCs) and tissues of the immune system are activated and how long it takes for a reaction to occur.

The two types of hypersensitivities that are referred to as allergies, are type I or ‘immediate’ hypersensitivities, and type IV or delayed type hypersensitivities (DTH).

The cells and pathways involved in type 1 hypersensitivities are mast cells, IgE and the release of histamine. An antigen induces the formation of IgE antibodies, in individuals with an atopic predisposition, via B lymphocytes. Reactions occur only after a requisite initial exposure, in which the primed mast cells bind IgE and start the degranulation process. This commonly involves the respiratory, gastrointestinal and/or the skin and occurs within minutes to hours.

In type IV hypersensitivities, or DTH, instead of involvement of the antibody IgE, T lymphocytes are involved and the onset of symptoms take hours to days to appear. CD4⁺ , T helper cells, in response to haptens (small antigens), release cytokines/chemokines which can recruit macrophages to a site (such as in the tuberculin-type response due to a TB test) inducing local inflammation.

In the case of Type IV interactions the immune system does not need to be primed but does go through a sensitization phase. The outcome is acute inflammation and possibly edema. The skin is often the obvious site of DTH reactions (redness, swelling, hardening of the skin, rash, dermatitis).

The PPARs constitute a set of three receptor sub-types which are members of the nuclear receptor superfamily of ligand-activated transcription factors. They are encoded by distinct genes that function as lipid sensors that regulate gene expression in many metabolically active tissues (6).

The PPARs, so named because in early research it was found that PPAR-δ stimulation resulted in the increase in peroxisomes, have a significant role in cellular energy balance, fuel utilisation, the metabolism of fatty acids and other lipids, the generation and remodeling of adipose tissue and fibrotic and hypertrophic responses in the heart and vascular wall.

Many of these actions are via interactions with nuclear factors such as NFκB, NFAT and activator protein 1 (AP-1), thus modulating expression of pro-inflammatory cytokines and adhesion molecules, and altering cell signaling pathways (7,8). Thus, PPARs, in response to stressors, play a role in the complex orchestration of adaptive cellular physiology working in a concerted mode with the vitamin D receptor and the retinoic acid receptor (RXR).

PPARs have been found to be involved in inflammation and carcinogenesis, and other immune activity. Thus, many pharmaceutical companies have been involved in PPAR research in search of the perfect ligand in areas such as diabetes, obesity, cardiovascular disease and immunology with drug development in mind.

The endogenous ligands to the PPAR sites were originally unknown, earning the PPARs the name “orphan nuclear receptors”. Key to this discussion, PPARγ plays a significant role in allergic response, specifically PPARγ (9-15).

The high-affinity IgE receptor Fc epsilon RI (FcεRI), found on mast cells and basophils, plays a central role in IgE-mediated inflammatory reactions. PPARγ agonists have been shown to inhibit the expression of CD117 (tyrosine-protein kinase KIT or mast/stem cell growth factor receptor) and FcεRIα (9,11), and the maturation of bone marrow‑derived mast cells, as well as inhibiting the formation of granules and reducing the expression of β‑hexosaminidase (a marker of mast cell degranulation) and induce mast cell progenitor apoptosis (9).

Finally, a reduction in mast cell histamine content (15), histamine release (11,15) and suppression of body temperature increase in anaphylaxis models has been documented (12). Human trials of PPARγ agonist on patients with atopic dermatitis has demonstrated a decreased total body surface area involvement, severity of lesions, and number of flares with PPARγ agonists (16).

In allergic asthmatic patients a down-regulation of PPARγ expression has been observed in lung tissue (17,18) and noted to be a potential factor in dysregulation of pulmonary homeostasis (17). While in steroid resistant asthmatic smokers an inhaled PPARγ agonist has shown improvements in lung function superior to steroid inhalation (19).

Human data in a month long double-blind randomized controlled trial, with a PPARγ agonist vs. placebo reduced the late asthmatic response by 15% and a reduction of exhaled nitric oxide by 14% (20). Another double blind RCT of a PPARγ agonist in severe asthmatic patients was found not to have a positive outcome (21).

While PPARγ as a pharmacological target has strong preclinical data, the evidence in clinical trials is not robust. It may be that PPARγ needs concurrent support by engaging other pharmacological targets within a physiological network of allergic reactions. Intriguingly, PPARγ is now considered part of the endocannabinoid system (22-26).

The CB2 receptor is a G protein-coupled receptor located on T & B lymphocytes, as well as natural killer cells, macrophages, neutrophils and mast cells (27). The CB2 receptor has been found to play a significant role in immune dynamics including the resolution of inflammation, cancer, atherosclerosis, osteoporosis and chronic pain (28). The CB2 expression in lymph nodes and spleen is higher than in peripheral blood cells and is different in various immune cell populations; B cells > NK cells > monocytes > neutrophils > CD8 T-cells > CD4 T-cells (29,30).

CB2 is a particular attractive for cannabinoid agonists selective for this site because of a paucity of psychomimetic activity. Nonetheless, in the face of remarkable volumes of preclinical data, only one CB2 potential drug molecule (cannabinor) has made it to phase II clinical trials (31). Other human data comes from marijuana smokers provide insight as to the effects of CB2 ligands on immune function. Lung alveolar macrophages removed from marijuana smokers have diminished capacity for the generation of TNF, gmCSF and IL-6 (inflammatory cytokines) (32).

Notably, CB2 ligands have demonstrated the inhibition of FcεRI-induced degranulation in mast cells in a concentration dependent manner. GPR55 (a putative CB3 receptor) also appears to show the same effect. CB1 appears not to have a role in inhibition of mast cell degranulation (33).

CB2 agonist have also shown a role in the retention of immature B cells in the bone marrow (34) and demonstrated a significant decrease in CXCR4 (a chemotactic chemokine) in bone marrow cells (34). CB2 is involved in the inhibition of lymphocyte recovery after bone marrow transplantation as well (35).

Other data suggest that cannabinoids can inhibit the production of TNF and other cytokines by several different pathways, some independent of cannabinoid receptors (27). Conversely, cannabinoids have also been shown to increase the production of cytokines (including TNF, IL-1, IL-6, and IL-10) if administered with appropriate immune stimulation (bacteria or antigens) (27) or, in some cases, without immune stimulation (36). Challenging a common misconception of CB2, this strongly suggest true immunomodulation and not simple immunosuppression.

The use of herbal remedies as a substitute for medical care is growing rapidly (37). An observation by this author is that in the United States, due to lack of s public health care system, every recession is accompanied by an increase in the sales of natural products. This is likely due to health insurance being tied to employment. As U.S. citizens lose their jobs, they also lose their health insurance.

Intriguingly, laboratory studies suggest that in some cases the overall pharmacological effects and therapeutic efficacies from medicinal plants may not derive from a single compound but from several compounds generating synergic activity (38-42). Synergy as a pharmacological construct, is often cited as a general mode for the biological activity of these compounds (38-43).

Preparations of Echinacea spp., have been used for more than a century for treatment of a variety of infections (44). More than 3 million physician prescriptions for Echinacea preparations are written annually in Germany (45) where there are more than 800 Echinacea products on the market (46). Most preparations are derived from the aerial parts of E. purpurea and underground parts of E. purpurea, E. angustifolia, or E. pallida (47).

Although controversial, the Echinacea spp. are often used interchangeably for the treatment of colds, flus, respiratory infections, and inflammations (48). Echinacea is documented to have immunostimulating, anti-viral, antibacterial, antifungal, insecticidal properties and anti-inflammatory properties (47,49).

Despite some negative outcomes in a few clinical trials using echinacea to treat upper respiratory infections, there are enough positive data in the human trials to offset the negative results. As a result, the meta-analyses that have been performed suggest that Echinacea products are effective (50-53).  A Cochrane review reports some Echinacea preparations may be better than placebo and that the majority of the Echinacea studies demonstrate positive results (51).

A meta-analysis by Schoop et al. (52), reports that standardised extracts of Echinacea were effective in the prevention of symptoms of the common cold as compared with placebo. Islam and Carter (53) conclude that there is a beneficial effect from Echinacea, but also suggest that differences in products and doses make evaluation challenging (51).

Linde et al. (50) suggest that there is evidence, although inconsistent, that Echinacea is effective in treating URIs. A meta-analysis of studies with children  (< 18 y/o) found that Echinacea reduces the incidence of URIs by 40% (54). Finally, the most recent meta-analysis finds that the evidence supports Echinacea’s benefit in decreasing the incidence and duration of the common cold in adults (55).

Echinacea’s effectiveness is believed to be related more to the enhancement of innate immunity, rather than antimicrobial activity (49,56) The stimulation of innate immunity by Echinacea extracts are well established (57-65). Studies have reported that echinacea extracts have the ability to activate human phagocytic function both in vitro and in vivo (58,59,61,66-68). Additionally, the plant has shown ex vivo immune stimulation in human immunodeficiency disorders (60).

The immunomodulatory effects are believed to be mediated by induction of cytokines from macrophages and antioxidant activity (49,69). However, some people, mostly those who are not experienced with the clinical use of echinacea, believe that echinacea products are simple immunostimulating and as such, would be contraindicated in an attenuating an acute immune response. Only recently has basic research supported a biphasic response, clinicians who have extensive experience with echinacea preparations have been aware of this for many decades.

The search for endogenous ligands for the cannabinoid receptors has led to the discovery of several polyunsaturated compounds derived from fatty acids, mostly arachidonic acid (70).  These fatty alkylamides, although not as widespread as other classes of natural products, are relatively abundant in plants, and occur in a variety of families, including the Asteraceae, Brassicaceae, Leguminosae, Piperaceae, and Rutaceae (71). Examples of plant species containing alkylamides similar to those of Echinacea spp. can be found in Spilanthes and Zanthoxylum species (28).

The alkylamides found in echinacea species and other medicinal plants, have been of pharmacological interest since humans first noted the tingling and numbing effect from chewing plants rich in these compounds (72).

The anaesthetizing tingling of these compounds is associated with activation of tactile and thermal trigeminal neurons (73). This property was utilized by native Americans (74) and eventually by physicians in the early 20^th century for a variety of purposes including toothache and infections (75). Alkylamides were later recognized as insecticidal by a number of researchers (72,76-78) but eventually interest in these compounds waned. Nevertheless, these fatty acid derivatives have become a subject of renewed interest in the last few decades due to their recent identification as cannabinoid ligands (28,79-81).

The endogenous cannabinoid ligands are the fatty acid metabolites, known as eicosanoids (82). These endocannabinoids (e.g. anandamide from the Sanskrit term “ananda,” meaning bliss and 2-arachidonoyl glycerol) are structurally similar to the alkylamides, which are also fatty acid derivatives, and show nanomolar affinity for the type-2 cannabinoid receptor (CB2).

The affinity of the alkylamides for the CB2 are in the same range as the endogenous ligand anadamide (79). Research supports this, E. purpurea extracts demonstrate that particular isobutylamides modulate TNF mRNA expression in monocytes via CB₂ receptors (79,81). Alkylamides binding to CB2 increased IL-8 and monocyte chemoattractant protein, both proinflammatory proteins (79).

This may offer new insight into not only the mode of activity of Echinacea, but also immunology. Nadja Cech’s group, in collaboration with Bastyr University demonstrated a typical cannabinoid response from both extract and alkylamides of Echinacea; select isobutylamides from E. purpurea  inhibited IL-2 expression in T-helper cells (83). Additionally, recent work demonstrates a T_H-biasing effect, in which T_H1-cell activity is suppressed and T_H2-cell activity is increased (80). The cannabinoids show the same effect and this makes a case for the treatment of chronic inflammatory diseases by CB2 ligands (27).

Some have suggested since alkamides have anti-inflammatory activity, this is the primary effect of echinacea preparations (84). Anti-inflammatory activity has been verified through the inhibition of cyclooxygenase and 5-lipoxygenase (47) and the inhibition of IL-2 (83). Nonetheless, there is quite a collection of peer-reviewed research that shows immunostimulation by echinacea extracts and its compounds (57-68).  

As for echinacea and PPAR activity, in the author’s hands, we observed inhibition of IL-2 via PPARγ activation (85). We also found that a large number of the alkylamides across the spectrum of unsaturation that differentiate this class of compounds activate PPAR (89). 

Previous research has also demonstrated that Echinacea extracts inhibit mast cell degranulation. The authors of this research concluded that inhibition of mast cell activation coupled with the well-established inhibition of proinflammatory cytokine effects by alkylamide rich Echinacea extracts suggest utility in allergic diseases (90).

The alkylamides are not the only active constituents. There are other compounds in the Echinacea spp. that deserve mention. Three other constituent groups have shown activity; the hydroxycinnamates (caftaric acid, caffeic acid, chlorogenic acid, cichoric acid, cinnamic acid, cynarin, echinacoside etc.), polysaccharides, and glycoproteins (91,92).

Another phytocompound found in Echinacea, as well as cinnamon, clove, rosemary and black pepper, and such medicinal plants as Bidens pilosa, Angelica archangelica and Apium graveolens, isβ-caryophyllene (BCP), a sesquiterpene. BCP is considered a phytocannabinoid as it binds CB2. Research shows that via a CB2 mode of activity BCP has demonstrated significant cardioprotective effects in preclinical research in induced myocardial infarction models. Notably, BCP reduced the myocardial expression of inflammasome proteins including NLRP3, procaspase-1 and pro-IL-1β via TLR4 mediated NF-κB/MAPK signaling in CB2 dependent manner. Moreover, BCP enhanced the expression of the CB2 receptor and PPARγ and activated myocardial CB2 receptors resulting in the mitigation of oxidative injury (93).

Considering the number of phytochemical families that are active, the explanations of the effect of Echinacea include suggestions that the activity may be due to an entourage effect (85). There has also been in vitro antioxidant activity demonstrated by the hydroxycinnamates for both E. purpurea and E. angustifolia extracts (94,95). However, antioxidant activity will be addressed in the next section on Taraxacum officinale.

One of the most ubiquitous medicinal plants, dandelion (Taraxacum officinale) is well-known as a food due to its rich content in nutrients. Although considered by many to be an annoying weed, every traditional culture that has a native Taraxacum species has found medicinal use for this versatile genera (97). Unfortunately, dandelion is often overlooked due to is prevalence. An initial clue into its medicinal properties is provided by the name Taraxacum which is derived from the Greek words “taraxis” for inflammation and “akeomai” for curative (98).

Moreman (74) reviews use of dandelion by various tribes of the native North American culture shows use various parts of the dandelion for food and medicine. For example, the spring stems and leaves were used as vegetables and eaten to build the blood for conditions such as anemia and as a laxative-tonic, while decoctions of the roots were taken for stomach pain and to produce postpartum milk flow. Infusions of leaf and root were taken for kidney trouble and dropsy and used as a bitter tonic, the flower blossoms were taken for menstrual cramps.

In traditional Chinese medicine Taraxacum mongolicum is thought to have activity in a variety of health benefits (99), this includes clearing heat, especially of the liver and urinary tract and to promote lactation (100). In traditional Ayurvedic medicine T. officinale is used similarly as in TCM and said to be valuable in liver disorders and a useful diuretic (101) and to clear heat (102). An early 19^th century reference suggests that Taraxacum was used for chronic inflammation, digestive problems, as well as cirrhosis (103).

Although the diuretic properties are well known and recently observed in the first human trial (104), this brief overview will focus on the immune properties of dandelion.

The anti-inflammatory activity of dandelion is most likely partially due to its antioxidant activity and its hepatic activity. Recall that the liver is a key lymphatic organ with the largest population of fixed macrophages (Kupffer cells) of any bodily tissue and is therefore influential on the reticuloendothelial system and immune response.

Much of the traditional use of dandelion has supported hepatic activity for dandelion, indications such as liver and/or gall-bladder inflammation and stasis, cholelithiasis, metabolic toxicity, jaundice, hepatitis, and dyspepsia secondary to deficient bile secretion (105).

Medicinal plant preparations in general that have hepatic activity are likely to also influence Kupffer cells, although in varying degrees. This obviously can lead to immune up or down regulation. As a hepatic anti-inflammatory, dandelion, at least in clinical observations, appears to also have a systemic anti-inflammatory effect.  Phenolic compounds are believed to provide some of the anti-inflammatory activity (98).

A large portion of the research on the activity of dandelion has focused on the antioxidant activity (99,106-109). Past research reports significant antioxidant activity, typical for polyphenol rich plants, and inhibition of inducible nitric oxide synthase (iNOS), as well as synergic activity with other micro and phyto-nutrients such as the ubiquitous catechins and ascorbate (99,106,107).

Sumanth and Rana (108) confirmed an antioxidant effect and observed increases in the levels of superoxide dismutase, catalase and glutathione using a hydroethanolic preparation. Zhu et al (109) using a hydroethanolic extract, confirmed Rana’s results in finding increased superoxide dismutase, catalase, glutathione levels along with peroxidase levels and also found reduced lipid peroxidation.

Hu and Kitts (99) demonstrated protection of cells from peroxyl-radical-induced intracellular oxidation speculating that the protection may have been the result of scavenging of intercellular and intracellular peroxyl radicals by a phenolic rich extract from dandelion flowers. This team also showed a synergic effect with α-tocopherol and a 40% ascorbate equivalence which they believed was responsible in regenerating the α-tocopherol. Thus, dandelion’s antioxidant activity is established.

Antioxidant activity has generally been accepted to be a mode of activity for immunomodulation (110-112). Both anti-inflammatory and antiallergic properties are known to be induced be particular antioxidants (113). The reduction/oxidation (redox) reactions that are crucial to immune function can lead to tissue damage, allergy and autoimmune diseases if balance in this system is lost. 

Research has confirmed that polyphenols can make improvements in the overall redox status of immune cells (114). In compromised subjects (aged or diseased) this can lead to enhancements in such functions as chemotaxis capacity, microbicidal activity, lymphoproliferative response to mitogens, interleukin-2 (IL-2) and tumor necrosis factor (TNF alpha) release (111).

For example, in preclinical (in vivo) models many of the gallate derivatives have exhibited inhibition of histamine release from mast cells (murine model) (112). Additionally, the catechins are known to significantly inhibit type IV allergies in murine models (110). Finally, kaempferol has shown positive effects on IL-4 and JAK3-dependent responses suggesting that compounds rich in this compound may have positive influence on allergies, autoimmune conditions and cancer (115).

Another pathway where dandelion has exhibited activity is in the nitric oxide (NO) pathway. NO is an important effector molecule that plays a role in the majority of the steps of inflammation, and if unchecked, can also lead to tissue damage, inflammation and is involved in allergic response (116). Taraxacum extracts and individual constituents have demonstrated inhibition of inducible nitric oxide from immune cells (99,117).

It must be kept in mind that many of these effects are based on in vitro and in vivo preclinical research. Regardless, the bottom line is that in the previously mentioned cases the treatments with echinacea and dandelion were effective. From an energetic model of medicine many of the pathways discussed can be seen as leading to a reduction in the “heat” of a system.

That is, the inflammatory process is interrupted or reduced and therefore the overall effect of this process can be seen as “cooling” the inflammatory processes. Considering the combination of E. purpurea extracts and T. officinale extracts we have multiple modes of activity including affecting key messenger molecules (see Table 1). The alkylamides via CB2 may down regulate cytokine production. Additionally, the inhibition of cyclooxygenase and lipoxygenase, as well as antioxidant activity, are likely responsible for the effects in the patients discussed above.

Hydroxycinnamates, present in both plants, especially cichoric acid and caffeic acid are some of the most efficient antioxidants from natural sources (118). Additionally, direct activity on mast cell degranulation is a strong possiblity, considering the modes of activity of CB2 and PPARγ and the speed in which these patients recovered from an acute hypersensitivity.

An interesting thought lies in the potential of the improvement in other tissues and biochemical pathways influencing hypersensitivities that extracts of T. officinale radix and E. purpurea radix may have. In other words, this likely served as more than a treatment for downregulating an immune process.

Rather, there were likely beneficial effects related to other activities, and other undiscussed constituents of the plants that are still unseen. As the late, great herbalist Michael Moore once said “the advantage of medicinal plants is that they are broad spectrum and naturally dilute. The disadvantage of medicinal plants is that they are broad spectrum and naturally dilute.” 

CB2 ligands	PPARγ ligands
1. Anandamide MW 347.3	6. 15-deoxy-Δ (12,14)-prostaglandin J2 MW 316.4 (fibroblasts activity 7 μM)
2. 2-arachidonylglycerol  MW 378.3 (PPARγ)	7. 13-hydroxyoctadecadienoic acid  MW 296.4
3. Dodeca-2E,4E,8Z,10Z-tetraenoic acid isobutylamide      MW 247.3 from Echinacea spp.	8. 13- oxooctadecadienoic acid MW 294.4
4. Dodeca-2E, 4E-ene-dienoic acid isobutylamide MW 251.3 from Echinacea spp.	9. Undeca-2E-ene-8,10-diynoic acid isobutylamide MW 231.3 from Echinacea spp.
5. Dodeca-2E,4E,8Z-trienoic acid isobutylamide  MW 249.3  from Echinacea spp.	10. Hexadeca-2E,9Z,12Z,14E-tetraenoic acid isobutylamide MW 303.3 from Echinacea spp.

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Pre-clinical trials on extracts or isolated constituents from andrographis, eleuthero, ginseng, rhodiola, schisandra, and ashwagandha have shown direct viricidal effects on various strains of influenza and rhinovirus, specific antiviral actions (including inhibition of non-structural proteins involved in the replication of SARS virus), and indirect non-specific antiviral actions via activation innate immunity , anti-inflammatory effects, detoxification and repair of cellular and tissue damage induced by oxidative stress, and other effects of potential relevance in the progression of viral infections, see Figure 1 for details (Panossian et al. 2020).

Key elements of innate immunity stimulation are activation of first-line defense response, followed by inhibition of NF-κB and inflammation mediated by proinflammatory cytokines. Important features of adaptogens are their beneficial effects on detoxification and repair processes, leading to recovery and increased survival in virus-induced oxidative stress. Key to this are activation of the antioxidant NRf2-mediated oxidative stress response signaling pathway, the production of detoxification enzymes, the activation of molecular chaperon Hsp70, which mediate cytoprotectant and repair processes, and the activation of the melatonin signaling pathway for regulation of homeostasis (Panossian et al. 2018).

Adaptogens have been subject to numerous clinical trials. Although these are not specific to SARS-CoV-2, the available clinical data provide support for the hypothesis that adaptogens may be beneficial in all stages of viral infections.

A meta-analysis of andrographis clinical trials (including over 7000 patients) demonstrated improved cough and sore throat and reduced the duration of these and other related respiratory symptoms (Hu et al. 2017). Other studies indicated that Andrographis at a dose of 1.2 g daily reduced intensity of symptoms and signs of rhinitis, sinus pain and headache, as compared to placebo (Panossian et al. 2020).

Much of the research on eleuthero is from observational studies done in the Soviet Union during the 1970s, with studies involving over 4500 subjects. In addition to showing improvement of performance under stress, cardiovascular and pulmonary disorders, trials indicated that eleuthero given prophylactically can reduce influenza mortality rates and typical complications, such as pneumonia, bronchitis, and otitis media. Positive effects of eleuthero were seen in both adults and children (Panossian et al. 2020).

Adaptogenic effects of rhodiola have been well-established in clinical trials, and rhodiola has demonstrated utility in specific pulmonary indications. As an adjunctive therapy in chronic obstructive pulmonary disease, rhodiola significantly improved tidal breathing and ventilation efficiency. A significant decrease in acute respiratory distress syndrome complications was observed in patients preventatively treated for acute lung injury caused by post-traumatic/inflammatory and thoracic-cardiovascular operations (Panossian et al. 2020; Tao et al. 2019).

Numerous clinical investigations on schisandra have confirmed that in viral respiratory tract infections, schisandra targets viral RNA synthesis and replication, and stimulates innate and adaptive immunity. Trials have also demonstrated improvement in chemotherapy-induced immunosuppression, COPD, and fatigue (Nowak et al. 2019; Panossian et al. 2020).

A review of 30 human clinical trials of ashwagandha, indicated the safety and efficacy in subclinical hypothyroidism, chronic stress, insomnia and anxiety, cognitive impairment, among others (Tandon et al. 2020). Adaptogenic effects were studied in three clinical trials, one of which reported significantly increased oxygen consumption, maximum velocity, and average absolute and relative power under exercise conditions with ashwagandha supplementation, an outcome that may be relevant in convalescence from respiratory disease (Panossian et al. 2020).

Reviews of clinical trials on ginseng species on immune response to respiratory tract infections, indicated significant evidence for immunomodulatory activity of ginseng. The studies also demonstrated that ginseng elicited a reduction in cytokine levels, decreased severity of oxidative stress, reduced the duration and frequency of symptoms, and demonstrated potential for prevention of respiratory infections (Iqbal et al. 2020; Panossian et al. 2020; Ratan et al. 2020).

Multiple clinical trials on a fixed combination of andrographis and eleuthero confirmed a significant relief of symptoms of uncomplicated respiratory tract infections caused by the common cold. Studies showed relief of sinusitis, headache, myalgia, nasal congestion and nasal secretion, and an acceleration of recovery time (Panossian et al. 2020).

The multitarget effects of adaptogens on the neuroendocrine-immune system make them a potentially important preventative and adjunctive treatment for SARS-CoV-2 infections. They provide baseline support through their immunomodulatory, immunostimulatory, and antioxidant effect through all phases.

Adaptogens help to combat infection through their specific and non-specific antiviral properties, alleviate escalating inflammation through their anti-inflammatory effects, as well as their capacity to repair oxidative stress-induced injuries in compromised cells and tissues, and address secondary disease states and comorbidities through various, infection-related activities.

• Hu XY, Wu RH, Logue M, Blondel C, Lai LYW, Stuart B, Flower A, Fei YT, Moore M, Shepherd J. et al. 2017. Andrographis paniculata (Chuan Xin Lian) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One 12(8):e0181780.
• Iqbal H, Rhee DK. 2020. Ginseng alleviates microbial infections of the respiratory tract: a review. J Ginseng Res 44(2):194-204.
• Kwon YJ, Son DH, Chung TH, Lee YJ. 2020. A Review of the Pharmacological Efficacy and Safety of Licorice Root from Corroborative Clinical Trial Findings. J Med Food 23(1):12-20.
• Nowak A, Zaklos-Szyda M, Blasiak J, Nowak A, Zhang Z, Zhang B. 2019. Potential of Schisandra chinensis (Turcz.) Baill. in Human Health and Nutrition: A Review of Current Knowledge and Therapeutic Perspectives. Nutrients 11(2):333.
• Panossian A, Brendler T. 2020. The Role of Adaptogens in Prophylaxis and Treatment of Viral Respiratory Infections. Pharmaceuticals 13(9):236.
• Panossian A, Seo EJ, Efferth T. 2018. Novel molecular mechanisms for the adaptogenic effects of herbal extracts on isolated brain cells using systems biology. Phytomedicine 50:257-284.
• Panossian A. 2017. Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals. Ann N Y Acad Sci 1401(1):49-64.
• Ratan ZA, Youn SH, Kwak YS, Han CK, Haidere MF, Kim JK, Min H, Jung YJ, Hosseinzadeh H, Hyun SH, Cho JY. Adaptogenic effects of Panax ginseng on modulation of immune functions. Journal of Ginseng Research, in press  JGR532_proof ,  22 September 2020,  1-9.
• Tandon N, Yadav SS. 2020. Safety and clinical effectiveness of Withania Somnifera (Linn.) Dunal root in human ailments. J Ethnopharmacol 255:112768.
• Tao H, Wu X, Cao J, Peng Y, Wang A, Pei J, Xiao J, Wang S, Wang Y. 2019. Rhodiola species: A comprehensive review of traditional use, phytochemistry, pharmacology, toxicity, and clinical study. Medicinal Research Reviews 39(5):1779-1850.
• Yang R, Liu H, Bai C, Wang Y, Zhang X, Guo R, Wu S, Wang J, Leung E, Chang H. et al. 2020. Chemical composition and pharmacological mechanism of Qingfei Paidu Decoction and Ma Xing Shi Gan Decoction against Coronavirus Disease 2019 (COVID-19): In silico and experimental study. Pharmacol Res 157:104820.

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.

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.

I hardly ever treat anyone without including some herbs for nourishing and supporting their nervous system. Any imbalance causes there to be stress in the system. From an Ayurvedic perspective, ‘stress’ can disturb the quality of vata that is responsible for smooth flow of information and regulation of our bio-rhythms, which can cascade impacting the other doshas, pitta  and kapha. This leads to chronic stress also being implicated in most degenerative diseases from heart disease to diabetes to cancer.

Vata is the quality associated with change, movement and lightness. All stress involves some change, and severe stress usually involves some form of ‘shock’ to the system. To find balance means you have to digest the shock and adapt to the stress. Along with basic breathing exercises and massage, plants are of course valuable stress managers. Herbalists will usually make a tailor-made prescription to suit each individual’s needs. Some of Ayurveda’s renowned plants are:

Ashwagandha

Withania somnifera’s potent nourishing and adaptogenic abilities to help us cope with stress makes it my favourite plant to prescribe for supporting resilience. I normally dose at 2–5 g/day as a powder (capsule or in some almond milk) or 10–25% of a liquid tincture prescription.

I use it whenever there is any sign of deficiency, coldness or weakness leading to tiredness or debility. This makes ashwagandha the herb of choice when there is any chronic imbalance that results in depletion and convalescence. Its grounding and stabilising effects help in insomnia, palpitations and anxiety.

Its nourishing properties help stabilise weight and enhance vitality. As one of Ayurveda’s premier rejuvenating rasayana plants, used to extend the quality and quantity of life, it gives deep and enduring energy to the immune, reproductive, structural and nervous systems. By helping to support thyroid, brain, pancreatic and heart function it brings strength to the organs responsible for the foundation of our health. At a cellular level ashwagandha enhances our Heat shock protein response to stress — meaning we can tolerate more stress for longer with less harm — as well as enhancing glutathione recovery, so essential for consistent cellular rejuvenation.

Brahmi

Bacopa monnieri is a wonderful cooling herb for the nervous system and mind. Named after ‘brahman’ or the ‘universal consciousness’, it is renowned for influencing the quality of consciousness and it balances all three dosha. Clinical studies have shown that Brahmi can help increase cognition, memory and concentration whilst also greatly improving anxiety. I normally dose it at 2–3 g/day as a powder or 10–15% of a liquid tincture prescription.

I use it whenever there is any signs of mental or emotional imbalance resulting in nervous anxiety or debility. I specifically think of using it whenever there is nervous depletion resulting from excess work or thinking leading to anxiety and brain fatigue. Its ability to bring mental clarity makes it useful when an emotional experience(s) is too difficult to digest and we can become stuck in a repetitive cycle of feelings potentially leading to depression.

Its impact of the 5-HTP and serotonin pathways are valuable here . Its effects on improving cognition, enhancing learning and memory as well as regenerating brain cells indicate its use in Alzheimer’s, ADHD and autism, but also in any form of mental illness from depression to eating disorders.

All of this helps bring vitality and energy back, which is also shown in its impacts on the thyroid. It is also a useful addition to formulas used to heal hot skin conditions from acne, eczema to psoriasis which if they aren’t caused by any nervous system imbalances can ceryainly cause them.

Gotu kola

Hydrocotyle asiatica’s greatest asset is its ability to penetrate deeply into the circulatory system and carry its consciousness enhancing properties into the brain. I give it at 3–10 g/day as a powder (or capsules) or 10–25% of a liquid tincture prescription.

Whenever a client needs relaxing in order to think clearly I will consider gotu kola. It relaxes the channels of circulation, allowing more blood to flow whether this is needed for nutrition or wound healing. Either way, it reduces the stress of ’trauma’ caused by a wound, shock, skin disease, inflammation or mental fog. As it balances all three dosha it removes the ‘shock’ of doshic imbalance.

Commonly used in Alzheimer’s, epilepsy, spasmodic disorders, skin inflammations associated with stress and joint inflammations. It is also used to help prevent deep vein thrombosis. By normalising the cell adhesion molecule function it enhances cellular communication and promotes cellular intelligence. Gotu kola is true food for the mind.

Tulsi

Ocimum tenuiflorum (syn. O. sanctum) or holy basil is one of my favourite nervines. Its light aromatic scent is wonderful for lifting the spirits and alleviating a tired mind, even mild depression. I include it in a mix as 2–6 g powder per day or as herbal tea or at 5–15% of a liquid tincture prescription. It is packed with essential oils that help to open the lungs, and relax tension.

Tulsi is very useful for headaches, allergic irritation, nervous digestion and when taken as a strong herbal infusion, the physical ache associated with ‘flu and colds. It has become considered as an adaptogen in some circles with its ursolic acid content showing potent cellular repair and cortisol regulating effects.

Vacha

Acorus calamus is used in both Ayurvedic and Chinese medicine for ‘opening the mind’ and bringing clarity whenever there is sluggishness and mental fog. Its pungent and bitter flavour helps it penetrate its healing potential deep into the mind.

This warming quality ‘cooks’  and scrapes accumulations that are obstructing clear thinking. Used at 1–3 g/day (powder) or 5–7.5% of a liquid tincture prescription. It has a strong acrid taste and so should be used at a low dose. And not just because of the dose. It contains B-asarone at various levels depending on the country of origin due to its chromosomal make up so just use short term at a low dose.

Vacha’s ability to aromatically awaken digestion and clear mucus from the body indicates it whenever there is ‘stuck’ behaviour leading to depression, speech impediments and emotional stagnation with a heavy kapha type or cold vata type person. Called vacha meaning ‘speech’ in Sanskrit, its traditional use speaks volumes for the insights our ancestors discovered about plants for such specific uses.

A 43 year old woman presented with anxiety, ‘butterflies’ and poor sleep following a bout of intense stress. Her appetite is good but her digestion has become erratic resulting in bloating, constipation and general abdominal discomfort. Whilst she isn’t usually an anxious person, she has been fixed in this place for a while can’t stop her mind dwelling on the issue and is anxious about its impact on her health and mood.

She is now regularly fatigued and has developed restless legs and the occasional palpitation at night. She has a fast, thin and thready pulse high in vata quality with a pale tongue with teeth marks. A recent healthcheck showed Blood pressure and thyroid levels were all fine with no other symptoms of note. Otherwise she has a good diet- bar a bit too much sugar and coffee. Diagnosis is vata imbalance with nervous system (majja dhatu) involved with vata. So we decided to calm vata, strengthen the nervous system and nourish digestion:

• Home made relaxing tea with chamomile, fennel seed, gotu kola, liquorice and ashwagandha
• Home self-massage with warm sesame oil with patchouli and boswellia
• Daily breathing practice of rhythmical breathing
• We had a full discussion on the importance of supporting the digestive system and ‘feeding the fire’ agreeing on a diet of less coffee and sugar and more warm foods including almonds, nutmeg, hemp seed oil, ghee, rice pudding and saffron. Ensuring the herbs and spices are visible and tasty in each meal.
• Tincture (but it could have been a powder mix) 1–2 tsp three times daily in warm water

Prescription

• Ashwagandha root 25
• Gotu kola leaf 15
• Brahmi leaf 15
• Tulsi leaf 10
• Vacha root 5
• Motherwort aerial parts 10
• Rose flower 5
• Fennel seed 5
• Liquorice root 5

Taken as 5 ml (1 tsp) three times daily before food in a little warm water

The ashwagandha, gotu kola, brahmi all help to settle anxiety and calm tension. Vacha’s moving pungency is a specific for enkindling digestion and opening consciousness, combining well with the tulsi. Gotu kola and brahmi help with repetitive thoughts. Motherwort, rose and ashwagandha are good for palpitations.

They are also excellent for healing emotional trauma with vata aggravation. The vacha and fennel strengthen and warm digestion and help to move the aggravated rising vata energy downwards. Sweet licorice builds endurance and combines very well with ashwagandha as a tonic to reduce vata anxiety.

After a couple of months, she felt more settled and her digestion was much more reliable. We moved onto just the herbal tea and some ashwagandha powder with the breathing and massage becoming integral parts of her regular routine.

• Bradwejn J, et al. A double-blind placebo-controlled study on the effects of gotu kola on acoustic startle response in healthy subjects. J Clin Psychopharmacol 2000;20:680-4. https://doi.org/10.1097/00004714-200012000-00015
• Cesarone MR, Belcaro G, De Sanctis MT, Incandela L, Cacchio M, Bavera P, Ippolito E, Bucci M, Griffin M, Geroulakos G, Dugall M, Buccella S, Kleyweght S, Cacchio M. Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology 2001;52(Suppl 2):S15-18.
• Cesarone MR, et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology 2001;52(Suppl 2):S49-54.
• Dadkar VN, Ranadive NU, Dhar HL (1987) Evaluation of antistress activity of Withania somnifera. Indian Journal of Clinical Biochemistry 2, 101-108.
• Davis L, Kuttan G (2000) Immunomodulatory activity of Withania somnifera. Journal of Ethnopharmacology 71, 193–200. https://doi.org/10.1016/s0378-8741(99)00206-8
• Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern.Med Rev. 2000;5:334-46.
• Pointel JP, et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. https://doi.org/10.1177/000331978703800106
• Russo and F. Borrelli Phytomedicine, Bacopa monniera, a reputed nootropic plant: an overview . Volume 12, Issue 4, 20 April 2005, Pages 305-317. https://doi.org/10.1016/j.phymed.2003.12.008
• Russo A, Izzo AA, Borrelli F, Renis M, Vanella A. Free radical scavenging capacity and protective effect of Bacopa monniera L. on DNA damage. Phytother Res. 2003 Sep;17(8):870-5. https://doi.org/10.1002/ptr.1061
• Sharma R et al: Efficacy of Bacopa monnieri in revitalizing intellectual functions in children; J Res Edu Indian Med pp 1-12, Jan-June 1987.
• Singh RH, Singh L: Studies on the anti-anxiety effect of the  Medhy Rasayan drug, Brahmi (Bacopa monniera Wettst.) – Part 1; J Res Ayur Siddha 1 pp 133-148, 1980.
• Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, Nathan PJ. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001 Aug;156(4):481-4. https://doi.org/10.1007/s002130100815

Books

• Caldecott T. Ayurveda: The Divine Science of Life. St. Louis, MO: Mosby Elsevier; 2006.
• Pole S. Ayurvedic Medicine: The Principles of Traditional Practice. London: Churchill Livingstone; 2006.
• Gogte VM. Ayurvedic Pharmacology and Therapeutic Uses of Medicinal Plants. Mumbai: Bhartiya Vidya Bhavan; 2000.
• Bhavamisra. Bhavaprakash Nighantu: Authentic Text with English Translation and Notes. Varanasi: Chaukhambha Orientalia; 2007.
• Sharma PC, Yelne MB, Dennis TJ. Database on Medicinal Plants Used in Ayurveda. New Delhi: Central Council for Research in Ayurveda & Siddha, Dept. of ISM & H, Ministry of Health & Family Welfare, Government of India; 2002.
• Williamson EM. Major Herbs of Ayurveda. London: Churchill Livingstone; 2002.
• Government of India, Ministry of Health and Family Welfare. The Ayurvedic Pharmacopoeia of India. New Delhi: Ministry of Health and Family Welfare, Dept. of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH); 1989.

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.

The Ayurvedic cannon details very specific treatments for bone and joint diseases. The earliest texts of Charaka Samhita (150BCE-100CE) and Sushruta Samhita (50-500CE) detail various symptoms associated with joint pain as part of other diseases involving fever (jwara) and neurological vata disorders (vatavyadhi).

Vaghabata in his Ashtanga Hridaya Samhita (600CE) mentions a disease named vatashonita meaning ‘vata in the blood’ which is associated with intense joint pain and has symptoms similar to gout. Madhava Nidana (c650-950) in his classic on pathology is the first to mention amavata as a disease in its own right. Amavata literally means ‘toxic vata’ and is commonly associated with Rheumatoid Arthritis.

Ama is a term used to describe all unmetabolised wastes that have cold, heavy, wet and sticky qualities infamous for obstructing the channels and causing degeneration of health. Vata relates to the functional principle in the body associated with all movement and is associated with the qualities of cold, dry, lightness and irregularity. Vata is also associated with the experience of pain so commonly felt in bone and joint diseases.

• Low digestive fire leading to creating of toxins (mandagni, ama)
• Vata aggravating diet and lifestyle (vatakara ahara vihara)
• Malnutrition including nutrient deficiency and wasting of the tissues (dhatu kshaya)
• Incompatible foods; milk and fruit, milk and fish, meat and dairy
• Inappropriate diet: stale foods, cold foods, constitutionally inappropriate foods, processed foods, fermented foods.
• Excessive exercise (Ati vyayama)
• Deficient exercise (Kashaya vyayama)
• Injury
• Hormonal disorders
• Hereditary causes (sahaja vikritis)

The basic pathogenesis of bone related diseases is due to the intimate connection between vata and the bones. There is an inherent link between the main site of vata in the colon and the bones. The colon is responsible for the uptake of many types of minerals that nourish the bones. This is the link to their natural qualitative relationship as both vata dosha and the bones are high in the air element.

This means that a healthy vata directly nourishes the bones. The other association is that from the colon excess ‘wind’ and ‘toxic gases’ can be expelled, whilst important minerals are absorbed, ensuring that an excessive accumulation of vata does not occur.

If the digestive fire is low then vata will be aggravated in the colon. This will lead to a dual problem. Firstly, there will be reduced assimilation of these precious mineral nutrients intended to nourish the bones, hence leading to a deficiency. Secondly there will be an increased accumulation of toxic wastes (ama) leading to an excess. These toxins will be carried by vata to the connective tissue, joints and bones where the ensuing congestion will lead to the multiferous forms of ‘arthritic’ diseases.

These ama toxins have a watery, sticky and mucoid like nature and hence have an affinity for similar kapha-like tissues in the body; hence the attraction to the protective linings of the connective tissue and synovial fluid covering the joints. Vata is the mover and ama is the obscurer. The joints then become involved which can result in pain and deformity.

Whilst the main dosha involved with bone and joint disorders is usually vata the other doshas may also be involved. Some general signs and symptoms of bone and joint diseases are:

• Vata: Thin body and bones, fragile, bones breaking easily, rough and dry skin, cavities, rough, severe pain, migrating pain, loose joints
• Pitta: Inflammation, red hot joints, sharp pain, fever, infective disorders
• Kapha: Excess and large bones/teeth/hair, stiffness, itching, pitting oedema over joint, less pain, thickening skin, osteo-tumours, heaviness, hirsutism

It is said that when one dosha is involved the disease is curable, if two dosha are involved the disease can be managed and if all three dosha are involved then it is incurable.

Ayurveda has a time tested ability to differentiate the causative factors, the pathogenesis and the diversification of the different forms of every disease. This allows for remarkably precise and accurate treatments that are individualised to suit every patient, which is why we recommend seeing a herbalist rather than simply buying an over-the-counter product.

Rheumatoid arthritis is a chronic condition involving loss of mobility and enduring pain of the joints with some swelling of the synovial joints. It has similarities to many arthritic diseases with specific clinical features associated with Rheumatoid Arthritis (RA).

Arthritis is the generic name for a number of diseases involving inflammation of the tissue surrounding one or any number of joints with pain, redness, warmth, pain and restricted motion. Such conditions may include rheumatoid, osteo, psoriatic, gout, ankylosing spondylitis and tuberculosis.

RA is a chronic inflammatory disease which typically affects the synovial membrane involving the peripheral joints of the joints of the fingers, wrists, feet and ankles and later the hips, knees and shoulders. The symptoms manifest between exacerbation and remission and are three times more likely to occur in women than in men. RA is diagnosed by a blood test indicating the presence of rheumatoid factor. It is also diagnosed by X-rays revealing rheumatoid erosions around the joints. The exact causative factors of RA are not known by are thought to involve some form of autoimmune condition or some infective pathogen. It affects 1-3% of the population and peaks between 30-50 years of age.

Arthritic diseases are usually treated with pharmaceutical medication that may have associated side-effects; Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), steroidal anti-inflammatories (corticosteroids), immunosuppressive drugs (methotrexate, cyclosporine) and remittive drugs (penacillamine). Whilst these drugs may offer symptomatic relief they have been associated with hepatotoxicity, kidney damage and immunodeficiency.

Whilst there are obvious similarities, amavata cannot be directly linked with arthritis as it has a distinct pathology and treatment strategy with different objectives to those sought by allopathic mediciation. It involves the diagnosis of the three dosha and the treatment of them along with the tissues, channels and digestive fire. The objective is to treat the root causative factor as well as the symptoms.

Weak digestive fire, sedentary lifestyle, heavy oily food, no exercise or exercising directly after eating heavy food can all make people more susceptible to the onset of arthritis.

People of a vata/kapha constitution become susceptible to this condition due to the extreme opposites of qualities. This constitutional combination can be like two people living in one body, always contradicting oneself…I should, shouldn’t etc.

The seasonal change that takes place moving from the heat of summer to the coolness of Autumn can aggravate chronic conditions that may have remained dormant during the summer months where heat and dryness kept them under control.

Arthritis is a condition that often manifests in the autumn season as it is aggravated primarily by an excess of vata that builds up in this season.

Toxins are produced from the causative activities associated with vata and are carried quickly to seats of kapha (joints) and fill the channels with a waxy toxic material (ama) which has similar qualities to kapha. Joints are a primary site of kapha. This produces weakness of body, heaviness of heart, affects the joints (comprising of synovial fluid) of waist, neck and shoulder, stiffness and is itself a cause of many diseases.

Low grade fever, reduced appetite, increased thirst, lethargy, alternate feelings of heaviness and hollowness (kapha/vata). Symptoms can be reversed at this early stage by correcting digestion and with simple Ayurvedic treatments such as steaming and oil massage.

• Stiffness
• Pain
• Inflammation
• Excess saliva
• Coated tongue
• Lack of enthusiasm
• Thirst
• Bloating
• Insomnia
• Fainting and constipation. At this stage stronger treatment such as cleansing the system and herbs are required.

Ayurvedic treatment methods for arthritis:

• Support digestion
• Remove toxic ama
• Rejuvenate the whole system and repar damage

The first line of treatment should be ‘lightening’ therapy involving strengthening the digestion whilst initiating cleansing treatments. Enkindle digestion with spices such as ginger, asafoetida and trikatu. Once digestion is working well and toxins (ama) have been removed through appropriate diet and herbs you move to a rejuvenation treatment to restore vitality (ojas).

Diet should be light and warming with lots of digestive spices. Including some high quality essential fatty acids and oils is important. It is worth avoiding foods with the same sticky-clogging-inflammatory nature of amavata; dairy, gluten, flour, sugar, greasy foods and rich meats such as pork.

Some people benefit from avoid members of the Solanaceae family (potatoes, aubergines, peppers) as well as other potential irritants such as peanuts, soya and corn.

Recommended herbs are guggul, ginger, celery seed, castor oil, haritaki, boswellia, gotu kola, turmeric, ashwagandha and sariva. Triphala powder at night to clear ama from the colon is also beneficial. Warming and invigorating oils, such as mahanaryan oil and castor oil packs, help to remove congestion and gentle exercise and yoga are recommended but avoid strenuous exercise such as jogging or weights.