#185 Adaptogens, Plant Medicine and Medical Herbalism with Dr Sally Moorcroft

Dr Sally: You know, and that's happened with some herbs in the past, you know, they've become endangered or, you know, like like golden seal which is an amazing herb, you know, it is like a natural antibiotic which is really very effective for infections. You know, I've used it a lot in sort of ear infections, chest infections, sore throats and it's very effective but it's almost endangered in the in the wild from over-harvesting and so I don't and I don't want that to happen, you know, you don't want to think, oh gosh, you know, we're we're getting so we're so all loving these herbs so much that you know, that they're actually going to disappear from the wild and that that it's not being harvested sustainably.

Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life.

Dr Rupy: Today on the podcast I have Dr Sally Moorcroft and we're talking about herbal medicine, also called phytotherapy, which refers to using a plant's seeds, berries, roots, leaves, bark or flowers for medicinal purposes. Dr Sally embarked on a medical career almost twenty years ago now, but her experience in hospital medicine coupled with her travels to France and Australia introduced her to herbal medicine and led to her complementary therapy practice, which has been in for almost two decades. Today we talk about a range of things on a subject I'm not terribly familiar with. The history of herbal medicine, the overlap between Native American, Ayurvedic, traditional Chinese medicine practices and many others, how we extract the products from the plants themselves, what adaptogens are, I'm sure everyone will agree you're seeing it everywhere from coffee to bars to chocolates, it just seems to be in everything. Anti-inflammatory herbs and actually what that means. I also asked about resources for people interested in medical herbalism like myself and we're going to link to those in the show notes on the doctorskitchen.com. And we also do something really interesting, we workshop some cases like patients with gastritis or gastroesophageal reflux disease or high cholesterol, patients that I'm very familiar seeing in in clinic and we have limitations about how much we can do with our drugs and I wondered if there is an extra area around medical herbalism that would be beneficial for other GPs to explore, you know, with with interactions and conditions in mind as well, which we actually also talk about today about the things that you need to be thinking about with regards to potential drug interactions. If you're new to things like slippery elm, marshmallow root, devil's claw, rhodiola, boswellia, like me, I think you're going to find this episode super useful and I'm definitely going to dive into the resources myself that Dr Sally recommended. As a reminder, Dr Sally Moorcroft is an award-winning integrative and functional medicine doctor. She's got a long interest and passion in food as medicine and leads a team of doctors, nutritionists and practitioners at her practice. She's also got a BSc in herbal medicine and is currently completing IFM certification and training in medical acupuncture as well. She's got most of her specialist interests are in women's health, particularly menopause, perimenopause. We've talked about that on the podcast before and I'm sure we're going to be talking to Dr Sally again at some point in the future about phytochemicals in more generally. She's also the founder of Dr Sally's Botanicals, a range of organic herbal teas and tonics based on formulations used in her clinic that I've personally tried and I think they are absolutely fabulous. Make sure you check out the podcast on YouTube. You can watch this on YouTube as well. Due to popular demand, we've started putting all the current podcasts and the library of podcasts on YouTube, so make sure you subscribe there and download the Doctor's Kitchen app whilst you're on the mood for downloading and subscribing to things. You can find it on the App Store. Every week I also send a newsletter, the Eat, Listen, Read newsletter. You get it for free, it's got recipes in and it's got mindfully curated content to help you have a healthier, happier week.

Dr Rupy: Well, first off, I should say, thanks so much for giving me some of your teas. I really, really enjoyed drinking those over the last couple of months, because we we met at the integrative and personalized medicine conference earlier this year.

Dr Sally: Oh, I'm pleased you like them.

Dr Rupy: Yeah.

Dr Sally: Yeah, which is your favourite then?

Dr Rupy: Yeah, I had the happy gut and I think you also gave me a Valerian based one. Is that am I getting that right?

Dr Sally: Yeah, so it's actually it's Tulsi.

Dr Rupy: Oh, Tulsi, okay. Yeah, yeah.

Dr Sally: Yeah, and lemon balm, I think in that one. So, yeah.

Dr Rupy: Gorgeous. Yeah, no, it was it was wonderful. And I I made them into sort of like, because obviously it was during the summer, I kind of brewed it and let them cool and then I added a tiny bit of sweetener and I'd put them into glass bottles and I'd have them during the day over ice and stuff. So it was actually really, yeah, it was they were they were great. I love them.

Dr Sally: Yeah, I'm kind of my favourite's the happy gut. Like I kind of go between the different ones, but that's my favourite at the moment. So, yeah, and I like the fact that you can get a few bags from them. So I'm usually getting like three cups from each of the little pyramids. So that I was really happy about that when we kind of formulated them. Yeah, because you don't know, you know, obviously you make the formulas, you know, they they obviously we had to source the herbs and then they were made up by the, you know, this company that makes them into the the little pyramids and you know, you don't quite know how it's going to turn out. You know, you can sample them beforehand and they're and they're blends that I've used for a long time, but it's different when it's in the pyramid, you know, you kind of get a different flavour and the herbs are, you know, the the size of how they much they've been chopped down and that all affects the flavour and everything. So I wasn't quite sure how they were going to turn out, but yeah, I was really happy. We've been, yeah, I've been really happy how they turned out. So it's really it's been exciting. A whole journey really.

Dr Rupy: Yeah, well you should be because they're they're delicious. Well, I wanted to start really just talking to you about how how you got into medical herbalism because you, you know, you trained as a doctor, you you spent a few years doing hospital medicine, but you from from what I gather from your from your CV, you you very quickly sort of pivoted into medical herbalism. And I I wonder why. Maybe you could take us back as to, you know, what what happened perhaps earlier in your life.

Dr Sally: Yeah, so I do think about it because lots of people ask me. So I have thought about it over the years, you know, what kind of influenced me. And I think probably the seeds were set from an early age, although I didn't realize because I grew up on a farm and we grew a lot of like the food was from the farm. So we've always kind of the family we grew our own vegetables. We were really into like organic vegetables and growing everything in the garden. So I was really always interested in nutrition and then I had an allotment when I was a medical student. So, you know, I kind of that food was the first way in really was the nutrition. Um, and but before I went to medical school, I spent a year living as a nanny and I just by chance, I I answered an ad in the Lady magazine actually. I was just looking for for my gap year to do something interesting. So I answered an ad and I ended up in um, Drome Provence, which is sort of in the mountains, the south of France and just that area is um, it's very lots of biodynamic organic um, farms. There's a there's a really big kind of um, you know, a cultural just use of herbs in the south of France as like tisanes and it's kind of embedded in the culture there. So I didn't really know anything about it. I I just went. I I was living with the family as a nanny and it was just going to the market every week. So you know, you'll see like the big bags of the linden flowers and everybody's drinking like lime flower tea in the evening and um, it's just so much part of the culture there. And then obviously I started going to, you know, the pharmacies in France where you'll kind of get half of the pharmacy is like the homeopathic medicines or the herbal medicines and the pharmacists are trained to be able to advise on it. And I just kind of it was total eye opener. I hadn't really seen that. I hadn't really had any contact with it before, but it just kind of opened my eyes a bit thinking, okay, this is interesting. It's a different way of doing things. And um, and then actually the family that I ended up living with, um, used anthroposophical medicine, which is a kind of a combination of herbs and homeopathy. It's based on Rudolf Steiner's work and that's just what the family happened to use. And obviously me living there and having sort of minor ailments meant that they treated like the father treated me with different things out of their sort of family cabinet. Um, and I just was like, oh my god, these actually work. I didn't really, you know, I had really no idea of what they were. And the first thing that ever I used was, I remember to this day still that there was like a fold up sofa and I was pulling it out and I got my fingers trapped in the sofa and it was this huge indentation in my finger where the bed had actually collapsed on my hand and and he just gave me some arnica cream to put on it. So I put this arnica cream on and I went to bed and then the next morning it's just completely gone. There was nothing. And and I thought there's no bruising, there's absolutely nothing, but my hand had been completely crushed in this bed. Um, and that was the first thing I thought, my god, this is like magic cream. What is this stuff? So I got interested from there and then, you know, the harvest, we lived in the valley with the lavender flowers were harvested and then in the village was where they distilled the essential oils for the lavender. So, you know, that was also part of the local culture was the growing the lavender, the lavender oils, um, so it it was really just being embedded in that culture for a year, I think. And then after I left, as I was going through medical school, different summers, I traveled a lot in India. I went to India four times and so I kind of got interested in Ayurvedic medicine then after that really was going to India and homeopathy, which is kind of quite popular in India as well. So I got a little bit of introduction to that. And I saw just as my I was getting more interested and I was up in the mountains, I went to see like a Tibetan doctor just to see what it was all about. It was the doctor actually that the Dalai Lama um, used up in um, Dharamsala. So I just thought I'm going to go see him for a consultation. And it was just a really interesting experience. So I I did that. I started getting interested in yoga. I did some yoga up there as well. And um, and then the and then when I did my elective for my uh, in my fourth year, you know, medical school, um, I ended up in Australia and I was went to sort of in the outback in Tennant Creek and I and I actually was at the hospital originally, but then quickly moved and ended up in the Aboriginal health center, which was really interesting because they had they had a lot of different projects going on there, but you could go out into the reservations and talk to some of the elder Aboriginal like community leaders. So I learned a little bit about the bush medicine and the sort of Aboriginal culture and also they had um, a big sort of drug and alcohol rehabilitation center where they were using art therapy. So I kind of spent a little bit of time in that. So I just kind of got interested in all sorts of different approaches. And then I had some health problems, uh, I think they were probably stress induced and also induced after the going to India and getting amoebic dysentery and you know, like the a bit of food poisoning. So, um, so I ended up actually, um, sort of using some herbal medicine and acupuncture on myself and I think it just all kind of came together. And then as I went through hospital medicine and working in the hospital for a few years, I I just started to feel like I want more time. The time was the big thing for me. I just want a bit more time with people and I want to feel like I'm not just using a sticking plaster that I can help to get to the root of problems. And I was obviously with the food thing, you know, and I know this amazing campaign you're doing with the food hospital, but you know, like 20 years ago, I was trying to say, you know, I remember one, you know, elderly lady who was recovering, she'd had a gynae operation, ended up in our urology department, very ill, um, and she was just not eating anything. And I could just see she's literally wasting away. Like she's having no protein. How can she be expected to heal from two major surgeries? She's not eating any protein. You know, it was just simple things and I just kept sort of saying things and I felt a bit like, I you know, nobody's listening. It is very difficult to create change. You know, there were things that I wanted to try and uh, introduce. You know, I was talking about gut microbiome and maybe, you know, for clostridium difficile, this was like 20 years ago and people were just like, you know, what are you talking about? You know, you're just completely loony. So I I just kind of very after a few years, I just felt like, you know, I'm really not in the right place here. You know, it's going to be so difficult to to change anything and and and I don't feel like I'm really making the change that I want to to to do and I'm I haven't got time with people to try and address the root cause of things and to do a more preventative approach, which is kind of what I was really getting interested in. And um, so I just thought it was a by chance, I just found a leaflet, someone gave me a leaflet, I think for the herbal medicine degree and I thought, you know, this is quite interesting. I was kind of skeptical to be fair at the beginning because I but I just thought, you know, with an interest in plants and looking for a more holistic approach, I thought, okay, this could be, you know, and and obviously the experience I'd had in France, I thought, okay, you know, this could be interesting. Maybe for minor ailments, you know, there's something in this and I was also kind of thinking about, okay, we're going to have this, you know, obviously this big problem with antibiotic resistance, you know, maybe I was starting to look at herbs as alternatives for like minor infections and thinking, okay, maybe this could be an area for research, you know, you could be looking at, okay, can we use some of these antiseptic properties in the plants to help reduce antibiotic resistance and things like that, you know, there maybe it needs, I'm interested to look at the research and to kind of look into it more. So I started the degree, not really knowing where it would go, but hoping that I would actually eventually be able to bring it into like an NHS practice and actually amalgamate it somehow. Um, and then I got completely inspired when I did my summer placement. So you have to do like each uh, year you do so many clinical hours. You have to do 500 clinical hours over the four year degree. So, um, you a lot of mine were spent in summer placements in there's a it used to be actually, it's gone now, but it was a um, clinic of herbal medicine in the Archway Hospital in North London and it was it was actually on the hospital um, premises and there was a really close connection with one of the medical herbalists working there and the gynae department and she worked very closely with quite a few of the consultant gynecologists and we would get a lot of patients who were um, waiting for hysterectomies or patients that didn't want to have a hysterectomy. So we'd get quite a lot of endometriosis patients, also polycystic ovaries and quite a lot of menopause patients as well that didn't want to take HRT. So that was kind of one of the specialties of the clinic and and I was I spent um, quite a lot of summer um, placements there and and actually that's what totally swayed me like, this is amazing. Like actually the results were getting, you know, there's so many women that are not getting are not having to go for a hysterectomy. Actually, we're just completely turning things around. And that's when I kind of thought, okay, this is not just about, you know, helping a sore throat. You know, there's actually a lot more in this and you can do a lot if you really have the time with people and you tailor it and you know, it's a it's a complicated, it's obviously much more complicated than just giving someone some sage for a sore throat. But you know, the potential of what you could do with it, um, so I I think that that's kind of what turned the corner for me. And then when I finished the degree, I was I had two small children by this point as well because I'd had two babies. I had one in my first year of the herbal medicine degree and one in my third year. So I was kind of thinking, how am I going to make all of this work? And I thought I'll just set up a practice and see how it goes. So I set up a just a small private clinic and it was just immediately like completely full. So I sort of did it it just filled within within three weeks, I had like, you know, the phone was just ringing all the time and um, I couldn't actually manage the the capacity was a bit overwhelming actually. I wasn't really expecting it. But over the years, I just, you know, I've seen thousands of patients now, but it it's evolved and um, I I slowly I started very general. So I was doing a lot just kind of seeing all sorts of I had lots of kind of elderly patients with arthritis or children with eczema or sort of recurrent um, chest infections, ear infections, um, that sort of thing. Then quite a lot of digestive problems, you know, IBS type problems. Um, so it was very general to start with and then slowly over the years, I got more and more women's health type issues. It slowly became a lot of menopause patients that just kind of happened. I didn't really go out looking for it, but it just sort of gravitated towards more women's health. And then I kind of thought, okay, if this is the patients that I'm going to be seeing, I need to kind of specialize my training. And there were gaps. I felt like there was gaps in my knowledge. And so slowly I've keep doing more and more, you know, as as time goes on. I I did um, the medical acupuncture training, I think initially, that was nice. I was using quite a lot of medical acupuncture for a while. Again, especially with the arthritis patients. So I'd often be doing some nutrition, some herbal medicine and then acupuncture. So I did that for quite a few years. And then I and then actually my uh, so I was doing my appraisals through the Independent Doctors Federation, which are sort of for doctors working outside the NHS really. And my appraiser was this amazing guy who he'd done all sorts of things, but he was a GP in Sussex and he'd done the homeopathy training. So his background was actually he was an army doctor and then he'd done homeopathy, which is a really interesting mix. You know, I would never have put the two together, but he kept telling me like, you need to do homeopathy, you're really missing out, you know, you're missing this massive tool. And for like the whole three years I had him as my appraiser, he's like, you know, you need to go and do the homeopathy training, you know, he was like, herbs are good, but homeopathy is the king, you need to go and do that training. So, so eventually I did. He recommended me to go to Bristol. So that's, you know, I went to um, what's the National Center of Integrative Medicine now and I did the five years homeopathy with them, which was good. It's like another tool that I do use in my practice. And then I did biodentical hormone therapy training, really for the menopause patients that I felt like needed that extra support. And then I started the functional medicine training, which has been like the I knew that there were gaps in the nutrition really that I needed to kind of get more knowledge, particularly with all the gut microbiome stuff that I was really interested in and you know, that it's a good kind of way of getting more into the biochemistry and the um, you know, the kind of gut microbiome stuff in more detail. So I'm doing the, you know, the certification with the IFM nearly finished, but so that sort of pulls it together as well. But yeah, so and then and then it's kind of developed really.

Dr Rupy: Yeah, it's yeah, that's one way of putting it. Uh, it's definitely developed over the last uh, 18 plus years, your your experience and stuff. I just want to go back a bit because um, clearly, you know, you've got a lot of experience on all these different areas. But go going back to France where I guess uh, all of this sort of started. Um, I wasn't aware that there was uh, as much of a culture around sort of um, herbalism and nutritional medicine, uh, as, you know, almost on par with um, the sort of culture within uh, traditional Indian medicine, traditional Chinese medicine. It was actually a follower of mine, I think she was an email subscriber. She reached out and said, you know, in South of France, we have all these uh, sort of herbs and stuff and we have this sort of practice and and I I was kind of blown away uh, at like how involved it is and also how pharmacists sort of sit alongside that conventional medicine very very nicely. As they do in Germany, I think I I read something about Germany having a similar sort of approach to traditional medicines. I wonder if you could speak a bit more about that.

Dr Sally: Yeah, I mean, absolutely. And Germany was another inspiration for me that model because and and actually at medical school, I had a friend who was um, German. She did a like an intercalated year with us and it was really interesting learning about their training because in Germany, you know, actually part of the training, you do a herbal medicine module and you do a homeopathy module and that's just part of the undergraduate training. Um, and I and I and I was just like, oh my goodness. And I think with pharmacists as well. And in fact, actually with um, I know it's the same in Poland because one of the staff we have now working in the center is she's um, a nutritionist, but she's a pharmacist as well and she's Polish and she said that she's got a really extensive herbal medicine knowledge from her pharmacy training in Poland. So again, it's just Poland is also another massive cultural tradition there. You know, and I'll often have Polish, I've had a lot of Polish um, patients over the years because you know, that's just the tradition that they that they use it again, just part of their everyday medicine that they're very used to using. But I mean, absolutely in France. I mean, I know that, you know, you you just go into the pharmacy, you can get calendula tincture really easily, you know, if you've got a wound or, you know, you need to it's just or calendula cream if you've got some skin rash, it's just there and the pharmacist will just give it, you know, that they'll just say, oh yes, here, you know, it's just part of that completely part of that. And I would say, you know, half, almost half and half, you know, you've got half your sort of conventional drug medications, half is herbs and homeopathy and it's just assumed that, you know, for certain things we'll go to that side and for certain things we'll go for that side and they're very comfortable and knowledgeable with the whole spectrum really.

Dr Rupy: We we're going to have to talk about some of those names because that kind of just rolled off the tongue for you, but for me, uh, it went way over my head, but but um, and and also I just wanted to touch on your experience in Australia because I mean, I I used to practice in Australia. I was out there for a couple of years. Um, and uh, I remember going to some of the markets and meeting uh, someone who who's from an Aboriginal background and she was telling me about all these different bush herbs from a culinary perspective. And I was trying them and I and I bought a whole bunch of different herbs to experiment and they were like nothing I've ever tried before. It was like this really uh, sort of wonderful concoction of different astringent based herbs, bitter herbs, um, like flavours that I've never sort of experienced before. And I I whenever I think of Australian food and whenever people I think uh, think of Australian food, they think of avocado and toast, you know, that sort of brunch sort of food, but there's just such rich um, herbs and and such rich plants and a diversity of different ingredients that are inherent in the Australian mainland that we just don't really make that much use of. So, um, I I yeah, I I just wonder if there's going to be a sort of resurgence of all these like traditional herbs using the culinary sense that also have medicinal purposes as well.

Dr Sally: Yeah, I mean, you can see it with a lot of the Ayurvedic herbs, can't you? I mean, they've become so popular, you know, turmeric and all the, you know, that's the biggest one, isn't it? But, you know, you can kind of see that that will happen. Like you kind of see over the years, okay, that's the new one that everybody's kind of talking about. But, you know, as time goes by, I'm sure that that will happen, you know, because there's so many and also you see with like fermented food, don't you as well? You know, the fact that that's so um, much part of some traditional systems and cultures and that now we're sort of like, oh, fermented food, you know, great. It's just all these amazing beneficial things. Like maybe we should be eating it, you know, but it it's, you know, maybe not part of our tradition here until quite recently, is it? So,

Dr Rupy: Yeah, absolutely. What we we've been chatting for about 20 minutes and we haven't really defined or discussed exactly what we mean by herbal medicine and what it actually involves. So perhaps we should start there and then we could sort of wander down a bit of the history around uh, medical herbalism, actually what it means to be a medical herbalist and and then dive into some of uh, the herbs that I have no experience of prescribing or or using and and that's why I'm I'm fascinated to do a bit of a deep dive in into some of them with you today.

Dr Sally: So, I mean, the term is not protected. So, you know, in terms of there's no protection or um, regulation surrounding the use of the word of the term, you know, the title. So, um, so I would say, I mean, that's a key thing is is is knowing, you know, if people are looking for a herbalist to look for somebody who's gone through the the the sort of um, is registered with a regulatory body, you know, with a I mean, we can talk about that later, but you know, there are some bodies where people have to have a certain um, knowledge and um, you know, really have have a degree in herbal medicine. So, so in terms of the title, it it isn't protected. So, um, and obviously there's loads of different traditions of herbal medicine, but um, it it's basically the key thing is that you're using the whole plant extracts. So, and that can be different parts of the plant. So it's very often aerial parts, but it could be the roots, the bark, the seeds, the fruit, um, rhizomes, you know, all parts of the plant. But the main thing is that you're using the plant in its kind of whole sense rather than extracting an isolated constituent, because obviously lots of drugs are come from plants, you know, so, um, but what you're doing with a with a drug is you're taking one isolated constituent, often an alkaloid, which is some of the strongest ones, and you're then synthetically manufacturing it. So, you know, that that's kind of the difference. And it's very targeted. So normally, if you're taking one constituent out of the plant, um, it will have a targeted effect on particular receptors and so it's very targeted in the body. Whereas when you're looking at using the whole plant as a medicine, you're obviously getting hundreds of constituents in there. Um, and so it has a lot of kind of multiple effects in the body. Um, and often, the theory is, and I think it is true from my practice is that it's it's generally very well tolerated herbal medicine and and and there are few side effects. You know, there's sometimes there are some, sometimes particularly digestive symptoms. So some people might just get a bit of diarrhea or unsettled stomach, you know, that um, so it's not completely without any um, side effects, but generally mild and generally very well tolerated. And that's thought to be because within the whole plant, you often get kind of buffering constituents, things which can counteract these more these stronger, particularly the alkaloids. You for example, a really good example I often give is like with ephedra, which is um, is a Chinese herb. So you have in that, um, you can extract like the ephedrine. So that's obviously got quite a stimulating can increase blood pressure, but then actually within the plant, you have um, other constituents which actually lower blood pressure. So when you take the whole plant together, it you get a more um, balanced effect. And that's often what you'll see. You'll kind of you start extracting constituents and some things will do one thing and then you'll find another constituent which almost does the opposite or or actually, you know, sometimes they work synergistically as well. Sometimes you'll get like saponins in a plant which can help the some of the other active constituents to be absorbed across the phospholipid membrane into the cell. So sometimes the constituents act synergistically and sometimes they act to buffer the more active stronger parts. So they're kind of like a safety, you know. So that's the main difference between the two.

Dr Rupy: Just to be clear, so when we're talking about medical herbalism, we're really talking about the utility of these um, plants uh, in in sort of a in a prescriptive manner uh, rather than culinary or is there sort of like a spectrum where there's a there's quite a bit of overlap in in the middle of it? And the other thing I just wanted to clarify is when you said rhizome, is that to mean like the root, like the like uh, like ginger or turmeric for example?

Dr Sally: Yeah, I think it's a spectrum because you know, like obviously some herbs sit in the middle, don't they? They can be culinary, they can be medicinal. It's sometimes to do with dosing, you know, but I mean, I think it's a very kind of it is definitely a spectrum. If you think of garlic, I mean, you know, garlic and ginger are good examples, you know, we use them in cooking all the time, but they can be have medicinal effects. And the same with lots of the spices, you know, lots of the spices and turmeric's obviously another good example, you know, which is something you use in cooking, but it has a medicinal effect. It's usually to do with the dosing. So, you know, the higher the dose and the more consistently that you take it. So often with herbs, they need to be taken consistently to kind of to build up to having a medicinal effect in the body. So say for like, um, I don't know, chamomile tea, you could have chamomile tea one cup of tea, okay, it's going to have a very minor effect, you know. Um, if you have maybe three or four cups of chamomile tea, which are a strong infusion and you do that every day, regularly, that's going to have a more medicinal effect. So, you know, that there there it is to do with dosing and the regularity that you use it. And then the spectrum is, you know, you'll you'll find that some um, herbs sit in that sort of food end and then they obviously get stronger and stronger in terms of their active constituents till you go up to kind of poisonous plants really. So, you know, and some plants are um, obviously toxic and poisonous and have very strong constituents in. Um, and then you can also have um, some herbs which are just um, very nutritious. So they're almost medicinal by being very nutritious. Like maybe nettles, which I think, okay, nettles are medicinal, they're used in medical herbalism for their nutrition. So they would be used if you think someone's say very depleted or anemic or, you know, you're going to use them to help to improve the nutritional status and, you know, you could use it as a source of iron. So you might actually think, okay, well nettles, they're sort of a food, but they're nutritious. Like they would actually fit into um, medical a medical herb as well. But it it's a hugely grey area, you know, like because obviously some herbs are food and how often do you take them? You know, it's it's a grey area for for that one for sure.

Dr Rupy: I like the uh, the example you used of ephedra actually because I think that's quite telling about medical herbalism in in a lot of ways, you know, in sort of conventional pharmaceutical um, in conventional pharmaceuticals or at least for, you know, the way I think about um, pharmacology, you have a constituent that's come from a plant among which many other uh, drugs have actually been derived from. Um, in a high enough dose to have a fantastic effect. I mean, you know, we use this in anaphylaxis and in ICU and all these different areas, whereas in the whole plant that it's been derived from, you have all these different constituents of it that actually mellow that effect. So it makes it less effective in that particular setting, but it might be more widely uh, um, uh, tolerated in in a milder form in different sort of um, disease or condition states. Is that is that a fair assessment would you say or?

Dr Sally: Yeah, definitely. And I would say generally herbs take longer to take effect for that reason. Like not always, you can use herbs in acute settings and you know, if you use kind of mega doses in, you know, you can use them in first aid for example, but generally as a whole, they're better suited for chronic conditions where you you know, you expect that they're going to take a little bit longer to have an effect. So, you know, um, so for that reason, I think that, you know, that that's how you would kind of expect to see like if I was using herbs, I'd probably, you know, I'd expect to see a change within three or four weeks. So, you know, using consistently. So you're kind of you're kind of aware that, you know, when you're using them, they're going to take a bit longer as well. But they that that's the thing that they but they'll often the good thing which I enjoy using them is that you'll often see that they take longer, but they're often providing this kind of, I always see them as being quite nutritious. A lot of herbs are nutritious as well and supportive to the body. So, you know, for example, adaptogens which are herbs that can help support the body when it's under stress. So they often help to bring about homeostasis in the body and they help to counteract the effects of cortisol and and stress hormones. And so actually, you use them for, you know, you use them to just slowly improve resilience in the in the body. So they're quite nutritive. So often I see plants as being quite nutritive when you're using them, you're using to support different organs or systems in the body in quite a nutritive way.

Dr Rupy: I want to talk about um, adaptogens in a second actually, but I I just wanted to remark on a couple of things that I've noticed uh, over just looking at a variety of different sort of traditional cultures that have used herbs, spices and different um, herbs in a medical sense. There seems to be quite a lot of overlap. Is that something that you've come across as well within traditional Chinese medicine, even sort of native uh, American medicine and Ayurveda? Is there is there is there an overlap? Would you say or?

Dr Sally: Yeah, massively. Yeah, and the history is really interesting actually. So if you look at the history, um, you'll see like there's there's definitely different traditions and you know, you asked me about the history and we we've kind of skipped over that, didn't we? But you know, if you think of actually, um, a lot of the earliest records of using herbs go back maybe 3,000 years. And you'll see even sometimes those plants actually that were mentioned way, way, thousands of years ago, they're still being used now. You know, there there's such a long traditional use of them. But you can look at different um, medical systems as well. And there's very often a root of um, the way that the imbalances in the body are described. So you'll often see patterns. It's very much kind of a medicine based on looking at patterns within the body. So particularly with Ayurveda, obviously you have these doshas, don't you with the pitta, kapha, vata and then which kind of represent heat and fluid and air or wind in the body. And then in Chinese medicine, you'll have a similar, you know, there's a similar principle, you know, where you have um, so there's often these um, almost kind of root imbalances that you see within many of the traditional systems. Um, and um, and in our kind of traditional Western herbal medicine, which was the humoral system, you see it there as well, like the different humors of the body. There's very often this looking at a balance of damp and dryness or heat and cold. And then you're very often looking at kind of stagnation in the body or constriction of tissues. There's there's often looking at tissue states or you're looking at the um, particularly heat and cold is a huge thing, you know, when you're looking at traditional medical systems, you're looking at is there particularly in Chinese medicine, you'd say, you know, there's stagnation and heat, sort of damp heat is often considered to be if you imagine arthritis where there's a lot of swelling and heat in a joint, you would say that's damp heat um, with stagnation. You know, so you're kind of describing what you're seeing. I see it as just very descriptive. You know, people didn't understand the body, but they could kind of describe what they were seeing and they would describe these imbalances and obviously start to put patterns together. Um, so you see that very much and then you see herbs being used to counteract those balances. So you might see, okay, if you've got a um, damp heat condition, you're going to use a cooling drying herb to counteract that. You know, it's very much um, the way that you know, we would say, oh, it's an anti-inflammatory. Okay, the traditional system will say it's cooling and drying that or it's moving stagnation, you know, that that's kind of how they're describing it.

Dr Rupy: And it it's interesting because it it's almost like it overlaps onto um, sort of the psychological uh, symptoms and signs as well of the individual. So, you know, if someone is described as um, too hot, you know, it could also be pointing to things like stresses in their life or how they're not sort of uh, moving on from certain things in their past or there's like some sort of emotional trauma in there that needs to be worked through as well as the physical side. And I think sometimes the limitations of how uh, you know, people outside of medical herbalism see it was like, oh well, they're just sort of treating it with a pill, but you know, especially in your practice, you you think of the individual more holistically where you look at their emotional support, their psychotherapy, uh, and all the other sort of uh, context of what makes a healthy uh, healthy mind and body.

Dr Sally: Yeah, and definitely, and you know, like the in a lot of the traditional systems, you'll see this connection say between heat and the liver and anger, for example, in China, you know, in Chinese medicine, they'll say, okay, if you're angry or you're having mood swings, that's a liver stagnation or that's maybe liver heat or, um, you know, so you'll see the language of it, it's very holistic in the way you describe, you know, and you and you absolutely, you know, you'll kind of say, oh, melancholy and depression, maybe that's a kind of cold stagnant condition. You want to kind of warm, use warming stimulating herbs. You know, that that's very much in the traditional systems, you'll see this the way that the the emotional symptoms are very closely related to the physical ones, you know, they're kind of part of the whole spectrum of the imbalance that you're looking for. So, and the herbs are used, you know, in that way. So, and there's two kind of, you know, there's often most medical herbalists are using some of that traditional system plus the more science that we understand about the active constituents and maybe what and what's kind of called phytotherapy, which is a little bit more say when you're using something as an anti-inflammatory or an anti-spasmodic or, you know, maybe a bit using them in that sort of way. But I think having the knowledge and pulling it together, it's particularly helpful where patients have um, multiple symptoms, you know, where you're kind of can step that's what I've enjoyed using and that's what I love about using an integrated system is you know, you it's very easy to just step back and go, okay, that's connected to that and that's connected to that and you know, I pull it all together and I can see that there's these maybe three different root problems, you know, and we're going to slowly target each one and then you just see the symptoms, you know, this whole picture just starting to change and a lot of those, you know, what were seemingly individual, you know, unconnected problems just actually they're often the root the roots are the same, you know.

Dr Rupy: Yeah, yeah, yeah. No, I I find it fascinating. And so you you mentioned this this term adaptogenic that uh, or adaptogens that I hear being bandied around everywhere now, like it's in everything from hot chocolates to my coffee to my sweets, you know, I'm not that eat that many sweets, but you know, like brownies and all that kind of stuff. And I I I don't I don't like know too much about this area, I'll be honest. So, you know, I know Ashwagandha, I know there's some uh, different types of dried mushrooms that have adaptogenic properties. Why don't we go, why don't we define exactly what an adaptogen is? Like where did this term even come from? And um, and what what are adaptogens? What do you tell us a bit more about them?

Dr Sally: They're definitely the new trend, aren't they? I think everyone's like, oh wow, everyone's talking about them. I think they're really cool. I mean, I like them because there's not that they are a particular um, there's a particular property within herbs that has this action that you don't really get from anything else. I think that's very unique. That's probably why they've become super popular. But but they they were originally, so it's 1959, there was a, oh sorry, 1957, there was a Russian, I think he was a doctor or a scientist, but he kind of coined the phrase and I think that they were using, my understanding is that they were using them in sort of for helping astronauts go into space. That's what the first research that was used to help with reducing the effects of stress of going into space travel, which is when they started researching them. So he coined the term and and there's like four different characteristics that a herb has to have to be considered to be adaptogen. So they have to be normalizing in the body, um, non-toxic, um, nourishing and um, and non-specific. So they have kind of a broad range of actions. Um, so and and generally they work by helping to promote homeostasis in the body and modulating the HPA axis. That's how most of them work. So they generally their effects are to do with um, helping to improve resilience when you're under stress. Um, I mean, they're that the there's different, there's some trials that have been done in animal studies and like in vitro studies which show that they have um, um, anti-depressive effects that they can support the immune system, can help with fatigue, um, that they can help with brain cognition, um, and then there's human trials that show that they can help with fatigue against the background of um, sort of mental stress and helping with resilience. So, um, and obviously there's a huge diversity, there's lots of different types of adaptogens and there's different, yeah, there are loads. You can kind of pick, you know, when I'm using them, I'm kind of thinking, what do I want the emphasis to be on? So some adaptogens are a bit more supportive for the immune system or they can be like modulating to the immune system, which is really helpful, uh, you know, because you you don't really want to overstimulate the immune system, obviously. So you're kind of it's much more helpful to modulate it and balance it. So like the medicinal mushrooms are often good for that. Astragalus, that's a lovely adaptogen for the immune system that's modulating. And then you've got the more stimulating adaptogens such as the ginsings. So like Panax ginseng is the most stimulating, you've got Siberian ginseng, um, and and these are uh, so these are good when someone's exhausted. So often you would use those when people like burnout sort of situation and rhodiola as well. So they're very nice for modulating the cortisol response. If someone's in that kind of phase two, phase three stress response where cortisol might be kind of high, you know, there might be spikes in cortisol or it's, you know, kind of or it's dropping, someone's becoming kind of unresponsive and it's starting to sort of flat line, it can be useful in in both of those situations. You can it can kind of help to modulate cortisol. And then you have Ashwagandha, probably the most popular one, which is um, also it's lovely because it's relaxing. I think the key thing with Ashwagandha that makes it so helpful is it's good for that sort of tired but wired phase where you're, you know, you've overstimulated because you've been doing too much, probably your cortisol is a bit too high, your sympathetic nervous system is in overdrive, but you're actually exhausted, you know, you can't sleep because you're kind of wired. Um, so it's helpful because it can help to reduce the cortisol and relax and help you to sleep, but it's also it's very nourishing to the body for, you know, when you're depleted and and it can help to again, it helps to modulate the immune system. It's sometimes used in cancer support as well. It can help with the um, helping reduce the effects of chemo and um, you know, if you obviously to be used with a lot of care and um, professional guidance for that, but but you know, they do have different, you know, there's there's there's kind of different areas that they can be used in.

Dr Rupy: So this is what like I love and I have an issue with when it comes to these kind of ingredients being put in all these different products, right? Because it seems that there is some evidence that it is relevant for certain condition states and you know, a lot of people in your practice for whom you've prescribed these to have benefited from them. But if I go to like, you know, my local sort of herbal pharmacy or whole foods or, you know, you'll find them in supermarkets these days as well and regular pharmacies. There isn't that sort of like personalization. It's just like adaptogenic. And that can be applied to rhodiola, ashwagandha, and I don't know whether like that's going to be good for me or that's not relevant for me. And people just, you know, just pick one up because someone, probably one of their mates down the pub has said, oh, you need to get yourself some adaptogens. It's really calming. Do you know what I mean? And and I've I've got like some really good GP friends who have benefited from Ashwagandha. Like, you know, they absolutely swear by it. They take it every single day. You know, they obviously live very stressful lives and and they've told me to take it and I've tried it myself and I haven't had any effect. But I I don't know anything about the dose. I don't know anything about the the quality of the product. And I if I don't know, and I obsess about all these kind of things, I'm pretty sure most people, even those listening to this, don't don't know either. Do you know what I mean?

Dr Sally: Yeah, I do. I think it's a huge problem. You know, I wish I think there needs to be a lot more education. You know, I hope it will, I mean, I really hope that that will come as get people get more interested. It it's a minefield. And I mean, obviously, you know, I see people come with huge carrier bags of things they've been and bought and they don't know what they're doing with them and you know, they're like, oh, should I be taking all these? Yeah, I've got 20 in a bag or something. I'm like, no, no, you shouldn't. You know, but um, you know, that's exactly what happens. And and I don't know, you know, I I feel like maybe a little bit of knowledge is not a good thing sometimes, you know, because and and people do try to kind of, you know, they kind of try and make these combinations and you know, it's difficult. We're in a difficult position, aren't we? Because most GPs don't really have the knowledge and you know, you can search online, you can get huge amounts of information which is not personalized and um, you know, and

Dr Rupy: So so for someone listening to this who could probably uh, who may benefit from taking um, uh, these kind of products, adaptogens or all the others that we'll discuss, before we even get to discussing them, maybe we should sort of think of a blueprint or a strategy for approaching these additions to one's lifestyle. Um, before they get sort of sucked into the advertising, like, you know, supplements of this is good for your brain or this is good for your gut or this is, do you know what I mean? Maybe it like would you always want someone to see a practitioner like yourself or have that sort of like, you know, um, human touch before they go and invest in different supplements? Is that is is that the way you you think people should approach this?

Dr Sally: That's I think that is the ideal, isn't it? Because I think even I have to be quite honest, even me doing this job for nearly 20 years, I can't treat myself. You know, it's very hard to be objective. You know, even when you know, you know, I know sometimes what's wrong wrong with me, but still to be objective with myself is very difficult. So, you know, even the knowledge is not it's not all of it. It's actually the objective look at you and, you know, somebody that that's what's so helpful about seeing somebody as well. Um, I mean, I think, you know, a a medical herbalist and a nutritionist is often very knowledgeable as well, you know, so they maybe they don't have the detailed knowledge of the herbs, but very often a lot of nutritionists use adaptogens and are trained in using adaptogens. So, um, yeah, I think that's going to help you to get a more personalized, um, more tailored approach and also they will be able to recommend very good quality because the quality is another issue, which is another thing I have to say I'm very passionate about and talk a lot about with patients is the quality of things you're buying because it's an unregulated market, you know, at the moment, you know, so if you're buying something, the quality is a huge issue because you may you won't get any benefit if it's poor quality and and if it's adulterated or contaminated, you know, then obviously there's problems with that because it's, you know, there might be safety issues, but um, I mean, that's another thing to kind of, I think that education needs to happen around is the quality of the products and, you know, and also for me like the ethical harvesting because you know, I know with the herbs we're using in our teas, for example, we're looking at fair wild certification and for me that's another thing, you know, if these things become very popular, I don't want to see um, the whole of the ecosystem being destroyed and that we and and we don't have any of these herbs left. You know, and that's happened with some herbs in the past, you know, they've become endangered or, you know, like like golden seal which is an amazing herb, you know, it is like a natural antibiotic which is really very effective for infections. You know, I've used it a lot in sort of ear infections, chest infections, sore throats and it's very effective, but it's almost endangered in the in the wild from over harvesting and um, so I don't and I don't want that to happen, you know, you don't want to think, oh gosh, you know, we're we're getting so we're so all loving these herbs so much that you know, that they're actually going to disappear from the wild and that that it's not being harvested sustainably. So, um, I think that's the other thing that I I hope that there'll be more awareness of that and but you know, you've got to think about the quality because it's it's obviously with the herbs, you know, there's a lot dependent on how they were grown, how they were harvested, how they were processed and along that whole process of of the production of it, you know, there needs to be traceability checks, there needs to be, you know, all the herbs we use in our clinic, you know, there's there's um, there's there's batch testing on each one. So, you know, you're you're looking at the levels of the active ingredients, you're looking for heavy metals, for pesticides, you know, that's all got to be kind of checked for and um, and you know, how it's been stored, you know, if if it's very old and it's been stored in a warehouse that's, you know, in very hot country, for example, there's not going to be many active ingredients left in that, you know, whereas something that's been harvested and processed correctly, you know, and and used um, you know, depending on obviously the herb, but something with volatile oils in, you know, they're going to degrade quite quickly. So that there's lots of things at the moment. I think that I I totally agree with you. I don't think people understand the complexity and maybe quite what they're buying.

Dr Rupy: So so similarly for as a strategy, um, to what we just talked about with adaptogens, you know, you want to make sure that you're personalizing your adaptogen choice, uh, let's say, you know, on top of everything else that you're going to be correcting or trying to optimize within your lifestyle, whatever is causing stress or inflammation in your body. Um, in terms of choosing the right product, what what are some key things or key metrics to look out for for an individual who's finding themselves in a health food store, uh, you know, with the abundance of labels and claims on on the shelf and they're sort of overwhelmed as to what type of Boswellia or turmeric uh, or devil's claw to to sort of choose.

Dr Sally: I think the the first the key thing is to look for the good manufacturing practice. So that's the first thing I would recommend people look for. So any um, reputable company is going to be signed up to the good manufacturing practice. It's a voluntary quality assurance scheme, but it it basically means there's traceability, there's good manufacturing practice covers everything from the harvesting to the production of the supplements or the herbs. So, um, so that's kind of the basis that we so anything that we use in our clinic, that's the basis basic quality assurance that we'd look for. So there has to be, so good manufacturing practice is just like a little GMP, it's a it will be a little stamp on the product. Um, and you'll often see if you go on a website, you'll see that I mean, what I always look for is someone asked me, oh, what's about this supplement, Sally, you know, like is this any good? And I don't know the company. It's quite easily to look at the on the website and you'll they should have um, traceability information on there, like how do they test it? Are each batch tested? Do they have they signed up for good manufacturing practice? Do they know where their herbs are coming from? You know, that all should be on the website. It's usually it's quite easy to see a reputable company because they're they're testing, they're they've got traceability, you know, that they're taking that really seriously. They will kind of advertise that, you know, that will be on there. Um, and you know, if you're looking for ethically sourced, then there's the fair wild certification, which means that you know, that that they're not being that they're being harvested sustainably. So you can look for those. And then um, within our clinic as well, we kind of audit our supplements and we there's also some further quality assurances. There's an Emerson, there's an American um, quality assurance um, sort of stamp that has further like there's a bronze, silver, gold for that with the gold ones being that every um, every batch is tested, every single supplement that comes out of that factory is tested for quality. So, you know, there's that that's kind of the top and and they're obviously the more expensive ones, but you know, if if I'm looking, particularly if I've got someone who's very ill, you know, with serious chronic health conditions, um, or is very allergic to things and very sensitive, then you know, we're using those kind of very high grade ones where you know that there's nothing mixed in, that there's very good um, levels of everything.

Dr Rupy: I I'd love to sort of workshop some uh, random examples of of how uh, medical herbalism could could work alongside conventional. So let's say we have like a typical patient that doesn't have any other um, medical comorbidities and they've got gastritis. Let's just assume that they've had an endoscopy and everything's normal, they don't have like a Barrett's esophagus, they don't have an ulcer, they don't have anything to suggest anything more severe, but they are requiring, no, let's say uh, 10 to 20 milligrams of omeprazole, a PPI, uh, as and when, um, or or they use it regularly, let's say, otherwise they get symptoms. And let's say we've optimized all their lifestyle stuff, you know, we've stopped them having too many fried foods, we've stopped them having like high sugar, we've tried to maintain an eating window, we're not getting them to, we're getting them not to eat too late, etc, etc. Um, you know, as a conventional medic, my only tools are sort of those medications and I just mess around with the doses. I go up and down, I might change one, I might add something else, but I'm kind of limited to to that. And I and I wonder how you might approach that patient who, you know, they've seen me as the GP, the GP's not doing anything. I I need I need some relief. Like what how would you approach that?

Dr Sally: Yeah, so that's quite common. I do see lots of people with that. Yeah, I thought so. That's why I thought I'd workshop it. It's a really good example. Um, so I'd probably start with something simple like slippery elm. So that's one of my go-to easy start somebody on. So slippery elm's really nice, very, it's high in polysaccharides, it just coats the gut. It's very healing. So that's I would often go slippery elm and marshmallow root. So both of those are high in these polysaccharides, they're very healing and they kind of um, reduce irritation and inflammation. Um, and they have some prebiotic effects as well, like the slippery elm. So it's they're really nice for just settling the gut. So they're probably like the easy things I'd just go to. And then I might add, often I might add in like a DGL licorice, which I don't know if you've heard of that or

Dr Rupy: No. What what's DGL?

Dr Sally: So, so they licorice is another um, herb with it's an anti-inflammatory, so it works on the again that kind of NF kappa B inhibition and um, and it's it's very again, very soothing and healing, good for the digestion. Um, but it you have to be a little bit careful with licorice because of the glycyrrhizin in it. So if you take glycyrrhizin or licorice in excess doses, um, it can cause uh, increase in blood pressure. So that is one herb you have to be careful with in terms of overusing, particularly somebody with high blood pressure. So the DGL licorice is a deglycyrrhizinated licorice. So it's like you take out that glycyrrhizin. And and that's really nice, um, you can get it in capsules, you can get it in chewable tablets and it's really good for people with gastritis or heartburn, you know, because they just chew, they often chew it before they go to bed and it's really great, um, for, you can have it in your bag and you just if you get any heartburn, you just chew on it and it and it's really effective for um, reducing acid and heartburn and reflux symptoms. And and it's healing, you know, it's really helpful for helping it to heal up as well.

Dr Rupy: And what what is slippery elm? I've definitely heard of it, but I I don't know where it comes from or what what it is.

Dr Sally: It's a bark of a tree. Um, Ulmus fulva and it it's when you um, when you it's a powder, well, it's a bark that's then powdered and when you add water to it, it goes very gloopy. It's got lots of polysaccharides and mucilage in, which means it's a little bit like if you mix water with it, it goes into like a wallpaper paste. It's like really gloopy. Um, and very soothing. So it it's a really old traditional, it's used for stomach ache, you know, it's a very long, there's a long history of use and it it's um, it actually it was also often used for children, um, who couldn't take breast milk. I think it was made into like a gruel. It's very sort of nourishing. So it was used as a food for babies as well. So it's got lots of nutrients in, but the main thing is it's like very coating and um, soothing. So it's good for any kind of irritation. Like so I'd use it upper digestive, so heartburn, indigestion, reflux, um, but also kind of lower down, you can use it for, you know, sort of uh, IBS or even in IBD, you know, it's very just it's soothing to the whole gut really. So, um, so yeah, that that's it's a very simple, nice one to use first. And then I would,

Dr Rupy: And what what plant does it come from? Sorry, but I'm just trying to visualize it. I know what turmeric looks like, but

Dr Sally: Frankincense.

Dr Rupy: Oh, frankincense. Ah, right. Okay. So is it like an oil or is it like how how is it how is it delivered?

Dr Sally: It's a resin. So, yeah, it's a resin from the plant. So you see when you see it, it's like these little lumps of resin, like very, it is very thick and sticky. Um, so it's actually quite hard to extract. So when you extract it into a um, tincture, it's, you know, it it's, it tastes absolutely disgusting. I mean, to be honest, I wouldn't use it in a tincture. It's I have tried and it's really foul. I mean, so it's more generally used um, in powder form. And and so that's what how I've used it as a powder mixed in with turmeric, um, in capsule form actually.

Dr Rupy: And so it works on NF kappa B and Cox 2, similar to how some of our sort of like non-steroidal anti-inflammatories uh, work as well. Any other sort of um, uh, effects? I know like turmeric is pretty multifactorial, like it can uh, I think it has like similar activity to some of statins that that I prescribe. Um, it can have an effect on free fatty acids, but what any anything else with Boswellia in particular?

Dr Sally: So it can reduce the inflammatory prostaglandins. I mean, it works in that it's similar in many ways to the turmeric. Um, I I don't think there's quite as much research into Boswellia. I mean, turmeric has got huge amounts of research, hasn't it? Whereas Boswellia is not so well researched. Um, so as far, I mean, it doesn't have the kind of hepatic effects that turmeric does or the um, I'm trying to, I don't think there's, I don't know of it as being really used for high cholesterol like turmeric or having those kind of it's not as it's not got that kind of wider use that turmeric has. It's more targeted. I I really see it as more being an anti-inflammatory, more targeted. Um, and then like I say, for this for more sort of use in cancer care as well for um, for for supporting, well, particularly like I say in brain tumors or brain mets as well.

Dr Rupy: And in terms of like uh, inflammation fighting um, uh, herbs and and and um, and tinctures and stuff. I obviously like, you know, inflammation isn't the enemy and inflammation is a very important process. It's part of the immune system. It's how we fight infections and stuff. So there's a balance to be struck. But let's assume that we're dealing with patients who have excess inflammation for whatever um, upstream cause. What what what else is in sort of like your basket of goods uh, when it comes to uh, inflammation balancing um, effects?

Dr Sally: Yeah, there's loads. I mean, there's actually loads. I think herbs are really quite, you know, they're very useful for inflammation. So you've got you've got sort of like your more systemic ones. I mean, and you've got the really well-known ones. Um, I mean, ginger's a another good one that's had quite a lot of research on. And um, and then you've got sort of ones which are more specific for different um, systems. So like devil's claw, one that I used a lot again for arthritis. So, um, and then, I mean, you've got, there's just, I mean, you could go go on forever really.

Dr Rupy: What what is devil's claw? I've heard of this thing again. I think I must have seen it uh, in a store and I I have no idea. What what it sounds aggressive.

Dr Sally: It does actually, doesn't it? I've never thought of that. Yeah, it's not a very nice name actually, is it? No, it it's a South African herb. It's it's a really interesting, again, it's got a lot of research for arthritis, um, for helping with pain and stiffness. A lot of herbs work in a similar way, you know, on the kind of NF kappa B or Cox 2 or they work by helping to reduce those inflammatory cytokines. So there there's very similar pathways in terms of how most of them are working, but they're sometimes they have more specific kind of um, actions in particular systems in the body. Um, and devil's claw has that. So it's very targeted towards musculoskeletal system. There's some good trials on it for back pain, um, and uh, it's often used in arthritis. So it's quite a it it's um, used a lot in South Africa. I mean, which is where it comes from originally, but so, um, yeah, I mean, again, I I've I've used it um, when I was seeing a lot more with arthritis patients, I'd often use it alongside, say the turmeric, the Boswellia and the devil's claw together with some ginger, you know, that was kind of a standard

Dr Rupy: Oh, so is it like pre-mixed sort of thing or does it something that you compound yourself?

Dr Sally: Well, they're formulas that I that I had in my dispensary. So, you know, I I had them. Yeah, that's how I was using it, but the you could also it's often used in tincture form as well, devil's claw is um, I mean, some of these herbs and I think just thinking of how you're using them because that's quite helpful maybe to think about too is um, you know, because often there's different ways of using the herbs. You can think of the tisanes and the teas and the tinctures and then using capsules and that's dependent on the constituents you're trying to extract maybe or sometimes the taste as well. Because I know, you know, like devil's claw doesn't taste very nice as well. So, you know, there's certain herbs that you would not want to put in a tea, for example, because they're really horrible. Um, and um, and then certain herbs that would be uh, like marshmallow, which is probably one of my favourite herbs is um, extracted best in water. So that's, you know, you're best to use that actually overnight infusion where you soak the root overnight in water and then, you know, that's the best extraction for the marshmallow root. So it's some, you know, there there are variants in how you can extract the different constituents and that will have an impact on how effective they are used in the body as well. So, um, yeah, so I mean, and the and the taste, like I say, you know, because some of these ones we're talking about like the Boswellia and the devil's claw are just disgusting. So, you know, I think if someone was going to make a tea, I definitely would not do that with those.

Dr Rupy: I mean, how how do you determine like uh, the dose for the the individual? Because this is one of my uh, sort of bugbears with the the sort of uh, nootropic and adaptogenic trend of just like putting it in like, you know, your chocolates and all this kind of stuff. Like it's sort of similar to, do you remember Benecol? I don't know if Benecol's still around, um, but it you know, it was a a phytosterol based uh, margarine and they were like, oh, if you you put this on your on your bread every single day, it'll reduce your cholesterol. And I was just thinking, well, it's sort of like an inefficient way to get the correct dose of the active ingredients of that particular food if you're trying to lower your cholesterol. You'd rather just like have a a really good diet and then if you need to take uh, lipid lowering therapy, you just take that on on top. That's the way I think about things. And so if I'm having a chocolate bar with a bit of ashwagandha in, I'd rather just have normal chocolate and then take a a specific dose of the ingredient, uh, the the herb in, you know, my my daily routine. And so so how do how do you think about sort of dosing and again, is that personalized to the individual or are there sort of set standard doses for for for this sort of um, uh, this sort of practice?

Dr Sally: Yeah, I mean, I totally agree. I think it's gimmicky. I'm afraid. You know, I just think like, are you really getting any benefit from that? I don't know. Like, um, so sometimes they are, aren't they? I think they're just kind of like put on the label to make for it's kind of marketing, isn't it? You know, you look at the ingredient, maybe there's not actually very much in there. So, um, so I mean, with dosing, and and there's there's different traditions with dosing. So looking at different sort of um, if you're looking say in traditional Chinese medicine with herbs, they tend to go quite high dosing. So you'll see often very high doses that they'll use of herbs there. Um, and then you'll see in different traditions, different dosage. So there is a spectrum, like, and you'll see herbalists trained in different traditions will use different doses. So, and for example, when I was training, sometimes, you know, some of the lecturers we had would be using like drop doses, you know, they'd be using very tiny, almost homeopathic or or very small dosing. And then like I say, you'd kind of go up to a um, some of the Chinese, when you're reading, you know, the kind of formulas for the Chinese medicine, they're very high dosing. Um, and I and I and I don't know whether it's interesting to think like have these differences developed because of the genetics of the kind of cohorts of people they were treating, you know, I mean, I don't know whether in different cultures, people have different, you know, genetics and that might influence the dosing strategies. I I don't know, it's quite interesting because there's quite a bit of disparity between different traditions on how how much you do use. But um, and the West and in the West here in the UK, we're quite um, a hybrid, you know, like we've got influences from many different traditions. So you'll see like we have got influences from these kind of traditional European systems, we've got some um, influences from Ayurveda, there's often TCM influences and then you've kind of looking, there's often influences from America, like there's the physiomedicalist herbalism, which was in America, you've got the there was quite a big um, move of um, knowledge over from Native American Indians with, you know, when the wagon trains went over and then a lot of that knowledge came back to the UK as well. So we've got some like some of our herbs are traditional Native American herbs, like Echinacea is a Native American Indian herb that was used there and that came into this country. So we're a little bit of a melting pot with influences and you kind of often see that in the dosing as well and in the way that the formulas are produced. So, you know, you might see um, people using a simple, which is like one herb on its own, you might see more complex formulas and then, you know, going into kind of a traditional Chinese medicine system, they use a lot of herbs together in quite complex formulas. So you're maybe getting smaller amounts of individual herbs, but you'll have a synergistic effect with them. So, I mean, that's quite an interesting way to practice is because very much in the in the Chinese um, system, you will use like they'll have a way of writing a prescription where you have like a leading herb, which is your more active one, and then you have secondary herbs and then you'll have like a harmonizing herb which um, kind of enhances the effect of all of it. So, and so you might be using three secondary herbs with similar actions, but they're slightly, but they work synergistically. So there's actually quite a lot of science behind how you combine them, the way that you use the dosing, you know, whether you use smaller amounts of synergistic herbs or whether you kind of go mega dosing with one herb. Um, and I've kind of my original training was in the Western herbal approach, which is quite simple. So you kind of, you know, we were trained like, you know, you should just have five herbs in a prescription and they need to be quite high dosing and it's what simple. And then I did um, I did quite a lot of training in TCM and I kind of ended up like with some sort of hybrid way of prescribing, which I use a I love the TCM system and the way that, you know, that they kind of use um, the diagnosis that you do in TCM. And so I I actually do use a kind of more TCM approach often with my herbal prescribing. So I'll often use this way of doing synergistic herbs at smaller doses. So you can, you know, there's there's different ways of doing it. So I think if you're looking at, you know, just using one herb on its own, it's good to look at the research about, you know, I mean, for example, turmeric, you know, there's good research with different dosing strategies. So, you know, there's some, some of the studies in osteoarthritis on turmeric, you know, the average that's used there is about 850 milligrams a day and that's for like curcumin extract. So, you know, you've kind of got, um, there's, you know, research for that. If you're using it in ulcerative colitis, then you generally need a higher dose. So there's there's studies show like 2,500 milligrams a day to be effective. So you can kind of look at studies and see, you know, in certain conditions, you know, if you're looking at as a simple, it kind of depends on what you're using it for. Um, and then when you're using them in combinations and formulas, you're generally you're driven more by the traditions of, like I say, how it kind of fits together in a formula.

Dr Rupy: Yeah, I was just going to say that's a really interesting insight into into the differences in practice. I mean, like we're we're pretty sort of algorithm uh, focused. So, you know, if I'm going to be starting someone on lipid lowering therapy, let's say, uh, for for the listeners, you know, uh, high cholesterol, um, or, you know, someone with gastritis, we're going to start at a minimal dose of the first recommended um, uh, medication and and then titrate upwards as needed or, you know, change if there is any side effects and then go to second uh, generation, third generation, etc, etc. Whereas it seems with medical herbalism and perhaps other sort of um, practices, there's a bit of a hybrid approach and sort of like test and feel as you go along. Is is that is that fair to say?

Dr Sally: Yeah, I think there's known sort of safety parameters of, you know, like, okay, these are the and there is the kind of, you know, when you're training, you're looking at, okay, these are the there's parameters, it's not just like there's no kind of guidelines, you know, you do, but I think that I mean, certainly from my experience, what I've what I know is that people respond in different ways. So I'm very much looking at, um, so when you're kind of treating holistically, you might be looking at, okay, this person is quite sensitive. So, you know, that they've had a lot of reactions, for example, in the past to medications or food, I'm going to go with a smaller dose. So, you know, for somebody with that sort of history, I'll be thinking, well, actually, I'm probably going to go with um, maybe half of a sort of standard dose. Whereas somebody maybe who has got really severe symptoms but is quite robust, you know, they've never had any problems with sensitivities in the past, I'm just going to go with obviously a higher dose. So, you know, you have parameters for each herb where there's recommendations of like grams per day or mils per day for the tinctures. Um, and then you're kind of working within that, which I'm sure is kind of what everybody's doing in practice, isn't it? You know, you kind of if you've got somebody in front of you who you know is like super reactive and has got a long list of had side effects to lots of things, you you'll go in with a smaller dose. But there are, you know, for each herb, there are sort of standard doses for kind of how they've been used traditionally.

Dr Rupy: Yeah, I I'd love to sort of workshop another one, sorry if I if I don't mind. This is great. This is really, I think this is really useful for other people to think about, you know, how they could potentially uh, utilize these strategies in their lifestyle as well. So, another common one is um, high cholesterol. So let's say we have uh, a man or a woman, uh, let's say in their 50s, uh, they've got persistently raised cholesterol. They've already been seen by the lipid clinic. There isn't a sort of uh, familial hypercholesterolemia, uh, but they are at risk of uh, cardiovascular disease. No matter what dose or let's say they are on high doses, they've been on high doses of statins and fibrates before, they don't tolerate the really high doses, they can just about tolerate a low dose of statin, but their cholesterol is still outside of the range that we want it to be. Let's say it's above six 6.5 or let's say seven. Um, we're optimizing everything else in their diet. So they're on a low sugar diet, they do not have a high amount of saturates um, coming from uh, meat products uh, in in their diet. They they've basically optimized their exercise. So we're trying to, you know, push up their HDL. What what would you recommend to to this mythical patient here? Because this is this is another common one. I reckon a lot of GPs would struggle with as well.

Dr Sally: Yeah, it's true. And I probably don't see that so often that I used to, but I mean, in the past, what I have done, I have had success in terms of usually what I've done is a combination of, so in herbal medicine, you're looking at uh, often supporting the liver. So you'll often use things like um, the bitter herbs, which can help with, so the bitter herbs stimulate digestion and increase bile production and so help with kind of nutrient absorption and um, breakdown really kind of helping to to break down and emulsify fats, for example. So you you'd often use the bitter herbs. So you might think like dandelion root or you could use artichoke. There's some small studies about artichoke with it. Um, I mean, the the research for I've tried different approaches actually for cholesterol. So I I actually the last um, the last patient I had, I've actually gone like a TCM kind of approach, which is where you do quite a special, you know, you're kind of looking at the patterns in the body. And and if you look at TCM, you'll see this pattern of like um, phlegm, which is, you know, kind of makes sense if you think of cholesterol, I guess, you know, in terms of damp, they talk about dampness again. So, you know, I've kind of gone with a bit of a TCM approach, which has been successful. That's kind of a lot of different Chinese herbs that I've used. But in terms of um, simple things, then, you know, you've got like turmeric, there's obviously there's some studies on turmeric, um, working in a similar way to statins, you know, um, so, you know, that would be a simple thing to put in and that, you know, that would be a definite and that's going to probably help with insulin sensitivity as well, which might be linked. So, you know, that that could be helpful. Um, or I'd go bitters. So I'd go I I I'd just go with like the dandelion root, um, and those kind of simple bitters. That that's kind of what I've done in the past until I've started having a go with the more kind of complicated TCM approach, but that's very personalized because you're kind of looking at the patterns of a lot of different things. So I think if you want simple, I'd just go with the turmeric. There's some evidence for comiphora, molmol, or guggul, which, you know, uh, which is um, Ayurvedic herb that there's evidence, some evidence for that for using cholesterol, which I've experimented a little bit with that and I have put that in formulas as well in um, again, like with the bitters and the turmeric and the and I've had some some success with that, but it wasn't um, kind of consistent, I would say.

Dr Rupy: Yeah, it's interesting, isn't it? With with um, sort of the more personalized approach, it's harder to sort of just give general advice, but like, oh, just do this and we'll we'll whack your cholesterol down. And I and I think there's the expectation, I think partly because of the way we've presented Western medicine from the patient that that's how it should be. And I think what we're seeing offered in sort of, you know, online stores and and sort of wellness pharmacies is the similar is the similar model that patients have been sort of taught to expect. And I I think that's wrong and I think, you know, the more personalized traditional Chinese medicine, TCM measures and Ayurvedic measures, I think are are probably going to be a lot more popular or should be at least anyway because, you know, it's it's not a one size fits all like you've like you've eloquently explained.

Dr Sally: Yeah, I mean, it's just it is more effective. You know, like if you personalize, I mean, what we're doing in the clinic now, which I find really interesting now, we're also doing like the nutrigenomics testing and things as well. So some of our nutritionists are really uh, you know, we're kind of trained with life code and and I've been doing a bit of that and that's just fascinating. You start looking at the snips and, you know, these all these variations that we all have and you think like, well, no wonder we all react differently, you know, we're actually genetically there's these differences and, you know, and also when you start looking at gut microbiome and all these pathways, you know, we're so we're all just there's no wonder that we react in different ways to things.

Dr Rupy: Yeah, it's going to look pretty archaic, I think in the next 10, 15 years when we look back at how we would prescribe sort of one size fits all medications within medicine, you know, just me giving a statin to whoever comes in the door without really knowing what their single nucleotide polymorphisms are, their their sort of genetic variability, like it's going to be like, what, I can't believe we were doing that. Uh, just 10 years ago. Um, and just on the subject of um, limitations, I think with with herbal medicine, I think there, you know, I don't want to give the impression that, oh, you can just take these these herbs and you'll be fine. What what kind of key things do you always want to make sure um, whenever you're prescribing uh, medical herbs that, you know, patients aren't on in terms of other medications and also are there sort of considerations with other condition states?

Dr Sally: Yeah, yeah, so that's really important to think about that. So obviously there's some herbs that have more contraindications than others. So, you know, St John's wort's the big one, you know, so obviously if you're thinking that you want to prescribe that, you're going to have to look at if they are on any medication. So there's quite a lot of interactions. Um, so you're going to have to think about, you know, some herbs we know act on the CYP450 liver enzyme system. So that's the kind of big one because that's going to potentially interact with how some pharmaceutical drugs are broken down. So, you know, the St John's wort's the big one, you have to be careful with that with like the oral contraceptive pill. That's a big one that I don't know if people are always aware of because it can make the pill not so effective. So I think one way to make you more depressed is potentially to find out you're pregnant when you didn't mean to be. You know, I always think, oh god, you know, I definitely don't want to do that if someone's, you know, is struggling already with low mood, now they have an unwanted pregnancy as well. Um, so, you know, that's a big one and the immunosuppressant drugs and warfarin, digoxin. So obviously like St John's wort, you have to be careful with those and um, immunosuppressant drugs. And then there are some herbs which can have have um, blood thinning effects. So for example, ginkgo, um, high doses of garlic, turmeric, um, um, Chinese Angelica, you know, you might need to, I would always tell people to stop them like a week before surgery or obviously also contraindicated with anybody on kind of blood um, thinners. So there's certain some herbs that have that, not so, I mean, like turmeric, I wouldn't in just food state, but if they're on a high dose, you know, you might need to be careful with um, blood so, um, blood thinners, like I say, or surgery or dental, you know, if they're having extensive dental treatment, for example. So, um, licorice, you have to be careful with high blood pressure, particularly if they're having high doses of that. And then, you know, and then there's, you know, there are, they're the big ones that you know, you kind of need to be careful with. I mean, in terms of herb drug interactions, there are some, if you start looking at the literature, you know, you can see theoretical concerns which come from maybe in vitro studies, very high doses in vitro studies and then you can and and then there's a whole kind of spectrum of, okay, we go from theoretical concern with in vitro isolated constituents to actually case studies of um, documented um, you know, with St John's wort, for example, you know, there's um, that they're kind of documented cases of reported problems. So, you know, you've got a spectrum and normally, you know, if you're looking at prescribing them, you're kind of uh, obviously avoiding all the contraindicated ones for anything in the middle, you might be just monitoring closely or you might just be giving a lower dose, you know, you kind of got there's a bit of an in between sometimes with just monitoring more closely or making that call of kind of risk benefit analysis really that you're doing in the middle there. Um, so, you know, so generally, I'd say herbs are very well tolerated. So you kind of as long as you know these main um, areas to be careful with. The other big things in terms of obviously is people on chemotherapy, which is obviously very, you know, you have to be very careful with that, um, or an immunosuppressant medication, anywhere where you know that it it warfarin, digoxin, where there's a narrow therapeutic index, you know, all of those type of medications have to be very, obviously that that is a whole area you have to be very careful with. And then in terms of, you know, patients, you're you're um, obviously anybody with um, sort of liver, kidney issues where it might reduce the excretion or blood coagulation problems, you know, it's kind of severe allergies, you've obviously got to be looking for all those more serious problems that are going to affect maybe how your body's metabolizing the herbs, for example, or excreting them, or, you know, obviously they're pregnant or elderly, maybe reduced kidney function, for example, with elderly patients. So kind of all those kind of normal kind of contraindications that you would be looking for and um, uh, I think probably the main things in practice are, you know, just being aware of the main herb drug interactions. Um, and I think, you know, I mean, I've been using herbs for like nearly 18 years now and like touch wood, I've never really seen, you know, I I haven't in practice ever ever seen any serious adverse effects. And you know, and I see patients who are on medication all the time. So as I think as long as you're using them safely, um, you know, I I like I say, touch wood, I've never I haven't seen any problems. So I think it's quite possible to use them safely. It's just obviously have to be careful with how you're doing it and, you know, looking for the um, you know, the red flags and just being aware of when you you should be using how to use them safely basically.

Dr Rupy: Yeah, yeah, definitely. I mean, for for anyone listening to this and we're interested in like, you know, uh, sort of a lay person's guide to medical herbs. Are there resources or books that you point people towards? So, you know, if they do have, uh, you know, persistent UTIs or they have menopause symptoms or they have other digestive complaints, they can sort of get some sort of guide as to, okay, what herbs might be appropriate for them before they entertain maybe, you know, booking an appointment and having more regular sort of follow-ups.

Dr Sally: I mean, there are some, there's some lovely books. The first book that I ever was given and was my Bible for a long time was the Andrew Chevalier book, the encyclopedia of herbal medicine and um, that's uh, I mean, Andrew Chevalier was a was a president of the of the National Institute of Medical Herbalists for a long time and is really, you know, he he's a very well-known herbalist and his books are really, it is an encyclopedia, you know, that was the one that I kind of started with. Um, and um, so I think that's probably a really good one to to use. The other person that I used a lot when I was initially starting for for women, particularly for women's health, for children and pregnancy is Aviva Rom. So she's produced quite a lot of different books. She's absolutely fantastic. She's American. She's actually a herbalist, a midwife and a doctor as well. And she is um, so and and she her books are, they're really grounded, very, very easy to use with lots of with actually doses in and how to use everything and I mean, she's an amazing resource. So, um, for for like I say, for any women's health problems, she's written books for for for um, how to use herbs in children, for children and in pregnancy as well. So her books are very, very helpful. Um, and then um, there was another um, I'm trying to remember the name. Uh, Hoffman, I think it's David Hoffman, which is the other book that we kind of started with when I was starting, which is another sort of nice um, general introduction and basic recipes and like how to treat simple things. You know, that that was another good one that I used when I was first starting.

Dr Rupy: Yeah, yeah, absolutely. I um, I'm definitely going to look into those for sure. And I and it like I I want to bring this to a close because I feel I feel like I've just been peppering you with questions about that. I should really just do a BSc in medical herbalism myself rather than badger you about it.

Dr Sally: I love it. I love it. That's what I'm all about. I love it. No, it's fine.

Dr Rupy: Um, but yeah, like are there sort of um, basic sort of collections of medical herbs in small doses that you would say, okay, this is like a a nice sort of foundational level to just maintain. I mean, like, you know, I'm relatively healthy person, eat very well, obviously, you know, don't have too much stress in my life. Is there sort of like the equivalent of a multivitamin, even though I don't actually recommend multivitamins, but but you you know the point, the point I'm trying to make is like, you know, foundational support in terms of like collections of medical herbs that you think people most people would benefit from.

Dr Sally: Yeah, I mean, um, I I I I struggle to kind of give generic advice, I guess for that because I think it is different for everybody. I guess some of the more nutritive ones, you know, so like nettles maybe, you know, that would be something that could be helpful. The the other what's might be interesting for you to to look at as well is in Ayurvedic medicine, you have these kind of um, uh, tonics which are used for longevity. And and I quite like the idea of these. So there's things like gotu kola, you know, which I guess if I was kind of thinking about anything, I'd probably just go with something like that. Maybe just got to, you know, got to kola because it's going to be good for kind of brain function and it has that traditional use for kind of longevity. So I think that's kind of what I I'd be going for the Ayurvedic, these longevity tonics because I just feel like that's kind of what we all want really, isn't it? So, you know, that they're the ones to go for.

Dr Rupy: And in terms of like teas, um, is that like a nice sort of gentle way into have some medical herbs in your life? Is that because I they're not particularly high dose, I'm assuming and you know, it'd be very hard to have significant side effects from them.

Dr Sally: Yeah, exactly. And that's kind of what I've tried to do with the teas that I've done, you know, is do nice formulas for every people to use every day really, every day. So, um, yeah, absolutely. I think teas are a great way in. So, you know, I and um, that's again, like I've used Tulsi in quite a few of the teas that I've created and for that very reason because I think that's another one of those kind of nice gentle adaptogenic longevity herbs and it's nice for sort of reducing anxiety and for brain function. So it's a, you know, that that's another nice one to take as a tea. I I'd say, you know, mostly with herbs and I think with food, it's the same advice in terms of diversity. I'm quite into like, you know, having little bits of different things. You know, if you think about the gut microbiome and how, you know, now the advice that I'm always giving people is diversity and having a rainbow diet and having all those different phytonutrients and it's the range of all of them which is important. And I think it's the same with the herbs as well to an extent, you know, if you're kind of having little bits of lots of these herbs, you know, as long as you're not trying to treat something, if you're looking for just a general overall health support, having diversity is helpful. You know, so maybe using the spices and ginger, I mean, I I love doing ginger, you know, just as like a decoction. So taking a fresh ginger root, chopping that up and then like simmering it for 15 minutes and having that um, as a drink, you know, so you that's a nice thing that you can do. Um, and so, you know, there's these simple things that but having a bit of diversity, I I think if you're going to do something every single day, unless you've got a health problem you're trying to address, that's probably it's not as beneficial as having diversity with what you're having. Um, because lots of these herbs have different effects in the body and some of them, I mean, I was looking at some research where, for example, licorice can help change the, you know, the gut microbiome. So it helps to improve lactobacillus and bifidobacteria. And and I think it's the same, you know, lots of these flavonoids in the herbs, there's herbs have, you know, most herbs have some types of flavonoids in, they've got all these lovely antioxidant effects, you know, actually, it's the same advice in terms of like a rainbow diet, you know, you have lots of these different types of flavonoids, you're going to get all these different diverse antioxidant benefits and and the herbs that help with the gut microbiome are going to be helpful for again, that kind of diversity of of creating a kind of robust um, biome as well, you know, so it's the same kind of advice, I think.

Dr Rupy: Yeah, yeah. Well, Sally, this has been super educational for me. I I've loved the workshopping as well. Um, and uh, yeah, I'll I'll dive into more of your teas as well. I think they're they're really good because um, I like I said at the start, I I I like I infuse them and I'll put them into bottles and I just keep them in in my fridge because you know, when you want something a little bit more flavourful than just uh, plain water and I I love water, but like a little bit, you know, you want something a bit more exciting than plain water. They're they're lovely to have. I I honestly think there's like a niche in flavoured water with herbs and certain um, spices and even like gotu kola and that kind of stuff uh, that hasn't really been tapped into. Uh, so I'd love to see that.

Dr Sally: Maybe I should be doing that then. Maybe that's my new strategy. Thank you.

Dr Rupy: Maybe you should be doing that. Awesome. No, thank you. That was great. That was fab.