This may have been the first comment that came out of my mouth in a light-bulb moment, but you will have to watch Bendy Brain Episode 5 on YouTube to find out why….. ¹

The thing is, in my MSc in Mental Health Science I am primarily researching the causes and treatment of depression; yet I can’t help myself [while I have University access to journals and scientific papers] in dipping my toe into neurodivergency. I blame three of my daughters for egging me on because they are adamant that they have diagnosed something in me. But I digress…

It seems that Attention‑deficit/hyperactivity disorder (ADHD) has been widely misinterpreted in adults, particularly in women. Nevertheless, it is widely recognised as a neurodevelopmental condition characterised by inattention, impulsivity, and [in girls and women mental] hyperactivity. It makes females feel overwhelmed because they cannot follow the organisational systems other people can, seem to start twenty-thousand projects they cannot finish, and still cannot say ‘no’ when an extra opportunity comes their way.

Apparently, ADHD is not a personality flaw or a behavioural choice, but it reflects differences in brain development, catecholamine signalling, executive‑function load, and sensory processing. ADHD brains are wired differently.

And I have been asked if there is anything herbal that could treat it by people hesitant to go down the orthodox drug regime. Especially when they can’t get their heads around the fact that the drugs used are stimulants, and they expect that I would prescribe some sort of sedative to reduce mental hyperactivity. This isn’t helped just by a cup of lavender tea…

This matters because herbal medicine is often misunderstood as a ‘natural alternative to stimulants’, so it possibly would make sense to some people to take herbal capsules on a like-for-like basis. But the evidence shows something more nuanced: herbs can support the physiological systems that shape symptom expression, but they do not replace pharmacological treatment when it is needed.

I’ve seen recent reviews which highlight growing interest in natural products and traditional herbal formulas as adjunctive therapies. A 2026 review in Frontiers in Pharmacology² synthesised preclinical evidence showing that certain herbs and specific traditional medicine formulas modulate catecholamine neurotransmission, synaptic plasticity, neuroinflammation, and the gut–brain axis which are all mechanisms relevant to ADHD symptom clusters.

But herbs working through these mechanisms do not ‘treat ADHD’ directly; instead, they improve the biological environment in which ADHD traits are expressed.

A separate 2025 systematic review in Nutrients³ evaluated supplements including Bacopa monnieri, Ginkgo biloba, and caffeine. Bacopa consistently improved inattention, hyperactivity, and memory across multiple studies, while Ginkgo showed modest improvements in attention. Crucially, the authors emphasised that supplements cannot replace the well‑documented efficacy of stimulant medication.

So, what would a responsible, evidence‑aligned herbal approach look like?

1. Target the physiological drivers, not the diagnosis

Herbal medicine works best when it addresses the systems that amplify ADHD symptoms: sleep disruption, anxiety, emotional dysregulation, metabolic instability, and neuroinflammation. These domains are strongly implicated in symptom severity and improving them often reduces functional impairment.

2. Use herbs with emerging evidence

Bacopa monnieri: Consistently improves attention, working memory, and hyperactivity in clinical studies. Its mechanisms include enhancing synaptic plasticity and modulating neurotransmission. Evidence supports its role as an adjunct, not a replacement for stimulants.

Ginkgo biloba: Improves cerebral perfusion and executive function. Studies show reductions in inattentive symptoms, though effects are weaker than standard medication.

Saffron (Crocus sativus) and my favourite because I am making a special study of this spice for the treatment of depression; although not included in the above reviews, saffron has growing evidence in paediatric ADHD for improving attention and reducing hyperactivity. Its mechanisms overlap with dopaminergic modulation and anti‑inflammatory pathways — consistent with the mechanistic domains identified in the 2026 Frontiers review. (Inference based on mechanistic overlap.)

3. Mechanisms matter

The 2026 Frontiers review highlights four biological domains through which natural products may influence ADHD‑related behaviours:

• dopamine and noradrenaline signalling

• neurodevelopment and synaptic plasticity

• neuroinflammation reduction

• gut–brain axis regulation

And using herbs together aligns well with clinical herbal practice, where multi‑target modulation is often more relevant than single‑pathway intervention.

4. What can herbal medicine realistically offer?

Herbal therapeutics can:

• improve sleep quality and circadian stability

• reduce anxiety and emotional dysregulation

• support cognitive endurance and working memory

• reduce neuroinflammation

• stabilise metabolic fluctuations that worsen distractibility

They cannot:

• replace stimulant medication in moderate–severe ADHD

• ‘cure’ or reverse neurodevelopmental wiring

• function as stand‑alone treatment in high‑impairment cases

5. A balanced, evidence‑aligned conclusion

Herbal medicine offers meaningful support for people with ADHD but not by treating the condition itself. Instead herbs can improve the physiological systems that influence symptom expression. Evidence for Bacopa, Ginkgo, and other herbs is promising, particularly in domains of attention, sleep, and cognitive function. For neurodivergent individuals seeking holistic support, herbal medicine can play a valuable role provided it is used with clinical guidance, realistic expectations, and an understanding of what the evidence actually shows.

Meanwhile, I will continue to delve into the OU library of scientific papers until my access runs out in September…

¹ _{https://www.youtube.com/watch?v=x3SCSdMMfIo}

² _{Al Shahab, S., Al Balushi, R., Qambar, A., Abdulla, R., Qader, M., Abdulla, S. & Jahrami, H. (2025) ‘Efficiency of different supplements in alleviating symptoms of ADHD with or without the use of stimulants: a systematic review’, Nutrients, 17(9), p. 1482. doi: 10.3390/nu17091482.}

³ _{Deng, H., Li, B., Mu, Y., Xia, W. & Weng, N. (2026) ‘Molecular mechanisms and therapeutic potential of natural products and traditional Chinese medicine formulas in ADHD: a review of preclinical evidence’, Frontiers in Pharmacology, 17, 1766222. doi: 10.3389/fphar.2026.1766222.}

^Also; _{Hypermobility, POTS + ADHD, Autism, ND Connection with Leading Expert Dr Jessica Eccles https://www.youtube.com/watch?v=j7fzuYUAoDg&t=4307s The Hidden 20% and ‘ADHD Chatter’ on YouTube}

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Now there are extreme two tides to swim against. The tide of rubbish food and constant snacking, and the tide of you can only eat certain things if you want to be healthy.

The landscape of being healthy has shifted from a handful of common‑sense habits to a minefield of warnings, contradictions, and dietary tribes that all claim to be the ‘one true path’.

Today, people are bombarded with health cautions from every direction. Vegetables are no longer just vegetables; they are carriers of pesticide residues, fungicides, and soil contaminants. Meat is no longer simply meat; it’s a reflection of what the animal was fed, how it lived, and whether its diet altered the nutrient profile of the food on your plate. Even water, the most basic human requirement, comes with debates about filtration, microplastics, PFAS, and mineral content.

The result is that we become not only confused but mentally exhausted.

Add to this the dietary identities; carnivore, keto, paleo, plant‑based, low‑FODMAP, low‑histamine, and you have a perfect storm. Each group insists it has found the answer. Each group has a YouTube following, testimonials, scientific papers, and influencers ready to explain why their approach is the only rationally healthy one. And each group has its own list of warnings: avoid oxalates, avoid lectins, avoid grains, avoid dairy, avoid seed oils, avoid fruit, avoid fibre, avoid red meat.

So, yes, we throw up their hands and say, “What can we eat?”.

The confusion is not just intellectual; it’s emotional. When every food choice feels like a moral decision, we become paralysed. We want to do the right thing. We want to feed our families well. We want to avoid chronic disease. But we also want to live a normal life without turning every meal into a forensic investigation. The modern health environment has created a mismatch between what people can realistically do and what they feel they should be doing.

Yet the solution is not to give up.

Nor is it to spend a fortune buying everything organic, biodynamic, grass‑fed, regeneratively farmed, and hand‑picked by monks. The achievable way forward is simpler, far cheaper, far more achievable, and will keep us sane. We have to accept that in this modern world we cannot practically achieve a diet that is free from chemicals and stuff we don’t want to put in our bodies, and instead do what we can to limit the damage. Whatever way we choose to eat there are four things that we can do to keep our sanity and be better than giving up entirely

1. Any diet built around whole foods will outperform any ultra‑processed, convenience‑heavy diet regardless of whether every ingredient is organic. The body responds to overall nutrient density and metabolic stability, not primarily the pesticide molecule.

2. Second, cook more at home, this is the corollary to buying whole foods instead of frozen pizzas or ready prepped dinners. This single habit reduces exposure to additives, emulsifiers, seed oils, and hidden sugars more effectively than any expensive supplement or detox protocol. Home cooking doesn’t require elaborate recipes; it requires ingredients you recognise and methods you can repeat. I know this is hard for many families, I know McDonald’s is cheap and filling, but the simpler you keep it the easier it gets. We were quite financially restricted when our kids were young, so I do understand.

3. Third, reduce sugar consumption. Sugar is inflammatory and kids are developing Type 2 diabetes which used to be called adult-onset. We can’t police our kids outside the home, but we can re-frame what we count as ‘treats’ inside the home. I counted it as a great personal achievement when I weaned myself off expecting biscuits with every cup of tea…

4. Fourth, choose simple wins rather than trying to fix everything. Wash produce. Use a basic water filter. Buy better meat when you can, but don’t panic when you can’t. Plan to either make a week’s menu and just buy ingredients for that or buy in the ingredients you know you can use to rustle up your cottage pie or jacket potato fillings throughout the week. These steps deliver disproportionate benefits compared to their cost.

The biggest problem after all the noise and confusion about what to eat is when you have a family with young kids and/or teenagers who want to eat differently to you. When I sent my kids to school with healthy lunchboxes they got mocked. It was upsetting you must choose your battles, and I wouldn’t compromise my kids’ mental health on the altar of my principles, so I was not so strict when they took lunches.

After I read that even organic food contains some residue of the pesticides and chemicals from the air or water residue that seeps underground [and after the cost of my veg box soared], I gave up buying organic and just thought that I would do these things at least:

i] Never to buy vegetable seed oils, but use butter, coconut oil or olive oil instead

ii] Don’t buy food in packets or pre-prepared

iii] Make my own bread and cook my own food with ingredients

iv] Wash my vegetables and fruit

v] Reduce sugar consumption to the lowest I possible could

Finally, remember that humans are robust. Our physiology is designed to handle imperfect environments. The goal is not purity; it is resilience. And resilience is built through consistent, moderate, sustainable habits and not through fear, restriction, or chasing every new warning.

And if we do get mentally exhausted, or anxious, we have chamomile, lemon balm and lime flower teas that will really help to calm our agitation. Without side effects.

And if we want to increase our intake of vitamins and minerals, we can make teas with dried nettles, dandelion leaf, raspberry leaf, peppermint which are all things that grow in any garden at no extra cost.

They remind us that health isn’t found in fear or in chasing every warning, but in choosing a few steady practices that support us day after day. And we might find that it is enough.

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So, how is it going?

I rely now on blood-glucose testing strip to see how my body is reacting to food, which is one of the ways that we can see what we cannot feel.

The pattern is this: insulin rises after eating [varying on what type of food we have eaten carbs/fat/protein], glucose peaks around 45–60 minutes and returns toward baseline by 2 hours. Hopefully.

https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

Randomly, here goes….

1. Two hours after eating 2 slices pumpernickel bread with cheese and butter my blood glucose levels were 6.4 [26.06.26]

2. Two hours after eating chicken, carrots, and mushrooms my blood glucose levels were 6.8 [28.06.26]

3. One hour after eating a jacket potato, chicken and salad my blood glucose readings were 9.2 [29.06.26]

4. One hour after eating 2 slices of ‘normal’ bread my blood glucose levels were 11.00 [30.06.26] – unfortunately I didn’t test after 2 hours because I wanted to go to bed…

I have more results, but my pattern suggests that if I keep off bread and potatoes then I am fine. I do not think I will ever be able to indulge in starchy carbs as freely as my husband does, with no issues. And I think this is a pre-disposed genetic/family tendency that I will just have to live with. It means that I must keep up with my Fenugreek capsules and my Mulberry Tea, for like, forever…

But the point is that because I test my blood sugar, I can hopefully avoid the damaging diabetic neuropathy and other results of living with a high blood sugar level in years to come.

And one doesn’t just rely on one or two results to establish for a fact that one has pre-diabetes, or diabetes; one will get that diagnosis from a GP. But these little gadgets have been useful for me to keep track of tendencies and to see what specifically raises my blood sugar the fastest and highest.

If I hadn’t had a blood glucose monitor, I wouldn’t have realised that healthy, organic oats raise my blood sugar very high and very fast; or that I can tolerate pumpernickel bread but not ordinary wholemeal; or that I should be very circumspect about eating potatoes. It helps me maintain a steely backbone while watching my husband eating cheese on toast and roast potatoes.

But that is what it will take to avoid Metformin, so I will just have to pull up my big girl pants and get on with it…

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Parkinson’s is an incurable, progressive condition that needs to be managed rather than ‘cured’.

But what if we could ‘manage it’ better?

I treated my husband solely with herbs for several years, until he decided to accept the Madopar he had been offered. He hoped it would improve his fatigue as he was still working.

The problem with orthodox drugs [as we know] is that for all the positives they offer there is often a catch. The catch in my husband’s case was, because they regularly increased the dose to maintain effectiveness over the years, there appeared quite distressing side effects. The most difficult was the dyskinesia.

Later, because he didn’t want to keep upping the Madopar and Amantadine he agreed to Deep Brain Surgery. When this was switched on it made a great difference.

For a time…

As many people have experienced before me, watching someone you love slowly deteriorate motivates you to think ‘what can I do?’ I have managed to keep up with some herbal treatment which he has found effective in several areas. But the disease marches on, taking more land as the months progress.

Looking at some of the research papers I am sifting through for my MSc, I have come across quite a bit of interesting stuff. Some of the reviews I have been wading through include interesting thoughts on sugar/carbohydrates in the diet for neurodegeneration.

Apparently mitochondrial dysfunction and insulin resistance are prominent in PD, and the brain cannot use glucose efficiently. This creates an energy deficit state in metabolically vulnerable neurons. Recent reviews and imaging studies seem to show that PD is accompanied by systemic and regional impairments in glucose metabolism, which affects glucose uptake and glycolysis.

And this correlates with disease progression and dopaminergic neuron vulnerability.

Impairments in systematic and regional glucose metabolism exist in patients with Parkinson’s disease (PD) at every stage of the disease course, and such impairments are associated with the incidence, progression…which affect each physiological process of glucose metabolism. ¹

My husband’s consultant neurologist [he’s a nice man who tolerates me prescribing herbs to ‘his’ patient] may laugh at me [if I tell him] that I am steering my husband towards a ketogenic diet. BUT - the idea that we can meaningfully shift neuronal energy metabolism through diet is no longer fringe: it’s credible.

The review by Dai et al [2023] is a comprehensive review demonstrating that glucose metabolism impairment exists at every stage of PD. And it’s not the only one.

Recent studies suggest that glucose metabolism is a potential therapeutic target for PD, and describe how abnormal glucose metabolism is closely linked to the development and progression of PD.

Dysfunction of glucose metabolism impairs the normal functioning of neurons, which is widely observed in neurodegenerative diseases. ²

What can we do about glucose metabolism?

At the very least, we can do what people with pre-diabetes should do..

That is – as I am sure you know- is to reduce carbs. But whereas NHS advice is to eat whole grains and eat 6 small meals a day to keep blood sugar stable [yes, really], I think studies show that eliminating all carbs [even whole ones] is the way to go.

Systematic reviews and metaanalyses show that low‑carb and ketogenic diets can induce remission of type 2 diabetes in a substantial proportion of patients, including improvements in HbA1c. I wasn’t concerned with weight loss [my husband is a slim man] or diabetes 2 [I have tested his blood sugar alongside mine – never a problem], but I was concerned about the effect of potential impaired glucose metabolism in my husband’s brain.

Even if the neurologist may laugh, he isn’t the one living with a PD patient.

I am feeding my husband lots of good meat with butter and a few low carb vegetables. He seems happy. Most of all, he is thankful that someone cares enough to keep trying ways of lowering the inflammation in his brain and moderating his blood glucose levels.

At the very least, it makes me feel like I am doing something that may have a good effect.

^{1 Dai C, Tan C, Zhao L, Liang Y, Liu G, Liu H, Zhong Y, Liu Z, Mo L, Liu X, Chen L. [2023] Glucose metabolism impairment in Parkinson’s disease. Brain Research Bulletin. 2023 Jul;199:110672. doi: 10.1016/j.brainresbull.2023.110672 PMID: 37210012}

^{2 Chen L, Wang C, Qin L, Zhang H. [2025] Parkinson’s disease and glucose metabolism mimpairment. Translational Neurodegeneration. 2025;14:10. doi: 10.1186/s40035-025-00467-8}

Introducing Herbworks

Speaking of someone who was taught Biochemistry from Lehninger [if you know, you know], and Clinical Medicine from Kumar and Clark, I still suffer from the condescending attitude of some in the medical profession of the ‘what would you know’ kind.

It may be that there are ‘herbalists’ out there who have just done a 6-month course brewing chamomile tea and can list herbs that help people with insomnia, but with no understanding of why people can’t sleep. But I [and many others] are not one of them.

I sometimes get into arguments discussions with people who have been medically trained in the NHS [other medical routes are available] who feel that any challenges of the current orthodox medical model and research results must make me some sort of conspiracy theorist who cannot really understand how modern medicine works. It’s almost as if their training is superior to anything else and even has the capacity to drown out any study, report, or research that does not back up their blind faith in ‘science’ – even when some respected scientists question the validity of some research results.

Interestingly, when I comment positively on some quotes from respected cardiologists, or nephrologists, or GPs, and get told that I don’t know what I’m talking about – I have to wonder how the distinction is made between which medical professionals are thought to be reliable, and which aren’t. It’s a bit like a playground battle of ‘my textbook is better than your textbook’.

I mentioned a couple of my textbooks that I learnt from while training; I decided to learn this way because you cannot practise safe, effective herbal medicine without understanding the body at a molecular, systemic, and clinical level.

This doesn’t make me a doctor.
It doesn’t make me infallible.
But it does mean that when I talk about inflammation, endocrine feedback loops, hepatic clearance, or cardiovascular risk, I’m not just ‘following my intuition’ , or asking ChatGPT, or repeating what an influencer said on TikTok..

I’m drawing from the same biomedical foundations as the people who assume I don’t know what I’m talking about.

So, when I speak about mechanisms, or cite research, or challenge assumptions, and some professionals react as though I’ve wandered into a room I’m not qualified to enter, it annoys me. As though the textbooks I studied were somehow lesser, softer, or less scientific than theirs.

But here’s the truth:
I use the same textbooks.
I learned the same foundational sciences.
I simply chose to expand my therapeutic toolkit rather than restrict it.

Herbal medicine isn’t an alternative to science. It’s an application of science to a broader range of therapeutic agents. It’s physiology plus phytochemistry. Clinical reasoning plus plant pharmacology. Evidence plus tradition, not evidence versus tradition.

And perhaps that’s what unsettles some people: the idea that someone outside the medical establishment can be both scientifically literate and therapeutically expansive. That you can understand the Krebs cycle and still value chamomile. That you can read a lipid panel and still prescribe hawthorn. That you can recognise when a patient needs antibiotics and also know when they don’t.

Because at the end of the day, the body doesn’t care which professional group claims ownership of science. It cares whether the person in front of it understands how it works.

And that’s what I aim to do…

Introducing HerbWorks

My lasting impression was about two trees.

One is already gone from the world. The other is being held upright by engineered supports, surviving only because people refuse to let it fall. Between them sits a quiet truth about how plant life on earth disappears, and how it can endure.

The first was the St Helena olive, Nesiota elliptica.

Extinct.

Not ‘endangered’, not ‘critically threatened’. Gone.

Kew use the guidelines from the International Union For Conservation of Nature [IUCN] before labelling any plant extinct, so they have good reason. The last living specimen died in 2003 despite years of propagation attempts. Kew’s specimen is no longer an actual plant but a symbolic empty pot, an artefact; something preserved, labelled, and displayed because it cannot be encountered alive anywhere on Earth.

It has become a wood sample in Kew’s Economic Botany Collection, pressed and dried samples in the Herbarium [collected in the 19^th Century] and a DNA sample…

Standing in front of the photo of the conservation officer George Benjamin with the last remaining St Helena olive tree before it became officially extinct, I felt the strange uneasiness of looking at a species that has slipped out of existence within my own lifetime.

Extinction is often framed as something ancient or distant, a process belonging to geological time. But the St Helena olive vanished in the era of email, smartphones, and budget airlines. It disappeared quietly, without global headlines, without public mourning, without the world noticing until it was too late.

The St Helena olive is a reminder that what disappears now tends to be what no one is looking at.

Then I saw the Pagoda tree, Styphnolobium japonicum, planted in Kew as part of Princess Augusta’s original arboretum in 1760 [before the USA became a nation state], and hanging by a thread…

This tree, having lived through empires, wars, and the entire arc of industrialisation, now stands only because of human intervention, and only the lower branches survive. Its great limbs are held up by metal structures, braces that counteract gravity and age. It is not thriving; it is being supported by humans who care, who know how important this is. The staff have even left a hand-written note explaining how they are banking up the earth around the trunk trying to encourage new shoots.

There is something deeply moving about this. The Pagoda tree is no longer simply a botanical specimen. It is a relationship. It survives because people have decided it should. It is a collaboration between centuries of growth and decades of maintenance. Without those supports, it would collapse. With them, it continues to witness the passing of time.

Placed side by side—the extinct St Helena olive and the ageing Pagoda tree—these two encounters form a kind of parable. One species vanished despite human effort. One individual persists only because of it. One shows the limits of rescue; the other shows the possibilities.

But the deeper lesson is that longevity is not protection. The Pagoda tree has endured revolutions, climatic shifts, and the rise and fall of entire world systems. Yet it is still vulnerable to the same forces that erased the St Helena olive: environmental stress, pathogens, the slow erosion of resilience. Age does not guarantee survival. History does not guarantee future.

Kew is often described as a sanctuary, but sanctuaries are not static. They are active attempts to hold back entropy. They require labour, attention, and the willingness to intervene. The St Helena olive shows what happens when the world moves faster than our capacity to protect. The Pagoda tree shows what is possible when we choose to act early enough.

Walking away, I realised that botanical gardens are not just collections. They show us what we have already lost, what we are in danger of losing, and what we might still save if we decide it matters. They remind us that extinction is not a concept but a timeline; our timeline, and that the line is shorter than we think.

Go to Growing Medicine's Website

“Just eat better, move more, stress less”…

..while living in a system that makes all three of those things surprisingly difficult.

Trying to be healthy today means reading ingredient labels and carrying an invisible checklist everywhere you go.

What am I eating?

Is it organic?

Is it ultra‑processed?

Is it inflammatory?

Is it going to wreck my sleep?

Will it spike my blood sugar?

Should I be keto, low‑carb, Mediterranean, carnivore, plant‑based, or some hybrid that requires a spreadsheet and a degree in biochemistry?

And feeling health-guilt for not doing enough, not knowing enough, not being consistent enough, even for not caring enough. Feeling guilty when your husband says, ‘am I allowed to eat that?’ in case you’ve become dictatorial. It’s absurd, but it’s a fact that we are living in a culture where health choices have become moralised. You’re not just making simple food choices, you’ve been weighed in the balances and found wanting.

People who say “just follow the science” don’t actually agree on what the science says. One expert says seed oils are fine; another says they’re the nutritional equivalent of lighter fluid. One says red meat is a carcinogen; another says it’s the most nutrient‑dense food available. One says fasting is dangerous; another says it’s the key to metabolic repair.

All of them are absolutely certain they’re right, and have YouTube followings to prove it.

There may be science [somewhere] to show how a plant-based diet/carnivore diet/low-histamine diet/paleo diet is the right way to eat for better health. But in all this food noise, we have to make a decision that is right for us.

I hold that there are certain facts that are unassailably true: butter is better than margarine, ultra-processed food is not really food and should not be consumed on a regular basis if at all, and sugar in all forms can be a threat to health.

Apart from that I am cautious to make sweeping statements about eggs, milk, meat and specific vegetables [ever since I heard a nutritionist say a boy with allergies got better when he gave up broccoli! I thought broccoli was a superfood…]

The truth is that being healthy shouldn’t be this hard. Humans managed it for most of history without apps, macros, trackers, or influencers. But Western society has created a mismatch between what our bodies need and what our environment provides. We’re swimming against the current, and then being blamed for not swimming fast enough. And yet, despite the exhaustion, people keep trying. They keep experimenting. They keep learning. They keep listening to their bodies. They keep searching for what actually works for them rather than what they’re told should work.

Maybe that’s the real health-journey today; not perfection, not purity, not adherence to a protocol, but persistence. The willingness to keep going, keep adjusting, keep paying attention, even when the whole thing feels like a slog.

Because underneath the fatigue is something else: a quiet refusal to give up on yourself and let ‘Big Food’ win….

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This is not a problem of dishonesty. It is a problem of worldview.

Mention that a modest but reasonably consistent body of randomised trials suggests Saffron may confer benefits in low mood or anxiety, and a predictable set of objections materialises: the studies are small; most originate from Iran; there may be cultural bias; replication in Western settings is lacking, etc., etc.. These are legitimate concerns. Scientific production is embedded within social and economic life, and researchers working within a culture that has used a substance medicinally for centuries will bring historical assumptions to their work.

What I have come to notice is the selective application of this sociological awareness. There can be a dismissal of herbal trials tainted with ‘cultural bias’, but many drug trials [designed, funded, and analysed by pharmaceutical companies with revenues exceeding those of many nation-states] do not seem to raise the question of bias at all; at best there is a nodding acquaintance which is then averted. Cultural embeddedness is treated as contaminating results. Commercial embeddedness is treated as commendably neutral, or even as a marker of rigour.

This is not a defensible position. It is a double standard that has been mistaken for a standard.

Western institutional medicine has been granted a form of credibility by default that functions like cultural prestige. Studies from accredited Western universities are assumed rigorous before they are read. Studies from other Eastern traditions can often be assumed to be suspect before they are read. This reveals a set of assumptions in the background so naturalised they cease to register as assumptions at all.

The pharmaceutical literature has generated its own extensive record of systemic distortion, which have been highlighted by serious journals and researchers: selective outcome reporting, endpoint switching, publication bias in which negative trial results are suppressed, and the structural problem that commercially funded trials reliably produce more favourable results for the sponsor’s product than independently funded trials of the same intervention. These are documented phenomena, discussed in peer-reviewed literature and by former editors of major journals. None of this makes pharmaceutical medicine ineffective. But it means the very broad landscape of pharmaceutical research is not meaningfully cleaner than that of herbal research.

The phrase evidence-based medicine entered clinical discourse as a method to evaluate interventions through systematic appraisal rather than expert intuition alone.

A critic who says “saffron trials have methodological weaknesses” is making an argument that can be examined. A critic who says “saffron cannot work because it has not been validated through the route of institutional medicine” is making an assumption dressed as a proven claim.

Evidence is not a set of conclusions certified by powerful institutions. It is a practice of observations, of disciplined inquiry conducted by fallible people within imperfect systems. Recognising this does not undermine confidence in medicine. It is the condition for doing medicine well.

I listened to a lecture once where we were told that pure mathematics is the only discipline where you can prove something with absolute, logical finality; that physics, medicine, psychology, biology cannot prove things in the mathematical sense. Instead, they gather evidence, build models, test hypotheses, estimate probabilities, and falsify claims. The reason that they can’t deliver absolute certainty is because they rely on fallible things like measurements, instruments, interpretation, statistical interpretation and assumptions about the world.

Even the strongest medical evidence [a well‑designed RCT or a meta‑analysis] gives probabilistic confidence, not proof. [Even ignoring the funding question].

This is why scientific papers talk about their effect sizes, their confidence intervals, the p‑values and the likelihood ratios. It’s a sort of degrees of belief scale; but it is not logical inevitability.

In the end though, perhaps the most realistic evidence‑based position of all is acknowledging that no evidence arrives completely untouched by human interests, and learning to think clearly with objectivity is the best we can do.

Image attribution: Margaret Hamilton - restoration.jpg
[[File:Margaret Hamilton - restoration.jpg|Margaret_Hamilton_-_restoration]]

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When we had our last trustees’ meeting, we began discussing ways to open the school’s doors more widely to the local community. Enthusiasm was immediate and unfiltered.
“Could we have tutors come in and show people how to blend their own teas? Could we run sessions on sleep, digestion, children’s health, menopause?”

The answer was yes. And more than that; it felt necessary.

Because what people are asking for isn’t novelty. It’s literacy. It’s the return of knowledge that used to be woven into everyday life.

For most of human history, people knew how to look after themselves with plants because it was practical, accessible, and effective. Somewhere along the way, that everyday literacy slipped out of reach. Health became something you accessed through appointments, waiting rooms, and systems that are now stretched to their limits.

When someone learns:

• how a nervine calms the system

• why a carminative eases digestive tension

• how to blend a tea that genuinely helps them sleep

• how to soothe a child’s cough safely

• how herbs can support the menopausal transition

…they’re not just learning a recipe.

They’re learning how to read their own physiology.

And that is powerful.

One of the strengths of community herbal education is that it doesn’t require prior knowledge. People come because they’re curious, or tired, or overwhelmed, or simply ready to take back a little agency. If we put on local workshops we want them to be practical, hands‑on, and immediately useful:

If we had a session where people learn to blend their own herbal teas it will be a sensory, tactile experience where people smell, touch, taste, and combine herbs. And a lot of people are hungry for skills that make them feel less helpless. They want to understand their bodies. They want to know what they can do before they reach for a prescription or sit on hold for an appointment. They want to feel capable again.

Community herbal workshops would offer practical skills which would remind people that health is not something done to them; it’s something they can participate in.

Our trustees’ enthusiasm wasn’t just about herbs. It was about community. About creating a space where people can learn, ask questions, experiment, and leave with something they can use that very day.

This is the heart of herbal education: not mysticism, not exclusivity, but usefulness.

And if the early conversations are anything to go by, the community is more than ready.

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Thinking about it doesn’t make sense to me.

But people [lots of people] maintain it works.

When I was training over 20 years ago nutrition was one module in our degree course. Something that we acknowledged was a ‘useful’ addition to the complex mixes of medicinal herbs we would construct individually for our ill patients.

Food was supportive, but peripheral. The real work happened in the tinctures, the decoctions, the carefully balanced phytochemical synergies…

Two decades later, I have had a re-think.

What once sat at the margins of clinical thinking has moved to the centre of some of the most compelling conversations in modern medicine. And not fringe conversations either, but the work of clinicians like Dr Chris Palmer¹ and Dr Georgia Ede², both Harvard‑trained psychiatrists, both deeply grounded in evidence, both willing to ask the question that has perhaps been ignored for far too long:

What if diet is not just supportive, but foundational [ biologically, mechanistically, clinically] to both physical and mental health?

This shift didn’t happen because of ideology. It happened because of patients.

Because people with chronic, treatment‑resistant conditions [depression, bipolar disorder, metabolic syndrome, autoimmune disease] began reporting improvements due to a change in diet that were too consistent and too physiologically plausible to ignore.

Chris Palmer’s work reframed mental illness not as a purely psychological phenomenon but as a metabolic one. Talking about the ketogenic diet he says,

It also changes neurotransmitter levels, regulates calcium channels, decreases inflammation, improves the gut microbiome, increases overall metabolic rate, reduces insulin resistance…¹

Palmer’s clinical observations showed that dietary interventions, particularly low‑carbohydrate and ketogenic patterns, could stabilise mood, reduce symptoms, and in some cases achieve remission where medications had failed. Not because food is medicine in a vague holistic Hippocrates sense, but because food is the primary regulator of metabolic signalling.

Georgia Ede took this further, mapping how specific dietary components [seed oils, refined carbohydrates, ultra‑processed foods] drive inflammation, oxidative stress, and neurotransmitter disruption. Her argument is simple but radical: the brain is an energy hungry organ, exquisitely sensitive to metabolic instability, and modern diets destabilise it.

Once you see that, you can’t unsee it.

This is where things get uncomfortable for conventional nutrition, and for me. The more meat-based diets, the ketogenic diets, starting infiltrating my cosy mind-set. These ‘extreme’ diets don’t make sense to me.

Because on paper, a carnivore or ketogenic diet shouldn’t work, at least not for the long term. It is the antithesis of the plant‑rich, fibre‑heavy, whole‑grain‑centred models I was taught. It breaks every rule of balanced eating. They look extreme.

And yet people with rheumatoid arthritis, Crohn’s disease, psoriasis, depression, anxiety, and chronic pain keep reporting improvements. Not subtle improvements, but life‑altering ones. For some individuals, particularly those with autoimmune or inflammatory conditions, the removal of plants appears to quiet the immune system in a way nothing else has.

…the way we eat has a profound impact on brain development, neurotransmitters, stress hormones, inflammation, antioxidant capacity, brain energy production, brain aging, and brain healing.²

So where does this leave me?

Not with dogma. Not with a single dietary prescription for all humans. But with a clear, unavoidable truth:

Diet is not an accessory to health. It is a primary driver of it.

Twenty years ago, I was taught that nutrition was a helpful adjunct to herbal medicine. Today, I would invert that entirely. Herbs can support. Lifestyle can support. But diet is the daily metabolic input that shapes every cell, every hormone, every immune signal and is the foundation. And sometimes, the interventions that ‘don’t make sense on paper’ are the ones that force us to rewrite the paper.

How does this affect me?

I concentrate much more on dietary interventions and use herbs as the accessory. This, at least, does make sense while I finish reading Dr Ede’s book and get to grips with her research. Then I will let you know what I think of the carnivore diet.

Whether I like it or not…

¹Palmer, C.M. (2022) Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health – and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More. Dallas, TX: BenBella Books.

²Ede, G. (2024) Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health. London: Hodder & Stoughton

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Cholesterol is a structural molecule required for life. It forms the backbone of cell membranes, is the precursor to steroid hormones, and is essential for vitamin D and bile acid synthesis. The body manufactures most of its cholesterol internally, tightly regulating levels according to physiological need. This is not the profile of a toxin. It is the profile of a foundational nutrient.

A persistent misconception is that LDL is ‘bad cholesterol’ and HDL is ‘good cholesterol’. In reality, neither LDL nor HDL is cholesterol. They are lipoproteins which are transport particles that just carry cholesterol, triglycerides, fat‑soluble vitamins, and antioxidants around the body to the point of need.

LDL delivers cholesterol to tissues that need repair, hormone synthesis, or membrane support. HDL returns excess cholesterol to the liver. Both are part of a dynamic transport system, not independent actors.

The problem is not LDL itself, but oxidised LDL, a damaged particle created by inflammation, high blood glucose, smoking, and oxidative stress. Oxidised LDL is what the immune system reacts to, initiating arterial inflammation.

GPs usually tell my patients that cholesterol is the cause of atherosclerosis, and that if they do not take statins they could die of a heart attack. But the evidence shows that inflammation and oxidation are the initiating events. LDL becomes problematic only when oxidised, and this oxidation is strongly associated with high blood glucose, high insulin, smoking, and systemic inflammation.

In this context, cholesterol often acts as a repair molecule, arriving at sites of endothelial injury to stabilise damaged tissue. Blaming cholesterol for appearing at the scene of inflammation is like blaming firefighters for being present at a fire, just because they are usually on site.

Over time, recommended cholesterol targets have repeatedly shifted downward and the acceptable ‘safe’ level of cholesterol has been consistently lowered, with guideline committees repeatedly redefining what counts as ‘high’ cholesterol. This lowering of LDL targets creates a moving threshold that brings more of the population into the treatment net.

More people are labelled as now ‘high risk’, even when their cholesterol levels would have been considered normal a decade ago. And statin prescriptions increase, not necessarily because of worsening population health, but because the definition of risk has broadened.

Statins do lower LDL, but LDL reduction is not the same as reducing mortality. For people without established cardiovascular disease, the absolute benefit is small. Meanwhile, side effects [muscle pain, fatigue, cognitive effects, and impacts on glucose metabolism] are widely reported.

An important nuance is that current evidence suggests ApoB-containing lipoproteins are not merely innocent bystanders in atherosclerosis. ApoB [apolipoprotein B] is a structural protein found on LDL and related lipoproteins, and because each particle carries one ApoB molecule, ApoB levels act as a marker of the number of circulating LDL-type particles that may enter and become trapped within damaged arterial walls, particularly in the presence of inflammation and metabolic dysfunction. So, for many individuals, addressing inflammation, diet, metabolic health, smoking, and physical activity offers far greater benefit than just medicating cholesterol transport particles.

I do not recommend that people simply stop taking prescribed medication, but it can be true that a conversation with a GP about deprescribing or alternatives is not always productive. Many clinicians work under time pressure, guideline pressure, and medico‑legal pressure, and these constraints can make nuanced discussions difficult. No one should discontinue medication without understanding the underlying issues, improving their health at a foundational level, or at the very least taking an active interest in the research and the physiology involved. That said, I cannot leave this subject without recommending herbs for heart health. A growing body of research explores how certain botanicals influence inflammation, oxidative stress, and endothelial function. Several herbs contain bioactive compounds that interact with the same inflammatory and oxidative pathways implicated in vascular injury.

Turmeric has been shown to modulate NF‑κB signalling and reduce oxidative stress markers in human studies. Ginger demonstrates similar effects, with evidence of improved endothelial‑dependent vasodilation. Rosemary contains rosmarinic acid and carnosic acid, both potent antioxidants that help limit lipid oxidation.

Herbs such as hawthorn and garlic have been studied for their ability to support endothelial nitric oxide production, improving vascular tone and reducing the inflammatory burden on vessel walls. Meanwhile, demulcent herbs like plantain leaf and marshmallow root offer mucilage compounds that soothe irritated epithelial tissues, including the delicate endothelium lining blood vessels.

Vascular health is not about cholesterol numbers but about reducing lifestyle and dietary factors which increase inflammation, oxidative stress, and metabolic strain which are the true drivers of endothelial injury.

References

Malhotra, A. (2017). Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition. British Journal of Sports Medicine, 51(15), 1111–1112.
Malhotra, A., Redberg, R.F., & Meier, P. (2020). Time to reassess cardiovascular risk from saturated fats. BMJ, 368:m260.
Malhotra, A. (2017). The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance. Pharmaceutical Journal.
Malhotra, A. (2013). Statin wars: have we been misled about the evidence? The Guardian.
Malhotra, A. (2022). Evidence-based medicine has been hijacked: a personal view. Journal of Insulin Resistance, 7(1).

Kendrick, M. (2007). The Great Cholesterol Con. John Blake Publishing.
Kendrick, M. (2014). Doctoring Data. Columbus Publishing.
Kendrick, M. (2021). The Clot Thickens. Columbus Publishing.

Image: Credit to the U.S. Food and Drug Administration is appreciated but not required.

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Fatigue.

Pain.

Gut disruption.

Anxiety.

Insomnia.

They think each one has its own cause, and its own solution. But clinicians who sit with patients long enough to listen know something different: symptoms arrive in constellations. They cluster. They reinforce each other. And they almost always point to a single beginning, an underlying pattern the system can no longer compensate for.

I was reminded of this again this afternoon.

A patient came in who is currently under three different hospital departments. None of them communicate. One reverses decisions made by another. He never sees the same consultant twice. He was given ten minutes of explanation before being wheeled into theatre for a major surgical procedure. Ten minutes to understand a life‑altering intervention. Ten minutes to ask questions he didn’t yet know he needed to ask.

He wasn’t disillusioned because he is anti‑medical. He was disillusioned because the system treated his symptoms as separate and therefore treated him as separate pieces too.

Without going into details, he has five major health conditions, and three minor health problems.

From a pattern‑based perspective, these aren’t eight isolated problems. They reflect a system under strain from one starting point which has cascaded from one organ to another, ricocheting from side effects from the twenty medications he is on. And, yes, of course some of the medications are present to deal with the side effects of the other medications, but they in turn produce more…

Most clinicians are trained to identify the problem in front of them, not the pattern behind it. So, the patient is sliced into organ systems, each one managed by a different department, each department making decisions in isolation. No wonder the left hand reverses what the right hand recommended. No wonder the patient feels like a bystander in their own care.

Herbal medicine is built for this kind of constellation. Not because herbs are gentle or natural, but because they modulate multiple links in the chain in a network simultaneously. They work where the pattern lives; in the interactions, not the isolated parts.

The real question isn’t ‘What herb treats fatigue?’ or ‘What herb treats gut disruption?’
The real question is: What is the system trying to do, and why can’t it do it anymore?

Metabolic mechanisms are highly interdependent, and their interactions often lead to overlapping and clustered symptoms across all systems of the body.

And it’s not because clinicians don’t care. It’s because the structure they work in is built on separation.

Gastroenterology sees the gut.
Neurology sees the headaches.
Rheumatology sees the inflammation.
Endocrinology sees the hormones.
Psychiatry sees the mood.

But the patient doesn’t experience their body in departments. They experience it as one interconnected system trying to adapt. My patient hasn’t been failed by individuals. He was failed by a model that assumes complexity can be divided into parts without losing meaning.

Herbal medicine becomes powerful here because it can modulate multiple systems simultaneously; nervous system regulation, inflammatory tone, sleep architecture, gut–brain signalling, endocrine balance. Not as a scattergun, but as targeted intervention at the level where the pattern originates. And the tincture I can make can address every system in the body by careful choice of herbs, pinpointing the underlying weaknesses of a system under stress.

People don’t fall apart in pieces, and they don’t heal in pieces either. The work is to see the pattern early enough that the system can recover, not collapse. When clinicians learn to read constellations instead of symptoms, patients stop feeling like problems to be managed and start becoming people who can finally get better.

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Dr Dilis Clare writes with a clarity that only comes from experience:

“The early years of doctor training have been shaped by those who control the curriculum to be so intense and conformist such that nothing else seems possible. As they mature, though, doctors often take personal knowledge and experience more into account rather than blindly following a party line… Pressurised doctors, typically lacking sleep, time, and resources, want to avoid possible litigation as much as possible… In my own case, three main questions presented themselves:

1. Why was I routinely prescribing patients medicines with known longer-term risks?

2. Why was I in a position where I had to prescribe drugs to deal with unwanted effects from other drugs?

3. How could I continue to benefit patients with my medical knowledge at the same time as expanding therapeutic options to offer patients?”

Perhaps, all GPs could ask themselves these questions.

Her questions were not fringe. They were not anti‑science. They were not nostalgic. They were the questions that arise when a clinician finally has enough distance from training to see the shape of the system they were trained into.

And they expose a tension at the heart of modern medicine: the insistence that herbs are either dangerous or ineffective. They cannot logically be both. If they are ineffective, they cannot cause harm. If they are dangerous, they must have physiological activity. The contradiction reveals something deeper: the dismissal is cultural, not scientific.

Once in practice, the tidy logic of the curriculum collides with the messy reality of human physiology. Doctors see patients who don’t fit the algorithm. They see side‑effects that require more drugs. They see chronic conditions that don’t resolve. They see people who want to participate in their own care rather than be passive recipients of prescriptions.

Yet, to consider anything different becomes a threat, not because it is unsafe, but because it is unprotected by institutional authority.

This is where the GP’s three questions become unavoidable. Why are long‑term risks acceptable when safer options exist? Why is polypharmacy normalised? Why is the therapeutic toolkit so narrow when the evidence base for herbal medicine is expanding every year?

What could medicine gain if it stopped dismissing herbs?

1. A broader therapeutic toolkit.
Herbs offer modulatory, multi‑pathway actions that align with the complexity of chronic disease. They can reduce symptom burden, support physiological resilience, and in many cases reduce the need for escalating pharmaceutical interventions.

2. A safer starting point.
Many herbs have wide therapeutic windows and favourable long‑term safety profiles. They are not replacements for drugs, but they can often be first‑line options for mild to moderate presentations where pharmaceuticals carry disproportionate risks.

3. A more collaborative model of care.
Herbal medicine invites patients into the process. It requires engagement, observation, and participation. This is not a threat to medicine; it is a remedy for burnout—for both patient and practitioner.

4. A return to clinical reasoning.
Herbal practice is pattern‑based, not protocol‑based. It asks clinicians to think, not just follow. Integrating herbs does not dilute medical expertise; it expands it.

The GP who asked those three questions did not abandon medicine. She expanded it. She recognised that the binary ‘herbs versus drugs’ is false. The real distinction is between a narrow toolkit and a broad one, between a system that fears complexity and one that works with it.

So, what did she do?

She began a Herbal Medicine degree at Middlesex University.

What steered her towards herbal medicine?

One shove was seeing the side effects of a medication given to teenagers for acne [Roaccutane]. She explains;

“Refusing to generate prescriptions I could not justify proved very unpopular with the teenagers concerned, but most parents were grateful. A few did move to another practice as a result. I later came to appreciate that common skin conditions like acne are frequently responsive to a herbal medicine toolkit.”

One realisation that Dr Clare came to was that during her training in herbal medicine,

“the observation that the gradually increasing prescribing of herbs that I was doing was consistently proving effective for my patients, or at least more effective than what I had managed to date.”

If modern medicine stopped reflexively dismissing herbs, it would not lose rigour. It would gain options. It would gain nuance. It would gain a way to treat the patient in front of the clinician, not just the condition in the guideline.

The strapline to the book title states; A revealing history of medicine that restores herbs to patient-led care. This, surely would benefit GPs as well as their patients.

And perhaps most importantly, it would allow doctors to practise with the independence, curiosity, and humanity that drew them to medicine in the first place.

¹ Clare, Dilis, MBBCh, DRCOG, BSc (Herbal Medicine), and Tim Morrissey PhD. Uprooted Medicine. Tribes Press, 2025

² www.schoolofherbalmedicine.co.uk

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A patient I’ve mentioned before, the same woman whose inflammatory arthritis was confidently labelled ‘just osteoarthritis’ and treated with a breezy suggestion to take paracetamol, recently told me another story. It is a case study in how women’s symptoms are still too often reframed as emotional states rather than physiological events.

She had been prescribed SSRIs and Evorel 25 patches. On paper, this is a reasonable combination. In practice, her body had other ideas. Within hours of applying the patch she developed an extremely rapid pulse, profuse sweating, a pounding heart that felt as if it were trying to exit her chest, and difficulty breathing. She genuinely thought she was having a heart attack. On the brink of calling an ambulance, she tore the patch off - and the symptoms subsided.

This wasn’t a one off. It happened again the next time she applied the patch, pushing her to the edge of a panic attack. She needed the SSRI. She also wanted the HRT. So, she did what many women end up doing when the system doesn’t help them: she experimented. She cut the patches in half. That [it seems] her body could tolerate.

Now, the physiology here is interesting, and importantly, not far-fetched; oestradiol is not a passive hormone. It has direct effects on central autonomic regulation, serotonergic signalling, and noradrenergic responsiveness. Transdermal delivery is often described as ‘steady’, but in reality there can be a relatively rapid rise in circulating oestradiol after application, particularly in sensitive individuals or those who absorb efficiently.

Oestradiol also modulates serotonin pathways [the same pathways targeted by SSRIs such as sertraline]. This creates a biologically plausible interaction: not dangerous in the sense of toxicity, but capable of temporarily altering autonomic balance. In practical terms, that can mean a short-lived increase in sympathetic output: tachycardia, sweating, heightened interoceptive awareness, which the brain then interprets as threat.

In other words, the sequence she described [rapid onset after application, resolution on removal, recurrence on re-exposure, and tolerance at a lower dose] is not the pattern of imagination. It is the pattern of a dose-dependent physiological response with a clear threshold effect.

A clinician with even a passing interest in mechanism could have explored this. They could have asked whether she might be particularly sensitive to hormonal shifts, whether the site of application affected absorption, whether her SSRI dose or timing played a role …

None of this requires specialist training, even I could do it. It just requires curiosity, and a willingness to take the patient’s timeline seriously.

Instead, when she recounted the episodes, her GP waved a hand and told her she must be imagining it.

When she explained that it had happened twice, he doubled down: she had ‘got herself into a state last time’, so naturally she was ‘expecting it again’. The implication was clear. Her body was not the problem. Her mind was.

This is the part that made me angry. Not because it is rare, but because it is routine. Women are still told, implicitly or explicitly, that their symptoms are exaggerations, misinterpretations, or emotional artefacts. The diagnostic label becomes anxiety not because the physiology points that way, but because the clinician has reached the limits of their interest.

The irony, of course, is that she was not anxious until the symptoms began.

The symptoms created the fear, not the other way around. Acute autonomic activation feels like danger because, physiologically, it is indistinguishable from it. But once a clinician has decided a woman is anxious, every subsequent symptom is funnelled through that lens. It is a self-reinforcing loop that absolves the clinician of further investigation.

What she needed was not a miracle of endocrinology. She needed a GP who could ask a few sensible questions. She needed someone who recognised that plausible mechanisms exist even when guidelines are silent. She needed a clinician who understood that adverse reactions are not moral failings, and that reproducible symptom patterns deserve attention.

Cutting the patches in half should not have been her responsibility. It should have been a collaborative adjustment, not an act of self-preservation.

This is why we need a more ‘pattern-aware’ approach to women’s health. Not because herbalists or integrative practitioners are inherently better, but because we are trained to listen for patterns rather than dismiss them.

We are taught that when a patient says, ‘This happened twice, and here is the sequence,’ the correct response is not, ‘You imagined it,’ but,

‘Interesting, let’s figure out what is going on…’.

Patients do not need perfection. They need clinicians who are willing to think.

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Herbal medicine is not an alternative to modern healthcare. It is a different way of thinking about the body. Where conventional medicine often targets a single receptor, pathway, or symptom, herbal medicine works with the body’s regulatory systems: metabolic, inflammatory, neuroendocrine, and immunological. Plants are chemically complex, and that complexity is not a flaw. It is the feature that allows them to modulate rather than override physiology.

Most chronic illness is not a single malfunction but a pattern: dysregulated stress responses, chronic low‑grade inflammation, impaired metabolic flexibility, disrupted sleep–wake cycles, or immune systems stuck in overdrive. Herbs excel here because they can influence multiple nodes in a network simultaneously. A single plant may calm the nervous system, reduce inflammatory signalling, support digestion, and improve sleep architecture. That is not what modern medicine sometimes dismisses as ‘vague’. Rather it is systems medicine.

Teaching all this matters!

Students learn to see physiology as dynamic rather than mechanical. They learn to map symptoms back to processes, and processes back to patterns. And then they add in herbal actions, and how to use them. And then they learn to intervene in ways that support the body’s attempts to restore equilibrium rather than suppressing those attempts.

One of the strongest arguments for herbal medicine is its safety profile when practised responsibly. Most medicinal plants have wide therapeutic windows, meaning the difference between an effective dose and a harmful one is large. Their actions tend to be modulatory rather than forceful. They nudge systems rather than hijacking them.

This does not mean herbs are harmless. It means they are predictable when used with clinical reasoning, appropriate dosing, and awareness of interactions. Teaching safety is central to my work: understanding pharmacokinetics, contraindications, quality control, and the difference between traditional use and evidence‑based application. Autonomy requires information, not fear.

When people understand how herbs work, they can make informed decisions about their own care.

Modern healthcare can be disempowering. Patients are usually positioned as passive recipients of treatment rather than active participants in their own healing. Herbal medicine reverses that dynamic. It requires engagement: noticing patterns, tracking responses, adjusting lifestyle, and understanding the rationale behind each intervention.

Herbal medicine requires effort…

Herbal consultations are conversations, not transactions. They create space for people to articulate their experience of illness, which is often missing in time‑pressured clinical settings. Teaching herbal medicine means teaching people to listen; to bodies, to patterns, to context. It means equipping future practitioners with the skills to support autonomy rather than override it.

I practise because herbal medicine works. Not as a miracle cure, not as a romantic throwback, but as a coherent approach to human physiology. I teach because the next generation of practitioners needs more than recipes and folklore. They need mapped reasoning, clinical discernment, and the ability to integrate traditional knowledge with contemporary science.

Herbal medicine is not about rejecting modernity. It is about expanding the therapeutic landscape so that people have real choices which are safe, effective, and grounded in an understanding of how the body heals.

At the School of Herbal Medicine, we spend six years teaching students to practise like this. Six years of learning to see the body as a dynamic system, not a list of symptoms. Six years of cultivating the judgement required to use herbs safely, effectively, and with respect for the person in front of you. I bother to do this work because it still matters. Because people deserve practitioners who can listen, interpret, and act with nuance. Because herbal medicine, when taught and practised well, restores something essential in healthcare: the possibility of being treated as a whole human being.

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I found such a sign in the Oxford Botanical Gardens yesterday, it was in their medicinal plants section, and it said, Plants & Midwifery: Surviving Childbirth which captures a fragment of that lineage. It lists opium poppy for pain, henbane for its sedative properties, mugwort associated with easing labour, and powdered ergot to strengthen uterine contractions. These were not gentle remedies. They were potent interventions, used with skill and care by women who learned through observation, apprenticeship, and generational memory.

This was knowledge built in kitchens, fields, and birthing rooms, not from lecture halls.

For much of European history, women were excluded from universities and largely barred from the institutional structures that formalised medicine. Yet midwives continued to practise because childbirth was not optional. Someone had to know what to do when labour stalled, when pain overwhelmed, when the placenta failed to deliver. Women stepped into that necessity because they always had.

At the same time, the relationship between midwives and formally trained physicians was complex. Early medical writers on childbirth often drew, directly or indirectly, on the practices and experience of midwives, even as they sought to redefine authority.

Knowledge did not flow in a single direction, but as medicine became increasingly institutionalised, the balance of power shifted.

One notable exception to this trend was Nicholas Culpeper, whose 1651 Directory for Midwives and broader body of work challenged the exclusivity of medical knowledge. By translating texts into English, he made them accessible beyond the university-educated elite.

And his approach acknowledged what was already evident in practice: women possessed deep and practical knowledge of birth and the body.

So how did men come to dominate the medical profession so thoroughly?

The shift was less about capability than about structure. As universities expanded and medical training formalised, access to education became a gatekeeping mechanism. Licensing systems, developed in the 18th and 19th centuries, increasingly defined who could practise medicine, and on what terms. These systems were designed within male-dominated institutions, and they reshaped medicine as a profession grounded in credentials, regulation, hierarchy and gender.

The rise of obstetrics as a medical specialty further reframed childbirth. What had long been managed within communities by experienced women was increasingly positioned as a medical event requiring instruments, interventions, and formally recognised male authority. Midwives did not disappear, but their role was narrowed, regulated, and in some cases subordinated.

Narratives about women being less rational or too emotional to practise medicine helped justify these changes. They were not neutral observations, but part of a broader cultural and institutional shift that consolidated authority within a professional class.

And yet, the historical record remains clear…

Women diagnosed, treated, advised, and innovated across generations, long before medicine became a profession in its modern sense. The plants in Oxford Botanical Garden medicinal herb beds are not just quaint relics of how women used herbs. They are evidence of a deeply rooted, practice-based knowledge system; one that operated alongside, and sometimes outside, the institutions that later claimed authority over health and healing.

The story is not simply one of loss or exclusion, but of continuity. Even as structures changed, women continued to care for the sick, attend births, and pass on knowledge.

They always have.

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I have spent years explaining mechanisms to patients, students, and colleagues. I can map the endocrine cascades, the inflammatory pathways, the circadian dependencies. I can articulate, with precision, why certain habits compound and others corrode. None of this knowledge evaporates when I wake up in my own body. It sits there, fully intact, while I negotiate with myself about whether I will do the things I know preserve my health.

This is the part people rarely admit: knowledge does not confer immunity from struggle. If anything, it sharpens the edge. When you understand exactly what is happening inside your cells, your joints, your mucosa, your brain, the gap between intention and action becomes even more stark. You are not simply “failing to be consistent”. You are watching, in real time, the divergence between what you know and what you do.

The cultural narrative suggests that inconsistency is a moral weakness. A lack of discipline. A failure of character. But the truth is far more mechanical. Consistency requires energy, and energy is not an abstract virtue. It is a physiological resource governed by hormones, neurotransmitters, sleep architecture, immune load, and the accumulated debris of stress. When those systems are compromised, consistency becomes an uphill task, even for those who can describe the hill in exquisite detail.

There is also the quiet humiliation of professional knowledge. When you work in health, people assume you are living in a state of perpetual optimisation. They imagine you glide through your routines with clinical precision. They do not see the mornings when your joints feel older than your years, or the nights when sleep fractures into useless fragments, or the days when your own advice tastes like chalk. They do not see the negotiations, the recalibrations, the internal audits of what is realistically possible.

Consistency demands repetition, and repetition demands stability. But bodies are not stable. They shift, fluctuate, resist, and recalibrate. Hormones transition. Immune systems misbehave. Stress accumulates in layers that are not visible from the outside. The body you had last year is not the body you have today, and the strategies that once worked may no longer fit the current terrain. Consistency, then, is not a single behaviour but a continuous process of adaptation.

The hardest part is accepting that knowledge does not grant exemption. You can understand the mechanisms and still struggle to apply them. You can teach others how to build sustainable habits while privately wrestling with your own. You can know the benefits—deeply, empirically, professionally—and still find yourself negotiating with fatigue, pain, or the sheer weight of being human.

But perhaps this is the point. Consistency is not a performance of perfection. It is the ongoing act of returning to yourself, even when the return is imperfect. It is the willingness to continue, not because you are strong, but because you recognise the cost of abandoning the process entirely. It is the quiet, unglamorous work of aligning knowledge with action, one decision at a time.

And some days, that alignment is the most difficult thing you will do.

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Her GP, she explained, had declared her symptoms to be “just osteoarthritis” and to keep taking NSAIDS. This seemed to be the totality of any help offered.

But my patient’s symptom pattern; painful fingers, toes, knees, shoulders, but not hips - is not the pattern of osteoarthritis. And her finger joints were swollen, red and very warm. This really did not look like OA to me.

OA has a biomechanical logic: it favours loadbearing joints, the DIP and PIP joints of the fingers, the base of the thumb, the hips, the knees. It does not typically present with red, warm, swollen joints. It does not usually involve the shoulders early. It does not move across the body in a way that suggests systemic inflammation. And it certainly doesn’t spare the hips while affecting almost everything else.

What she described was something different: an inflammatory picture that deserved proper investigation.

Perhaps because her blood test had not revealed the rheumatoid factor [RF] it made the GP defer to OA.

But surely, he/she would know that there are inflammatory arthropathies that do not have the rheumatoid factor present. When finger joints are red, swollen, painful and RF is negative a patient can have seronegative rheumatoid arthritis, where RF-negative RA behaves clinically like RA; it just lacks the antibody.

And there are other inflammatory conditions to consider as well as seronegative rheumatoid arthritis; Psoriatic arthritis, Gout (if acute and severe), and other seronegative spondyloarthropathies.

The bottom line is that OA doesn’t produce red, swollen, inflamed finger joints, and it usually includes pain in the weight bearing hip joints.

She told me about her encounter with her GP without bitterness, but with a kind of quiet resignation. The frustration wasn’t about the diagnosis itself; it was about the absence of assessment. She knew herself that if her joints were red and swollen, that the pain wasn’t simply stiffness or wear-and-tear. But one doesn’t argue with a GP.

She hadn’t come to me for a diagnosis. She came because she wanted to understand whether diet and herbs could help her reclaim some sense of agency over her body. She wanted to know whether there was anything she could do that didn’t involve simply swallowing NSAIDs and hoping for the best. She wanted to walk without pain…

We talked about inflammation in a way that made sense to her—how systemic patterns differ from mechanical ones, how food can modulate inflammatory pathways, how herbs can support immune regulation, circulation, and pain modulation.

She wasn’t naïve. She didn’t expect herbs to cure her in a month. She didn’t imagine that cutting out certain foods would magically reverse joint damage.

And it won’t be easy. It never is easy to radically change your diet and to take unpleasant-tasting tinctures. But, as one of my former patients said – you will if you are desperate [and he has been pronounced in remission by the hospital].

My patient left with a plan; we are juggling her diet around to suit her particular situation to make it doable. I don’t know exactly yet what is cause her chronic inflammation – but something is. I will tweak her tincture each month if necessary, and we will adjust her diet and keep thinking.

But importantly, she left with confidence that she could turn her health around. And that, in many cases, is where healing begins.

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It is not hunger that people notice first. It is confusion.

What do you eat when there is nothing to put things on?

Bread occupies such a quiet central place in modern eating that we rarely notice it. It carries food, contains food, and turns loose ingredients into something that feels like a proper meal. Sandwiches, toast, wraps, pastries; entire menus are built around it. Remove bread and the structure of everyday eating suddenly becomes visible.

And, fresh bread is delicious…

Bread, in other words, functions as a small piece of domestic technology.

It solves several practical problems at once. It holds food together. It makes meals portable. It provides a quick, predictable source of energy. Most importantly, it allows a meal to assemble itself with almost no thought. And it tastes nice.

When bread disappears, you have to answer questions that bread normally answers for you. What holds this meal together? What makes it portable? What turns a few ingredients into something that feels finished?

The modern food environment reveals how heavily it relies on a single, very convenient format.

The usual response is imitation. Lettuce wraps, gluten-free loaves, low-carb breads; various stand-ins that attempt to recreate the experience. But imitation often misses the point. It preserves the assumption that bread itself is indispensable.

A more useful approach is to replace the function rather than the form.

In practice, bread performs three main roles.

Structural foods which act as the base that holds other ingredients together. Sturdy vegetables can do this perfectly well, but you have to get used to the idea. A roasted pepper filled with mushrooms and herbs could work just as effectively as a slice of toast topped with something.

Bulk foods remove the need for a carrier altogether. Lentils, beans, eggs, roasted roots, and other substantial foods allow a meal to exist comfortably in a bowl or on a plate. When the centre of the meal is filling enough, nothing needs to sit on top of anything else.

Then there are ritual replacements. These satisfy the quiet psychological expectation that a meal should feel complete. This is where I would miss the thought of bread: what else can I dunk into my lentil soup?

There is a health dimension that sometimes motivates the experiment in the first place.

Bread is not inherently harmful for everyone, but wheat and other grains do not suit every physiology. In some situations, the issue is obvious. People with coeliac disease must avoid gluten entirely. Those dealing with insulin resistance or type 2 diabetes often find that large amounts of rapidly absorbed carbohydrate make blood sugar control more difficult.

Less widely discussed is the observation that certain inflammatory conditions sometimes improve when grains are reduced or removed.

Some people notice changes in joint pain, inflammatory bowel symptoms, migraines, or chronic skin problems when wheat disappears from the diet. The exact mechanisms are still debated. In some cases, gluten or other wheat proteins may play a role. In others the effect may come from changes in blood sugar regulation, shifts in the gut microbiome, or simply the removal of highly refined carbohydrates that displace more nutrient-dense foods.

None of this means bread is universally problematic. Many traditional cultures have eaten grain-based diets for centuries without obvious harm.

The issue is less about the existence of bread and more about its modern dominance.

Removing bread for a period of time becomes a simple experiment. It allows people to observe how their own body responds when a very large dietary constant is temporarily removed.

For some people nothing much changes.

For others the difference is surprisingly noticeable; improved satiety, improved sleep, skin, hair, aching joints….

The real challenge tends to be logistical.

Cafés build menus around toast. Airports and service stations revolve around sandwiches and pastries. Workplaces default to portable, bread-based lunches. Navigating these spaces sometimes requires a little planning, not because bread is nutritionally necessary, but because the surrounding infrastructure assumes it will be there.

What begins as dietary restriction often ends as a design exercise.

Living without bread means questioning inherited defaults and asking what familiar foods actually do. When those functions become clear, it becomes obvious that bread was simply one elegant solution to the problem of quick, coherent meals.

It gets complicated. But, it might be worth trying.

Dr Wolfgang Lutz said in ‘My Life Without Bread’ [2014]

I did not like to try anything on my patients

that I had not tried myself…

He began a four-year experiment on living without bread, and he saw his health dramatically improve.

He woke up ‘brighter’, he gained stamina, his arthritic pain eased, his mental health improved, he slept better, he developed less fungal skin infections, his scalp was in better condition, his hair stopped falling out, his digestion improved, and he ‘felt good in himself’…

Dr Lutz also said;

It is, I know, frowned upon to place much weight on personal observations of this sort. Yet, what is more convincing to the doubting scientist…than to observe the effects of something first-hand?’

So, I’m thinking of giving it a serious go.

When I think of lack of real health, I don’t just throw medicinal herbs at the problem. I think about what I consistently eat, and bread has always been a favourite of mine.

I will let you know how I get on…

Introducing HerbWorks

When you understand which pattern you are looking at, it will change how you treat it.

Formally, guidance influenced by the World Health Organization classifies allergic rhinitis by duration (intermittent or persistent) and severity (mild or moderate–severe) gives a framework that is useful for assessing impact.

But in practice, pattern recognition is often more clinically helpful than duration categories.

1. The “Sneezer–Runner” Type

This is the classic picture.

• Repeated sneezing

• Streaming, clear, watery nasal discharge

• Itchy nose and throat

• Red, watering, itchy eyes

This pattern is strongly histamine-driven. Pollen is recognised as a threat. IgE antibodies activate mast cells. Histamine is released. Blood vessels dilate. Glands secrete. Fluid pours out.

The body is over-reacting.

These are the patients who can empty a tissue box in an afternoon. They often respond reasonably well to antihistamines because histamine is central to the symptom picture.

The aim here is not suppression but modulation.

Nettles (Urtica dioica leaf)
A gentle antihistamine and anti-inflammatory. Particularly effective when started a few weeks before peak pollen exposure.

Elderflower (Sambucus nigra flower)
Traditionally used for catarrhal states with streaming discharge. Lightly drying without being harsh.

Eyebright (Euphrasia officinalis)
Especially useful where ocular symptoms dominate.

Liquorice (Glycyrrhiza glabra)
Modulates inflammatory tone and supports mucosal integrity (with appropriate caution in hypertension).

Also think beyond the nose. Histamine load, gut barrier function, sleep, stress and overall inflammatory tone all influence how violently someone reacts. If you only treat the pollen, you miss the terrain.

2. The “Blocker” Type

This is very different.

• Persistent nasal congestion

• Sinus pressure

• Mouth breathing

• Post-nasal drip

• Reduced sense of smell

These individuals are not streaming. They are bunged up.

Histamine is still involved, but here the dominant feature is inflammatory swelling of the nasal mucosa rather than excessive secretion. The turbinates swell. [Turbinates are curled, scroll-like bony structures inside the nasal cavity that create controlled turbulence in the air you breathe. They are central to airflow regulation, humidification and immune defence.

The lining thickens. Drainage slows.

The body is holding inflammation in the tissues.

This pattern often follows a higher baseline inflammatory load; previous sinusitis, pollution exposure, recurrent infections, poor sleep or systemic inflammatory drivers.

We need to reduce swelling and restore movement

Antihistamines alone often underperform here because the issue is not primarily fluid; it is tissue engorgement.

Rather, think in terms of movement, circulation and resolution.

Goldenrod (Solidago virgaurea)
An underused British herb. Anti-inflammatory and gently decongesting to the upper respiratory mucosa.

Elderflower
Here it supports peripheral circulation and drainage rather than drying.

Peppermint (Mentha piperita)
Improves subjective airflow and stimulates local circulation.

Horseradish (Armoracia rusticana)
In suitable constitutions, can stimulate sinus drainage and break stagnation.

Local measures matter too: steam inhalations with thyme can be very helpful.

The clinical aim is to reduce inflammatory swelling and restore ciliary movement, not simply to block symptoms.

3. The Mixed Pattern

This is probably the most common real-world presentation.

Someone begins the season as a sneezer–runner and gradually becomes congested. Or they stream in the morning and feel sinus pressure by afternoon.

Bodies are dynamic. Immune responses shift. Viral exposures complicate things. Weather alters pollen density.

This is where rigid protocols fail.

Herbal approach: layered and adaptive

Begin by calming mast cell reactivity (nettles, liquorice) and then introduce drainage support if congestion develops. Alternatively, formulate more gently across both arms from the outset.

The key mistake here is over-drying. If you suppress discharge too aggressively, you can push someone from streaming into thick, stagnant congestion.

Two people can walk through the same meadow. One is unaffected. The other is incapacitated.

Hay fever is not just about pollen. It is an expression of immune dysregulation. It reflects:

• Barrier function integrity

• Microbiome balance

• Early immune programming

• Total inflammatory load

• Stress physiology

• Sleep quality

The nose is simply the visible end point.

So yes, there are three recognisable presentations: the sneezer–runner, the blocker, and the mixed type. They are not rigid boxes, but they are clinically useful distinctions.

When you identify the pattern, you stop treating “hay fever” as a single entity and start treating the individual response.

And that is where herbal medicine comes into its own — not in fighting pollen, but in helping the body respond with greater intelligence and less chaos.

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