Herbal Strategies for Inflammation: Addressing the Root Cause with David Winston

Hello, and welcome to the Virtual Herbalism Conference. I'm your host, Lindsey Feldpausch, and it is my pleasure to be introducing David Winston. David is an internationally recognized herbalist, ethnobotanist, author, and educator with over 55 years of experience in the field of herbalism.

David is a leader in the industry, known for his integration of traditional herbal knowledge with modern science. He's a founding member, past president, and current board member of the American Herbalist Guild. He is the founder of Herbalist and Alchemist, a highly regarded herbal products company, and he heads up the David Winston Center for Herbal Studies, where he has been teaching clinical herbalism for decades. He's also a contributing educator here at the Herbal Academy.

David's unique approach to herbalism integrates his deep knowledge of plants, clinical experience, and a commitment to evidence-based practices. He's authored some influential texts, including herbal therapeutics, specific for herbs and herbal formulas, and Adaptogen's Herbs for Strength, Stamina, and Stress Relief, which is highly regarded as the book for understanding adaptogenic plants. If you caught David's talk last year at the conference, he spoke about adaptogens, and it was an incredible class. David, we are so grateful to have you back. Thank you for joining us today.

Thank you, Lindsey. It was a pleasure last year, and always, it's going to be a pleasure this year as well. So thank you for inviting me. In today's interview, Herbal Strategies for Inflammation: Addressing the Root Cause, we'll explore what inflammation is, the role it plays in the body, root causes of inflammation, and the science behind how herbs can support an imbalance in inflammation. David's insights are sure to help us understand this issue and the role that herbs can play. David, let's dive in and just start by outlining the role of inflammation in the body for our audience.

All right. With inflammation, there's two, well, more than two, but there's two levels of inflammation. There's the very low level inflammation that occurs daily just from being alive and just through normal metabolism. As our cells metabolize and they go through the Krebs cycle and all that thing, there's a certain level of normal oxidative stress, the production of reactive oxygen species and nitrogen species that create a very low level of inflammation. This is, in a healthy person, is dealt with by our cellular and mitochondrial antioxidants like superoxide dismutase and catalase, and reduced glutathione. So that is normal.

More significant inflammation is a complex response to stimuli. And that stimuli could be pathogens, It can be trauma, it can be toxins, it could be allergens. And basically the inflammation, and we think of inflammation as bad, but inflammation is the body's normal response to this stimuli, again, trauma, pathogen, toxin, etc, in an attempt to heal the body. The body is basically trying to help enhance tissue repair, to get rid of damaged tissue, whether it be necrosis, whatever, and to then stimulate the body so that it can restore balance of function. That's really what inflammation does.

Of course, the classic signs of inflammation, there are four of them: heat, pain, redness, and swelling. Sometimes a fifth is added where some cases with severe inflammation, you can have loss of function. You could have something with your finger, let's say you have an infection, it gets so inflamed and red that you no longer can actually even move your finger. So that would be the whole loss of function. So what happens with inflammation is you have all of these inflammatory mediators in the body. I mean, this gets really complicated. But these inflammatory mediators, their job is basically to do things like clear out necrotic tissue, eliminate the cause. So if it's a bacteria or a virus, you want to get immune cells in there to eliminate the cause and, of course, promote tissue repair. This is done by things like histamine and serotonin and cytokines and eicosanoids, including prostaglandins and leukotrienes. These are part of this really complex... Think of it as a combination of a ballet symphony and orchestra. Everything is basically affecting everything else. You have this really complex It's like this dance going on with the body. And so when we look at inflammation, we're looking at, oh, my God, it's red, it's swollen, it hurts, it's bad. But the body is attempting to do something here. So it seems like it is a problem when we tend to think of inflammation as the problem, except in many cases, and inflammation can be the problem, we'll get to that in a minute. But in many cases, that inflammation is the pathway to resolving the underlying problem.

So was it last week? I had just gotten home from teaching at the American Holistic Veterinary Medical Association, and I went out for my more normal walk and jog. And unlike when I was young and made of rubber, I'm not anymore. And so I'm jogging down the road and they're cutting down a tree. So what am I doing? I'm looking up and watching them cut down the tree. Yeah, this is one of those little reminders, pay attention to what you're doing. And so I stepped off the road into a ditch and down I went. And I got pretty caught up and I mildly sprained both of my wrists. And I'm walking home and I've got blood running down my hand. It was lovely. I mean, the good news was I wasn't hurt very badly, but there was definitely some inflammation in my body is saying to... First off, it's saying, Don't do that. That was really number two, pay attention. Number two, it's saying, All right, we're going to fix this. We've got to get in there. We've got to increase blood flow. We've got to open up the capillary so that we can have enhanced blood flow. We've got to heal that damage. We've got to stop the leakage of blood. So my body is attempting to do all these things. And meanwhile, what's my response? It hurts. It's red, it's inflamed. So that's actually a positive response to that type of trauma.

So anyway, this process is all This is all done again, primarily through these inflammatory modulators and the immune system, which, of course, is intimately tied in with this. This is all done initially through what's called the innate immune system. This is the nonspecific immune system. It is not specific in its effects. It just is responding very, very quickly to whatever the insult is. There are these compounds that are known as PAMPs. I'm trying to remember. It's Pathogen Associated Molecular Patterns. This is like things like cell wall membrane viral RNA and DNA, mannans from like, fungi. All these things stimulate this immune inflammatory response. There are also these compounds called DAMPs, which is Damage Associated Molecular Patterns. And so this is a very nonspecific response. And again, this whole chain of things increases nitric oxide production, vasodilation, increases vascular permeability, which you would think is bad. When you have, you sprain, I think an ankle and it swells up because there's increased vascular permeability so that the body can actually, again, heal that tissue, even though initially we're like, oh my God, it's swollen, throw ice on it, which actually turns out, by the way, not to be the best response in many cases, simply because, of course, it's actually stopping what the body is trying to do to heal. It used to be that icing was always the first response, and it turns out, for anybody who's interested, back in the 17, 1800s, back in Germany, the early what today is known as naturopathic medicine, the whole nature cure movement, they were very much into what was known as hydrotherapy. One of the techniques they practice in hydrotherapy, and naturopathic physicians still practice in hydrotherapy, is this alternating hot and cold hydrotherapy. If you want to heal joint injuries and sprains and strains and bruises, I'll have to tell you, it is astonishing how effective this is. And what you do is, and of course, it depends on what you're trying to soak. If it's your hands, it's easy. If it's your feet, it's easy. If it's your butt, like a sitz bath, it's a little harder because you need two things to set your butt in, too. But if it's hand, you have one tub that has hot water, not scalding, but hot water, usually with herbs mixed in, meaning vulneraries or anti-inflammatories or herbs that move blood, and then it's one that's cold. I don't mean it's just like from an Arctic stream that just melted off a glacier, but it's cold to tolerance. What you do is you would put your hand in there for two minutes hot, then 30 seconds cold, then two minutes hot, then 30 seconds cold, then two minutes. You do five or six repetitions. I have to tell you that for trauma injuries and things like that, it is incredibly effective and it speeds healing dramatically. Anyway, just a really cool technique. I got off track back there. But anyway.

I love hearing about that. Obviously, the RICE, the ice application method, has come into question over the past few years, and I had not heard about that alternating methodology, so that's really exciting. David, we addressed the acute role that inflammation plays in the body and the important place that it holds. Let's discuss a little bit more when inflammation becomes problematic and really is then turning into the root cause of many chronic degenerative illnesses.

Well, after a couple of days where you have inflammation, if it is ongoing, again, initially, the innate immune system is triggered. But after three days, four days, five days, via the dendritic cells and lymphocytes, it triggers what's called the adaptive immune system. This is where you have memory. The adaptive immune system can also create what is known as adaptive inflammation. Adaptive inflammation is, for instance, one of the underlying patterns that you see in things like autoimmune disease and cancer. So this is no longer an acute episode. Now, if it's short term adaptive immunity, where again, you have, maybe you injure yourself badly enough, the adaptive immune system is involved. But after a period of time, as the healing occurs, that settles down. And that is that. But what happens is for many of us, we are under chronic inflammation. And I don't mean chronic, really low-grade information, but chronic, moderate to high levels of inflammation. Now, this can be caused by numerous things. For instance, let's look back at what we'll call the Foundations of Health. I think I actually talked about this when we did the Adaptogen's class last year, when I was talking about adaptogens aren't a replacement for the Foundations of Health. The foundations of health would be, in my opinion, number one, a healthy diet. And of course, a healthy diet is, I would call it, I think we could say it has an anti-inflammatory component to it, as opposed to the typical Western diet, which is highly pro-inflammatory. So if you are getting the average American consumes 20 parts of omega-6 fatty acids to one part omega-3s. In indigenous diets, higher to European contact or wherever in the world this was, the average is about three or four parts of omega-6s to one part omega-3s. So high levels of omega-6s are pro-inflammatory. High levels of sugar, which increase cortisol and increase insulin, are pro-inflammatory. Many of the artificial flavors and colors and things that are added to food are pro-inflammatory. Number one, we have aspects of diet which are pro-inflammatory. If something is stale, if something is rancid, it is pro-inflammatory. If something is fried, it is probably pro-inflammatory. If something is smoked or grilled and you have nitrosamines, it is pro-inflammatory. There are all these things that are pro-inflammatory, but then if we're eating a healthy diet and we are getting lots of flavonoids and oligomeric procyanidins and isoflavones and all these and carotenoids and all these other compounds that are, I'm going to say this a lot because I'll explain it in a little bit, that are anti-inflammatory. It helps to basically inhibit the negative effects of all these dietary pro-inflammatory compounds. All right, that's just a simple overview. That's diet.

Then we get to things like sleep. A lot of Americans have this thought that Warren Zevon, in one of his songs, said he'd sleep when he's dead. Well, probably between living a unsustainable lifestyle, and then, of course, there was probably the alcohol and drug use. Regardless, he certainly died too young. Sleep is essential. It's foundational. When we sleep, when we go into delta sleep, the glymphatic system is engaged. This wasn't discovered until in the last 15 They always wonder, there's no lymphatic system for the brain. How does the brain clean itself? Well, it turns out when you're in delta sleep, your brain shrinks, and the brain is washed by cerebral spinal fluid and clearing out things like beta amyloids and tau proteins, helping to prevent the inflammatory damage caused and associated with these compounds with Alzheimer's and probably also helping to prevent things like Lewy body dementia. Sleep also, or a lack thereof, increases cortisol levels. We have both. We have a high sugar diet increases cortisol, obesity increases cortisol, lack of sleep increases cortisol, chronic stress increases cortisol. Of course, cortisol is not only pro-inflammatory. Mean, we need a certain level of cortisol. It's like we demonize things. So, oh, cholesterol is bad. Well, actually, that's where you manufacture all your hormones from. So no, cholesterol is not bad, but there is cholesterol that is inflammatory. That in beyond a normal level is certainly problematic. So healthy, good quality sleep, exercise, healthy lifestyle choices. What does that mean? Well, I don't no matter how many inflammatories you take, if you smoke two packs cigarettes a day, it is very unlikely to be able to undo all the damage you are doing to yourself. Or if you live in a place where there is highly polluted air, these fires that they've been having during the summer in Canada, we had a couple of days with very poor air quality here from those fires. But two summers ago, we had a week where you went outside, it was orange, and it looked like the fires were next door. These fires, the closest fires, were a thousand miles away, and some of them were 2000 miles, 3000 miles away. You could see smoke drifting in the air. It was orange. The sun was red. I mean, it looked like apocalyptic vision. At that point, the air quality where I lived, and I'm in Eastern Pennsylvania, I'm in a very rural spot, our air quality at that moment was some of the worst in the world. If that's what you're breathing in, if you work in the Holland Tunnel, the tunnel that connects New York and New Jersey, breathing in all that car exhaust, if you live in a place that has regular weather inversions where the air gets stagnant. Denver, for instance, is really well known for these sorts of things. But again, these fires from Canada, the whole upper Midwest, the air quality has declined rapidly over the last two years because especially during the summer, they have so much of that. If you live downwind from an incinerator, there are all these reasons. Actually, if you live on a bus route, studies have shown if you live on a bus route, your life expectancy is going to be shorter and your risk, if you're pregnant, of having a child with Alzheimer's goes up. Because of all these particulates from the exhaust. I mean you've been in a car behind a bus, most of them, except if they're electric now, they stink. Or if you're behind a diesel truck, it's just nasty. Well, that stuff does us no good. Then, of course, without going into too much detail, then, of course, we talked about stress as the other factor. Stress, just by increasing cortisol and norepinephrine levels, increases the level of oxidation in the body, thus the level of inflammation. So number one, we'd have to look at things from a foundational level. So before we even get to herbs, eating a diet that helps inhibit a little bit inflammation, doing lifestyle choices that help prevent damage is foundational to helping prevent inflammation in general.

The other thing that I alluded to before that I'll just briefly mention here, when we talk about terminology, so let's talk about anti-inflammatory. Anti-inflammatory herbs, the term anti-inflammatory herbs doesn't mean what anti-inflammatory means when you're talking about pharmaceuticals. So with pharmaceuticals, anti-inflammatories, and there's all sorts of different types, you have your NSAIDs and you have your other types of anti-inflammatories. What they tend to do is, in a sense, shut down the entire process of inflammation. The problem is, as we already mentioned before, there are benefits to low-level inflammation. And when you shut down everything, you shut down not just COX-1, but COX-2 and 5-Lox. When you shut down the whole process, then there are problems that occur, which is why there have been numerous anti-inflammatory medications, like Celebrex, that were introduced in the market. Within five years, were taken out of the marketplace because of the secondary damage they caused. And that was in part by shutting down the entire inflammatory cascade. You don't want to entirely shut it down. There's no herb that I'm aware of that fully shuts it down. They are, think of them as helping to inhibit the process, but they don't entirely shut down the process. So there's herbs that inhibit COX-1, but don't inhibit COX-2, like turmeric, for instance. So number one, when we talk about anti-inflammatory, again, within the herbal community, and this isn't a slight, it's just there's this tendency to adopt scientific terms that don't always actually mean the same thing. Another one would be the term "antioxidant." You have inflammation, you want to use antioxidants, they quench free radicals, these are the reactive oxygen and nitrogen species, and once upon a time, Abbie Hoffmann. No, I'm just kidding. That's a '60s joke. Okay, he was a radical. The reality is that for the most part, our antioxidant herbs do not actually primarily quench free radicals. Yes, they do it to a minor degree. But if they did it to the degree that we think, it would actually probably inhibit mitochondrial production of things like catalase and superoxide dismutase and glutathione, and things like that, which would actually be problematic. So it turns out that what our antioxidant herbs are doing, primarily, is they are actually upregulating genes. The genes are upregulating are called the antioxidant responsive elements. When these are upregulated, they have a systemic anti-inflammatory effect. Again, but they are not shutting down all inflammation. Think of them as cooling down the fire. You're bringing it back to a level which is a healthy level of inflammation, but you're not throwing a gallon of water in a small campfire and totally putting it out. There's still some colds in there which are necessary, but again, you want to keep it at that extremely low level.

I absolutely love that you brought up the foundations. It's so important to me when I look at what herbalism is today, especially in clinical practice, we are not just utilizing herbs. We are looking at all of these other factors, lifestyle, diet, sleep, stress, and we have to be, right? But I also think that you pointed out something really important as well. As you're mentioning the energetic side where they're cooling the fire. Herbs can be applied to cool the fire that have been traditionally used as such for millennia. On the other side, you're in this deep physiology of how plants work in the body, and I just find it completely fascinating, David. So thank you. I'd love to hear a little bit more about the ways that herbs work to modulate inflammation, like what herbs are we working with here. Obviously, there is a plethora of ways in which they can be applied for various issues. But when we look at that term anti-inflammatory, again, we're seeing this blanket statement. It's not really communicating a lot. I'd love to hear you touch on that as well.

Well, you mentioned energetics. There's two ways of looking at this. One way, from science, the problem is there's not a lot of good terms that tease out the subtleties and the differences as to how these things work. There's the term anti-inflammatory. There just isn't a whole lot of other language. On the other hand, from an energetics perspective, from a TCM perspective, which is the system I have been, one of the systems I've been trained in, so I can talk much more about that than I could something like Ayurveda. The idea is that there's- there is herbal energetics and there is human energetics. So human energetics or differential diagnosis and then herbal energetics. And understanding these two things, I always ask my students, how many of you want to be good herbalist? Everybody raises their hand. That's the wrong answer. And I mean, yes, we all want to be good herbalists, but I try to encourage people not just to be content to be good, but do your best to be great. And by that, I don't mean you think you're great. This isn't an ego deal. This is about constantly striving to do your best, constantly striving to grow, to learn. When you make a mistake, understand it, learn from it, grow. The idea is that we're going to keep growing. We talked earlier before we started recording. The idea is if you are in clinical practice and you get to a point or you think you know everything you need to know and you're done learning and you're just going to mechanically go through it, I wouldn't send anybody to you. That is not a good clinician. A good clinician is, you have to be open-minded, constantly open to learning new things. Every patient you see is a unique being, unless you've seen that person before, who you have never seen before. Yes, they may have rheumatoid arthritis, and you may have treated hundreds of cases of rheumatoid arthritis, but you've never treated this person who may have rheumatoid arthritis and who knows what else. The understanding of herbal energetics and human energetics is what allows us to match to the specific herbs we need to the specific patient that we are treating. So energetics, human and herbal, allows us to stop treating diseases and start treating people. For all of you listening, I'll tell you right off front, I'm not saying that treating diseases never works. Yeah, there are herbs that are good for hypertension. And yes, there are herbs that are good if you're recovering from a myocardial infarction. And yes, there are herbs for benign prostatic hyperplasia. All true. But as an example, let's talk just for a moment about depression, which I know is, well, not entirely off the beat because there's actually a lot of research showing a lot of depression has to do with neuroinflammation, which has a lot to do with gut inflammation. So I'm sure talk about that. But with depression, if you look at the statistics from the published studies on pharmaceutical antidepressants, they work about 40 percent of the time. Which is okay. It's better than placebo, which is about a third of the time, but it's not terribly impressive. Then actually, some years ago, somebody got a hold of a bunch of unpublished studies, and when you factored those in, the efficacy probably wasn't, overall, a whole lot better than placebo. But the problem is when you treat depression as a single entity, and I'll tell you this is for almost anything with the exception of a wart, when you treat depression as a single entity, even if you're using herbs, if you're using St. John's wort instead of Zoloft, your effects are still going to be 40 percent of the time. What allows you to make that leap where your efficacy is now 65 or 70 percent of the time, and yes, would I like it to be 75, 80, 90 percent? Sure I would, but nothing's going to work all the time. But the thing that makes that leap is treating the person. You always want to be able to understand how to treat the specific person. As you mentioned earlier, and that, of course, includes any herbalist who is not working with diet, lifestyle, exercise, stress reduction techniques, who isn't dealing with all those things is missing the boat. Herbs are not foundational. Herbs are my favorite therapeutic tool, but it is not foundational unless you're talking about eating certain herbs as part of your healthy diet. You need to deal with that. Then, of course, we need to address the specifics of it. From a Chinese perspective, inflammation, you can have, it could be, most inflammation is heat. You You can have hot damp or hot dry. You could also have wind show up. But inflammation, that would be whether if there was spasmodic pain or pain that comes and goes, that would be a wind pattern. On the other hand, on the other side of it, you have things like cold-damp, cold-dry. But that's not usually inflammation. That's stagnation, which can lead to a low-grade inflammation, but it's not what we normally think of. We talked about inflammation being heat, swelling, redness, and pain. That's always generally a heat pattern. But the herbs that we might use to treat a hot, damp pattern are different than the ones we would use to treat a hot, dry pattern. That gives us at least a little bit of an ability to look at where the inflammation is. That's number one, where is the inflammation occurring? Is it systemic? Is it localized? Then is it a hot-damp? For dampness, it's going to be hot, it's going to be red, it's going to be swollen. If there is pain, it's likely to be very sharp type of pain. On the other hand, if we have a hot, dry pattern, so let's talk about a respiratory infection. And so, again, there's heat, you might have a fever, it hurts maybe when you cough, but But for instance, if you have a hot damp pattern, when you cough, there's lots of mucus, and that mucus is going to be yellow, green, or bloody. If it's hot and dry, the mucus would still be same colors, but there's virtually none of it, or there is no mucus at all. With a dry pattern, again, the tissue is going to be desiccated, dry, not a lot of fluid. There won't tend to be so much swelling either. There may be pain from movement, like a lack of synovial fluid in the joint. Or I've had a couple of patients over the years that had interstitial cystitis, which is usually a hot, dry pattern. That interstitial cystitis so bad, it hurt to walk. It felt like sandpaper when they walked. The herbs we're going to use to treat those patterns are going to be different because we have to account for the energetic difference. Now, that doesn't mean, and just so people understand, when you're dealing with energetics, my teacher, Dr. Ang, used to say, "Yin becomes yang, and yang becomes yin." When he first said this, and his English was not great, my Chinese was nonexistent. So I will admit sometimes there were some communication problems. But the first time he said this, I just shook my head and said, "Oh, sure." I had no idea what he was talking about. And so what he means is, if you have a... yin becomes yang and yang becomes yin. Let's say you have a pattern of extreme dryness and heat, and you throw all these herbs at it that are cold and wet. What you wind up doing is flipping it to the opposite extreme rather than bringing it back to the center or homeostasis. And so when you create a formula, it's not just about opposites. It's about things moving it in the direction you want to go, but not dealing with extremes. And that's what helps to create that more homeostatic or allostatic process of regaining normal self regulatory capacity. I think that's answered your question.

I absolutely love hearing more about your energetic approach because I do think that this is the crux of how we approach applying herbs to inflammation. I think we can look at turmeric as the anti-inflammatory. It is touted as for everyone across the board, sold in every grocery store, supermarket, Sam's Club, what have you. This is a warming, drying herb. When we look at people who are in warm, drying, energetic states, this probably isn't the herb for them. Maybe they need something more like Solomon's seal, which will increase synovial fluid and the arthritic dryness. I think it's so important to discuss this in application of herbs. David, how do you approach acute inflammatory responses versus chronic maladaptive inflammation with herbs, clinically.

When we're dealing with acute inflammation, and of course, there are myriad causes for an acute inflammation, as opposed to that chronic maladaptive inflammation, which they call "inflammaging," which maybe we'll talk about more in a little bit. Number one, taking general anti-inflammatories like turmeric can work in some cases, but I think the more specific you get to the person and their specific pattern, the more effective you're going to be. A little bit about and curcumin and the fact that there is just a wide amount of misinformation out there. Number one, if I have somebody... Let's go back to, let me think. A sprained ankle. Here we're talking about some acute inflammation, or it could be an acute gastritis. Whatever we're dealing with, the first thing we want to look at is what tissue are we dealing with? If I have somebody For somebody with acute gastritis, the things that I'm going to use would be very different than somebody with an acute ankle sprain. That's number one. Where are we dealing with it? How are we going to apply the medicine? If it is something musculoskeletal, especially like a sprained ankle, a lot of my approach is going to be topical. So we go back to that alternating hot-cold hydrotherapy, which works great. I would also use, let's say there's bruising. In Chinese medicine, they're what are these topical applications called, hit plasters, and they're used in martial arts. Basically, think of it, it's this tarry substance full of essential oils and compounds. You basically cut it to fit the area. You peel the plastic off and you slap it on. It just sticks right on there. We did an experiment one time with somebody who fell down the stairs on their butt and had this huge hematoma on their rear. It was a student, and they allowed us to do this. We basically put a hit plaster on half of the hematoma and not the other half. After three or four days, the half of the hematoma that had the hit plaster looked like it was a three-week-old bruise. It was yellow, modeled and everything. The other half, which we didn't apply anything to, just looked like a fresh, black, purplish bruise. It was astonishing how quickly that helped. We also would use internally herbs that move blood. What does that mean? Well, interesting enough, and it seems like an oxymoron, but it isn't. In Chinese medicine, herbs that move blood, increased circulation, stop bleeding. There's all these herbs that can be used either externally as a Dit Da Jiao, a martial arts liniment. Dit Da Jiao means fall hit wine. Or we can take many of the same herbs internally to enhance circulation and to move blood and to help carry away the damaged tissue. And so these are from a Chinese perspective, these are herbs like dan shen (Salvia miltiorrhiza) and herbs like hong hua (safflower) herbs like dang gui, which Americans call it dong quai, but it's dang gui. Herbs like myrrh, frankincense. But from a Western perspective, it's also herbs like witch hazel, which works amazingly well. Or yarrow. So these are all herbs that we can use both topically and orally to help enhance healing and reduce inflammation.

Now, if we were talking about something like gastritis, on the other hand, which is generally a hot, damp condition, then we are going to be talking about taking things that are mostly going to affect the gastric mucosa: parsley, plantain leaf, chickweed, aloe, all these things that are cooling and moistening and help heal the tissue. But you might, to balance it out, you might want to throw in, let's say there's some bleeding. I throw in a little bit of yarrow. If there is pain, depending on the nature of the pain, and pain is a whole other topic worth exploring at some point, not today. But we have different herbs, and they affect different types of pain. So if the pain was sharp and stabbing, we would use St. John's wort, or depending on where it is, maybe prickly ash or the Chinese herb, Ligusticum chuanxiong. If the pain is dull and throbbing, then we might consider something like Aesculus, horse chestnut, in very small doses. If the pain is tearing, then we might look at herbs like mistletoe. And so there's all these indications that differentiate specificity for the specific type of pain. When it comes to gastric pain, in addition to things like chamomile, which can be useful but is mild, we have a Chinese herb called xiang fu or Cyperus, not cypress, Cyperus. Most of our listeners have probably seen this plant growing. It's also called chufa or nut grass, or earth almond. And they even sell a cultivated variety now as a snack. I think they call them Tiger almonds or something like that. They're nothing to write home about taste-wise. But anyway, the wild ones, which are used in Chinese medicine, they look like little black. They're little black. They're not roots, they're little tiny tubers, is phenomenal for gastric pain. It is my number one herb for pain that occurs from here to the groin. Anywhere in that area, this is an herb that you want to know. Other herbs for that gastric pain? Wild yam (Dioscorea), one of the places where it actually works really well, as opposed to all the people using it for menopause It's a causal symptomology for which it has no benefit whatsoever, sadly. We have all these herbs and we're going to be treating it. Again, we're going to be using things to deal with the pain. We're going to be using things that help reduce the inflammation. And again, the parsley, the chickweed, the cabbage leaf juice, the aloe, all of those help reduce inflammation in the gastric mucosa or actually in the intestinal mucosa as well. And so what we're doing is we're not just using anti-inflammatories. We're using anti-inflammatories that have benefit specifically to the tissue and the area where we We're trying to treat that. And again, some of them may be used topically, other ones orally, and we are going to mix them in with other herbs that enhance the healing process.

So for instance, if we have somebody with what is colloquially called leaky gut syndrome. What we're really talking about is a loss of intestinal epithelial barrier function. Yes, we see this with inflammatory conditions. People with IBD, inflammatory bowel disease, ulcerative colitis, Crohn's, people with IBS, irritable bowel disease, people with chronic constipation or a slow transit time, people with chronic diarrhea, people with abnormal gut flora, maybe because they've taken antibiotics or any number of, for instance, there is this low-grade inflammation. Studies have clearly shown that a loss of intestinal epithelial barrier function is linked to a whole range of chronic degenerative diseases, including autoimmune diseases, Alzheimer's, depression, anxiety, cardiovascular disease, increased risk of cancer, type 2 diabetes, and the list just goes on. If we're trying to heal the intestinal epithelial barrier, here I might be using some turmeric, and maybe I combine that turmeric with a little bit of cat's claw, which is one of the very few areas where I think cat's claw really works well. Then to tie it together, something like licorice, which is incredibly soothing and healing to the gut mucosa or plantain leaf or something of that nature. There are many options. It's not like there's any case where there's only one herb that's going to work. But in some cases, there are certain specific herbs that really may be indicated for that area or that tissue.

I love that you brought gut healing into the mix because really this is also at the core of our practice of herbalism. I think that really the fact that gut healing is at the root of all bodily healing is so important to mention. Within that increased gut permeability, we're seeing the interaction with the immune system through the leakage into the bloodstream and the systemic impacts there. How are you working with that gut immune access in regard to supporting inflammation?

Well, again, what we are doing, because remember, the intestinal epithelial barrier is one cell thick, and there are things that can heal it remarkably quickly if you do the right thing. So obviously, just to recap, If you're eating things that are really pro-inflammatory, that's probably going to inhibit this. If you're smoking, it's going to inhibit this. If you drink a lot of alcohol, it's going to inhibit this. So obviously, first off, get rid of the things that... Or if you have overt food allergies or in some cases, food sensitivities. So if you have celiac and you continue to eat gluten, you're going to have an issue. On the other hand, you might have non-celiac gluten sensitivity, which is real but much less common than people believe. They did a study some years ago where they tested people who believe they had gluten sensitivity, and it was true, 14 percent of them actually did. But that means 86 percent did not. But if you have a sensitivity to a food, a substance that you react badly to, and whether it's a type 1 or type 2 sensitivity, getting that out of your diet is probably a good idea. On the other hand, it can be incredibly difficult in some cases. The good news is there's lots of gluten-free stuff out there now, although the majority of it is simply gluten-free junk food. But there's lots of gluten-free stuff out there as opposed to 20 years ago where it was really hard to find those things. But I still find I have a really strong sensitivity to casein in milk. I figured this out when I was about 18 or 19. And so I avoid, I mean, I can handle a little bit of ghee or butter because they have virtually no casein in them. But any other product with casein, even if I don't know I've ingested it, 15 minutes after I've ingested it, I know I've ingested it. There's a very, very significant and quick response. And so trying to make sure that you to figure out what those things might be, eliminate those from the diet is really a good idea. And then you also If you're going to look at, are they taking any medications? Are they taking NSAIDs? Well, you want to irritate your gut. Take NSAIDs, take aspirin. All these people taking the low-dose aspirin every day. A study came out in the last year showing that that had very little benefit for most people with significant increased risk of gastric bleeding. And so that is tremendously pro-inflammatory. So number one, look at things that are going to interfere with the ability to heal the tissue. And then some of the same herbs we talked about before, aloe gel. Now, aloe gel, there was a study done, this is 25, 30 years ago, and it was a really interesting study. Now, it was also a really cruel study. I'm not a big fan of cruel animal studies. I'm a big fan of veterinary studies, meaning these are animals who are already sick and they're going to try to help heal them. Making animals, hurting animals and killing them or whatever for science, I don't want to get into that argument. I understand the rationale behind it, but there's some stuff that's just overtly cruel. Anyway, this is one of those cruel studies. They took a bunch of mice or rats and they burned them, which I think is horrible because they did nothing to deserve that. And one group, they just let heal on their own. One group, they put bottled aloe gel on them. And the third group, they used fresh aloe gel from the leaf. And the group that got the fresh aloe gel from the leaf healed in four days. The group that did nothing healed in six days. The group that got the bottled aloe gel healed in nine days. When I talk about aloe, I'm talking about buying the big aloe leaf in the supermarket, and you cut the end off, and you scoop out the clear gel inside. Don't scrape because you don't want to get the aloin, which is in the green. If you're pulling out anything green-colored, you're doing it wrong. Putting that in a little... It's just a tiny bit of water. There's all these aloe drinks out there. They don't have enough aloe in them, probably to be very effective. But you could take that aloe gel, you could get some fresh plantain leaf, juice it. You could also juice some cabbage leaves and nice green cabbage leaves. You got the juice, cabbage leaf. You can juice plantain leaf, although you need a very good juicer, like a Norwalk juicer to get juice out of that, you could juice some parsley. Then you add in a little of that aloe gel, and you just drink that several times a day. You can see healing not only in the stomach and small intestine, but in the intestinal epithelial barrier from something like that within a couple of weeks. I mean, it doesn't take very long. Again, licorice is phenomenal here. Cat's claw actually works really well for helping to heal the intestinal epithelial barrier. Turmeric can be used to heal the intestinal epithelial barrier, but you want to use turmeric not curcumin. And why do I say that? I said, I want to talk about this, so let's get to it. All right, so most of the research out there is on curcumin, not turmeric. All right, so I am not saying curcumin doesn't work because there's lots of studies showing that it most certainly does. But let's understand something. Number one, most people think that curcumin and turmeric, including most researchers, that they're synonymous. They are not. The curcuminoids, there are three of them, were extracted from turmeric, and they were promoted as the active ingredients in turmeric. This was done about 30 years ago, and it was done by a company. One of the reasons, possibly they were looking for a stronger product, but also maybe just possibly because they could patent their curcuminoids and you cannot patent turmeric. All right, so there might have been a financial reason for this. They have been promoted as the active constituents. The problem with curcumin is it is poorly absorbed and quickly excreted. So that means it's hard to get it in your body, and then once you do, your body gets rid of it very quickly. So in order for curcumin to be absorbed, you have to complex it with bioperine, which is a black pepper extract or phosphatidylcholine, or micelle, something, so that it gets into the body and stays longer to have more of a therapeutic effect, which is fine. But at this point, you are not talking about an herb anymore. You're talking about a phytopharmaceutical. I'm not against phytopharmaceuticals like ginkgo leaf. Pretty much the best way to use ginkgo leaf is as a really standardized extract. But it's a little bit different than an herb. Also, studies have shown high doses of curcumin is a gastric irritant, whereas turmeric is gastroprotective. So you're dealing with something that is a little bit different. I would also point out that a study that came out about seven or eight years ago with a curcumin-free product, they took all the curcuminoids out and just used turmeric with everything else, had just as much anti-inflammatory and anti-tumour activity as did curcumin. In fact, in the intervening 30 years, they've discovered at least 15 to 20, maybe 30, constituents in turmeric that are active, that are not in curcumin. Curcumin and in whole turmeric, some of those constituents enhance the absorption of the curcuminoids without adding anything. I would also point out the traditional Ayurvedic combination is not turmeric and black pepper, it is turmeric and ginger. Anyway, turmeric, I am a huge fan of turmeric. I have tried because I get free samples all the time from companies who want me to promote their products and tell my students and when I teach about them. I have tried dozens of curcumin products with patients, and I see some results. But I will also be totally honest and say I get way better results clinically with a well-made whole turmeric tincture made from the fresh root than I have ever gotten with any curcumin product that I've ever tried. So turmeric is great, but you mentioned it's drying. Well, with a leaky gut, the little drying, and it's not super drying. Turmeric is slightly drying. So there's degrees, as opposed to something like rhodiola, which is so drying that you do not want to give rhodiola to somebody with a yin deficiency. Anybody with dry eyes, dry mouth, dry skin, dry cough, dry stools, vaginal dryness, lack of synovial, don't give them rhodiola because it'll just make it worse. Turmeric is not that drying, slightly drying. It's easily counteracted by mixing it in with something that is somewhat moistening and it doesn't have enough tannins to bind the mucopolysaccharide. So we're talking about gut and healing the intestinal mucosal barrier. Two herbs we haven't mentioned at all so far, slippery elm and marshmallow, both of which are very mucilaginous. lots of gags, glycominoglucans, which are healing to tissue. You don't want to mix really astringent herbs with them because the tannins bind with the mucopolysaccharides, creating what I call a mucusoidal phlegm ball, and it creates this really bizarre stringy mass that you cannot undo. It ruins. You never want to use really mucilaginous herbs with really astringent herbs, either in a tea or a tincture, because that's what will happen. And it totally ruins whatever you've just done and you've lost most of your activity. I would also point out that slippery elm, by the way, does not make a good tincture. So if you see people selling slippery elm tincture, it suggests a certain level of, I don't know, lack of knowledge, maybe. Marshmallow makes an okay tincture, although both of them are way better as just cold infusions and let them get slimy and gross. It's a little bit like drinking a cup of mucus, but it's healing to the tissue. And yes, to that, you could add had some fresh chickweed juice or fresh plantain juice or fresh cabbage juice, all of which are incredibly healing to the mucosal membranes. And so that works for gastro, It works for gastritis. It works for gastric ulcers. It works for ileitis. It works for inflammatory bowel disease to a degree. I mean, it's helpful, but you need more for IBD. It works for loss of

intestinal epithelial barrier function. And so the beauty is, we have so many things in our materia medica that can be helpful in these situations, which is one of the reasons that I encourage with my students in my two-year program, my students learn about 300 plants in exquisite detail. And they used to say the Eclectics were materia medica mad. Well, I'm materia medica mad because I'd rather know the right herb for the person rather than trying to fit the person to whatever herb I have. I just think ultimately, if I'm going to do the best I can, then I need to know the most so I can match them appropriately. All right.

We have got the gut healing herbs and protocols. So helpful, so important. In cases of autoimmunity, even if we heal the gut, we're still having an active immune reactivity based on what's occurred before. This then leads to inflammation from that autoimmune process. How are you working with anti-inflammatories or reducing inflammation in cases of autoimmunity?

All right. With autoimmunity, again, we have the adaptive immune system and the adaptive inflammation. This is, again, you've got this triggered. The dendritic cells have triggered this pattern, which then brings on recognition as you have this ongoing process. So autoimmune disease is a little bit more complex than many people think. Many people think autoimmune disease is simply an overactive immune system. That's actually mostly not true. And there are multiple reasons that immune underlying pathophysiologies for autoimmunity. Let's say, to keep it relatively simple, with autoimmune disease, there are three groups of herbs that I tend to use. Now, these are groups. Which of the herbs within that group I use depends on the specifics of the patient. But I'm almost always using these three groups of herbs.

The first group are what I call immune amphoterics. The word "amphoteric" comes from the Physio-Medicalists. These were medical doctors from around the 1840s through about 1915 in the United States. And an amphoteric is something that helps to re-regulate a system, whether it's hyperactive, hypoactive, or both. And in the case of autoimmune disease, the both is what really is happening. The studies have clearly shown that in most autoimmune disease, type 1 diabetes may be an exception, but in most autoimmune disease, you have a prematurely aged immune system, which has lost its normal self-regulatory capacity, thus allowing the immune system to overact and affecting self-antigen tissue in the body. And the process creates what are called immune complexes, which is where the inflammation and damage occurs. When you see somebody with rheumatoid arthritis and their fingers are all gnarled and swollen, that is from the immune complexes that have been formed through this autoimmunity process.

Number one, we're using immune amphoterics, and you can use immune amphoterics for hyperimmune conditions like allergies. You can use immune amphoterics for hypoimmune conditions such as cancer, HIV/AIDS, persistent chronic Lyme disease, which causes immunosuppression. You can use them for conditions where you have both things happening at the same time, i.e., almost autoimmune disease. Some of the herbs within this grouping include, some of them are adaptogens, but not all adaptogens can do this, and not all immune amphoterics are adaptogens, so don't assume they're the same. But some of the ones that I'll mention, like Asian ginseng, and American ginseng, and schisandra, and rhodiola, most definitely are adaptogens. But then there's other ones that are not, like maitake mushroom, reishi, which may be an adaptogen, but the evidence for it is actually terrible. You have herbs like cat's claw, you have herbs like licorice. So these are the immune amphoterics. I'm going to be choosing some immune amphoterics depending on the disease, but even more, the energetics and the symptom pattern that the person displays. I'll be using some of those.

Number two, I use a group of herbs that I call immunoregulatory herbs. I coined this term. Although I'm not saying nobody's I've ever used that combination of words before, but I have a specific meaning for it. These are herbs that are anti-inflammatory. They downregulate excessive immune response, although they're not immunosuppressive, and they help prevent the deposition of immune complexes. This includes herbs like gotu kola, and Chinese herb dan shen and Chinese herb, huang qin, Bikal skullcap. This includes herbs like true cinnamon. It includes gotu kola. Did I say sarsaparilla? Well, if I did, I'm repeating myself. Sarsaparilla. These are all immunoregulatory herbs. I'm using a combination of appropriate immune amphoterics and immunoregulatory herbs specific to the patient.

Then the third category of herbs I use are what are called alternatives. Now, not alternatives, alteratives. The original concept of alteratives, these were things that helped to clear blood dyscrasias. They were originally used as anti-syphilitics once upon a time. Over the years, as they found ways to treat syphilis, it morphed and these alteratives were basically used to... You read in books, alteratives help to alter an unhealthy state to a healthy state. Okay, so if that was the real definition, wouldn't all herbs be alteratives? I know a few of you are using herbs to alter a healthy state to an unhealthy state, but for the most part, that's how why we take herbs. My definition of an alterative are herbs that enhance normal eliminatory function via two or more of the major eliminatory pathways, be it the liver, the kidney, the lung, the bowel, the skin, the lymph. So all of these herbs affect at least two, usually three or four of these eliminatory pathways, upregulating the body's ability to enhance elimination of metabolic waste. But they don't excite an increased noticeable activity. They're not overtly diuretic, they're not overtly laxative, they're not making you sweat a lot. They're just upregulating the normal processes. In my opinion, if you are treating, and these have traditionally for at least 250 years, been used to treat things like cancer, chronic arthritis, chronic skin conditions, and more recently, autoimmune diseases. You also find that these herbs, many of them, help increase methylation, especially for people who are poor methylators, people who have MTHFR gene SNPs and things like that. It enhances the body's ability to eliminate these things. But then it also means if it is enhancing methylation, it means you absorb certain nutrients like B vitamins more effectively, which, of course, are foundational and essential nutrients. To me, that is what an alterative is. Some herbs that we've already mentioned, like sarsaparilla and gotu kola, are alteratives. Other herbs that are classic alteratives, things like red clover, burdock root, burdock seed, tag alder bark, red alder bark, poke root, which is a little gnarly. It's a low-dose herb, to be sure. Figwort, nettle leaf, yellow dock, dandelion root. These are all alterative herbs. I'm using combinations of these three to treat autoimmune diseases.

But then I'm also looking at the specifics of the person who has the autoimmune disease. If they have chronic low-grade infections, which have been shown to enhance, stimulate autoimmunity, then I'm dealing at clearing those chronic low-grade infections. Whether we're talking about fungal, bacterial, or viral sinusitis, gum disease, chronic low-grade UTIs, chronic low-grade vaginal infections, whatever. If there's some type of infectious process going on, we want to deal with that. Another thing is if they have leaky gut, then we want to deal with that. The herbs we talked about before would be addressing some of those issues. If there is molecular mimicry going on. For instance, we see a strong link with molecular mimicry and type 1 diabetes. Children who are fed cow's milk, and I know somebody's going to be real unhappy with this, but this is what the studies say, children who are fed cow's milk have a significant increased risk of developing type 1 diabetes. And that is because there is bovine insulin in cow's milk. And so in some cases, the body reacts to that. I'm not saying you shouldn't feed your children cow's milk or not. I actually think the best thing to feed children is mother's milk. That's the one that I recommend for babies. So underlying, there are all these different possible pathophysiologies for autoimmune disease that we have to address and recognize. And yes, they all lead to inflammation, but some of them, chronic infection, inflammation, molecular mimicry. Your cells are attacking cells that have a similar self-antigen. It's going to cause inflammation. Again, loss of intestinal epithelial barrier function, inflammation. And so inflammation, chronic inflammation, inflammation, which the term they've coined is called inflamaging. This is the chronic inflammation associated with aging, is also the chronic inflammation associated with all chronic degenerative disease. So whether we're talking about atherosclerosis, heart disease, Alzheimer's and other forms of dementia, whether we're talking about cancer, whether we're talking about type 2 diabetes, whether we are talking about autoimmune disease, at the root of all these, they are all inflammatory processes.

So having in your diet, again, not just eating an anti-inflammatory diet, a healthy diet, but there are certain things that we know are really useful, whether it be green tea, or actually black tea or white tea. Studies have clearly shown regular drinking tea, actually even regular drinking coffee. For many people, the biggest source of flavonoids in their diet is coffee, actually. But for some people, coffee is problematic because it can be overstimulating, it can worsen depression. Things like mate can be useful. Just don't drink it scalding hot like they do in South America because that increases your risk of mouth cancer dramatically. Really hot things in your mouth is not a good idea. Your mouth doesn't really like it. The skin cells don't like it. The mucus membrane cells in your mouth don't like it. Beets, rose hips, black grapes, grape juice. I'm not a huge fan of fruit juices simply because they have so much free fructose in them. But in small amounts, like a little bit of pomegranate juice, eating pomegranates. Eat the seeds, too, even though you can't really digest them. They certainly have some fiber in them. I mean, all of these things, strawberries and blackberries and raspberries and strawberries. Here's one of the kickers. Anything that's food, and I'm talking about naturally occurring food, not like food dyes. Anything that's pretty much red or purple or yellow or orange is either has carotenoids or flavonoids in it. And so make them the foundation of your diet, those inflammatory foods. But I will mention one other thing. We're talking about gut healing. Really important. The number one nutrient Americans are deficient in is fiber. 60 percent of all Americans do not get enough fiber. Here's one that is so easy. I highly recommend this. Number one, get some organic psyllium seed. All right? Easy to get, not expensive. And before every meal, you put a spoon of this in, and then you pour room-temperature water over it. Let it sit five or 10 minutes until it turns like slime. Stir it up really well and drink it before you eat. It will reduce postprandial blood sugar levels, which is, again, high blood sugar, oxidative. It will help lower cholesterol levels. And the psyllium stimulates production of butyric acid in the gut, which heals the gut mucosa probably better than anything else. And it acts as a bulk laxative. It's like, of all one of the supplements most people take, this is probably dollar for dollar, the point of the best things. I mean, if you're allergic to psyllium seed, you've got flaxseed or chia pets. I always tell my students, take two chia pets and call me in the morning. Of chia seeds, obviously. Although you don't really want to bake with chia seeds. When you bake with chia seeds, you get really high levels of acrylamides, which are a highly pro-inflammatory and pro-carcinogenic compound. So you want chia seeds, keep them in the freezer, by the way, and just stick them in smoothies, stick them in your oatmeal, but don't cook it in the oatmeal. Just stick it in after the oatmeal is cooked and cool down a little bit. Give it a little time just to absorb some of that moisture. But any of these things I'm talking about, you want to make sure they get slimy before you take them because they're hygroscopic. If you take them dry, they absorb moisture in your gut, and they can actually cause a bowel blockage. So don't do that.

I would love to stick a little bit more on the metabolic inflammation, David. Obviously, diet is huge and fiber as well. You've talked a little bit about the botanicals, but are there any others that move the needle in cases of metabolic inflammation you could touch on? What you're calling metabolic inflammation, I think, is what I'm calling inflammation, basically. Is it correct?

Well, we do know that are certain, again, antioxidant, anti-inflammatory nutrients. I am not opposed to people getting some of their nutrients in the form of supplements. I am actually a much bigger fan of getting their nutrients from their diet. Studies have routinely shown that getting things from your diet tends to work better. I think they work better because when you get vitamin A from your diet, it's almost always associated with all the pro-vitamin A, the carotenoids, the not just beta carotene, but gamma carotene, delta carotene, astaxanthin, zeaxanthin, cryptosanthin, lutein, lycopene, etc. So you're getting them in a form that is not only very bioavailable, but you're getting with all these cofactors that are essential for them to work properly. So making sure you're getting adequate carotenoids, vitamin A, vitamin D. I see patients, people become much more vitamin D conscious. I have seen patients who have vitamin D, a 25-OH D level of eight. That level, you can get rickets. There are a lot of people who are not getting adequate vitamin D, and while you can get adequate vitamin D from the sun, but in the latitude like where I live, which is in Pennsylvania, you can only actually get vitamin D from the sun sometime between late April and very early October. And the rest of the year, the sun is at the wrong angle from the Earth for you to actually effectively get vitamin D. A cool thing that you can do, any of you grow mushrooms, I grow shiitakes. Even if you don't grow them, even if you buy them at the store and it's a sunny day, take the mushrooms, turn them upside down so the gills are facing up in the sun for an hour, and it increases the vitamin D levels. It's the D2, the less active form, but it increases vitamin D levels, and then you can cook them and eat them. Vitamin D is something that I do tend to give people as a supplement, and you want to take it with fats. It's more absorbable if you take it with fats. Then you have things like zinc and selenium. You can get your selenium intake every day from eating three Brazil nuts a day. Three Brazil nuts contains between 200 micrograms of selenium. It's all you need. But how many people are eating unless they're eating Chunky Monkey? Most people aren't eating a lot of Brazil nuts. Zinc. Yeah, you can get zinc from Rocky Mountain oysters. I don't know how many of you know what Rocky Mountain oysters are, not in my wheelhouse, but you can get it from pumpkin seeds. All right. It's a reasonable source of zinc. If you like oysters, real oysters, it's there, too. Although, honestly, really, these days, I would really don't recommend eating raw oysters unless you want to gamble with hep-A. But again, try to get these things as much from the diet. But if you can't, taking a good multivitamin mineral that You don't need a lot. 15 to 30 milligrams of zinc is plenty. 100 to 200 micrograms of selenium is plenty. So you don't need massive doses. In fact, really high levels of zinc, like over 80 milligrams a day, it actually suppresses immune function. So these sorts of things, vitamin E, and of course, vitamin E, one of the best sources of vitamin E is whole grains. All right. And you don't It needs a ton of vitamin E because naturally occurring vitamin E is not just D alpha-tocopherol or, worse, the synthetic DL alpha-tocopherol, but it's all four tocopherols mixed with all four tocotrienols, which is way more effective than any of them by themselves. Look at our immune systems and how complex it is. Nature loves complexity. We were designed to absorb nutrients, complex nutrients from complex sources, which are foods. And that's why... And when I do give people, even if you're going to take a supplement, there are some really nice natural... I'll use the term superfood. I'm not I'm not a big fan of that. But things like spirulina, which is just this super nutrient dense blue-green algae. I mean, that to me is preferable in many cases than like an isolated vitamin mineral supplement because you have such a wide range of things in there all naturally occurring. Those are all things that I think are really important because, again, that is foundational. And then there are other things that you can do on a daily basis, and I would say eat your spice cabinet. So what am I talking about? Everything in your spice cabinet is antioxidant and anti-inflammatory, except for salt and cream of tartar. Unless those spices have been sitting in your spice cabinet over the stove for the last 15 years, in which case they might as well be sawdust. But fresh, grown, and dried spices, whether we are I'm talking about basil, cinnamon, ginger, turmeric, oregano, thyme, za'atar with sumac leaf, all of these things not only make your food taste better, unless not, we can include garlic in with that, even black pepper, white pepper. All of these things, bay leaves, all of these things are wonderful. And when What I'm suggesting is you start using them. I mean, to taste. Don't get crazy. Don't stick so much in there that it's like, I can't eat this. It's terrible. But if you are using, and you don't have to use the same ones every day, but if you were using these in your diet, liberally on a daily basis, along with all those incredible rainbow-colored fruits and vegetables. And by the way, don't forget your white vegetables. And by that, I don't mean white potatoes. But things like cauliflower has really high levels of anti-oxidant anti-inflammatory compounds, as do all the eat brassicas. Lots of brassicas, eat lots of alliums. And I mean, everybody's talking about a plant-based diet. Well, yeah, absolutely. A plant-based diet. But if you're going to eat animal protein, and I do, wild game or things like bison that is grown. You don't corn-finish bison. If you take a cow that's been field-raised and grass-fed, and for the last two weeks, you fatten them up on corn, the omega-6 to omega-3 fat level in their body in as little as one to two weeks changes profoundly. So go and get things from local people that you know from local organic farms, if you can, and afford them. Work together in co-ops and things like that where you can reduce your cost of foods. And of course, this is even more of an issue, though, in places that are food deserts. If you can have a garden, even if you just have a patio or a balcony and you can grow a pot of basil and you can grow a one to the tomato plant, don't bother growing corn or zucchini. They I don't do well. But you grow things. Oh, and when I was talking about spices, let's not forget cayenne peppers. And so basically what you want to do is you want to make your diet, which again is truly the foundation here, this powerful process for reducing inflammation in the body. Then when the normal daily occurring inflammation, maybe the air quality is not as good, maybe, I don't know, you got stuck behind a bus at work. You were someplace and people were smoking. The normal insults that you come across, you are going to be able to withstand them more effectively. The daily aging that occurs simply because we're getting older. It's funny. All Americans want to live to be 90, but nobody wants to be 90. Everybody wants to be 35 until they're 90. Well, sadly, it doesn't really work that way. But you can do the things that we're talking about. And again, don't forget exercise. There have studies show that sitting all day is like as pro-inflammatory to your body as smoking a pack of cigarettes. So you sit all day? Well, number one, there's things you can do. When I was a kid in school, I majored in two things. This was in grade school. I majored in daydreaming and fidgeting. I would have been diagnosed as having ADHD, among other things, but there was no such thing when I was a kid. They just thought you were problematic. But as a kid, I was never sitting still. And I'm doing pretty good today, but usually I'm swinging side to side. When I teach, I'm walking back and forth. And a study came out in the last three years showed that fidgeting when you're sitting, is actually a really good antidote to sitting. All right? So if you're not bothering anybody, fidget. Get up every half an hour to an hour. Walk around a little bit. Our bodies are meant to move. Deep breathing, especially if you have good air quality, doing things like yogic breathing exercises is phenomenal. I mean, you can change your brain wave patterns in as little as two minutes by doing deep breathing. You can go from an alpha state to a beta state to an alpha state in as little as two minutes. And then, let's not forget, and this may seem like I'm jumping off the topic, but I really don't believe that I am. We talked before about stress, and stress is pro-inflammatory. Well, for a country that's not actively at war, we probably have to be some of the most stressed out people in the world. And so some of the antidotes, because there's some things we don't have a lot of ability to change at the moment, not easily. But spending time with people you love. Last weekend, well, when you see this, it'll be several months, but Lindsey and I were at the International Herb Symposium, and it was a joy. It was wonderful just hanging out with all these other cool people who love herbs, and it was delightful. And find things that bring you joy. Find things that make you happy. Find hobbies that, you know, thrill you. Not just, it's okay. Find things that you can be passionate about. Find ways to make a difference in the world, to make the world a better place for everyone, not just based on what you think, for everyone. Because I honestly believe, and we know that when we feel good, it's not only things like oxytocin, but endorphins are released, and they are anti-inflammatory. So exercise. I don't care whether you're going to walk birdwatching, or whether you're jogging or swimming or playing sports or making love or whatever it is that brings you joy. Consenting, of course. Whatever brings you joy, find ways to bring that into your life. Because I think, honestly speaking, the world we live in today is pro-inflammatory. I think it is inflammatory to be someone who people look at negatively simply because of how you look or your gender or your skin color or your religion or you're different. It's incredibly stressful. So I think if all of us go out into the world and truly make the world a better place, a place that is more accepting, a place that is healthy for all, a place that hopefully one day where we can not have wars to settle our differences, the world itself will be less of a pro-inflammatory place. I don't think when we hear about inflammatory speech, I don't think that's just a metaphor. I think it is actually inflammatory to us. I just highly recommend finding joy in in your life. If you're my age, if you have grandkids, spend time with them, especially when they're little and they think you're cool, because when they get older, they're probably going to not think you're so cool anymore. And if you don't have grandkids or your grandkids are older, find a way to help. There are places that need people to help mind children. There's nothing like hanging out with young children to remind you of not only how precious this life is. But seeing, because as we get older, we tend to look at life through these very dark glasses, and our vision tends to get really narrowed. Well, there's nothing like young children to just like, wow, look at the sky. And remember the wonder in life. Try to find moments in your life every day where you can feel that sense of wonder, of ecstasy, of joy, of like, Wow, I am so fortunate to be here and make the world a better place. So that's my philosophical take on reducing inflammation.

That was the best public service announcement. I loved that. Thank you. I truly agree that joy is the answer to many of our inflammatory problems in this world. I think this ties really well into my next question, David, which I want to focus in on the inflammatory aspects of mental illness basis and neuroinflammation. I'd love to hear your perspective on herbs and their ability to cross the blood-brain barrier, and if that's even necessary.

Well, it's not entirely necessary, but many of them can and do. So we now understand, although in Ayurvedic medicine, they've understood this for thousands of years, in Ayurveda, they have this group of herbs called medhya rasayana. And the medhya rasayana are the brain tonics. And so this includes herbs like bacopa and gotu kola and butterfly pea, shankhpushp, eclipta, a whole range of things that are these medhya rasayana. In the West, we now call these nootropics. Nootropics are herbs that help enhance cerebral circulation, reduce neuroinflammation, enhance memory, focus, and cognitive function. My experience is many of them can at least help slow the progression of Alzheimer's and deal with some of the sequelae of Alzheimer's, like Sundown syndrome, where people get super anxious and agitated when the sun sets. They can be highly useful for those sorts of things. We know that neuroinflammation is strongly linked to gut inflammation. If you have gut inflammation, there's a very good chance you have neuroinflammation. Now, can you get neuroinflammation without gut inflammation? The answer is yes. So 40 some odd years ago, I had a patient come to me who had had bacterial meningitis. She was in the hospital. She had recovered from the meningitis. They saved her life. Then they released her. She was a storyteller by profession. Unfortunately, she had all this neurological trauma from the bacterial meningitis, and she couldn't talk, at least not effectively. She had lost her balance. She was not going to die, but she had serious, serious sequelae from the neuroinflammation. The doctors told her that after a period of time, they could try doing some occupational therapy and that hopefully over the next year, her brain would heal and that she would be able to regain full speech and movement and function. Well, that didn't sit real well with her husband, who was a friend of mine. He calls me up and says, "Is there anything you can do?" I said, "Yeah, I think so." We put her on a protocol call, and in two months, 95 percent recovery. Now, that's an N of one. That means I can't prove that if we had done nothing in two months, she wouldn't have been there, except her doctors were astonished. Her doctors were like, they were shaking their heads. They're going, this is really, really atypical, unusual. You're very lucky. Well, she wasn't lucky because the next person showed up like six months later. And then there was a period of time for several decades. Again, the weird part was it wasn't like these people were talking to other people and getting referrals. They didn't know each other. But all of a sudden I became like neuroinflammation, chronic head trauma, come see me. And I treated so many people with chronic head trauma. At one point, a local hospital actually was interested in doing a clinical trial with my protocols. That was around 1998. And then the pendulum had swung because from '95 to '98, there was this period where the media was just enamored with herbs. They had just discovered them and everybody was like, "Oh, herbs are a miracle." Then all of a sudden the pendulum swung and it was all of a sudden, "Oh, my God, herbs are dangerous." This guy was walking down the street last week. There was an herb. He looked at it, he It's like, that's ridiculous. They backed out of it. They decided, no, we didn't realize herbs were so dangerous. Yeah, I mean, let's be real. Yeah, there are herbs that are quite dangerous. Don't play with gelsemium or aconite. Most herbs are remarkably safe, especially not only compared to pharmaceuticals, but to compared to over-the-counter drugs and possibly compared to food. There's many more deaths from food than there are attributed to herbs. Nevertheless. This started me on this path of working with a lot of people with head trauma. Again, there are a lot of these nootropic herbs. Gingko was one of the best known ones. Lion's mane, but gotu kola. Another one from her spice cabinet I forgot to mention earlier, rosemary, sage, not thyme. Sorry, we can't get rosemary sage. Lots of herbs in Chinese medicine like white peony and yuan zhi, Chinese polygala, and suan zao ren, ziziphus seed. There are all of these herbs that have been shown to enhance cerebral circulation, reduce neuroinflammation, enhance cognitive function, memory, focus, things like that. Holy basil is another one. They're amazing herbs. Again, which ones I choose depends on the specific person I'm working with and what I'm trying to address. But these herbs, and some of them, like turmeric. There was a study, and this is a curcumin study, not a turmeric study, but there was a study done about 8-10 years ago. When I first saw the study, I was perplexed because turmeric has never been used to treat depression, not historically. But when more I thought about it, it made sense because, again, turmeric has not only anti-inflammatory effects in the gut, but also neuro anti-inflammatory effects. Although I would point out that some of the compounds in whole turmeric are much more effective at passing the brain blood barrier than is curcumin. Nevertheless, in this study, there are two of them with people with major depressive disorder, which is much harder to treat than mild to moderate depression or normal dysthymia. Really worked. It was very effective. A lot of these things help reduce gut inflammation and neuroinflammation. One of the beauties is, a lot of the herbs we're working with are nonspecific, meaning some of them I would only use, I mean, I'm only going to use slippery elm or marshmallow for gut GI inflammation because it doesn't go anywhere else. You're dealing with mucopolysaccharides, and that's what it's going to affect. But there are other compounds or other herbs like the Chinese herb, chai hu, (bupleurum) and gotu kola (centella), which are pretty profound systemic anti-inflammatories. Like centella, the specific indications, you use it for inflammation, tissue that is red, hot, inflamed, and it doesn't matter where in the body. It can be neurological, it can be skin, it can be gut, it can be heart, it can be musculoskeletal, it can be the bladder. Really doesn't, it doesn't matter. If the tissue is red, hot, and inflamed, think gotu kola. I would point out, though, that most of the commercial dried gotu kola in the marketplace, gotu kola can be as dry as an herb, as a tea. But when it's dried, it should be beautiful, vibrant green. Almost 99 percent of the gotu kola in the marketplace is brown, gray, or yellow. If that's what you find for gotu kola, it's inert and it's not going to do anything. Plus, it grows in sewage ditches in India and Sri Lanka. Yeah, no, thank you very much. You want organically-grown gotu kola. It can be gotten from Hawaii, but it's pricey. That's why I usually use a tincture made from the fresh herb. That's much more available.

I would love to hear a little bit more about how mast cells play a role in the inflammatory process and histamine-derived inflammation. Could you speak towards that and obviously, herbal interventions here?

All right. So with mast cells, and of course, mast cells are part of the initial... With the histamine, the inflammatory mediators, again, histamine and the inflammatory cytokines and the prostaglandins and leukotrienes upregulate things like mast cell degranulation and histamine release. That is fine if you're talking about local tissue for a short period of time. The problem is it's also upregulated with allergies. And so the people who have autumn or spring allergies are miserable with the swollen red itchy eyes and sinus congestion and swollen sinuses, and they're just absolutely miserable. And then we also have things like a relatively newer condition, what's known as histamine intolerance, where where people, again, become very sensitized to histamine. The beauty of this is that we have a whole range of herbs that basically inhibit histamine release, stabilize mast cells, prevent mast cell degranulation. We have herbs like, and some of these are really well known, like rose hips, strawberries. My favorite way is the blueberry solid extract, which is a concentrated extract of strawberries, but It's not standardized. It's just cooked down until it's really strong. You have herbs like the Ayurvedic, a rasayana herb, rejuvenative remedy, amla fruit, which is phenomenal for histamine intolerance and allergies. But again, red inflammatory tissue. Gotu kola, can also work here. We have lots of herbs that we can use to help reduce these issues. Now, if you have allergies, for instance, what I would recommend, let's say you have spring allergies. Now, some people have spring and autumn allergies. Then if you have allergies that last all year round, then you're not usually looking at pollen so much. Then you're looking at things like dust mites in your home, animal dander. You know what? It's always the people who have animal dander allergies. Nine times out of 10, they have pets, and they sleep with the pets, and the pets sleep on their head. They've got a cat hat for when they sleep or their dog sleeps curled up right around their head or their shoulder. If you have animal dander allergies, you absolutely never want your pets in your bedroom, ever. You need a HEPA filter in your bedroom so that you're at least getting a seven or eight, nine hours a night where you're not being exposed to those allergens. But most people have pets, absolutely refuse to change that. But nevertheless, it's your call. So, there are other types of allergens in the environment, mold and pet dander and dust mites, if it's year-round, because those things are year-round. But if it is seasonal, what I have people do is you need to start six to eight weeks before allergy season. And so think of it this way. This is imaginary, but let's say here's your inflammatory threshold. Above this line, you're symptomatic, below this line, you're not. So if normally you're here during allergy season, it takes very little to bump you up to being symptomatic. So what I have people do is take these herbs that inhibit inflammation, and I have them start six to eight weeks before allergy season, try to drop their this reactivity level down here. So when the season comes and they're up to here, they're still pretty much asymptomatic or they are asymptomatic. I'm using things, again, like amla fruit, goji berries. I'm using the immune amphoterics we talked about before. One of my favorite ones to use here is astragalus, or huang qi. I'm using immunoregulatory herbs. Gotu kola might be a good one there, but there are other things that might be really useful. If the person has animal dander allergies, then as one of my immune efforts, I'll use licorice. I have not found anything better for animal dander allergies than licorice. But if somebody is going to start taking licorice regularly, First off, you should be taking it as part of a large formula, small amount of licorice. Licorice can cause what's called a pseudo-hyperaldosterogenic effect, meaning it causes you to retain sodium and excrete potassium. Thus, your blood pressure goes up, increases the risk of arrhythmias. If somebody is going to take licorice long-term, first off, if their blood pressure is above optimal, that means 120 over 80, I won't give it to them at all. All right. By the way, yes, there's DGL licorice, but DGL licorice doesn't work very well in this situation. So you're just not going to use licorice. So if their blood pressure is relatively good, I will have them recommend they check their blood pressure once a week. I will recommend they reduce their sodium intake and It increases the intake of potassium-rich foods. And again, the licorice is a very small part of a larger formula, and that formula could involve amla or green tea or blueberry powder or holy basil, which is another immune amphoteric. And so a little bit of cinnamon, which is an immunoregulatory herb. That can work really well so that when allergy season comes, you're not suffering.

That's very helpful, David. Thank you. I know that you work in your practice person-specific, and we're looking at body system affinities, and there's so many things that go into choosing how to formulate herbs. But I'm going to ask you if you have any favorite synergistic pairings or triads for inflammation. This can be in specific tissue targets or body systems or basically more energetic. I'd love to hear.

Yeah. Synergy, understanding synergy is really important, and it's part of all traditional systems of medicine. It's understanding that certain herbs are greater than the sum of the parts. In Chinese medicine, it's called duì yào. Duì yào means two herbs, herb pairs. All Chinese formulas are built out of these herb pairs. You find this in Ayurveda, in TCM, in Physio-Medicalism, in Unani Tibb of Campo, etc. All these combinations. For instance, for tissue that is red, hot, and inflamed, we talked about centella, gotu kola. But centella and sarsaparilla, or smilax, especially if it is gastrointestinal or musculoskeletal, is even better than either one by itself. Or the classic Ayurvedic formula, the Triune formula called triphala, which everybody thinks is a bowel tonic. Oh, and by the way, triphala is quite useful for helping to treat gut as well. But triphala is also profoundly anti-inflammatory for especially gut inflammation. But it has also been used to strengthen the eyes because it helps strengthen the small capillaries in the body. Because, of course, one of the three ingredients is amla, which we were talking about before. Other combinations as anti-inflammatories. Well, I mentioned one earlier. The classic combination in Ayurveda and Unani Tibb is turmeric and ginger, not black pepper. I mean, it's not that black pepper is bad, it's fine, but it's actually turmeric and ginger. And ginger has profound anti-inflammatory effects all by itself. You would think energetically because it's so heating, but there are studies showing that even with rheumatoid arthritis, ginger actually reduced inflammation. And so, again, turmeric ginger is another really remarkable formula. A fourth one that I will mention is a Chinese magnolia. The Chinese magnolia is very interesting. It contains a chemical called honokiol, which they've done a lot of research on. There are six or seven species of magnolia that grow in the Southeastern United States. Of course, this is part of what botanically is known as the East-west disjunct, where there's all these herbs that only grow in Eastern China, in Eastern United States. Because at one time, these are areas that have been pretty geologically stable. So you still have the original plants from Pangaea, whereas the rest of the world, they were died out or changed more. And so you'll find we have Panax ginseng and Panax quinquefolius growing in these two areas. Very closely related species. We have schisandra in both areas. We have magnolias in both. Anyway, only very recently, literally within the last two months, did I find evidence showing that the American magnolias also contain honokiol. Which is really interesting because, again, it's a really interesting compound. It has been shown that, for instance, magnolia bark with... I think in the studies, it was barberry. I think it was the Indian barberry, Berberis aristata. But it could be any of the Berberis species. Had a really incredible effect, number one, for lowering blood sugar levels, reducing inflammatory cholesterol levels. It also, the combination helped reduce neuroinflammation and depression. That's a really interesting a combination as well. I would also point out the magnolia bark are phenomenal for damp heat inflammation. People with rheumatoid arthritis, the magnolia bark with gotu kola, or magnolia bark, gotu kola and sarsaparilla, is a sweet combination. You'll see changes that almost look like you've put them on a biologic. Really significant drops in things like high sensitivity C-reactive proteins and other inflammatory markers.

We have talked about so many incredible interventions that we can utilize for inflammation. As a final takeaway for our audience, can you just outline a simple protocol for systemic chronic low-grade inflammation that would be your foundational suggestion?

All right. This is somewhat off the top of my head, although I've used something like this. I think for many people, drinking a tea, two cups a day of the following formula would be a lot... First of all, it'll taste good, and I think would be a great way to help reduce inflammation. We'll start off with one or two parts, and a part can be anything depending on how much you want to make. So one or two parts green tea, one part, holy basil, two parts linden flower, which is a lovely calming nervine, half part cinnamon, and two parts hibiscus. This tea is going to taste for most people, it's going to taste delicious, and it has broad spectrum anti-inflammatory activity, quote unquote, antioxidant activity, mild adaptogenic activity with the holy basil, nervine activity with the linden flower and the holy basil. Holy basil also has anxiolytic activity, mild antidepressant activity. Cinnamon enhances digestion. It's an immunoregulatory herb. It moves blood, enhances circulation, reduces insulin resistance. Holy basil also lowers blood sugar levels. Then again, linden flower, hibiscus also help lower blood pressure. I think that that would be a lovely thing that people could do on an absolute daily basis, and you can tweak it to taste. You can add a little more of something or a little less. I'm sure you could be creative and add another. If you like sour, add in some rose hips or whatever. But I think something like that is a real foundation to something you can do easily to help reduce inflammation. And then all the other stuff we talked about, especially the foundations of health, sleep more, but get good quality sleep, exercise regularly, take care of yourself, And a lesson I learned two weeks ago, don't do stupid stuff. Don't fall into ditches. So, yeah, so your hindsight is joining. Yeah, but it did remind me that when I am walking and running, I do actually have to pay attention to where I'm going and putting my feet.

Thank you so much, David, for all of your wisdom and incredible life advice. Can you please share with our listeners where they can find you out in the world, if you have any programs or opportunities for learning more from you coming up?

Yes. Well, my website is herbalstudies.net, but that's the website for me and my school, the David Winston Center for Herbal Studies, which is a two-year program in clinical herbal medicine. We are currently in our 46th year, and the next program starts in September of 2026, which will be the 47th and 48th year. Lord willing, I'm planning to do one more after that. I figured 49 and 50. Fifty seems just like a nice round number. I've been threatening to retire for years, but I'm pretty sure about that, just age and everything else. But hopefully, the school will continue. I just will step back and do a lot less. But for the next two programs, I will be just as involved as I am. I would also point out that I have an herb company, Herbalist and Alchemist, which makes some rather amazingly good tinctures and herb products. You can find that information information at herbalist-alchemist.com. A lot of the formulas that I've been using clinically for 45 to 49 years, those are the basis of the formulas that we make. They're the things that I've seen work over and over and over again within my clinical practice. And so those are the places you can see me. And if you're on the website, there's a a list of where I'll be teaching. I regularly travel and teach all over the US and Canada and Europe, occasionally elsewhere. And if you are at one of those conferences or medical schools or wherever, and I happen to be teaching, please come on up and introduce yourself and say, "Hey, I saw you in such and such a place," because for me, I'm always excited to meet some new folks or even re-meet folks in the herbal community because I feel so blessed that I've gotten to spend almost my entire life as part of this incredible community of caring, loving, creative, interesting, and slightly crazy people who make up the American and world herbal community. It is just a vital, amazing group of people. Here's the thing about herbs. You start working with them, the next thing you know, you're addicted. It's one of those healthy addictions. I just want to thank you all so much.

Thank you so much, David. We are so honored to have had you here with us today. I will make sure to get all the links in the chat to ensure folks can find you on the internet. And 50 years is so incredible. I am so grateful for all of your teachings today and throughout all the other ways in which we, as a community, get to learn from you. So thank you, David.

My pleasure. I always tell people, in my first Herb Studies program in 1980, I had two students, and I was so excited that anybody wanted to study this because for a very long time, I was very isolated. I actually believed that for about a decade, I believed I was the only herbalist in the East Coast. It wasn't true, but the other ones were pretty well hidden in either rural or ethnic communities, and I had no way to know they existed. It's like you find something you're really passionate about, you want to share it. To be alone in it also, of course, makes it much harder to learn more. We have come a long way, and you and the other herbal elders are the backbone of what we've built in this community. So thank you. Thank you. Great interview. So thank you so much.