I entered the world of research because I often felt that the quality of research in herbal medicine was questionable by many. To dig in deep, during my Master’s degree, I conducted the quality assessment of the COVID-19 clinical trial using Ayurveda intervention and compared it to the COVID-19 clinical trial using non-Ayurveda intervention, including conventional medicine (majority).

We found out that there was a difference between Ayurveda and non-Ayurveda trials. Initially the results favoured Ayurveda trials, so we conducted a sub-group analysis. The subgroup analysis could not establish the difference in the quality between two groups. 

After the completion of my degree, we conducted a next stage study to assess the characteristics and reporting of traditional medicine including Ayurveda and traditional Chinese medicine and compared it with conventional medicine. We found out the traditional medicine trials were less likely to report the results than conventional medicine.

We have also conducted a pilot study on fibromyalgia participants who were offered group therapies and weekly one-to-one sessions of Ayurvedic lifestyle intervention and noticed a significant improvement in pain and quality of life. 

My next project will be around cancer, and we are still at the proposal stage.

Plants and fungi play a crucial role in both serious and non-serious health conditions. Because they are in their natural form, the human body is likely to adapt and respond to them more easily. It is very unfortunate that not enough scientific evidence is available to prove this point. While some does exist, definitely more is required. However, to give an idea, I can give an example of traditional medicine Ayurveda.

The 5000 year old classical textbook of Ayurveda talks about both curable and non-curable disease. From nausea and vomiting to cancer, you name the condition and you can find a co-relation in those books. In the management of every condition they talk about suitable herbs. The book even talks about emergency health conditions like poisoning. The number of trials conducted that demonostrate positive results regarding herbal efficacy during COVID-19 signifies that this area is worth exploring. So, I believe more robust scientific work is needed to validate the relevance of ancient wisdom in the modern world.

Coming from both backgrounds and while working with experts in research and experts in traditional or herbal medicine, I have noticed a disconnect between the experts in these two areas. A lack of comprehension between these two worlds has troubled me. There are only a few people who are or who choose to train in both the areas. I feel that basic training on both should be offered to see better results. However, this isn’t the biggest challenge, but a lack of funding.

Lack of funds in this area contributes to the majority of challenges. Neither it supports the ones who are already working in the system, nor tempting others who would join. Research in herbal medicine is majorly an individual interest and this approach according to me is not sustainable. 

The above challenge leads to another. I have talked to a few researchers in herbal medicine who stopped researching because they did not feel that their work attracted enough attention or appreciation. So, often they prefer to focus on their practice, which gives them more fulfilment. I believe most of the challenges can be faced if there comes a body which regulates the funds in this area as well.

As a practitioner, I feel lack of awareness is a challenge. However, it does not bother me since there are many who are aware and there are many who through their experience find a way to connect with this science. One thing that is not a challenge for me but for the client is finding the right practitioner. I have seen a few clients who almost lost their hope in herbal medicine before meeting me. I think more information should be given to the clients on how to choose the one who has the expertise to work with them.

The answer is both yes and no.

We know that the absence of evidence does not mean evidence of absence. So, I have seen both the segments. Ones who are intrigued by this area and wish to work to contribute in generating the evidence. While there are also some who are very much occupied by the conventional medicine parameters. They judge traditional medicine on the same parameter, which gives out a sense of bias.

According to me, different streams of medicines work on different modes of action. Hence, they should not be compared under the same parameters.

An integrative approach is the need of the hour. The concept has been introduced to us for quite some time. However, we are yet to see it flourishing in practice. Both conventional medicine and herbal medicine should work hand in hand. One can offer what the other requires. So, instead of fighting over evidence, more contribution is needed to work towards building the evidence.

I come from India, so herbs have been a chief part of our kitchen. It is very important to know the basic properties of the herbs you are using. This ancient kitchen wisdom has been transferred from generation to generation.

Unfortunately, there has been a gap or some misinformation in recent years in the name of modernisation, which have negatively interfered with regular household practices. Therefore, clearer information on the kitchen herbs or even herbs required for health conditions should be shared with the masses. Herbal Reality is already doing this good deed and I appreciate the work done in making this information accessible.

As a phytochemist, I work predominantly on the extraction, isolation and characterisation of natural bioactive compounds from plants. I use different methods of extraction to yield the highest possible quantities of biologically active (i.e. anti-oxidant, anti-inflammatory, antiproliferative) molecules.

In addition, I perform semi-synthetic synthesis reactions to functionalise the natural parent molecules in an attempt to increase their activity, such as introducing aromatic ring moieties.

Lastly, I carry out a series of biological assays to assess the novel derivatives’ bioactivity, for example, in cancer cell lines, and then prepare the hit molecules into nanoformulations to improve drug solubility and deliverability.

Natural compounds are structurally diverse and complex molecules, which means they can have multiple drug targets and an array of biological activities. This means that natural compounds and extracts can often have synergistic effects. In fact, around 70% of the worlds’ chemotherapeutic drugs are either based on a natural compound or a structurally similar analogue.

Nature provides scaffolds of these structurally complex molecules that have phenomenal activity in cancer cell lines and, in my opinion, were the backbone to chemotherapy research. We have also seen the importance and effectiveness of using natural products as an adjunct to standard chemotherapeutic drugs. So, it is of utmost importance that natural product research for cancer therapy continues. 

Natural product chemistry is certainly not always straightforward! Plants contain hundreds of molecules and extracting the one you want can be a complicated and time-consuming process, not to mention large quantities of solvents are usually required for the extraction and separating (chromatographic) processes.

In addition, for every kilo of dried plant material used, sometimes only a few grams (or even milligrams!) of the desired compound can be obtained, making the process arduous and tedious. 

Plants can definitely be misunderstood, perhaps because they have been less studied/explored with a scientific lens. However, I do believe the landscape is changing. I also believe that in a world that has been heavily influenced by industrialisation, herbal medicine can sometimes be viewed as an archaic and irrelevant practice.

I suppose some scientists believe that moving from natural drugs to synthetic pharmaceuticals is progress and that the only way is forward. But from what I see in the scientific community (at least in my small world!), many scientists are acknowledging the benefits of having both practices (herbal and pharma) as part of the medical system.

Herbal medicine has been (and continues to be in many developing countries) the primary healthcare system and foundation to medical care. The importance of herbal medicines to medicine is categorically and undeniably significant. In countries where allopathic medicine is too expensive or unavailable, herbal medicine is used and accepted by the population.

In addition to this, in more developed countries, a return to a more “natural” way of living has spiked the curiosity of the general population to enquire and use more herbal medicines, as they recognise the benefits of herbal medicines (including fewer adverse effects and synergistic properties) when compared to synthetic medicines.

As for the future, as long as we can safeguard and protect the natural fauna and flora of this planet, herbal medicines could provide the answers and solutions to many of the ailments of our current society.

Herbal medicines often have a better safety profile when compared to allopathic (that’s not to say that all natural products/plants are safe, since plants contain toxic compounds – it’s all about the dosage really!). However, this does mean that plants are fantastic to use against “everyday illness” such as common colds, flu and sore throat and, perhaps more importantly, herbal medicines are much more suitable for preventative healthcare, something that the allopathic medical system is not geared towards — modern medicine has been more focused on treatment rather than prevention.

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

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

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

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

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

There are many contributing factors to the rise in burnout:

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

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

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

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

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

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

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

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

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

Staying up late

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

Hooked on our devices

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

Inability to say “no” and the glorification of busy

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

Reaching for quick and easy foods

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

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

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

Marrying your macros

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

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

Avoiding fasting/eating regular meals

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

A diverse range of foods

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

A Mediterranean diet

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

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

Staying hydrated

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

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

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

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

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

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

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