Murnane Let's talk about type two diabetes and herbs. Can we treat type two diabetes with herbs and spices that we find in our kitchen cabinets? So, yes. And I guess my interest in diabetes has started. When I was working in Africa, in the valley in West Africa, and people that use local plant moringa. Hmm. Actually, it's not such a medical problem as it's not many places in the tropics. And the leaves are incredibly nutritious. They contain protein, vitamins, minerals. And in fact, there's a treatment for malnutrition. But in Mali, in West Africa, they also use it as a treatment for diabetes. And some friends, researchers in Mali wanted to do a clinical trial of it. So I supported them to do that. And that was a really interesting results. It looks like it's 400 grams of white bread, gave them some moringa afterwards and promoting crops and then measured their blood sugar levels, you know, every 10 minutes or so. And they found that the blood sugar levels that people take taking the moringa were lower by about one minute more per litre. Okay. Yeah. So that's quite significant. Yeah. Is compared to those who hadn't. And obviously that's a very short term measure of diabetes. So in clinical practice as these we look more a thing called HB one C, which is the percentage of red blood cells that are coated with sugar molecules. And it's a measure of how well your diabetes has been controlled over a period of two or three months. And so I decided to look and see what researchers out, what has already been done on different plots for treating diabetes and specifically what is their effect on they should be able to see long term control diabetes and Thomas surprise, we found that there have been 34 systematic reviews of randomised controlled trials. 34 Yeah, that's. Wow. Yeah. Over the phone that's. Most controlled trial is like a big Yeah. Research study with maybe tens or hundreds of patients comparing herbal medicine since something else. And the systematic review includes several websites and so 34 systematic reviews means there's been probably at least three, four or five times as many randomised controlled trials, which is this sort of top notch evidence that some people look for and we organise them in a league table with the ones that have the biggest effect at the top and are the ones that have the least effect at the bottom. And it was very interesting, said one that came out top with the biggest effects, or we describe one seamless and 11 zero. And a zero. Which people don't know, but the the leaf, the fresh leaf crushed up the juice a month reduced HB one C by 0.99. So it's almost 1%. Uh huh, uh huh. And by comparison, metformin, which is a standard counterpart diabetic drug that we use, would reduce HB one C on average by about half percent. So it's about twice as effective as Wow from these admittedly much smaller studies. Mm hmm. Mm hmm. And then next on the list was this idea about signal seeds, which is basically So that's not something you would probably cook with unless you have a problem with constipation. Maybe you might put it on your porridge or something. Yeah. Yeah. But the next one after that is. Is that the same as psyllium? Sorry. Yeah. Psyllium husk. So that's what you might find in supermarkets or health food stores. Gotcha. Yeah. Yeah. So that was number two on the list. That also used to be able to give about $0.04 on. The next thing on the list was fenugreek centigrade. C Green seeds. Yeah. Wow. So we call that we use the leaves in Indian cooking or Métis. Yeah, but. People do cook with. That. We do. Yeah. Absolutely. Yeah. Yeah, yeah. And so after reading that, I had some discussions with, in fact some patients from many friends as well, and they told me that they sent the seeds that we've lost water and then drink the water from it. That's it. And it's, I'm really enthusiastic to know what recipes you see, because I've also seen my taste. It also tastes great. I'm not quite I looked up a few recipes. I'm not quite sure how I would incorporate that, but it seems that people would take it for diabetes or more using like a powder and taking it as capsules. Mm hmm. There were a couple of studies from India where people would actually pass the powder and acid flour. Okay. Toxins with the fenugreek powder sort of incorporated. Gotcha. Yeah. Yeah. And that seemed to have quite a good effect. Fascinating. Yeah, absolutely. And then so the next one on the list after that was natural green. That's green. Green letters that just grow everywhere that grows like this. And that one seemed to have quite a big effect in some studies. Other studies had less of an impact, but certainly the best studies showed that. So would you still experiment to see what I first want to think about? Oh, so I've taken two cooking nettles from, I don't know. I've got. A very good friend in Switzerland and an Italian friend who taught me a recipe for natural. Risotto. Oh, wow. Which is really tasty. So basically, if you've got if you've got a dog in the beginning, probably got nettles somewhere. Yeah. Yeah. So instead of just chucking in the compost and you can actually fry them or you fold them and then mix them with rice and it makes a really good results. Amazing. Amazing. Tasty. Yeah. It's I mean, obviously the studies work looking at natural results of it. Yes. That might have an effect. So. Yeah. Yeah. And then there are a few Chinese remedies on the list that are complex mixtures of plants is probably not something you could easily breaking of sorts. Okay. But then with the last one of the top six on the list is not just sort of old, which is the black seeds. Gotcha. Yeah, we use that quite a bit. Love it. But it. Yeah. I've got a really nice friend of mine suggested Britain's stir fries, and it actually works really well. Yeah. Yeah. Vegetables and stuff. Amazing. And that's also reduces effects. Be able to see you have to take months and grams a day of it's obviously you know lots of time and that reduces your experience by one 7% which is again better than that for. Yeah definitely. And then there's a lot of other plants. Some of it's interesting, some of the more traditional plants that people traditionally associate with diabetes, like cinnamon, didn't seem to have a big effect on these. Wow. So, yeah, I mean, yes, herbal practitioners recommend cinnamon, and I love cinnamon, but it's probably not the best thing for, you know, if you want to take it as a treatment for diabetes, it probably doesn't have a massive effect. Gotcha. Okay. Ginger was a little bit better, but again, not a massive effect. But one of the studies we're looking at herbs is, of course, what we don't really know fully. It's how what happens if you combine. Yeah. And potentially I guess if you put two or three different ones together, you might have a much bigger effect than any single one of it. So some of them probably have different mechanisms of action. Yeah, once they work. So for example, the moringa that I mentioned, we know that that one inhibits some of the enzymes and so it makes it that way a bit like a caboose, which is a treatment conventional. That's gotcha. Basically slows the breakdown of carbohydrates, sugar. Mm hmm. Whereas something like fenugreek has it. It works more by reducing your release of insulin, and it also has a sort of soluble fibre and slows down the release of the sugars. And a lot of the plants have a fibre fibre just fine. So that's probably good. Yeah. It slows down, you know, reduces the glycemic index, slows down the absorption of sugar, it helps to flatten that sort of. Mm. Sugar absorption. Yeah. Yeah. That is fascinating. And I guess one of my questions is with this systematic review or the multiple ones that you came across where all these being performed, because I certainly didn't hear about this at med school and I don't think it's a UK thing. So are there particular countries that have an interest in this? Are they coming from places like Iran or India or China perhaps? Absolutely. You're quite right. So in fact, yeah, I know about that's what I thought. And I think most doctors and even most diabetes specialists, most nutritionists in the UK, because it's it's just not part of our training, unfortunately. And you're right that most of these trials were not done in the UK, so most of Charlestown in China or traditional Chinese medicine, most of the things trials were done in India, Asia and the maximum trials, all of those were done in Iran. Okay. Industrial research or herbal medicine. Gotcha. The fibre gel was psyllium seed. Once a lot of those trials were done in the US. That's sponsored by the company. Right. So there's potentially a conflict of interest. Sure. Good. Serving some of those independently. Yeah. So not much of this being done in the UK and I guess we do need to do more because obviously with the review only found plants have actually already done trials and for which there was already a systematic review and there's lots of other stuff out that hasn't had that level of research. Mm hmm. So, for example, there's a really interesting on premise import from Gamal. Gamal. Gamal is the, I guess, the Ivy League name. I'm not saying the technical name is Jemima. So that's true. Mm hmm. So if you it's something that herbalists use quite often in the UK, parts of based medicine, if you taste it's liquid extract of it's, it has a quite a magical effect. You can't taste anything sweet afterwards. It completely inhibits your sugar receptors on your tongue. Wow. So it's the favourite trick, which is, of course, of herbal medicine herbalists who are sceptical about herbal medicine should say because this gave us teaspoon of it and then gave us some custard cream and it tastes like a square of milk chocolate. Just it's like butter, it's got no sweetness, it just doesn't have an interest afterwards. Oh, my life taste. Yeah. Watson Yeah. Yeah. How long does that affect last for? A couple of hours, probably a couple of hours. Wow. So, you know, like some people with alcohol, we don't want to drink alcohol. We give them lots of use. Yes. Yeah. So for people who have a really sweet tooth and can't stop eating sugar, Jemmy would be a really good solution because it just take a teaspoon of it and then afterwards you won't eat anything sweet for the next couple of hours. Now you lose all the pleasure. Yeah, absolutely. Yeah. So herbal medicine superpower. If you want convincing that herbal medicine works since Geneva. You know, we don't want to read that new research. Yeah, Yeah. I mean, whether it has any effects long term on diabetes, there's less research on it, which is why it didn't come up. I've read the review, but I was just Googling out here and actually found someone has now done a randomised controlled trial of it and it does rating. So to be able to fine about half percent. So what do you do about as good as metformin. Wow. Wow. So that's just using it maybe as a capsule. But in fact if you took the liquids, what you're telling me, of course people who like should be sugary things with lots of music because yeah, you would lose all the enjoyment. Yeah, absolutely sweet stuff. But if you you know, if you have a sugar addiction, you can't stop. You know, you're one of these people who can't stop eating chocolate. Once it starts, then something important to me was probably way. Less fussing and trolling. Yeah, Yeah. On the subject of scepticism around medical herbalism, I guess, you know, doctors who were trained within the UK system or the US system might look at these systematic reviews and say, Oh well, those have done in a wrong, they've got different, you know, methods of, of rigour and we can't really trust, particularly if it's coming out of China or the rest of it. What do you say to those kind of sceptics around the studies and is there part of you that sort of agrees that we should be repeating them on on European soil, or do you think that they're just as good as the way we would do it over here? So I think that's a really good question. So one of the systematic reviews assess the quality of the inclusions and I guess obviously it's variable. So some of the studies are of poor quality for models. So yes, obviously this is I would probably have to go back and read each of them in detail to remember to remember the details of it. But some yes. On some things, you know, for example, the results on Psyllium since was based on only three studies. Some of those were done in the US. As I mentioned, they were some of the least funded by the company. Yeah. So that's something where you would probably want to repeat it. But I guess the other issue is what's the best dose? What's the best? Mm hmm. Because for example, the same Greek as I mentioned, there were lots of different preparations used. As I mentioned, some people incorporated in their flour. Yeah. Making sure putting these other people in capsules, maybe those things aren't equivalent. And I think those sorts of issues, since it's a process. The Nigeria seeds that was a some studies using oils, some using the powder. So the ones using the pounds of the tough with after effects for the ones using the old example aloe vera that was studies using the capsule and those less effective than the ones where they were giving them fresh juice and crushed. Okay. But the the only one trying each of the fresh juice and of the crushed leaves. So I guess it would be good. You know, from a scientific points of view, it was good to essentially do that. So and there are also lots and lots of research done on so absolutely, there's always space, more research. Yeah. But I think the key point is, yes, of course there will always be a need for more research and there's so many problems around the world. Used to be consensus. It's actually, you know, you spend the next hundred years doing clinical trials and of course all that needs to continue. But I guess what really surprised us is that there's already a huge body of research that's been done. And actually, I think we need to see doctors need to stop telling people there's no evidence that's not true. There is evidence. And and, you know, I think the beauty of a lot of this stuff is that it's not really harmful. So worst case scenario, even if it doesn't work very well, it's not going to do any huge damage. In fact, most of these studies people are taking the herbal medicine alongside the conventional. It's time to stop it. And there were almost no reports of serious side effects. I mean, a few people complained of upset stomach, nausea, diarrhoea. Um, and there was one report in one study of someone who had too much sugar, high protein. Oh. Okay. And that was a person who was already taking insulin for that diabetes. Gotcha. So I guess if you're already on insulin, then you need to be a bit careful because you don't want to give yourself a hard time. I mean, of course insulin give you a hypo even if you're not taking it. Yeah. Yeah. But that with no reports of high dose. So we have to know that sugar nestle in people who are not taking insulin seems to be perfectly safe to take it on side. Yeah. Mentioned treatments. Um, so it seems to me to be a bit of a no brainer. And also I think from my personal experience, I've spent quite a few years working in these sorts of health since we have this very diverse population, people from about 40 different countries registered with and a lot of patients, especially the non British patients, are really interested in herbal medicines and many people just don't like taking pills. And in fact, the worst control of diabetes, people with the highest blood sugar levels were often from minority ethnic groups and so on, and often doctors are turning them around. What can we do to improve the diabetes control and inspections? And very often they come in and just think about herbal remedy. Yeah, or even maybe if they weren't too scared of their GP, they might even ask for advice on. Yeah. Which might work. Mm. And so being able to give some evidence based advice, you know, what's childhood. Well maybe fenugreek would be good but making jungle cinnamon because that's probably not going to make a massive difference. Mean that could be really valuable. Yeah absolutely. And in fact I've got some friends, colleagues in Switzerland who've started to put together information, booklets with different information on those evidence based herbs, plants, foods, in fact, spices, which can help management of diabetes. So this is coming at it from a slightly different time because traditionally we've been focusing on these are the foods you need to avoid. You know, anything with sugar, carbohydrate points that you need to voice is quite a negative message. Yes, that is true and it's important. But here's a positive message. You know, these are some things you could choose. That's your doctor going to help with, with control of your diabetes. An interesting one is the bit similar in Kerala. Okay. Yeah, we call it Kerala. Kerala in my household, but my mum prepares and it's but you have to because it's quite bitter. Yes. You have to sort of mellow the spice and stuff but it's let's you one of my favourite things that my mum makes. Yeah. Yes. Well very popular in patients and in stocks. There was a systematic review on Kerala which was it was one of the most effective but it didn't have an effect. Okay, better than nothing. I know. You know quite a lot of diabetic patients. Really not. Yeah. That was part of your diet is that. There's. Lots of things. Yeah. There's lots of different ways in which this is coming from my mum now. I haven't actually looked into it, but those are different ways in which people prepare it, right? So you can either have it sort of sauteed like my, my, my family make it, but you can also have it as a juice. You can also have as a powder you dehydrated, dehydrating protein powder, you add it to water or whatever. So there's various ways in which people are not too sure which one is more effective. But it is fascinating that this is stuff coming from different ethnicities, different parts of the population. And that was going to be one of my questions that she regarding, you know, the location of where you tend to get more research in this field seems to marry quite nicely, at least from my anecdotal experience of a being in India, finding myself, but also be working within an urbanised environment. I see lots of people from diverse countries and backgrounds where they might be a lot more receptive to the idea. Or they were. They grew up with the idea of herbal medicine being alongside conventional medicine or pharmaceuticals or whatever you want to call them. Is that something that you noticed? Yeah, absolutely. Absolutely, definitely. In fact, that was one of the things that really got me interested in this whole idea is, as I mentioned in practice, well, it's very multi-cultural. And I did talk. Patients come and say, you know, Dr. would you take this medicine I've got sent over from Pakistan. Yeah. Some with whatever and often it was just £2 a day. Just in a little baggie with no name on it or anything. Yeah. I'm absolutely. And I'm as I'm sure you know, the risk of diabetes is much higher in patients of Asian origin. Also non-Catholic, non-religious. So the UK British population is about 67% prevalence diabetes in the not ethnic groups, it's about 12%. And in some Asian ethnic groups, especially Pakistan, it's up to 20%, 20%. Age standardised diabetes is massive and also the control of diabetes is less good. So there was a study in in Glasgow in Scotland, which showed that the percentage of diabetic patients who had poor control, which was defined as having to be one CNS greater than 7.5%, which is the sort of target in this treaty. So white patients want Scottish spaces since 47% were above that supporting control. So that's pretty bad. So percent for black patients in Glasgow it was 57% for patients of Pakistani origin. In Glasgow it was 66% in two thirds have poor control of diabetes. And obviously that then translates into more complications of heart disease, kidney disease, all the rest of it. So it's really important to, you know, redouble our efforts to try and improve control of diabetes, especially in patients with minorities. And this is a real opportunity. This is something that people are really excited about it find it interesting. As you say, it's part of this culture, what they grew up with. And if medicine can embrace that and say, look, you know, this is something that you can do to help people diabetes, I think it would help to engage people more, get the more interested and make them, you know, take on board some of the other advice as well about reducing carbohydrates. MM Absolutely. But yeah, I completely agree that I think people who've come from a different culture are probably much less sceptical about herbal medicine, but maybe, you know, your standard white British person who over the decades indoctrinated that, you know, just stuff is not scientific, there's not much evidence that it works. But even that I mean I think quite a lot of white British people are actually all interested in. Oh, yes. Yeah. It's just a lot of people automatically assume that doctor is going to have a negative reaction to all the mentioned. Yeah, yeah, yeah. Over the years, I mean traditionally medicine has been quite negative about, you know, herbals and stuff. And I think often people have been sort of have negative comments made by lots of rubbish or all the good that is. No. Yeah. So a lot of people I think don't even bother asking the doctor. Right. Absolutely. And I guess you know, when we look back at these studies and obviously it's impossible design to design the perfect study in particular featuring a review of existing studies. You know, you can't go back and tinker with them, but let's say we were starting from a clean slate. What are the issues with using HPI one C as a marker itself and what would be perhaps a better way of measuring the antidiabetic effect of a either a pharmaceutical or a herbal medicine, and B in terms of the heterogeneity, in terms of the actual substances use, you mentioned powders, oils, the actual plant itself in a juice like aloe vera juice. I guess you'd ideally want to, you know, do the, the review on a specific form and just use studies grouped in with those. So yeah, what would you do differently if you, if you did have a magic wand and you could change everything. Okay. I wish I didn't have a magic wand and unfortunately. I didn't want to go there, But. So well, first of all, in terms of how you measure the effects, a lot of the lots of different measures. I mean, as I mentioned earlier with the study on moringa, the simplest thing to do is just to measure people's actual blood sugar. Obviously, that's a short term issue. It's not fasting. Blood sugar is one measure, but it's only it's a bit of a snapshot in time and doesn't really tell you how good your diabetes control has been in the last few months. So it should be able to see it better that it's giving you an average. How you control this been over the last two or three months was obviously, you know, the absolute gold standard which has been done for some of the modern medicines before. It's looking at mortality effects. Does this actually save lives and does it reduce deaths? But that requires massive numbers of patients, you know, very long time follow up, obviously. So I would say that HB, I won't say is quite a good compromise, but obviously you need to have a follow up of at least two or three months and there are some studies showing people up for a few weeks and that really isn't long enough to know what the true effect is. Well, I guess if you can follow people up for six months or a year, that would be even better, because I'm sure, you know, it takes a while to actually have an impact. Yeah. So I guess if I was starting with a clean slate, I would I would support four patients per year. I want to check that haemoglobin making list each year. One seems every three months over that period of time. And obviously, as you say, you would want to pick the frustration that seems to be the most effective either. A lot of have missed traditional medicine recommends or from existing evidence. Yes. Yeah. But yes, I mean, there have been trials stone and all sorts of different preparations of something. And I guess I would I would go with the one that seems to be the most effective. If you could pick one preparation for all of them that appears to have the largest effect. Which one would you go for? Would it be a tincture, an oil, a powder, a capsule? Oh, I think that's sort of a case by case basis. It depends on which, of course, I mentioned for the other variables, a fresh new for the fresh juice that seem to have the largest effect for the system. That's a powder. That's like a gentle suction. So is it going ever since it was the powder again? But, you know, there weren't any trials on actually using the whole sequence of cooking, for example. Gotcha. So it was powder. It was oil that wasn't at trial. BE Of the other for fenugreek. I have to be honest, I can't remember which one came out best. The review on spring break was a bit old, so we're actually in the process of updating it now. All right, colleagues, we're going to redo it. There are more trials in with collaborating with university in China, some trials done in China as well with the use fenugreek. And hopefully when we finish that, that will give us a lot more clearer information on what is the best preparation of fenugreek, the best dose. Yeah. Yeah, that'd be awesome. And in terms of other words from a double, click on that for a second. So all of your fresh appears to be best. Did you remember how much they would use them? So if it was the crushed leaf, it was 15 grams twice a day. 15 grams twice a day. Okay, so that's a fair amount. I'm just thinking of the leaf because it comes out like a gel, doesn't it? Yeah. And then you just take it as a okay juice. The studies on juice fleshed out averages 150 mils, one stage. Oh, right. Okay. That's quite expensive in this country. I guess it would be. But in the more sort of exotic climates where you find out average is growing well out of there, it. Grows and grows a houseplant. Oh, can you? Yeah, I've got in fact, I've got so many at home that my wife keeps nagging me to get rid of them, give them away. I bought one and in a fight about 15 years ago and it's had so many offspring. I mean, I've probably donated literally hundreds to different, you know, things over the plate, you know, or just giving them to friends and stuff. And it just keeps sprouting up. More babies all the time. I keep repotting them and, you know, it just doesn't stop. So it's brilliant. Very easy to grow your cell phone and all you need is, you know, well with those. So you don't even need to win this. So you can grow very well in tools. Yeah. Yeah. Brilliant. Okay, cool. So other for an online life era, we talked a bit about the mechanism of action for a husk, you know, creating essentially a barrier of absorption. So you're going to have less of the sugars absorbed quicker. So you essentially give your body a bit of time to release the appropriate amount of insulin and you have a nice sort of glucose flattened curve. What happens with aloe vera? Does it work in a similar way? Is it the fibre constituents or the other sort of compounds that might be working? That's a very good question and I have to be honest, a lot of I'm sure I suspect that I mean, I know the anovia itself and the gel has a laxative effect. I guess the gel may contain some sort of soluble fibre, but whether it has another pharmacological activity, I would need to Look, let's not forget that. Well, I'm not 100% sure. Or get any particular mechanism of action for the other top six. That struck you, perhaps. Yes. So the fenugreek the it acts to reduce the incident production, which is interesting because I don't know exactly how it does does Yes. So fenugreek stimulates release of insulin and it also contains germ forming fibres to make the stomach not just. Yeah, interferes with glucose absorption from the intestines. So that's super interesting because that's working on multiple actions. Yeah. Compared to the drugs that we use, we use a plethora of different drugs to do those different actions. Yes. Fascinating. Exactly. It's there are many hopes that this is going to actually a combination. Yeah. Or if you have a number of different activities and obviously you could incorporate two more herbs in you know, a recipe. And in fact, some of my colleagues and it's really been trying that approach for the recipes and list of plants that can be useful for diabetes. I've been trying not to Ethiopia. I think the study is still underway. It was about six patients, so I think I already saw that preliminary results are really promising, but just that approach of influencing patients. Okay, here's the list of participants. I try and incorporate them into your diet. You can take two or three from the list and they found really significant reductions already in burns patients. And you can see levels. Hmm. Just through that provision of voice. There is some sort of an ongoing discussion amongst people who are touchy diabetes researchers, but also metabolic health research in that we should be minimising glucose excursions. Even in a non diabetic population, there are certain benefits to ensure that we're not having these swooping up and down curves that, you know, we see if we're having a big sort of carbohydrate rich meal, we might not necessarily be labelled with the type two diabetes label or the prediabetes label, but there is a growing concern that these precede diabetes for ten years or so and they proceed in sort of instant resistance precedes everything. What's your opinion on that and do you think there is a place for herbs to have a role in preventing the onset of prediabetes before we get to the point where even using herbs to treat people in the first place? Yes, absolutely. And I mean, I think I didn't mention it, but a lot of the studies also were looking at prediabetes. So our review was focusing on diabetes, but pre-diabetes, it's just, you know, it's a spectrum at the end of the day and we have sort of maybe artificially picked points on that spectrum. When we say the case which we won't see is above six and you're diabetic, if it's five over six or 6.5, then you're pre-diabetic. But you know, it's all a spectrum and these things are going to have the similar. But whatever points on that spectrum to take is I'm incorporating these substitutes, I'm sure will help a pre-diabetic in the prevention of diabetes as well. I mean, obviously, one of the key issues is weight loss as well. And I think, you know, having the loss of sugar carbohydrate for very, very rapidly, that's going to impact source the diabetes. So it's absolutely the facts fact for our next review of any group that we're looking at it would treat diabetes as well. But I pretty sure that it will have a similar effect. Yeah. We've had a history of using compounds like these in medicine for years, right? I mean, if you think about metformin, what the origins of that are, I mean, for anyone that might be on the fence about whether we should be even considering herbal remedies, perhaps we could use that as an example of how it essentially stemmed from a plot. Exactly. Yes. So I think many doctors and probably most people don't realise that metformin is a derivative from a natural product. So it actually comes from well, it was derived from a compound called gamma, which comes from a principle goes through this enormous form, which is a European traditional herbal remedy for diabetes. So does. It come from a. Quantity, quantity that is the compound from going through? And basically metformin is two quality molecules stuck together with a with a lethal group of stone cold. And that's how metformin made it actually derived from natural products. And so was the historical use of the original compound. But all. Right. So downstream is still used by herbalists and it's part of the traditional European pharmacopoeia. This is what was useful for diabetes. But but even before that. So going back to the ancient Egyptians, the ABC Papyrus, which dates from 1550 B.C., is already suggesting a high fibre diets. Oh, really? Three. Yeah. Wow. So that's something that people have known about for a long time. That's amazing. I went to Egypt recently, actually. We went to Cairo and we visited the pyramids and the papyrus is I mean, were everything on papyrus and stuff. It's an amazing product in itself. And I guess the only reason that we know about it is because they actually wrote it down. But you know, many other cultures in the world, they don't have such. Yes. Even here in Europe, you know, probably it dates back to the Romans or whatever. So but probably most cultures throughout the world use some form of herbal traditional medicine for treating diabetes because. Obviously, the term diabetes is remnants of modern actually traditional cannabis. Africa are able to diagnose diabetes without even resorting to medicines. They basically well, in the old days they used to test urine systems or an alternative was they would get people to pee next Alonzo and see if it's. Yeah, yeah, yeah, yeah. It's a good thing we've moved on from that. Yeah. So you mentioned cinnamon here, which is like people are on the fence about cinnamon. It's interesting you found that it didn't have an effect. Was there a preserved effect of cinnamon? Depending on the type of system, because from my understanding, there's two key types, right? There's there's a true cinnamon or on cinnamon, there's cassia. And the cassia I've heard is in some cases polluted with coumarin. And that can have the anti-diabetic effect, but it's not something that we see with sale on Cinnamon, Did they differentiate what substances in the world they just use and, you know, cinnamon? So some of them reviews grouped together and some of them have looked at those separately. so the latest systematic review that was done since buying the magazine itself didn't separate out the different types of cinnamon. It all got together. yeah. So for many of the trials, actually, the type of cinnamon used wasn't even clear. MM. So this particular review included, Yeah. This particular review includes 18 randomised controlled trials on cinnamon. Interestingly, quite a lot of them were done in Iran. Okay? Nine of them were done in Iran, two in Thailand, one in China, two in the USA, one in England, one in Pakistan, one in the Netherlands. And most of them actually didn't specify which type of cinema they were using. Only it's much more separate from specify that they were using the. Cassia versus the Salem. That's really. Interesting. They didn't analyse them separately. And of course we do have ranges. There is an issue about potency. Yeah, so. That's one thing I was going to ask you about in terms of, you know, if anyone's listening to this and perhaps they are prediabetic and they've spoken to their general practitioner and they've got the go ahead to try some lifestyle interventions before they might be onboarded on to a pharmaceutical as per their advice, like how would one go about choosing the right preparations or good quality herbs and spices to potentially use in the medicinal manner? I mean, I think if it's something you're incorporating in your diet and your preference, then I guess that's the way you would choose any region you go when you go shopping. I guess the quality becomes more of an issue. You could take them with just one product, one capsule or something. So I think in those cases I would go from looking. First of all, I support a traditional medicinal registration, medicinal system of traditional product registration. All right. Which means they have to go through a certain number of quality tests, etc.. So those would be the ones, you know, as far as buying is actually medicinal. Look for that. Traditional herbal medicine certification is not. But in fact, I think it's now illegal to market something as a herbal medicine in the UK. Without that, I think there's still a lot of hopes that are being kept around that are being marketed as supplements. Yeah, that particular claim. So you do have to be a bit careful and yes, I mean I know we've done studies of the results of John's was so comparing products in different supermarkets and the quality can be extremely variable. Yes, it's a real minefield for the consumer, right. Because the evidence and the studies might be using a standardised preparation of high quality. But what you're actually able to access in your supermarket or maybe even your local health food store might be entirely variable and have a real sort of and which is where I see the scepticism from general practitioners and other medics who can't ratify the quality of them versus the drugs that are held to quite high pharmaceuticals standards, of course. Absolutely. I suppose that's that's true, especially for the sort of capsule type formulations. But the good thing about the and systematic process involves the Russian foods, so that doesn't apply so much. Yeah, because I guess, you know, none of our foods is quality controlled the same way sort of pharmaceutical products. Yeah, yeah, yeah. That's, I mean, I guess most people know what to look for when they're buying things in terms of what's going to be good quality or not. Yeah, we spoke to Simon and he was like, We need to use the sniff test. You need to smell that. You need to ensure that there's a good amount of flavour. And I guess you sort of answered this next question that I had for you around the argument of it. Should we be optimum up to opting for isolated compounds or the whole herbs and spices themselves? Where do we sell that? Because there is a, you know, huge interest industry of isolating certain compounds, whether it be curcumin or resveratrol or quercetin and putting it into a pill form that's very accessible for people and perhaps even being a very high quality. However, you are stripping away a lot of the benefits from that whole herbal spice that might be explaining that, you know, in this case the antidiabetic effects that we see. Absolutely. And I'm being a bit cynical. I mean, I think one of the main reasons that people like purifying pure compounds and is that you can make some sense and make a lot more money out of this. Yeah, Yeah. But but no, absolutely. I mean, I think many of these plants, there's probably more than one compound that's working together to produce the effects. And so it's likely to probably have a bigger effect. I mean, as a as a sort of whole has a spiritual compound, bearing in mind that a lot of these things as well work through the fibre contents and find these. It's a pure compound. MM Yeah, yeah. With multiple subtypes. And yeah, I always think about it from the perspective of whole plants because you have the entourage effect don't you, for the different compounds that you find. It's not just the question of the vitamin E that's having an impact, it's the fact that you have it in combination and it goes back to the synergistic effect. That's a bit of an unknown with all these different herbs and spices, right? Absolutely. Absolutely. And in fact, you know, then what happens when you had several. Yeah, yeah, yeah. Just. Yeah, yeah, yeah, yeah, yeah, yeah. That's kind of what really interests me as well. It's like, okay, well, could we test some of these combinations that perhaps work better than other combinations? You know, people have sort of like little heuristics of of how to get the most of the ingredients like lightly steam them, don't cook them for too long unless they're tomatoes, in which case you get different benefits from eating them raw versus cooked for a long period of time. So all these different like I think traditions that have been passed down are probably encoded in some of the recipes that we still have access to. And that's why I always like, look at things through that lens as well. Yeah, it's really interesting and I think we've got a lot to learn from people who know how to cook things to make them tasty. Because I have to confess, after doing this review, I went to buy some carrot in the local supermarket and I tried cooking it and I have to say that's probably my cooking. So yeah. So again, Hudson, I tonight someone who knows how to cook is. Yeah, like it tastes good. Ah, you're not alone. Honestly, when you use it, you really know how you need to know how to make it. Because I remember I found that once in my mum's and my family's fridge and I tried cooking it as I would do some aubergines or some courgette because it kind of looks similar to that. So I thought, Oh, well, you know, just cook it like another nightshade. It doesn't work like that. It's very, very bitter and you have to use a bit more oil than you probably would. You need to cook it for a little bit longer. And that's why I probably, you know, the powdered forms of gorilla are probably more except acceptable to to people if they're coming at it for the first time. And of course, different people have different same spots and they use different things. And I guess some some cultures, some families of four people and setting bitter tastes, whereas yeah, in the West we're a bit more sanitised in tolerance to it's taste. Yeah, I think it's something that we develop from childhood. There's this really famous Oscar that was printed I think was in The Guardian and the New York A some some paper from them. America, I think was The New York Times, and it was a series of photographs and recipes of breakfast from around the world. And the title of the article was What Kids Eat Around the World. And it was just children who were photographed next to what they ate in the morning from different parts of the world to Brazil, India, China, Thailand and obviously the US and the UK. And you can just imagine sort of the image of the the the British kids and the American kids. They had like wee toes and Lucky Charms and you know, all these sort of beige items and you go to somewhere like India and they have like a trolley and they have all these different like lentils. That's for breakfast. You go to Brazil or you go to different parts of, of Asia or Turkey, and they have like Hannukah and they have pickles and they have so what they're they're eating for breakfast is actually quite sour. And it kind of speaks to the acceptance of some of these different ingredients, I guess is part of their normal diet. Yeah, You I think you're doing a systematic review on patient perspectives of herbal medicine, is that right? That's right, yes. So we've had a students who worked on it and we're just updating it now from different countries around the world. And that's also been really interesting. So there are lots of things that encourage people to use herbal medicine, parts of it's this culture of familiarity, advice from family and friends, but also people for whatever reason, just taking all the medicine who maybe have suffered side effects or just don't mind taking pills. And the interesting thing is that a lot of patients who choose to take tablets, since I'm a doctor about. Mm hmm. Because that's that sort of mistrust is something to talk about earlier that's that worries about how it's going to react. Yeah, but I mean, yes, many patients are enthusiastic about this, especially patients from ethnic minorities. Interestingly, most of the research done in high income countries like the UK is in one study which was in Scotland with patients of Asian origin in Scotland. Few studies in the US again focusing maybe on ethnic minorities that we know study is really asking, you know, what's what just the average white British patient think about taking health and medicines loans. So that was actually done, not necessary, but most of the studies were done with people really enthusiastic. So, for example, in the Asian community in Scotland, a lot of people are really enthusiastic about taking on some raising taking some of licence. Yeah, So there's definitely an opportunity that, you know, to tap into that natural interest and you know, just maybe add some evidence into the mix so that people are choosing the things that are likely to make the biggest difference. Yeah, yeah. Everything that we've talked about today, you know, underlines the fact that herbal medicines on and they are certainly powerful. There is evidence for them, there is acceptance for them. It's the foundation for some of the drugs that we most commonly use. I guess the next uncomfortable area that we need to address is what about the impact of the placebo effect? As we've been hearing more recently about antidepressants and disentangling the placebo effect from the genuine effect of those drugs? How do we disentangle the placebo effect, particularly if there are certain people in different ethnic groups that are more bullish on the idea of these medical herbs? Sure. Well, of course, all of the studies that I was mentioning in the systematic reviews were randomised controlled trials and the control groups many times were given a placebo. So that automatically takes account of effects. So that means that the effect was measured by the trial was on top of the placebo effect. Some difference between the actual active treatment versus the placebo. Of course not all, not all of the trials included a placebo, so some of them were against usual care. So in those cases, yes, there could be a placebo effect, but what lots of the studies were showing against a placebo. So we can discount that and say what, what discounts. It's obviously the placebo effect is real. But say that, you know, a lot of these is actually there is evidence that they're possible. Mm hmm. That's great. I want to dig into a bit about your background. So you mentioned your work as a general practitioner and your work, is it primarily or largely with homeless patients? Yes. So I work as a GP currently. It's a practice for homeless patients in Oxford Street Medical Centre. Okay, great. And talk me a bit about talk to me a bit about the arc of your career. So how did you go from practising as a general practitioner getting involved in medical herbalism and, and now looking after patients from a disadvantage and a background? Okay. I mean it's been, it's been quite a journey, I guess. So I've been interested in herbal medicine research since even before I qualified. So I guess I also grew up in a household where my mum was really interested in herbs. She had a smoke sage, I mean European herbs, but she had her herbs in the garden. She would make her soup with herbs that evening. She would often treats coughs with time. Yeah. When she got the menopause she would treat that with her sage tea. Yeah. So I grew up with that sort of background. And then when I was a medical student, I went to do my elective in Uganda and he stopped for care. I'm in a traditional healers clinic. I spent two months in. It was a local NGO started by, in fact, the local MP who invited all the traditional healers in the area to come together. It's a conference where they shared their recipes. They had about 40 traditional healers and they made standardised medicines, herbal medicines for treating common conditions like diarrhoea, worms, diarrhoea and actually had a small laboratory on the site where they would take blood samples and do microscopy for. Malaria. Parasites, eggs of worms and stool samples. And then they would prescribe their standardised herbal medicine. Right. And my project, my first ever research project as a student was following up those patients who were being treated for malaria and taking blood samples from them to see Wow. And the majority of them got better, which was really interesting. So that got me really interested. And then I helped to start a network of people doing research on medicines for diabetes, sort of For. Malaria. For malaria, Yeah. Uh huh, yeah, yeah, yeah. And was involved in a number of other studies on herbal medicines for diabetes. So I went to Madagascar for ten months we did a trial of pain and extract herbal extract from a local plant for reversing resistance to chloroquine. The standard treatment for malaria at the time I thought was really interesting and then went to work in Mali, in West Africa, where we were looking at a range of plants and being used traditional for treating malaria, but then focussed in on one particular plant called the Mexican pumpkin patch. Migrants. Mexican poppy. Oh, right. What's that? So the flowers looked like kind of most of the yellow sort of poppy. The leaves look more like a thistle very quickly, and it originates, as the name would suggest, for Mexico, but it's now become naturalised in much of Africa. Not sure why, but my theory is it means a contaminants and I smoke from Mexico, but it's okay. So in the particular village where I was working, the village chief was a traditional. He had learned about this from his grandfather. So that been several generations experience. So in a survey, the people who've taken this plant have the best results were less likely to have severe malaria, less likely to improve from malaria. So we then ended up doing an observational trial and then a randomised controlled trial comparing it against conventional treatments, which showed that it was almost not quite as good, but almost as good as conventional treatments. Almost as. Good really in terms of improving symptoms, in terms of reducing in terms of reducing the parasite counts and clearing of parasites completely. It wasn't as good then in that context, people got reinfected very rapidly. Yeah, clearing the parasites wasn't the main thing, right? In terms of improving their symptoms and reducing their risk of severe malaria. It was almost as good. That's amazing. I'm bearing in mind that, you know, when you were in a village that's 40 miles away. Yeah, that's not interesting. No running water or very poor access to healthcare. You know, knowing that that out of the 60 or whatever plots that people might use for treating the this one seems to work really well, giving people that knowledge is quite powerful. That's incredible. Wow. It means that, you know, people know what they can use, hopefully even when medicine isn't available, as unfortunately it's gotten worse recently in Somalia. Since I work as now, civilians have a conflict situation with the stomach, fundamentalists, etc.. So yeah, I mean there they're all the things that can help. So I think, you know, that's what's the lesson of doing such that perhaps more and more recently really started getting devoted in terms of medicine in the University of Southampton, which has a team interested in interpretive medicine, which is really giving me an excellent opportunity to work for clinical trials here in the UK as medicine. But it's a lot harder to do clinical trials here because regulations obviously are much tighter, sure than in Africa. So there's many more bureaucratic. Yes, yes. Just through basically you can't do a clinical trial. So clinical trial unless the product is manufactured to give in, stands for many of the most promising novel products. It's actually quite difficult. Yeah, but I mean, that's nonsense. Yeah. Yeah. So you're limited from the pool of meds that you could. And so. So clearly your interest in herbal medicine was was started right. Start your career and now you're getting an opportunity to research more widely, you know via reviews and the like. What about the other sort of site here which is the general practice and homeless patients. Right. So well it's really good to be able to offer people a menu of options in terms of what's treating this people can take. And so although I don't practice as a hopeless, I do offer people advice on herbal medicines when they're interested in it. So particularly in the in the homeless population, yes, diabetes is a problem. So in fact, recently we had a Polish patients who would not view has diabetes and who would not take it, just did not want to take any conventional medicine sports. And he had his how much rest with different herbs that he wants, which he gave me. And I said to him, You can try it. But I mean, his problem was unfortunately, he couldn't actually access those particular herbs that he wants in here in the UK, right. To get them. And he didn't have a kitchen as prepared as he was so that that's a bit a. Bit of a challenge when. People don't cover kitchens actually book or prepare them that you're really reliant stuff we combined capsules. Yeah. But so we do have a homeless medical fund the charity that pays for various treatments and it just doesn't pay for and so I do purchase through that So St John's Wort for depression, for, for helping people to sleep. So that's something that I do offer to people for whom I would be interested in this money. I mean, obviously it's not as strong as your benzodiazepines. Yeah, it's really Yeah. You know, for people who are open to exploring an alternative, it's definitely a good option. So what was that for? Valerian. Okay. Yeah. Just more frightening. So are there any others that you think of go to? Because that's a very common problem. You know, I was conscious about benzodiazepines and stuff. But when you have a policy not to prescribe those also addictive also some of which I think probably one of the top causes of death, sometimes population is overdosing and quite often prescription medicines out of that, that's benzodiazepines instead of drugs, gas to avoid someone who gets. So we try and avoid all those things as much as possible. So yeah, it's extremely useful to have an alternative. So let's say for Americans, the one I use the most for helping people see we got lucky. Also having an interest in comes to our oh one patron charity. The NHS. Yeah that's really helpful for a chronic pain. This is. Amazing. Yeah. And if there was a putting type two diabetes to one side and anti-parasitic have was as well, if there was a an ingredient or herb or spice that you think is a good all round to have that we tend not to have it our cooking like you know ginger or fenugreek or you know Nigella is they're sort of a powder. You think that people might want to experiment with the general health and wellbeing benefits? Well, I would say the one that I would probably pick for that would be my Gemma. No jealousies, okay? Because not only is it good for diabetes, as we've been discussing, it's also good for respiratory problems, for asthma. And believe it or not, they've done a randomised controlled trial of patients in conflicts that showed that it was actually helping. Wow. You know, a team in Saudi Arabia defence and I never to cook with my since, you know, it's just not part of my upbringing I guess, but it's something that came out of the review. So I went out to the local supermarket what's not back from the seats. And now every time I make stuff, I stick it in and it's really nice. It's good. Yeah, Yeah. I love it. Family likes. Yeah, yeah, yeah. Oh, that's a great tip. And I know we started a conversation of moringa. Moringa is not something I have used in my sort of stock of tinctures and powders and all the rest of it. I tend to have my, my supplements of which I have vitamin D3, something generally, you know, pretty book standard. I do have a greens powder that I use. It's got dehydrated spirulina and a whole bunch of other things that I've drunk for years. Moringa is something I keep on getting asked about. And in terms of the benefits that we talked about at the start, this pod, are there any others that maybe would be interesting to the listeners? Perhaps information benefits suggest digestive benefits or anything else that you come across because it's getting very popular? Yes. Well, I have to be honest. I don't know. And beyond the nutritional benefits that it's very high in protein, vitamins and minerals and some diabetic friends, it may well have other effects I would need to go to itself. I wouldn't be surprised if it does. Okay. I'm going to look into that. Moringa is that's the one that I get asked about. And that sounds like it could be a good all round. Or if it's high in protein and it's got a lot of nutritional. Value, certainly in fats in many countries in Africa, it's being produced as parts of the treatment for malnutrition. Oh, really? Yeah. So high in protein of different vitamins and minerals. Yeah, I've tried it before and I didn't like it. I think somebody gave it to me and I was. I was very strong. So, yeah, just word of warning to anyone who's going to go out and buy a big bag of moringa for those benefits you might want to try first. Yeah. I mean, I guess the way they take a loan is take it to speak of it, maybe mix it with simple stew. Okay? Yeah. Yeah. It's not. I don't think you don't have to drink it. Yeah. You can mix it in with other stuff. I'll try and stew. Yeah. Or try something tomato based maybe to sort of marry those bitter flavours. Merlin, you're. Thank you so much for taking the time to. This has been super fascinating and I'm sure we can have loads of follow up questions, so I might have to hunt you down again and get you to come back. Chris If you enjoyed that video, you'll love the library of content that we have on the doctor's kitchen Dotcom. Make sure you hit subscribe. We have podcasts in our library of Brain health will being supplements and lots more. Have a wonderful day.
