In this episode, Dr. Tom Guilliams rejoins the podcast to explore the complexities and misconceptions surrounding botanical medicine and how clinicians can maximize the therapeutic effects of herbs.

We learn from Dr. Guilliams that clinicians using herbs should consider the role of the microbiome in terms of absorption and activation of botanical compounds. He explains that because absorption varies from person to person, a personalized approach is needed for optimal outcomes.

Dr. Guilliams also discusses the limitations of traditional clinical trials in evaluating botanical medicine, and he proposes a new framework that considers individual characteristics, such as genetics and microbiome composition. While Dr. Guilliams encourages listeners to embrace the use of botanicals, he also advises questioning the source and efficacy of herbal products and considering the traditional uses of herbs in addition to the isolated compounds.

Please check out the full conversation to learn more about:

  • The limitations of curcumin and the need to consider the whole components of herbs.
  • The historical and traditional uses of botanical medicine for healing.
  • Issues with applying the pharmaceutical model to botanical extracts.

  • Why we need to rethink research processes and clinical trial methodologies for botanical medicine.
  • And much more!


Clearing Confusion Around Botanical Medicine | Episode 330


Dr. Thomas G. Guilliams: And unfortunately, we’ll get into some of the details why, but there’s some reasons why they didn’t all just immediately become gangbusters, cured all the herbs that we thought they were going to cure. And it’s partly because we use them very differently than the way they were used traditionally. Meaning, typically they were using whole plants or whole roots or whole leaves. And we were typically using extracts and purified compounds only. And also, we were diagnosing and treating very differently in a western model compared to the original herbalist way that these were used.

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs and health technology, as well as practical tools to help you transform your practice and the health of your community.

This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective functional and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello and welcome to this week’s podcast. We are going to talk botanical medicine. We get a lot of feedback from practitioners that this is an area that you’re interested in, but is confusing, and there’s a lot of different claims made about all the different ways in which herbs are processed, in which they’re used, and so we wanted to bring our favorite myth buster, I guess, back to the functional forum on the Evolution of Medicine podcast.

Dr. Tom Guilliams has been a leading researcher for decades, great lecturer, and really understands this world, and has actually made some meaningful contributions to understanding the difference between bioavailability and bioefficacy. We’re going to talk about turmeric specifically and some of the claims that are made there, and really give you some of the thinking that is required to do great herbal medicine. I hope this is going to be interesting and informative. Love to hear your feedback. Enjoy

So, a warm welcome back to the podcast, our favorite myth debunker Dr. Tom Guilliams. Welcome, Tom.

Dr. Thomas G. Guilliams: Hey, James. How are you doing?

James Maskell: I’m doing great, thanks. I’m excited today to get back into a conversation that keeps coming up, I guess, with practitioners. When I first came into the market and into the industry in 2005, obviously there’s a lot fewer companies around, and I guess there’s just the beginning part. It seems in the last few years, there’s been, I would say, widespread confusion about botanical medicine and how you maximize patient outcomes. And maybe, I guess, maybe we could just start there. Why do you think there’s so much confusion and what are some of the myths that you see that are confusing practitioners about botanicals and their physiological impact?

Dr. Thomas G. Guilliams: So, when I started the industry, that was like 10 years before you, so we’re talking 1995, ’96. The history of the use of botanicals was primarily in two different veins. One was the traditional healing uses of plants. So, we have these from all these different traditional medicine backgrounds. And probably the one that influenced us the most was European herbalism and American herbalism. Not so many people in the United States were using traditional Chinese medicine or Ayurvedic medicine or Tibetan medicine, but there was a lot of crossover. So, people were using these, they were using extracts, typically liquids and things like that, and sometimes powdered extracts. And then there was the pharmaceuticalization, if we want to call it, certain things like aspirin or colchicine or digoxin, things like that, where we had taken, in history, somewhere in history, we’ve discovered that the plant or some compound in a plant had a bioactivity. Either it was toxic or it had some sort of, actually most of these are toxic compounds, but at a lower dose, could be used therapeutically.

And so, in that time period, the 80s, the 90s and early 2000, there was this expansion of relooking at all of these herbals that we had used for years and years. And we had all these, some of them were in the U.S Pharmacopeia 100 years ago. And relooking at all of these and asking the question, ‘Well, what is the active constituent?’ Go in there and start looking at… We had a lot more ability with HPLC and TLC. These are all chromatographic methods to tease out what are all the compounds. We could isolate the compounds and then start doing cell culture data, animal studies, and then start getting into this. And there was a sense that we were going to be able to discover how all these plants worked, exactly how to use them, and there was going to be this magic, almost like a renaissance of botanical medicine or phytochemical or phytotherapy.

And so, a lot of companies, a lot of companies in Europe that were manufacturing these compounds that were being used in Europe, started just selling them into the United States. It became very popular. This was when St. John’s wort and Ginkgo and other these silymarin, milk thistle, it became very popular, not only within herbalist medicine, but within people who were maybe calling integrative or complementary and alternative medicine.

And unfortunately, we’ll get into some of the details why, but there’s some reasons why they didn’t all just immediately become gangbusters, cured all the herbs that we thought they were going to cure. And it’s partly because we use them very differently than the way they were used traditionally. Meaning, typically they were using whole plants or whole roots or whole leaves. And we were typically using extracts and purified compounds only. And also, we were diagnosing and treating very differently in a western model compared to the original herbalist way that these were used.

So, in some ways, and there’s a couple other reasons I think we can get into, but I think we took a drug or a pharmaceutical application of a traditional use of herbs. And in some cases that worked really well, but in many cases it didn’t translate as much as we thought it would.

James Maskell: Yeah. Well, could you give us then, I guess, an example of the thinking behind, or from a systemic point of view, the thinking behind the historical uses and whether or not they understood it at that time, but what was the thesis behind a holistic approach to herbology?

Dr. Thomas G. Guilliams: Well, I mean, the assumption that we have historically is that this was trial and error, that they probably killed a lot of people along the way perhaps or injured a lot of people. But over time, individuals, cultures, communities, tribes, whatever, figured out based on maybe even how animals, how they saw animal use them. But also just historically, this was just passed down, that these certain herbs, harvested at this time, prepared this way, would be helpful for these conditions.

And like I said, some, they weren’t diagnosing the diseases with chemical labs and salivary hormones and MRIs and these kinds of things that we’re doing today. So, they had a much more, let’s say, a simplistic view of digestive complaints or other sorts of diseases that they were diagnosing. And perhaps, if you look at the way that, for instance, a lot of them did write it down, like traditional Chinese medicine, but others didn’t write these things down, and they were kept in the healer community within those traditions. And then later people came in, Westerners typically came in and started asking questions. Well, as they were investigating their herbal tradition, they were asking questions about ‘What is it you’re using for diabetes? What is it you’re using for osteoporosis or weak bones’ or whatever, however they would describe it in those cultures.

And we had this naive idea that these were cures in the same way that we thought drugs were going to be cures for these. And if you really look at it, they were not just using herbs, they were using other modalities. Sometimes they were, like in traditional Chinese medicine, they would often put these in soups, eat and drink them daily at low doses. But in our pharmaceutical model, in order to get approved within our FDA approval system in more modern times, we designed clinical trials in a much different way than the way that many of these herbs were used traditionally. And it’s one of the reasons why a lot of these have failed in the way that we think clinical trials should be function.

So, we put 100 people, we take 50 of them and put them in the placebo group, 50 of them in our group of therapy, and then we just assume they all have the same condition, they all need the same dose, and we give it to them and we wait eight weeks, 12 weeks, whatever, however long we think that the data should tell us there should be a result. And then we run the numbers. And if you ask any traditional herbalist, would you give the same dose and the same single ingredient herb to everyone who comes through the door that has a similar symptom? Of course they would say no, they would never do that. They would look at other things. They would give different doses. Almost never is a drug, or I should say an herb given in as a mono therapy. Almost always they’re in traditional, they’re combined.

So, we took it out of that system and we tried to force it into our system. And at times, we did see some slight benefits, like early studies on black cohosh, for instance. There were some benefits from menopause. So, some of the things, but many of those compounds had been developed over decades and decades in Europe, primarily into products that were taken orally, and eventually they were tested. Now, we can look at back and say, were they as dramatic as we thought they were going to be? Some of them were, some of them weren’t. So, that’s, I think, a little bit of why it didn’t translate as the herbalist herbalism. What we’ve traditionally done now is we have focused on the mostly individual botanicals or phyto, botanical compounds, curcumin, resveratrol, very specific. Some of these are purified down to 95% pure or 80% pure material. And I think this has also been a hit-and-miss for various reasons as well that we can get into.

James Maskell: Yeah, absolutely. It reminds me of, I guess, just from a patient experience, if you go to a conventional doctor, your experience is healthy, healthy, healthy, healthy, lupus. But actually it didn’t happen like that. There was signs along the way that were missed and you only crossed a threshold for the disease at a certain point, but from a functional medicine point of view, function was decreasing and the pathway was being set up.

And I can see that, and the same example, whereas an herbologist wouldn’t wait until there was the disease. They’d be trying to rebuild the function along the way, which is a similar thinking to functional medicine, as opposed to waiting for the thing to arrive and then trying to find the one thing that would deal with that thing once it’s arrived. It’s a different paradigm of thinking about what chronic disease is and the pathway back.

Dr. Thomas G. Guilliams: Right. Yeah, I mean the whole modality is different. The whole therapeutic paradigm is different. So, it’s not surprising that you can’t just take the products or the herbs and botanicals used in that system and just transport them completely to another system that ignores all of that holistic idea of medicine.

James Maskell: Yeah. Well, I guess one other thing that’s become known now, which is probably not as well known, although you can understand that Benedict Lust, the initial original naturopath more than 100 years ago was talking about essentially the microbiome back then. And now, here we are 100 years later, and really just starting to understand it.

There’s this other whole mechanism, because anything taken orally has to make its way through the microbiome. And I can imagine that that sets into play another whole layer of complexity that people weren’t thinking about necessarily in the 90s and early 2000s either.

Dr. Thomas G. Guilliams: Well, yeah, I think this is one of several things that I think have complicated our understanding, and later we can talk a little bit about the bioavailability conundrum, I think, that we’re running into. But if you look at, let’s just say something that we did see some data on, which are phytoestrogens. So, there are a number of plant compounds. We think of soy, wild yam, even red clover and some of these compounds have what have been known as phytoestrogenic compounds. The compounds that bind, in some ways, either bind to estrogen receptors or have some sort of effect that would be deemed estrogenic in the animals or humans consuming them.

So, for many years, if you take something like genistein, which is a compound from soy, and it’s considered to have phytoestrogenic activity, however, it only has phytoestrogenic activity if the person consuming it has specific bacteria that are able to convert genistein or diazine, which is another component, into something called equol. So, equol is actually the bioactive, that when it absorbs into humans has this phytoestrogenic activity. So, if you consume the soy with genistein in it and you are able to convert equol converters or equol producers, it’s only because you have the specific bacteria that are able to do that.

And so, there’s a number of studies now that show that when you give, women primarily, genistein, you can basically determine, based on their urine, whether they produce equol or they don’t. And so, if you were to take, again, if we go back to our clinical trial and we take 50 women in, let’s say, in menopause or whatever, in certain years, and 50 women over here, and we say we’re going to give all of you genistein or soy, and then we’re going to see does it work, and let’s say 25 of those women are equol producers and 25 of them are not equol producers.

Well, what’s going to happen? When you add all their numbers together, some benefit, some don’t benefit. You take the average, the mean, and it turns out nothing happens. So, what you say is, well, soy doesn’t work or soy doesn’t produce the results that we thought it would. That’s because we didn’t understand that you are going to have a range of individuals. Now, it’s not just plus or minus. Obviously, some people produce twice as much as the other, some people produce none. And so, you get this range. Well, if you’re looking that at as a drug, you don’t want 50% of the people to respond and 50% not to respond based on their gut microbiome, you’d throw that drug away. You’d say, ‘That doesn’t work.’.

But this is how nature works. I’ve advocated for years, and this is also true, we could say this is true of curcumin or turmeric. This is true of green tea extract. We go down the list of all of the, mostly what we call polyphenols, found in plants, these compounds that a lot of people, the big category would be flavonoids that people are familiar with. But it turns out that almost all of these compounds are manipulated by the gut microbiome, but only certain bacteria. So, if you have certain bacteria that have enzymes that can convert them into other bioactives, you have the ability to affect a certain condition, whereas a person that doesn’t have those bacteria does not, aren’t able to do that.

As an aside, I think there needs to be a whole revolution in the way that we investigate phytochemicals and botanicals in human studies. We shouldn’t be asking the question, ‘Does resveratrol work?’ What we should be asking is, ‘In whom does resveratrol work’ or ‘What are the necessary characteristics of a person that allows resveratrol to have its bio bioactivity?’ And I think when we start asking those questions, I think we will really get to a leveraging of the botanical medicine that we thought. And maybe those herbalists had more of an idea of understanding the characteristics of the individual than we do, even though it may not be as modern in terms that we would use today.

James Maskell: Well, one of the things in common with the herbologists of the past and the homeopaths of the past and all of those areas was really taking time to understand the person in front of them, as opposed to just categorizing the symptoms and going off a decision tree. And that would lend itself to the thinking that there was something else going on in those long intakes to understand the kind of person that might have those characteristics. Would that makes sense to you?

Dr. Thomas G. Guilliams: And I think also the idea that they were, again, they weren’t using single herbs, they were often using cocktails of herbs because they realized that not only was there complementary activities within some of these plants, but also, when you’re treating complex disorders, you can’t just depend on one compound. And as we also know, and by the way, there’s some of this that goes on when you give an herb for a period of time, the bacteria that are able to break that down actually can increase. So, you can actually stimulate over time and make somebody more capable of leveraging that bioactivity of that compound, but it might take a while.

And so, if you look at, for instance, soy, the soy use in Japan, for instance, soy use in Japan begins at a very young age. And the ability for these phytoestrogenic compounds, which are very mild, by the way, compared to estrogen, as a person is going through puberty and growing through their whole, let’s say, fertility cycle, is very different than the way that we think of it is, give high doses of genistein to a woman who’s in 45, and just give her high doses and see what we can do. That’s a very pharmaceutical way to think about it, but it’s really, if it’s in the diet and in the culture, the whole microbiome, everything is adapted to the use of those compounds. It can’t necessarily be something that just is completely foreign to the body, and you expect to have the same results.

James Maskell: Yeah, super interesting. Yeah, I think the paradigm shift is so interesting and so significant, and so much wisdom is encapsulated in things that look fairly pedestrian from the past. That’s really, really powerful.

You mentioned curcumin a minute ago, and obviously that’s probably the one herbal or root, I guess, that is the most popular, the most researched or otherwise. My understanding is that this is a great example of what you’re talking about, where the goal of finding the very specific phytonutrient inside it, and then maximizing that has really led to it possibly not having the kind of impact that it’s capable of or that you see maybe in cultures that use it. And so, what have we learned from that from some of the research?

Dr. Thomas G. Guilliams: So, I drilled down in the whole curcumin world for years, and what I found was actually what I thought I’d find, but in a couple of surprising ways. So, I think most everybody listening probably has heard of turmeric or curcumin. It’s a very popular herb, it’s curcuma longa. It grows primarily in India and Asia, and the root of turmeric only contains about 5% curcuminoids. It’s got water and it’s got a bunch of other things in it. And early on, it was extracted and it was fairly easy to extract. And then there was these ability to purify out curcuminoids. So, it’s not just one compound, it’s actually usually three, but there’s actually more than three. And we typically can concentrate this at 95%. And so, this was being used, and this is where what we call the translational medicine or the translational science, there were thousands and thousands of researchers and papers published on the use of curcumin curcuminoids in cell culture.

So, they would take cell cultures and they would put curcumin on the cells or in the cells, and they found just these amazing findings. And what looked like we could cure cancer, we could basically stop inflammation, we could do all these awesome things in all these different cell types. And as it turns out, when they started looking at… And at the same time, they did publish studies on turmeric extracts and curcumin and found some benefits in humans, not nearly as dramatic as they saw with the cell culture and animal models, but something positive there. But the one thing they kept running into was the acknowledgement that curcuminoids, and actually turns out other flavonoids, have very, very poor bioavailability. You can take a gram in your mouth and just small amounts of lower than, less than 1%, in some cases, gets into the body. And so, the idea was that that explained why the cell culture studies didn’t mirror the clinical trials, is because we can’t get it into the cells as well as we think.

So, we need to do something to increase the bioavailability. And once we get curcuminoids in circulation at much higher doses, then we will see all of these benefits that we’re hoping to see. And that makes perfect sense. I mean that’s really the pharma, it’s called pharmacokinetics. That’s really the pharmaceutical world’s way of understanding how a drug would work. But there’s really a lot of problems with this logically. And one of them is, as we discovered, so there was all kinds of technologies invented to increase curcumin’s absorption, what we call phytosomes or sort of a lipid layer around it, the addition of black pepper powder piperine called, increases its absorption. And then there’s just a whole bunch of other technologies which we don’t need to get into, including even nanotechnology. And as it turns out, not surprisingly, most of them work by increasing the absorption of curcuminoids, and sometimes tenfold, sometimes a hundred fold, sometimes even greater than that, depending on the study.

And so, immediately companies just began selling these products saying, ‘Our curcumin absorbs 10 times better, 50 times better, whatever.’ I was watching this for years and I had a little skepticism. People who know me know I’m a little bit of a skeptic. And so, I started asking the question, ‘Who’s going to start doing the studies that show that a product that absorbs at 10 times the amount has 10 times better anti-inflammatory activity or 10 times better effects on cardiovascular risk or 10 times better effect on whatever it is that you’re trying to measure?’ And I kept on waiting and I kept on waiting and I kept on waiting, and nobody was doing these studies. And so, I started scratching my head saying, ‘I wonder why.’ And so, as I started digging into it more and more and more, I started to realize that what was behind these publications, which wasn’t well documented, was that yes, they were measuring tenfold absorption, but 99.5% of that, or 99.9% of all of that increased absorption was in conjugated forms that were inactive.

So, what we call glucuronidated or sulfated forms of these, which the liver basically removes and prevents them from activation, because this is what we call detoxification. This is part of the detoxification product. And then it dawned on me, curcumin is a very highly bioactive xenobiotic, meaning a chemical that comes from outside the body. The body sees this as a very… It’s like dynamite. You take a dynamite and you light it. You don’t take lit dynamite and walk around with it. And that’s exactly what we have. Curcuminoids are very active compounds. We know that from cell culture data. So, they’re deactivated, and they remain deactivated. We don’t really see these as being intermediate. There was one time people thought, well, these were going to be intermediate transitory forms, and then they would be de-sulfated and de-glucuronidated and used for activity. As it turns out, this is, I think, one of the same increase in bioefficacy, when we saw this increase in bioavailability.

So, I think it’s important, first of all, to acknowledge that. And now there are publications that are finally acknowledging that there was this discrepancy, which in pharmaceutical world would never have been permitted. Nobody would be able to use a sulfated form, an inactive form of a drug and say that that’s actually an active form and promote it as a higher bioavailability. So, that was actually exposed. There was actually a publication that came out and actually exposed this whole thing, actually like a year after I published a paper on this. And I’m not saying it was because of me, but somebody else had been onto this. And at the same time, going back to your comment on the microbiome, we started realizing that almost all of these compounds are modified in some, either manipulated in very modest ways or sometimes completely changed by the gut microbiome.

And these compounds typically absorb at a higher rate and are likely the real bioactives of almost every botanical phytochemical that we talk about. Almost every one of them is actually transformed by the gut microbiome. Those compounds are the real bioactives. And as it turns out, many of the flavonoids break down into very similar phenolic acids. So, these polyphenols break down into a series of about a dozen different phenolic acids. And it’s probably one of the reasons why most of these flavonoids work the same. I mean, when we do a study on curcumin and rutin and resveratrol and some of these other, camphorol, and some of these others that are very similar, they all have a very similar bioactivity in the end. And it’s probably because most of them break down into the same set of bioactive phenolic acids.

And I would suggest that this is actually, in some ways, the secret sauce of most of these polyphenols, that as you consume these polyphenols in all these different plant compounds, you get this symphony of phenolic acids that are dependent on a good, healthy, diverse microbiome. And with that together, you have, and again, this is low dose over long periods of time, not necessarily high doses over a short period of time, because high doses, as we know, the body doesn’t appreciate it, it doesn’t see these as helpful compounds when they’re at high doses.

So, anyway, so, I wrote a paper on this whole idea that, two things, one, by focusing only on the curcuminoids and avoiding all the other compounds in turmeric was sort of a misguided idea, but also focusing only on the idea that if we could increase curcumin’s bioavailability, we would solve this therapeutic conundrum that we run into. And I think we missed it on both accounts.

James Maskell: Yeah, it’s super interesting. I mean, it parallels to me, obviously the other thing that we’ve seen going on along the way, is the probiotic thing. And it’s like, there was just almost like a competition on how many strains would be in the bottle. And it’s like, ‘Is more better?’ And that’s what you’re saying there, it’s like, is more better? And I think in pharmaceutical medicine, there’s just this underlying assumption that more is better because that’s part of that paradigm, but I think there’s a lot more subtlety and holistic thinking needed to do this. Well, that’s such a great example there with the curcumin.

So, if you had to take the body of literature today and think through how best to get the therapeutic effect, the best possible therapeutic effects of curcumin, what does it look like? Is it having a tea every day with the actual root? Is it taking some example of it? Is black pepper in the mix or not? What’s real?

Dr. Thomas G. Guilliams: Well, I think a couple of different things. I think the idea of using turmeric just in a daily use. So, a lot of people are using ginger, they’re grinding it up, they’re using it in smoothies. So, just using it more in cooking, the whole root, I think is probably one of the best historical ways of using it as part of the diet. But when it comes to, let’s say, leveraging this in a more pharmaceutical or more nutraceutical idea, I think there’s been several publications over the last 10 years that suggest that, for instance, if you take curcuminoids, they don’t extract out using water. So, there’s a couple of different ways of extracting. Actually curcuminoids are extracted in a more robust ways using solvents and things like that. But if you just take water extract of turmeric roots, you will extract out a bunch of turmerones, and there’s a number of other compounds which we won’t get into, that are typically found that are not curcumin.

And those extracts, those water extracts have been used in clinical trials. And guess what? They’re anti-inflammatory, even though they contain no amount of curcuminoids. So, what we’ve learned, there’s been several different people over the years that have taken extracts of turmeric root, minus the curcuminoids, and discovered that they also have many clinical benefits, many benefits. And some of these have been actually repeated in human clinical trials. So, it suggests to us that we should really be going and revisiting some of the historical uses of these botanicals, and rather than extracting them only for these compounds that we understand or think we understand, and asking the question, ‘How can we extract the whole components?’ Obviously when you take a root, you have a lot of water, you have a lot of fiber, you have a lot of other things that may not be as commercially bioactive. So, if you can find a way to extract these things out, but sometimes you have to extract them out separately.

So, for instance, if you want a water extract and an oil extract and maybe something that takes the curcuminoids, and then if you could bring them all back together in your product, you might be able to take what you might say is the bioactive milieu of the plant and create a concentrated version of that and use something like that. So, there are several companies that are looking at that, and I think curcumin is one, because its popularity, it’s probably received some of the most attention in this area. But I think people are going to go back and ask the same question of, what if… That’s one of the reasons why I think you see just as good a benefit sometimes with grape seed extracts or grape extracts than you do with resveratrol, because these extracts have lots of other things, including the 5% or 10% resveratrol.

But now you have these other polyphenols in the mix, which is the way that the body would normally encounter the grape or wine or whatever, and it has all of these compounds in it. So, I think we’re starting, hopefully there’s going to be an expansion of this idea. It’s not going to stop the people who are going to try to say that we need a bioavailable quercetin or a bioavailable resveratrol, even berberine, which isn’t even flavonoid, it’s an alkaloid. So, I think you’re not going to stop this pharmaceuticalization idea, but I think most of those are going to hit dead ends just like the curcumin side did. It’s just that the marketing arm of these companies is good enough to keep it going even after the science behind the scenes, people like me, who can get on a soapbox and say, ‘Hey, look at the data. This isn’t working as well as we thought, don’t have as big a soapbox as the marketers who are selling all the products.’

So, I’m a very small voice in this, but I think eventually clinicians will realize, you can’t tell me that this absorbs 50 times better without having to show me that at least works twice as good, and they haven’t even shown that it works twice as good. So, I think this is going to be, I think, the next trend. I believe it’s going to be the next trend. I’ve got some friends that are researchers, and I’m trying to convince them: rather than taking your extract of your botanical and putting it on cell culture, why don’t you take the polyphenols that you know occur in the microbiome and put those on cells and tell me if you can learn something about how that polyphenol likely works in humans? Not just because obviously those compounds aren’t getting directly to the tissue that’s in the cell culture. So, we need to rethink the way that we do botanical research, I think, to really leverage this.

James Maskell: Yeah, it’s so interesting that you say that. So, my first job in the industry was I was a supplement rep. And the company that I worked for, the thing that they hung their hats on in this space, in the botanical space, was spagyric processing. And the concept of it was that you would take out the various parts, the things that were water-soluble, oil-soluble, the actual route itself. There was an ash mineralization process. And I remember going, at that point, it was like, ‘Well, who can we sell this to?’ Okay, I was just learning the industry. Well, there’s naturopathic doctors in Connecticut, and I would go. And more often than not, the first question that even the naturopathic doctor had was, ‘Well, how many milligrams and how concentrated?’ and whatever. And I would go back to the team and I’d say, ‘Well, I’m getting these kind of questions.’

And ultimately, what was needed at that moment was a revitalization of the mind around the holistic use of herbs. And here we are, from there, whatever, 16 years later. And you’re saying you think that something along those lines is a new trend to really think about what are all the different parts of the herb that are going to have an impact and trying to retain as many of those different pieces because it’s not exactly clear what parts are doing what, and there’s obviously a symphony, holistic effect that’s going on.

I guess a question that I have for you, Tom, is you’ve been in this industry this long. Do you feel like in the professional market, where doctors are learning some of this and trying to implement it, what is the role? Do you think that it’s reasonable to expect that a doctor that’s not trained in, a conventionally trained doctor, can get to a point where they can understand the subtleties of herbology to the degree necessary to get the outcomes? Or do you think that herbology is its own specialty and that should be done by people who are very well-trained in that area? And then how do you get teams of practitioners to work together?

Dr. Thomas G. Guilliams: Yeah. Well, I, there’s a whole bunch of questions there. I don’t think that most clinicians who are trained in a western style of medicine are going to, unless they want to completely embrace a different sort of herbal medicine. I’m not saying that the use of botanical extracts, the way that we’re talking about them, curcuminoids and things like that, should replace traditional herbal medicine. So, if somebody wants to go and learn Tibetan medicine or Ayurvedic medicine or traditional Chinese medicine or even Western herbalism, they’re going to have to learn the diagnostic modalities that are paired with the herbs used by those clinicians. So, they’re going to have to describe, and they’ll probably take some of the knowledge that they have, but they’re going to have to marry that. And this is where you really get complementary and alternative together, where they integrate together.

On the other hand, I think from the research standpoint, if we’re really going to try to leverage what I’ve been talking about, the fact that these are plant bioactives or at least the precursors to plant bioactives via the microbiome, then we need to change not only the way that we study these, but we need to then not get trapped into the idea that the only way to do a clinical trial is the way drug companies do clinical trials to get drugs approved. And we need to be asking questions. Because you know as well as I do, we’ve got all this personalization, genetics, epigenetics, all these other things that we’re learning, and yet we’re not applying any of that when it comes to clinical trials. We’re simply taking 50 people who have the same diagnosis and giving them all the same product at the same dose because that’s how drugs are approved.

But I don’t care. I’m not trying to approve these as drugs. I want to know when the person is in front of me, maybe I can take their genetics or their genomics, I can take their microbiome test, and then I can learn from that because there’s clinical trials that have taken this and said, ‘Yes, you are a candidate for the use of resveratrol and curcuminoids because you have the right microbiome to leverage this.’ Just like I would with equol and genistein, and say, ‘Yes, you have the ability to convert this in equol, this is going to benefit you.’

But if I just say, ‘Look, I’m going to give this to you and just,’ I mean, basically it’s trial and error every time, then that’s why a lot of clinicians get frustrated with pharmaceuticals, but also with nutraceuticals, because we still haven’t been able to marry the idea that there are individualities, and the microbiome is a really big part of this in understanding how to leverage these phytochemicals. And I think that that needs to be the next idea of personalization, not for the point of getting curcumin approved as a drug, but so that clinicians have a better idea of the type of patient that’s going to respond to the botanical.

And maybe if we go back to the uses of whole herb and herbalism and things like that, we would get more bang for our buck in the sense of hitting more patients that are likely to benefit. But that benefit, I think is going to be not leveraged as much as we can when we take the idea of concentrating and more directed. So, directed therapies to people that can use it at higher doses. So, I think there needs to be a rethinking and going back to the same ideas, but then bringing forward a new idea that’s not bound by the pharmaceutical framework of taking drugs from herbs to approved pharmaceuticals, which I think was the mistake of the nutraceutical world.

James Maskell: Absolutely. Well, I could definitely understand the confusion, because it’s complicated. It’s interesting, in the last few years I’ve met doctors who have come into functional medicine, learn everything, had amazing mentorship, and then decided that they don’t want to do it anymore because there’s this layer of complexity. It’s hard, and they just go back, ‘I’m going to go back and do sports medicine because it’s easy.’.

And I think what you sharing here is that there’s a layer of complexity that needs to be understood in order to be good. And that’s possibly why in the first iteration of this world, there wasn’t good herbs and bad herbs, there was just good herbologists, and ones that got great outcomes consistently, and one that didn’t. Functional medicine doctors that got great outcomes consistently and ones that didn’t is because they were having to learn the subtlety of doing the right thing at the right time for the right person over a treatment cycle. And that comes from experience and understanding the unique aspects of personalization that you are discussing.

I guess, with that in mind, as a takeaway, what would you say to clinicians who are considering what to look for in the herbal companies that they partner with? What is the thinking process that you should be looking for in how products are put together and how they’re formulated?

Dr. Thomas G. Guilliams: Yeah, I mean, I think a couple different things. One, obviously ask good questions. I mean, I always tell, one of the things they say, just because it’s new does not mean it’s better. And so, I think that’s one thing that both marketers, salesmen, clinicians, even patients, they want something new. And so, the assumption that it’s new is better. I think when we’re looking at leveraging an herb or a botanical compound, and it’s very similar to its traditional use and its traditional diagnostic, typically you have more traditional data and more published data at the same time. So, I think you’re safer in using these compounds that have been used a long time. And I think, when you’re dealing with newer patients, if you have somebody that has a messed up gut microbiome, and you know from other reasons that that’s true, oral therapies of botanicals are not going to be very consistent in those individuals.

It doesn’t matter who they are. If their gut microbiome is messed up, not only are they not going to absorb the things that could absorb easily or relatively easily, but they’re also not going to be able to likely convert those compounds into something beneficial. I would also say, give it time. The use of botanicals aren’t the same as some other drug that has been approved, that you can use. So, if you’re looking at an anti-inflammatory like curcumin or boswellia or something like that, they’re subtle, they take time to work in individuals, and they’re not going to, like I said, because of the microbiome and perhaps other factors as well, they’re not going to work in everybody. And that doesn’t mean the product doesn’t work, it just means that those ingredients are not going to be effective in those individuals.

So, you can’t use them in the way that you could say, yes, that always works, or no, it doesn’t always work. It’s going to take a little more trial and error. And I think clinicians, I mean, talk to other clinicians that have used these compounds, use these things for a while, they’ll tell you, yeah, I know certain patient types are not going to respond to that as well. They can say the same thing about omega-3s or probiotics or any other categories that we talk about. There are certain patient types that are going to respond better to, let’s say a certain probiotic, and some don’t respond to probiotics, they might respond to prebiotics better.

So, these are things that we need to really understand. And I think if you have a product, I mean, again, I don’t know that there’s one company that has the monopoly on all the right herbs and everything. Obviously, there’s a lot of people that are selling a lot of different products, a lot of extractors from all over the world. And so, ask questions about where these herbs come from. And a lot of these are, there are published data on some of the specific compounds that are being sold. So, ask some questions about that, and don’t be duped by the bioavailability. Ask about bioefficacy. Say, ‘Has this product been compared to the non-fancy form in its effect on clinical outcomes?’ I think unfortunately, you’re going to find that most of those studies aren’t done. So, again, this is where the clinician needs to practice medicine and be the one that makes the final decision.

James Maskell: Awesome. Tom, thanks so much for coming on. I know it’s a complicated topic, and I really appreciate your insights. I get a lot of feedback from practitioners that they just appreciate the way that you think through these kind of topics, and I’m really grateful to be able to share it here on the Evolution of Medicine podcast. This is part of the evolution, is a different way of thinking about how we use these assets and tools, and I think you’re a great steward of that thinking to our community.

So, this has been the Evolution of Medicine podcast. We’ve been talking botanical medicine with Dr. Tom Guilliams. If you have questions, feel free to get in touch, and I’m sure we can find a way to help you. But this has been the Evolution of Medicine podcast. I’m your host, James Maskell, and we’ll see you next time.

Thanks for listening to the Evolution of Medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools, like the Group Visit Toolkit. That’s goevomed.com/lmrc. Thanks so much for listening, and we’ll see you next time.

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