Botanical Immune Adaptogens

Continuing the theme of the last Two Herb Nerds podcast episode, Julianne Grant and Kristin Gilmour delve into the class of botanical medicines known as immune adaptogens or immunomodulators. They differentiate between some outstanding immune adaptogens, highlighting their nuances and demonstrating where they shine in clinical practice. 

Join Julianne and Kristin as they first explore the overlapping immune activity of medicinal mushrooms before taking a closer look at the clinical picture of Maitake (Grifola frondosa). They then outline the clinical benefits of other phytomedicine immunomodulators, namely Astragalus (Astragalus membranaceus), Withania or Ashwagandha (Withania somnifera), and Siberian Ginseng (Eleutherococcus senticosus), comparing and contrasting these herbs to better illustrate their individual applications. This episode provides valuable insights for herbal medicine practitioners working with individuals whose health conditions are significantly influenced by immune dysregulation.

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Transcript

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Julianne Grant 0:08

Welcome to the Two Herb Nerds Podcast with Julianne Grant and Kristin Gilmour, where botanical medicine comes to life. Whether you're a seasoned herb nerd or just beginning your journey, this podcast is your place to explore herbalism in practice.

Kristin Gilmour 0:22

Alongside our work as clinical naturopaths, we've spent over a decade immersed in herbal medicine research and education, and we're excited to share our love of plants with you. Hello everyone, and thank you for joining Julianne and myself for the Two Herb Nerds podcast. Today we're going to be expanding on the theme of our last podcast, where we spoke about plant adaptogens, which are a class of herbal medicines that enhance our body's ability to adapt to stresses. So they increase our resistance and our resilience to different forms of stress, and they act via multiple mechanisms to really bring the body back to equilibrium. Such an amazing class of herbal medicines. And in that episode, we particularly delved into a couple of herbs that stood out to us as more physical adaptogens. So namely Rehmannia and Rhodiola, and also a couple of herbs that stand out to us as more mental adaptogens. So really helping with that mental resilience. And this was Bacopa and Holy Basil. So have a listen to that last episode if you'd like to dive into the adaptogenic applications of those herbs. But for today's episode, we're moving into talking more about immune adaptogens. So these are the herbal medicines that really stand out to us in the immune modulating space. And I'd say it's helpful to note that when you are reaching for any herbal adaptogen in any subcategory, any of those herbs, those adaptogenic herbs, will support immune health in one way or another. It's just part of their nature. However, the plants that we're going to be talking about today, these are the plants that we typically place in this more specific immune adaptogen category. And these are the plants that will have a more profound adaptogenic effect on the immune system. So acting to strengthen it, modulate it, improve our immune response and surveillance, enhance different aspects of our immune system, like our humoral and cellular immunity. And they'll usually have quite significant inflammation modulating and antioxidant properties as well. So when immune system dysregulation is a real driving factor in your client's health condition, whether that be an infectious presentation, an autoimmune presentation, or a cancer type presentation, or even just a chronic inflammatory type presentation, this is where we can have such an incredible impact by employing some of these intelligent, specifically matched immune adaptogens that will help to bring that immune dysregulation back to balance.

The Immunomodulating Activity of Medicinal Mushrooms

Kristin Gilmour 3:14

And to begin with, one entire and really distinct group of nature's medicinal offerings to us really all fit into this category of being immune adaptogens. So you might sort of see where I'm going with this, but I'm talking about our medicinal mushrooms. So, Julianne, perhaps to start us off, could you talk to our listeners about some of the amazing overlapping qualities of these medicinal fungi and maybe pull out one medicinal mushroom for us as an example?

Julianne Grant 3:46

I'd love to because as you know, we have spoken a lot about medicinal mushrooms in the past, and we are always more than happy to keep diving into the use of medicinal mushrooms and where they fit clinically for naturopaths and herbalists. They are a realm of their own, but in saying that they blend beautifully with our other Western herbal medicines and anything that's on our dispensary shelves. So they pair very well with our other immune modulators and inflammation modulators in mixes. And so I love their activity for that. Rather than using them singularly in a capsule form or T form, which is still a beautiful way to use them. I think if we can start adopting them as part of our herbal dispensary, we'll get more from them, we'll get more flexibility from them, I think. And keeping in mind that medicinal mushrooms were generally brought to the Australian practitioner market in capsulated forms and in that powdered form. And it was for their immune activity. And that is how we came to understand medicinal mushrooms is that they are immune fortifiers, they strengthen and they modulate, and they are profound in this way. And there's obviously a really great biochemical mechanism behind that. We evolve with fungi, we have these um fungal receptors on different immune cells that recognize um them straight away, and that triggers our immune response to them straight away, which is why they are so uh important in this immune modulation space. But I think with medicinal mushrooms now, we do know that they actually go beyond just their immune activity. But I we are for for the purpose of today's podcast, we're going to focus on those overlapping. I had to pull myself back in there. Kristin, did you see? I wanted to keep talking about all of these extra activities that medicinal mushrooms have. So we will do that one day. But today we will focus on their immune activity. And I think to understand their immune activity, we just have to touch on what the immune system actually is so that we're understanding the impact that medicinal mushrooms have on all aspects of our immune activity. So we have our innate immune activity or our non-specific immunity, which is basically our body's first line of defense. It's very quick to act, it's a very nonspecific manner. It just kind of like opens up fire against whatever it views as a threat. Um, and the key components of or the key immune cells to our innate immunity are things like our natural killer cells, our macrophages, and our dendritic cells. Our dendritic cells are our antigen-presenting cells. So basically, they pick up a part of an infection or a foreign body, present it to our immune cells, and then go, there you go, recognize this, please defend against it. So they are really, really important, and how they mature and develop are really important. So that's our innate immune system. Then we have our complement system, which is almost, I visualize this as a bridge between our innate and our adaptive immune system. So it has substances that run through our serum that kind of complement our different cells within our innate system as well as our adaptive immune system. Um, and it's an important coordinator of our innate and immune and adaptive immune reactions. So it's important and it's often overlooked. The other and third arm of our immune system is our adaptive or our acquired immunity. And this is that antigen-specific immunity. So these are when we have antigen-specific reactions with our T and B lymphocytes, and these are more precise and longer-term, slower kind of reactions. So it's basically a learnt infection or threat. We send out exact mechanisms or exact cells that we need to fight that infection or invading cell. So they're our three arms to it. A little note I want to make because we about our immune system, because we will see this if you're herb nerds like us and you do the research, or just within our naturopathic knowledge and space, we often talk about our T helper subsets, which are part of our adaptive immune system as well. And we often focus on our T helper one and our T helper two kind of subsets. And I just want to briefly summarize that without diving deep into the chemistry. But if we can think about our T helper one subset as being something that recognizes and fights against our inside threats. So that's these sort of cytokines and I guess our immune army cells get released when there are invading viruses or intracellular bacteria, which is not as common as extra, but intracellular bacteria that invade cells. So when we have something that is internal, then we tend to release our T helper 1 cytokines and fighting machinery, so to speak. So, you know, its job is to release interferon gamma, which will then signal to activate macrophages and other cytotoxic type of cells to kill off that invading pathogen or that that cellular threat, which can also be a cancer cell. I guess if we were to, you know, sum it up in layman's terms is if something the T helper 1 team, our fighting team, they will go against any enemies that's gotten inside our house, so inside our cellular machinery. They're the ones that are going to kill it. And then we have our T helper 2 army or factory, and that is going to release cytokines and cells that look at destroying outside threats. So things like larger extracellular threats like parasites or worms. Um, but it's also heavily involved in the allergic pathway. So when we are tipping too much into allergic tendencies, then that would be a T helper 2 dominant kind of pathway. So we've got parasites, worms, allergic tendencies for that T helper 2. That's when we want that pathway working. So basically, T helper 2, we're looking for what's outside the cells. T helper one, we're looking at destroying what might be inside the cells or damaged cells. So there we go. That's kind of a bit of a quick wrap-up there. So, therefore, what are we trying to do with our immune function? Like, what are we actually trying to do? Again, that's all arms of those immune systems. So we're looking at when we want our patients to have a primed immune system, we want them to have a primed immunosurveillance. This is one of the most important things. Now, I know that, Kristin, both you and I see patients that probably haven't been well for a while, or at least at least have this area of their health dampened. It's really important to be able to pick up threats, find them, pick them up, and signal a response to that threat, a balanced response to that threat as quickly as possible so that we're not triggering this low-grade chronic inflammation or setting off downstream oxidative stress, inflammatory stress kind of um activations that can occur when we're not picking up threats quickly. So we also want to have an appropriate T helper one, T helper two, or adaptive immune response. We want that to be balanced out. And we want to have an appropriate inflammatory response too. So we want, you know, a heightened inflammatory response when we have a threat that's invaded our body. We want that to be killed off and mopped up quickly, you know, but we don't want to have an exaggerated inflammatory response or alternatively to that, a low-grade inflammatory response, which is almost more damaging, is it's not doing any favors in regards to eliminating that pathogen or that's or that cancer cell threat. It's kind of suppressing our innate immune cells. I'm not going to dive into that, that's another way. But we want to sort of modulate those kind of immunosurveillance, how we signal via T helper one or T helper two cytokines, and then how we're modulating inflammation in that response. And there's a lot more to it, but I'm just sort of trying to mop it up. So now we get to mushrooms, and this is where medicinal mushrooms are really important and profound in this space because they do impact all areas of our immune activity, all three areas. They also will impact inflammation, oxidative stress, et cetera, organ protective. This is what makes them so unique. But predominantly, mushrooms contain within their cell walls, they contain polysaccharides, which are broken down and they contain beta glucans. So beta glucans are our biological response modifiers. They they shift as soon as they're ingested. And those cells that I spoke to, spoke about before on our immune cells pick up that beta glucan, that will then trigger this amazing immune response or a biological response. So what we see with regards to beta glucans from mushrooms and how they impact the immune system with our innate immune system, they will trigger production of natural killer cells, of macrophages, and of dendritic cell maturation. So we go from that dendritic cell picking up the virus or whatever it is that we want to fight against to presenting that to increasing our natural killer cell production as well as macrophage activity. So that's awesome. That's our surveillance, that's our first line of attack. Then we have our complement. We understand that polysaccharides can enhance the tagging and the clearance of pathogens. So tagging is like the cell putting its hand up saying, I'm I have an infection or I am damaged. Please come and tag me and pick me up, and therefore the clearance of them. So it improves that coordination from our innate activity to our adaptive. And then we see that we had this T helper cell, this T cell modulation in our adaptive immune system that mushrooms can modulate. So usually there is a preference between before our T helper one polarization. Um, but overall, if we look at the mushrooms overall, there is more of balancing because we have some great mushrooms that do a great job at um tilting both, actually, working for those in allergies and working for those in autoimmune conditions. So we have this beautiful balancing act. It's again, I think the research on individual mushrooms will kind of prioritize the area of immune health that they belong in. Um, and we'll speak about one soon. But generally, when we're looking at using medicinal mushrooms, often it is because we want to polarize a T helper 1 response. Um, we want to sort of tilt towards that way. They modulate T reg cells as well, and they enhance our antibody responses. So they really do impact every area of those three arms and they kind of I'll use the term modulation, but they do empower them, they fortify them. We get a more concerned response in each arm of our immune activity. But the other area where mushrooms are super helpful for our immune activity is our gut health. You know, they they really, as polysaccharides, they support the um growth and the balance and the diversity of our bacteria within our microbiome. So they're what we term microbiome modulators. They also can support the integrity of our intestinal lining, they're directly anti-inflammatory to the gut, and they also promote the production of short-chain fatty acids. So, really, they they kind of hit our immune system from all angles. The other constituent of medicinal mushrooms that gets a lot of airtime at the moment is ergothionine. Now, ergothionine is more, I like to make that distinction between our beta glucans from our mushrooms as being activators of our immune system and of our defense and fortifying our defenses to ergothionine being that kind of protection, that organ protection, because ergothionine drives or mitigates, I should say, that collateral kind of oxidative damage that we see when we have an immune burst or a pathogenic inflammatory kind of burst. So, in can actually ergothionine works beautifully synergistically, and this is where plants work so well as a whole part versus individual constituent, because we may see that there's this support from ergothionine to our immune cell kind of longevity and function. We do get immune cell exhaustion. So if we have ergothionine working alongside our beta glucans, we might be actually able to clean up some of this function that has occurred within that immune activity and inflammatory bursts and oxidative stress bursts. So it's sort of like it promotes the longevity of the body, it promotes the longevity of our immune system alongside that. So when we're looking at who do we generally give mushrooms for, well, you could literally give medicinal mushrooms to anyone. They could eat it as a food, they could have it as a tea, they could be as powderful, it can be as a hydroethanolic. Um, they're they're fabulous for anybody to have. And we know within the research that the more mushrooms people consume, we see a lower incidence of uh diseases such as cancer. So I tend to, though, depending on the type of mushroom, predominantly use those that have an immunosuppressive state or immune challenge state. So that's something like my oncology patients or their cancer survivorship patients. I love it for in that space. Um and viral infection. So particularly those that have big viruses, so some of our big viruses, or have post-viral syndrome or continue to get viral infections, or when they do get some form of pathogen infection, but particularly viral infections, they are slow to respond and slow to eradicate. I think that's a really key for a medicinal mushroom. So any of those kind of immunosuppressive states where their immune response is lackluster. It's not robust. We're not eradicating and moving on. We're staying stuck in that state. So that's where I see medicinal mushrooms. And it's a very quick snapshot, Kristin. We have literally done seminars on medicinal mushrooms. So do you have anything to add to that?

Kristin Gilmour 18:10

I think that's a great foundation that you've laid for the immune effects of medicinal mushrooms. And I think it's very helpful to understand how the mechanisms of how they're sort of doing their magic, working their magic. Uh, and I I love I love the medicinal mushrooms as do you. I think it's also very useful. I think there will be quite a bit of crossover as we start to talk through these different immune adaptogens or immune modulators as to the types of patients that we're generally thinking to prescribe them for. They're often those never been well since patients and and those types of presentations. And I think that all this overlapping immune activity is really helpful to get our head around. And then when we drill down into some of the affinities and the nuances of the different individual mushrooms and plants, then we can be a little bit more specific about which immunomodulating mushroom or herb calls to us for which uh patient presentation.

Julianne Grant 19:14

And that's it. Like that you actually raise a really good point. So sometimes when we're talking about activity within the body, we do pull out a constituent or we pull out a group of constituents because that's what's found as the mechanism behind that particular physiological activity. So we talk about the plant in that way. But when we start talking about who we're prescribing it to, the plant or the fungi, the person picture, then becomes forefront, right? Not necessarily just the mechanism. I think it's really important as herbalists to remember that and to have that at the front of our mind when we're prescribing it. Because when you and I were discussing this podcast and we're thinking about which medicinal mushroom do I want to talk about, I could talk about any of them because, you know, they all jump to mind. But and we use them all, honestly, we use them all, but there are different patients that we use them for, depending on how they're presenting. So it's a really good point you make because yeah, the the couple that we've pulled out to talk about today as immunomodulators, we could have talked about 10, 12 more that are just as significant but for a different patient type.

Maitake (Grifola frondosa)

Julianne Grant 20:18

So if we're staying on this train, I will just talk about Maitake, I think. Um Maitake is an amazing medicinal mushroom, but particularly for fortifying the body's defenses against foreign invasions or foreign cells. So when that, when I say that, then I'm automatically thinking for oncology realm, survivorship realm, and also that viral, post-viral kind of immune dysregulation. Maitake really has the research behind it, the clinical use behind it, and also the traditional use to keep it in this area. Um, it's such a pretty mushroom, like one of its other names. So Maitaki is Maitaki, sorry, Grifola frondosa. And another common name is hen of the woods. And I love this visual because if you see it, well, if you see it growing in the wild, lucky you, it's a, it's um, I've never seen it growing in the wild, I don't think. Um, but then it grows like overlappingly. So the fruitium bodies actually, if you see it on a bit of wood, it will grow overlap. And it literally looks like the tail of a hen. Um, I don't know if the tail is the right word to use, but that's what I, you know, see it as. And it's just beautiful. Um, so if you ever hear hen of the woods, that's where it comes from. Energetically, like majority of mushrooms, it's neutral, it's a bit slightly cool, um, it's sweet, slightly dry, but it's really popular as a food. And I think a lot of its popularity originated as a food. It has this um like woody, smoky, really deep and rich flavor, like many mushrooms do. But this one in particular, and it was actually said to awaken the fifth sense, or yanami. Um, sorry, umami. That's something. Beautiful about this. So maybe we can encourage our patients and our clients to have it as a food as well. And according to traditional Chinese medicine, it was said to enhance qi and fortify the spleen, which I think is common for most of our medicinal mushrooms, too. The interesting thing around Maitake and why we focus a little bit around it, and the research focuses a little bit around it in the oncology setting is because it was discovered as having quite unique beta-glucan structure, and it's a beta glucan structure, without diving into it, that actually gives a mushroom or any plant that contains beta-glucans in a way, its immune activity, like its depth of immune activity. So research showed that beta glucans from mitake actually had more pronounced immune activity than that found within lentenin from shiitake mushroom, for example. And that's when it was backwinged discovered, which was about the 1980s, when it was discovered in Japan. These particular beta glucans were discovered. And actually, it was discovered as having the most prominent anti-cancer activity of beta glucans in mushrooms at that time. And also really effectively orally as an immunomodulator, which was something not always researched, like it's always often animal research, preclinical research, but um I should say petri dish research. But this was shown in animals, like taken orally, and then lots of case studies and lots of research within in humans, particularly in the cancer domain. So what happens once they identified these particular beta glucans is they purified them into beta-glucan structures and bonded them with proteins and they became proteoglycans. So this is where you might see Mitaki D fraction or mitake MD fraction. This is not a whole part of the plant. This is something that has been kind of purified as a beta glucan medicine, so to speak. So when you're looking at research, you might, for all of you have nerds out there that I'm sure go ahead and look at research, you know, just take that with a grain of salt. But there will still be this immune activity from the beta-glucans that we find within mitaki. So as I mentioned before, mitaki is this profound immunomodulating mushroom that helps to fortify our bodily defenses against disease-causing pathogens and agents, right? But it's specifically indicated in cancers, cases of cancer and cancer prevention. And what I love about it and what I think about it, and possibly because we've lectured in the tumor microenvironment, but it really does, it is an immunomodulator for that tumor microenvironment. And but don't just, I don't want people to think just about tumor in that way, because if we understand how a tumor microenvironment works, which I know we won't necessarily do right now without talking about it, it's kind of this cellular immunosuppressive environment. That also happens with viral infections and chronic replicating viruses and things like that within our bodies. So we can put that to lots of people, not just within the cancer domain or an oncology space. So it really does in those people. It enhances cellular immunity, including our very important natural killer cells and our macrophages. It shifts that cytokine pattern towards that T helper way, T helper one profile away from T helper two. It enhances our interferon gamma production, which is actually responsible for stimulating our cellular immune response. So again, immunosurveillance, et cetera, in aid immunity. And it supports our adaptive immunity via certain cells, C D4 and C D eight plus, cell numbers. So it enhances the number and activity of those cells, really important for that microenvironment that has been suppressed by something foreign or detrimental to our health, like a cancer cell. There is such a big body of research and case studies highlighting its use in cancer and as well as cancer survivorship. It really is a key mushroom here. I know we think of turkey tail, we also think of Rishi, but we really need to be having the conversation about mitaki because this is just as important in this space. Often the research shows its use alongside, you know, traditional medical oncology medicines, such as chemotherapy and radiation. And with these clinical trials and case studies, basically find that it seems to be, or mitarchy appears to be, effective in cancer prevention and in improving the outcomes for certain cancer patients, basically via this immune modulation that we're talking about before. So we might see in these trials as an example that there was improved survival time and life expectancy, there was reduced cancer growth and metastases, improved quality life, quality of life scores, and basically enhanced immune function within survivorship as well for five years post-cancer. So it's it's profound in that space, and it's one that I like to use. But don't, whilst we think of it like that, as we mentioned earlier on, Kristin, there is overlapping qualities. You can eat my taki and not have cancer. You know, you'll be fine. You you will just be switching on your immune system to be fortified and more robust and just continue to modulate your immune system in a healthy way. We are with inflammation modulating, we see it in research that it has some anti-allergy activity too. So really, it's very beneficial in all sorts of arms. It just has a focus for this pronounced anti-cancer, antiviral activity. So, really, our medicinal mushrooms, there are so many to choose from. They will all have this great, impactful immune modulation activity. But I implore you to get to know them. Like get to know those individual mushrooms. They will have affinities for certain organs, and that's where they really start to stand out in who you're using it for and which mushroom you use for which patient. So, Kristin, maybe we'll move away from medicinal mushrooms. I've definitely spoken enough now. And we'll start with one of our absolute favorites, and I'm sure a lot of people listening will agree with us, but let's chat about Astragalus and its immunomodulating activity.

Kristin Gilmour 28:16

I'd love to talk about Astragalus. Uh, I do I do just also want to say that um thank you for going through that information about Maitake. I think that it's such it's definitely the way that I also use it. And I remember when you first put together all the research around Maitake and how significant that was in the tumour microenvironment. And for me, what I really got out of a lot of that was when I when I wanted to reach for maitake, uh, I also was looking for some of the things that also showed up in the research, like you mentioned, like the cardiometabolic stuff or the liver stuff. There's some great research around that too. So thank you for sharing that.

Astragalus (Astragalus membranaceus)

Kristin Gilmour 28:57

And then, okay, we can move to Astragalus, which uh is of course a fantastic immune adaptage and many practitioners will also will already be utilising this quite significantly within their clinical practice. And I think it's actually a beautiful flow-on from speaking about the mushrooms because Astragalus, as we know, is also a high polysaccharide-containing phytomedicine that is also excellent for a depleted and often chronic immune system picture. And so, because of that, it actually does combine quite nicely with many medicinal mushrooms. I think this is evident across quite a few traditional formulas as well as current clinical formulas. A lot of these utilise this synergistic Astragalus and mushroom pairing. So you might see that a bit out in the wild. But for me, Astragalus was one of the first traditional Chinese medicine herbs that I felt I'd really got my head around how to use, both through my Western herbal medicine lens as well as through more of a TCM or traditional Chinese medicine lens. And I think with any herb where a particular culture or traditional medicine system has utilized and prescribed that medicine for thousands of years, there's of course so much to gain from integrating these traditional perspectives to better understand, in this case, how Astragalus actually behaves in the body as a medicine, both physiologically, of course, but also energetically. So I might just start with some of its traditional use in China, where Astragalus root has been used, of course, for thousands of years as one of the really important qi tonic medicines. And that's really what it's most famous for. It's for qi. And so in our Western herbal language, we would say it's a herb that helps us to build our vital force or the vital energy in the body that animates us. And in fact, it's a foundational herb in TCM, it's one of the 50 fundamental herbs which really form the backbone of classical herbal formulas and clinical practice. So Astragalus really is a top draw, and I would say must-have, or at least I must have, and I know you must have, Julianne, herb. Because it's just it's so safe, it's wonderfully um efficacious, it's pretty versatile, and it's often used to harmonize other herbs that it's paired with as well. So the Chinese name of Astragalus translates to big yellow or yellow leader, and it and it refers to the colour of the inner root and also its connection to the earth element, because yellow is the colour of the earth element in TCM, which in that paradigm rules the spleen and the stomach in that five-element theory. And so it's associated with supporting things like muscle strength, immunity, digestion, and blood. And I think we'll see uh that to be a little bit of a common thread across some of these immune adaptogens and these tonifying medicines. I think muscle strength is probably not something that first pops into my head as a Western herbalist, like in my Western herbalist mind when I think of Astragalus. But this is an aspect that is quite well known to oriental practitioners. And in fact, Astragalus has been used by martial artists and these types of um individuals to help rejuvenate and build muscle. And I really do see it in that rejuvenating, replenishing kind of space in that regard. So in TCM, Astragalus does have this particular affinity for the spleen meridian, but it also has an affinity for the lung lung meridian. And I think that these two TCM meridians give us a nice way of conceptualising how Astragalus patients can present to us clinically. So in TCM, the spleen isn't just a physical organ, it's also considered to be the crucial link in the process where our food, so the material we consume, is turned into qi and blood. So we can kind of say that the spleen rules transformation and transportation. So through this spleen influence, we're thinking about that ability to take in nourishment, to transform it, to assimilate it, and to ultimately be able to generate the qi or the vital energy and the resources that the body needs to function and to flow. So far, we have this, I guess, picture of a person who might need Astragalus, who maybe presents as quite depleted, tired. Perhaps they have reduced digestive vitality, so they need more nourishment. Um, and they they often present as somebody who's just not replenishing their reserves very well. So they'll need that qi boost in this spleen area. And then through the lung meridian, we get this really important connection with the ethereal qi from breath, as well as what uh TCM calls Wei Chi or defensive Qi. And I like to think of Wei Chi as being like my defensive force field or aura. You know, I think of it as really being fortifying the perimeter or my perimeter. And it's because we is traditionally understood as this protective layer that circulates around the exterior of the body and really helps us respond to and protects us, like a shield protects us against external pathogenic influences. So it helps, like this shield effect reduces the likelihood that factors like cold and wind, that these can enter the body and cause issues and illnesses like the cold, like colds and flus and stuff like that. I also find this is why it's such a great Astragalus is such a great inclusion in a formula for something like asthma when it's induced or exacerbated by the cold. So when you see that exacerbation of those kind of external pathogenic factors, then Astragalus can be great. So when whey Chi is deficient, the person might present as somebody who just catches everything that's going around, or maybe they take a lot longer to recover than they used to, or than everyone else seems to. Julianne, you spoke about this a bit with the medicinal mushrooms. Um, with Astragalus, they also might present as somebody who is sweating a bit like too easily. Um, chronic illness with debilitating sweats and fatigue is quite a specific indication of Astragalus. Or maybe they're just presenting and they just don't seem to have that robust defensive capacity anymore. So Astragalus has been traditionally used to really tonify that qi, to strengthen the lung, and to stabilise the exterior. So you're essentially improving the person's underlying resistance and their capacity to deal with whatever pathogenic assault comes along next. It's really like a great energetic shield or barrier defence. And I like that traditional picture a lot because I think it gives us such a strong theme of host immune resilience. And so through this picture, you can see how Astragalus would be traditionally a great medicine of convalescence, uh, of chronic weakness, um, that never been well since picture, like we mentioned, which again, of course, nearly every immune adaptogen is relevant to this picture. But for Astragalus, we might see somebody through our case taking where since that time, that person really just hasn't been able to muster up the energy to rebuild their energy reserves or return to their healthy immune baseline. And then if we add to this picture, if we if we look at Astragalus from a more energetic perspective, so taking into account its thermal properties and its taste qualities, it's considered to be sweet and mildly warming. And I think these qualities give us even more another layer of information about the herb's personality and behavior in the body, so we can help uh ourselves further differentiate between other herbs and other immune adaptogens. So the sweetness that's present, and I'm actually currently taking Astragalus at the moment, and I'm obsessed with the sweet flavor and even the smell of Astragalus, and that really gives us this beautiful, nourishing, restoring, and rebuilding quality, which is what we really need when we're depleted and we're weak. It's a wonderful tonic medicine, and that sweet taste that's also present in many of the medicinal mushrooms across actually every herb that we'll speak about today. We do often see that in our adaptogens and tonics because that flavor is the most deeply nourishing, strengthening, and tonifying taste that we have that harmonizes, lubricates, and helps build up our tissues. And actually, I did speak a little bit more about these types of energetics that we often see in adaptogenic medicines recently in a talk that you and I did, Julianne, at the Estuary Learning open house event this year. So you can always look that up if you're interested and you want a little bit more information about that. But the sweetness present gives Astragalus that replenishing capacity, and then the mild warmth gives it enough activation to support movement, vitality, and functional capacity in someone that's depleted. So we know that heat in a plant, that the thermal property of heat has a stimulating and quickening effect in the body, it promotes movement. Heat is a yang force. And although Astragalus isn't considered to be hot, like something like a Ginger or a Korean Ginseng or a Cayenne, you know, they're very hot and stimulating herbal medicines. Astragalus is just warming enough to gently activate the system and help a person begin to generate and use energy more effectively again. So it's restoring, it's gently building, and I also think of it as being stabilising and strengthening. And that stabilising aspect of Astragalus, I think, is really nice. I often visualise stabilising medicines as if someone is trying to climb a shaky ladder, and then, you know, I hate that feeling like not being on solid ground, and then you know, somebody else comes along and holds the bottom of the ladder so it's secure. So that stabilizes and holds the person so that they can safely then climb the ladder. So in the body, this stabilizing effect can actually improve tissue tone in that holding sense and really prevent the inappropriate loss or inappropriate distribution of fluids. And that's part of Astragalus helping with that excessive sort of sweating picture. So there's this real quality of Astragalus helping hold or helping the body hold itself together. Astragalus also actually raises what TCM calls central qi and um helps with prolapses and things like that in the body where the energy is pushing downwards. So I might have a depleted patient who is either maybe sweating excessively from a little bit of exertion, or they're just reporting that they have day sweats or night sweats, or just somebody whose fluids aren't being held particularly well. Perhaps their tissue tone is poor, maybe they have some history of organ prolapse, or they just seem to be a bit leaky, like they're losing their reserves almost as quickly as they can generate them. Astragalus can come in and have this containing and stabilizing quality that makes it really useful in that type of picture. For me, I often also think about it when somebody presents visually as being quite uh passive and pale. Um, it's a great tonifying and restorative herb systemically, so for the whole body. Um, with Astragalus, there is quite a broad range of tissue affinities that we can think of for it. But I I really love it for the kidneys. I think it's a beautiful kidney tonic herb. It has a great affinity for renal health, also for the stomach and spleen, for the liver, also the adrenal and nervous systems, and of course for the lung and the immune system, which we are focusing more on today. So if I try and attempt to put all of that traditional use and energetic perspective together, I really do think about Astragalus as gradually being able to build our reserves and then helping us maintain them. And now I think if we look into the research and get into some of the immune species specifics of Astragalus, this is a super interesting aspect to Astragalus's picture as well. And Julianne, you so beautifully laid the foundations of our immune health earlier in the podcast. Because I think a lot of the modern immune research really gives us a quite sophisticated picture of what the immune modulation that we're talking about energetically and clinically, what that actually looks like mechanistically in the body. And with Astragalus, I will say the evidence is still weighted quite heavily towards preclinical research, but it does give us a very detailed and increasingly compelling mechanistic picture. And we do also have some human clinical research and certainly a lot of clinical application that backs this up as well. So I mentioned earlier that Astragalus is also a polysaccharide-rich plant, like the mushrooms, and that's probably the constituent group that's emphasised most strongly when we're talking specifically about immune activity. But we also have saponins and we've got flavonoids and lots of other constituents as well that all do seem to play a synergistic role. Like you mentioned earlier, Julianne, with the mushrooms, it's just classic phytochemistry there. You know, if things are working synergistically, where everything is beautifully coordinated, like An orchestra, and we that's where we're able to achieve these modulating effects, you know, where we're able to get an intelligent response to what environment uh the plant medicine is being exposed to. And what the literature does suggest is that Astragalus does have this modulating effect across both our innate and adaptive immune system. It seems to be very broad in its ability to work on both of those arms, so both the rapid response arm and the slower, more highly targeted arm. At the level of immune surveillance, Astragalus has been shown to activate those dendritic cells, which you mentioned, Julianne. So we know that they're like those intelligent officers or messengers of the immune system. You know, they're sampling what's going on, carrying that information to the T cells and helping to determine what sort of immune response should happen next. Astragalus has also been shown to activate our macrophages, increase the expression of other costimulatory molecules involved in antigen presentation. It also appears to influence natural killer cell activity and macrophage phagocytosis. So we're seeing all these increased beneficial effects across some of those first-line cells involved in recognising and clearing threats. And I like to think about that like that defensive qi, you know, that that sort of surveillance immediate response. And then when we move into the adaptive immune response, the research describes effects on T cell proliferation and function, including influencing our CD8 positive cytotoxic T cells, which we know are so important because they can identify and destroy some of those cells that contain those intracellular pathogens, like you were speaking about, Julianne, the viruses, abnormal cells, tumor cells, those kind of things. And I think that's partly why Astragalus has attracted so much research interest in those contexts. Also part of Astragalus' effect on adaptive immunity is to do with its ability to balance those different T cell populations. You mentioned earlier about that T helper one, T helper two balance, Julianne, which we know is so important in determining the character of an immune response. For instance, you mentioned we know we need a really robust T helper one response to deal with viral infections. So Astragalus has been shown to do that in that particular situation. So it's able to act as an antiviral in this way through its immunomodulating effect. Astragalus has also been shown to have balancing effects on T helper 17 and T reg cells, which is particularly relevant when we're talking about immune tolerance and inflammation regulation. So T regs we know are really important for keeping our immune activity appropriately restrained and maintaining our tolerance. I always think T regs regulate, you know, regulate restrain while our T helper 17 cells are involved in our inflammatory defense. So the relationship between those populations becomes especially important in chronic inflammatory and autoimmune states, which again, Astragalus can be a great inclusion in a herbal mix for these presentations because it's so good at appropriately balancing activation and restraint. And it's so gentle. It's a beautiful phytomedicine in this regard. Another example in studies that shows Astragalus's potential at modulation is where Astragalus constituents have been shown to influence either M1 or M2 macrophage activity, depending on the environment, uh the experimental environment that was studied. So M1 macrophages are more associated with phagocytosis, antigen presentation, and pathogen killing, while M2 macrophages tend to be associated more so with inflammatory resolution, tissue repair, and mediators like interleukin 10. So, for example, Astragalus has been seen to preclinically enhance M1 polarisation when an antiviral and anti-cancer immune environment is required. So it really does encourage in lots, in all these different ways, the type of immune environment that we need to deal with the type of threat that we're experiencing. And so just throughout the research, I mean, we could go on forever, but we're seeing this really interesting capacity to influence the character of the immune response according to what's happening. It's such a real mechanistic modulating effect. And I just love how these research studies show the intelligence and the nuance of our herbs. One recent article described this effect really nicely as being bidirectional immune regulation. And it frames Astragalus so well in terms of restoring immune homeostasis and immune tolerance, which is a great description of an immune adaptogen. Of course, we also have an important gut immune component, as there is with all the polysaccharide-rich herbs. So Astragalus has been seen to strengthen intestinal barrier integrity, influence the microbiome, increase beneficial metabolites like butyrate. And we know all of that because of that gut immune connection can further support our immune regulation. So all of these are just layers upon layers of why Astragalus is so beneficial. You could layer on top of this its inflammation modulating and antioxidant activity, its mitochondrial activity, its tissue protective effects. And so all of this comes together, and then we we can sort of see that Astragalus patient sitting in front of us. I always think of that person whose physiological reserve has been really drawn down over time. There's depletion, there's impaired resilience, that slow recovery, fatigue, weakness. I use it a lot post-virally and for chronic infections. I love it for immunocompromised states where there's uh issues with blood cells like leukopenia. Uh I love it in adjunctive cancer support. I love it in autoimmune conditions. And we know in autoimmunity it's it's this dysregulated inflammation. There's a loss of immune tolerance and there's all these gut immune interactions. So you can see why it'd be so good for that. And I also have used it quite a lot to support convalescence. I particularly like it post-birth and post-trauma, and also for renal health, as I mentioned, gastrointestinal health. It's great for fibrosis and also for other chronic inflammatory conditions. I find it to be very supportive, very efficacious. It's super safe. I prescribe it long term, and I see that it really gradually restores health over time. Would you see it in a similar way, Julianne?

Julianne Grant 51:21

Absolutely. I think you've nailed it. It's a fabulous plant, and we both use a lot of Astragalus. I definitely see it as a building tonic. So now when you have your patients that have um low white cell count and have had for a very long time, um, that tends to be a real indicator for me to want to use Astragalus alongside some other nourishing and building herbal medicines or medicinal mushrooms. But I love Astragalus exactly in the way you have described it. It is so gentle. And I don't want our listeners to confuse gentle with low impact because it still has a really significant impact. It just does it in this beautiful, gentle, nourishing way. So no, Astragalus, Astragalus is one of our favourites for sure, Kristin.

Withania or Ashwagandha (Withania somnifera)

Kristin Gilmour 52:06

Yeah, and I think another favourite that's also beautifully gentle in a sort of similar but different sense is Withania. Maybe Julianne, could you tell us a little bit about how you use that as an immune adaptogen?

Julianne Grant 52:18

Yeah, Withania, Withania somnifera is a beautiful plant and not one that a lot of us come to think of as a first-line immune modulator. Um, you know, it's one of our beautiful adaptogens, like physical and mental adaptogen. It's calming, it's a beautiful nervine, it's nourishing, it's a building tonic again. Um, you know, it has it has such a strong and long history of use, like it's over 3,000 years of use in the Ayurvedic medical system. Um, and it's termed as a Raseyana, so one of those beautiful rejuvenating tonics that is specifically aimed at restoring strength and vitality after illness or depletion. And really, this is where Withania shines. So in modern day, we can look at that as people that have been chronically under stress and they had just depleted, whether that's ongoing illness or environmental stress, physical stress, mental stress, but that sort of depletion after that impact, Withania is beautiful at calming and nourishing the entire system. So it's really a resilience builder, I think, of Withania. So it falls in a lot of categories for the modern person and where we might want to use it. So I still believe it's primary use as an adaptogen and a nervine. I think that's honestly where I use it primarily. But I love knowing that it has this immunomodulation edge to it, which is still quite profound. Um, I remember, gosh, this is like 12 or so years ago, Kristin, I was researching um herbal medicines and for for cancer, actually. And Withhania research was one thing that came up. And the reason why Withhania came up in that domain as an immunomodulator is because it does actually have a notable trend towards tipping our T helper cells. So if we're talking about that adaptive immune response now, once again, that T helper response into a T helper one kind of response. And it's a real supportive herbal medicines in that regard. So there is some research around looking at that T helper 2 skewed kind of immune activity, such as what we might see for chronic allergy or atopic presentations. Withhania can be beautiful using it alongside them. Often there is this stress component to those patients as well. So withhania might fit beautifully in that chronic allergic or atopic presentation, but also think about it in the person that has is fighting cancer, you know, one of the most stressful situations we will go through, um, as well as wanting to support their immune activity and their immune vigilance. Um, withania will pair beautifully, even with a Maitake or a turkey tail or an Astragalus that we spoke of before. So I I love Withania in that regard. Um, and using it synergistically will really ramp up what you're asking that immune mix to do. Um, it also has some lovely research around it for its ability to enhance some of our innate immune cells, such as macrophage activation, but also slightly activates a natural killer cell activity and stimulation. So, you know, there is a nice, there is a nice arm to Withhania in that regard as well. It's probably just not as pronounced as what we would see in a medicinal mushroom or in Siberian or something like that that we're about to discuss soon. Um, but I think one of the most relevant parts of Withania is that it really does nourish our stress response because our stress response can be one of the most problematic issues with regards to a robust immune response from our gut out, really. So I think using withania in those people that present with a chronically stressed plus immunosuppression, never been well since, um, sitting in that post-viral syndrome, and it's very worrisome for them. It's stressing them. They're still trying to work and get through their daily life. Building them and nourishing them in that way with withania, particularly as a synergistic immunoadaptogen, I think would be a lovely person that I would look to put that to. Anyone with that um T helper 2 dominant picture, so that atopic tendency, I think Withania is beautiful there. It is gentle, it is nourishing, it will support them on every level, nervous system, immune, and gut. Um and also as an adaptogen, we can think about using withania that has that fatigue immune overlap. So again, we come back to that kind of picture of um stress-induced immune issues such as cancer, atopic skin conditions, which are so stressful, um, postviral syndrome where they're not able to live out their life energetically like they could. All of this is stressful. So Withania comes in for that stress, fatigue, immune overlap. Um, and any person that you can think of that has a strike, a high stress load that often catches colds or often catches whatever gets brought home, you know, that um executive worker or that athlete or someone that has that high physical stress load, Withania can come in and support their immune activity to keep their resilience high. Um, I love Withania there. It's such a beautiful, nourishing, gently warming kind of um herbal medicine, Raseyana is the best term for it, that I think of. And Kristin, I loved your discussion around the energetics of a lot of our immunomodulating plants being warming and nourishing. Um, and withania is no different. I adore it, I use it a lot, um, but it does cover a lot of those areas that I cover. So, you know, if any of your patients have an immune issue that impact that also impacts the nervous system directly, so it might be autoimmunity that impacts the nervous system, or there might be a cognitive component to their to their immune condition, then withhania is something I might lean on as well. And, you know, thinking of cognition or nervous system involvement, then we can look at pairing our lion's mane as a medicinal mushroom with something like a withania, um, and then throw in some astragalus for good measure. So there's there are some beautiful plants we can think about, depending on what that patient presentation is. But I think my final message with Withhania on that is that even though we know it as a beautiful adaptogen that is nourishing to our nervous system, a wonderful nervine, supportive of sleep, it will also support your immune activity, particularly in those depleted, stressed states. It will support our immune activity in that way. How do you see with ania, Kristin? Is that kind of your visual of it as well? Yeah, definitely.

Kristin Gilmour 59:21

I think that is such a great reminder of Withania's immune potential. And it is gentle in that regard, but it's so amazing at calming the nervous system excessive response, if you will. You know, we always talk about that tired and wide patient picture. Witha nia, if we can help to balance cortisol levels and things like that, get uh patients having great sleep and all of that combined with its immune support, just makes it so useful for those kind of people. I agree.

Julianne Grant 59:56

Yeah, it's lovely. And we do go through a lot of withania. I think pretty much every practitioner would go through a lot of withania in the modern day.

Siberian Ginseng (Eleutherococcus senticosus)

Julianne Grant 1:00:04

I would love to finish up with discussing Siberian ginseng because I think this is one that some of us, me putting my hand up here, um, have forgotten to use through with all these other mushrooms and everything we get to use. I um you have actually brought me back to the attention of Siberian ginseng through our um estuary webinar that we gave a little while ago. So I would love you to talk about the immunomodulating properties of Siberian and when you think it fit to use.

Kristin Gilmour 1:00:32

Well, yes, I would love to talk about Siberian ginseng or Eleuthrococcus senticosus. And I think out of uh Astragalus, with ania, and the mushrooms, I would say that I personally find Siberian ginseng to be probably the most stimulating immune adaptogen that we've spoken about, particularly when it's given uh at higher doses of its therapeutic um reference range. And the way that it is stimulating is in a real strengthening and boosting kind of way. I always think of Eleuthococcus as my primary endurance adaptogen, you know, Eleuthroendurance, I don't know, that's almost alliteration just to help try and remember it. But, you know, I think about like I was mentioning before, Astragalus helps to build our reserves, whereas Eleutrococcus, I really feel helps you go the distance. And I, you know, I always think about that song from the movie Hercules. I think Michael Bolton did a cover of it, but it's it's called Go the Distance. And I feel like that's my Eleuthococcus or Siberian Ginseng theme song that really helps me conceptualize what I'm using Siberian ginseng for. And if we think about the time when research into Siberian ginseng really took off, it was in uh Russia in the 50s and 60s, and at a time when overharvesting and the cost of another very potent stimulating adaptogen that we love that also has great uh immune modulating properties, Korean ginseng or Panox ginseng, you know, the worry about not being able to use Korean ginseng created a need for an alternative potent adaptogenic herb. And Eleuthococcus was then used in all of this Soviet research to improve stamina, endurance, alertness, and resistance to stress. And they studied it in lots of different populations, including in Olympic athletes and in Russian cosmonauts who are adapting to the extreme physical and environmental demands of space. I couldn't think of anything worse. I can't even imagine how taxing that would be. But there's also all this super interesting uh research in these trials where they put people through all sorts of extreme environments. Um, they got them to do things like prolonged cycling at high altitude and exercise in these super hot saunas. And they found that a leuthococcus could help uh participants maintain physical and cognitive performance under extreme physical stress. And so I do think about that research body, which we do have more access to within the last few years. More of it's been translated. And it's and it's really encouraging as well because throughout that research, they're usually using an extract that's similar to what we would use now as a uh hydroethanolic liquid extract. And so I do use Siberian ginseng a lot to help people cope with increased physical and environmental demands. And so you can think about those people that maybe need to improve their exercise tolerance or people who have an excessive workload, or for those typical sort of, you know, work hard, play hard type of people. Um, also type A personalities, because we know cyber engine sing is also neuroprotective and it helps with that cognition and mental resilience as well. Or, you know, anyone dealing with other types of prolonged stress like environmental stresses, you know, that could be traveling, flying, extreme temperatures, uh, toxin exposure, radiation exposure, you know, all of those kind of environmental uh stresses. And for that environmental stress adaptogenic effect, I actually really like combining Siberian ginseng with another beautiful stimulating adaptogen that you actually spoke about in our last podcast episode, Julianne, um, which also supports our mitochondria health, uh, rhodiola. And so there's a bit of crossover activity there, and they combine really nicely for that type of picture. And they're both stimulating. And actually, I think when rhodiola became more popular, uh, people did sort of forget a little bit a bit about Siberian ginseng, but it works beautifully. It's such a great adaptogen and it and it really helps with that typical sort of adrenal depletion or exhaustion type picture as well. Uh, when patients have those dark circles under their eyes, which often can occur with adrenal depletion, that could be an indication. And in China, Siberian ginseng is now understood to uh, through the TCM perspective, strengthen the kidneys. And on our face, that portion under our eyes that is connected to kidney balance in TCM. So that's a nice connection there where you might think about using Siberian ginseng. But also, of course, in the TCM paradigm, it's considered to be a chi tonic and it's also used to strengthen the spleen, like every um vital medicine we've spoken about today is or has been used for. But Siberian is quite a stimulating chi tonic. So It's very potent at boosting our vital energy, especially when it's given in those higher doses. And one little sort of, I guess, um paradox or thing to keep in mind with Siberian ginseng is although it is stimulating, it can still also help us with sleep and mood. And it can be useful for patients that are bothered by excessive dreaming. So I would usually prescribe it in a daytime mix for that type of presentation, but it can certainly help kind of calm that neurological stress as well. So all of those things would point me towards, oh, maybe I need to use some Siberian ginseng in this person's mix. And another way that I like to think about Siberian ginseng is that it is, it's really a fantastic metabolic restorative and regulator. So when we see stress affecting the endocrine system, like, or the cardiometabolic system, we might think of Metake, but we can also think of Siberian ginseng. So it works so well to normalize and increase energy in these systems. So if somebody has dysregulated blood sugar or blood lipid levels, they've got fatigue, adrenal depletion, and there's also impaired immunity. Maybe there's allergies, maybe there's a pathogenic load like a viral or a stealth infection burden, or perhaps it's it's a chronic illness or autoimmunity. Siberian ginseng is a great inclusion in a mix for these patients. And then if we think about Siberian ginseng's energetics, like uh Astragalus and Withania, it is warming in its thermals, but it's much more warming than these other herbs. So withania and Astragalus, we mentioned, are quite gently warming. They're more like a little kindling, uh, whereas Siberian ginseng has that warming potential that's much more stimulating and activating, and especially when we give it in in higher doses. It is also sweet, like many of our adaptogens, and it's also a little bit bitter, so it makes it useful for those lax or depressed tissue states as well. And then if we look at the research and we look at some of the specific immunomodulating effects of Siberian ginseng, there is, of course, crossover with some of the other phytomedicines we've spoken about today. But if I was comparing its immunomodulating uh mechanistic effect with a herb like Astragalus, Astragalus seems to have this very broad immunomodulating picture, whereas Siberian ginseng seems to be quite specifically useful and especially useful for maintaining that immune competence under stress. So research research describes increases in lymphocytes, natural killer cells, neutrophil phagocytosis, and other immunocompetent cells, and the recovery of activity of these cells, like natural killer cells under stress. And so, you know, it's great for that helping you cope, helping you go the distance when you're having something come against you. It's also great to modulate inflammatory signaling and it's um been found to suppress uh allergic reactions as well by inhibiting the release of histamine from mast cells. And for that particular action, I think it combines really nicely with bacal skull cap or scudillaria bacalenses. That's a great um combination for that allergic presentation. And so the picture is really one of improved immune surveillance and resilience, and especially when we're impacted by stress and fatigue. And so I guess within the immune system, as within the whole system of the person, I come back to that idea of being able to go the distance. You know, I might not be treating Russian cosmonauts, but I can definitely support my patients' immunity when they're exposed to the stresses that we commonly encounter. You know, a good, not a good, but I was going to say a chronic infection is a good example. So I view Siberian ginseng as a component of many herbal mixes for very difficult to treat infections like stealth infections, mycoplasmas, and it can be really effective for that kind of presentation as well. So they're the types of patterns that I'm looking at in my case taking. If I see overwork, I see prolonged stress in any of these areas, that's when I would employ Siberian ginseng to help my clients' immune system adapt and improve their capacity to handle what's being thrown at them. And interestingly, I remember when I was looking into unique herbs a little while ago for lymphatic support, and I came across this really interesting little study looking at Siberian ginseng, which is not known to be traditionally a lymphatic herb, but nonetheless it was found in this study to prevent lymphatic congestion and lower limb swelling in people that were forced to sit for six hours. And they thought this was because the herb supported lymphatic endothelial cell function, which had been found to do preclinically. But what I really like about this little trial in the context of what we're speaking about today is that it is a very literal example of Siberian ginseng helping the body go the distance and improving the capacity to endure a physical stressor, in this case, sitting for a long period, which I do many days. So that's how I really see Siberian ginseng, supporting our tolerance and helping us meet the demand. In terms of uh prescribing it and dosing it in sensitive individuals, I do use much lower doses and I do tend to prescribe it earlier in the day, as I do with most herbs that people might find stimulating. Um, but I do also use it in higher doses as well if I want a bigger sort of boost, a more stimulating effect. I've also used it both acutely and long term because both ways of prescribing are supported in the research, and I and I do see that translate clinically, and it's also quite safe to use long term.

Julianne Grant 1:12:15

So what do you think about Siberian ginseng, Julianne? Well, that's a fantastic rundown of a fantastic plant. Um, for my mind, the keys that come to my mind is more that that being able to tolerate Siberian ginseng because some people can't, and you mentioned you can low dose that too, but sometimes you need to work people up to being able to take Siberian ginseng, and that's maybe where Astragalus Withania and those plants fit in first. Um, but the other thought that always comes to mind with using Siberian ginseng, since you reminded me of it a little while ago, is that physical stress, like being under that physical stressor, I think, is um an important indicator for Siberian ginseng, and maybe even like a Korean ginseng or a rhodiola that we haven't even spoken about, the ginseng family today. Um, obviously amazing immunomodulators.

Lymphatic Immune Connection

Julianne Grant 1:13:05

The other thing you mentioned on, which just triggered me before we we end this podcast, is that lymphatic support is actually one of our crucial elements to chronic immune dysregulation. And often you will find in people that do have dysregulated immune responses or activity, is their lymphatics are sluggish. And they're one of the most important parts of our body to be able to communicate our dendritic cells and then produce the correct T cells, B cells that we need for our immune response to occur. So just check in on your clients or your patients' lymphatic activity because perhaps that's one of our missing links. And I know when we're talking about um tumor microenvironments and those um postviral patients that that their lymphatics is hugely important because perhaps they are not on point. So therefore, perhaps we're not actually maturing our immune system and our immune system cells as best as we can to have the most robust response to that um cancer or pathogen that we should be. So thank you for that reminder on Siberian. That's a that's a really good thing to be able to mention to our listeners. But Kristin, what an awesome topic of immunomodulators. Clearly, we love them. We've talked about them a lot. We know them inside out because we use them so often and we see um different patient pictures with those plants. So I hope everybody listening today has gotten a lot of clinical use from what we've spoken of and been able to go ahead and use those immunomodulators confidently and are going to take a deeper dive into some of their most loved or even less loved medicinal mushrooms that you could learn more of. So we look forward to talking to you in our next podcast episode.