Purity Doesn’t Have Units
The first time M came to clinic she brought a notebook with eight years of supplements written down. Eight years. She’d brought it because she thought I might want to see what she’d already tried (I did). The pages were color-coded. Adaptogens in green, antioxidants in blue, “mood support” in purple, with a small key inside the front cover. She apologized when she handed it over. Said she was sorry she wasn’t more organized.
What had brought her in, eventually, was that she hadn’t slept more than a few restless hours a night in months. She’d been crying in her car before work and crying in her car after. Her husband had asked if she was thinking about hurting herself and she’d said no, but she wasn’t sure that was true. She told me this matter-of-factly, the way someone reads off the symptoms on an intake form they’ve filled out before. Which was correct. She had filled this form out before. In the last year she’d been to two herbalists, an acupuncturist, a functional medicine doctor, and a Reiki practitioner. She’d done two ten-day cleanses. She’d been on a strict autoimmune protocol for the better part of three years despite no autoimmune diagnosis.
She had not seen her primary care doctor or had any labs in eight years. She recognized her depression and had never tried an antidepressant. When I asked her why not, she said, very simply, “I don’t put that stuff in my body.”
I don’t put that stuff in my body.
Eight years before, when she first got interested in herbal medicine and went to study with a teacher whose name doesn’t matter because so many say similar things, she was told that pharmaceutical antidepressants would “block her growth.” That she would never know who she really was if she was numbing herself. That serotonin reuptake inhibitors damaged the brain and the people who took them got stuck in their patterns. The teacher had a story she liked to tell about a student who got off her medication and finally became herself. She told that story a lot. M heard it many times.
I have heard versions of this teacher all of my career. I have sat across from her students for twenty-five years. I am one of them, in a way, because the herbal community I came up in shared most of her assumptions, and it took me a long time to see past them.
What M believed when she walked into my office was not a theory about pharmacology. It was a moral commitment. Synthetic was contaminated. Natural was clean. Her depression and anxiety, however bad they got, were a kind of signal. Something her body was trying to tell her, which she would only obscure if she “covered it up” with chemicals. The shame she felt about not being well after eight years of doing everything right was not, in her mind, evidence that the framework was failing her. It was evidence that she had not done enough.
There is a particular flavor of grief that shows up in folks like M after starting successful treatment. It comes after the emptiness fades. It comes after sleep returns. It comes after the suicidal thoughts recede. It is grief for the years.
The story I just told about M is one I see, in some version, every few weeks. The teachers vary. The supplements vary. The specific way the community failed the person varies. What does not vary is the structure of the belief. What does not vary is the moral weight. What does not vary is the cost.
There’s the person whose hypothyroidism went unmanaged for six years because levothyroxine was “synthetic hormones” and she was going to support her thyroid with herbs and seaweed instead. Her TSH was over forty by the time she let me run the test. She cried when we reviewed the results together because, somewhere inside her, she already knew. There’s the person with type 2 diabetes whose fasting glucose was averaging over three hundred and who would not take insulin because insulin was for people who had given up. He’d built his protocol around berberine, gymnema, and cinnamon, then added strict carnivore for a year. By the time he came back to insulin his vision was blurry and his feet had started to numb. There’s the person with an LDL never less than 200, who refused statins for fifteen years and had a heart attack at fifty-two and survived it, and still, after surviving it, was not sure if he was going to take the statins. The pharmacist filled the prescription every month. The bottle stayed on the counter.
I’m not telling these stories to ridicule the people in them. I love them. I work with them. They are some of the most thoughtful, careful, intelligent folks I know. They read more than most clinicians I know. They take their health seriously in a way most people don’t. They do not deserve mockery and they will not get any from me.
What I want to do is name the framework that hurt them. Because it is a framework, and once you can see it you can see it operating everywhere in our community. It runs underneath every conversation about toxins and detoxes. It runs underneath every horrified gasp about seed oils and fluoride. It runs underneath every refusal of an intervention that might have helped, every embrace of an intervention that didn’t, every quiet shame at having to admit to the herbalist that yes, the doctor put you on a medication, and yes, you are taking it.
The framework is simple. Everything humans make is contaminating. Everything humans haven’t touched is clean.
That belief is not a finding. It is a purity creed. And purity doesn’t have units.
Who I’m Writing To
This framework operates in a lot of places, and I want to be clear about which one I’m addressing.
It runs through what’s now called the wellness industry: the supplement empires, the influencer ecosystem, the functional medicine clinics that charge four thousand dollars for a workup the labs cost two hundred to run, the Instagram feeds of every concerned parent in America. That world is enormous, and not mine, though my clients pass through it constantly. It picked up the categorical framework that already lived among us and made it the basis of a marketing strategy. It industrialized something that was already there.
I’m writing to us. The herbal community has a history that runs deeper than the wellness industry and is not the same thing. The plant folks I idolized fought for sustainable agriculture and against the industrial poisoning of land and water. They knew the names of the plants and where they grew. They made medicines for their neighbors. They taught what they knew, mostly for free, in living rooms and at conferences in old summer camps. They were the early voices for organic farming when organic farming was still considered cranky, for the small farm against agribusiness, for the local apothecary against the chain pharmacy. They fueled real positive change. The world is better for what they did. They made me, in many ways, and I am still grateful to them.
We were here first. We did not invent the supplement aisle and we are not in charge of the influencer economy. What we are in charge of is our own framework, and the framework has a problem that we have not been honest enough about, and the cost of not being honest about it is borne by the folks in our clinics.
Pollution and Order
The belief is a creed because it isn’t held the way scientific claims are held. It isn’t tested. It isn’t revised when contrary evidence comes in. It isn’t graded for confidence depending on the strength of the data. It is held the way moral commitments are held, and like other moral commitments, it organizes behavior, identity, and community. When M told me she didn’t put that stuff in her body, she wasn’t reporting an empirical observation. She was telling me who she was.
The person I want to bring into this conversation is Mary Douglas, a British anthropologist whose 1966 book Purity and Danger asked one question of an enormous range of human cultures, from biblical food laws to central African ritual practice to modern European table manners. Her question was what those beliefs were doing in the cultures that held them, not whether they were true. Her answer reframed the field. Pollution beliefs look like they’re about hygiene and danger, but they’re often doing something else entirely. They’re systems of classification, ways of organizing what belongs where. Dirt, in her famous formulation, is matter out of place.
Hair is clean on the head and disgusting in the soup. The hair has not changed chemically. What changed was its place in an ordered world. A shoe belongs by the door; on the pillow it becomes filthy. Food belongs on a plate; smeared on the wall it becomes dirt. Things become unclean when they violate the classification. The dirt is dangerous for what it represents, not for what it physically is.
The herbal and wellness world has its own version of this. The clean side contains the natural, the ancestral, the traditional, the whole, the unprocessed, the plant, the earth. The contaminating side contains the synthetic, the laboratory, the factory, the industrial, the processed, the artificial. Once that system is in place, the empirical question gets quietly displaced. We stop asking, “What does this substance do, at what dose, in what body, under what conditions?” and start asking, “Which side of the line is it on?”
That is why canola oil feels contaminating while coconut oil feels clean. That is why white sugar feels like poison while maple syrup feels like nourishment. That is why an SSRI can feel like an invasion while a capsule of imported, standardized, industrially extracted ashwagandha feels like nature. The category is doing the work before the chemistry ever gets a hearing.
This is also why the empirical incoherence of the framework doesn’t bother the framework. The natural world produces some of the most acutely lethal substances known to science, and the laboratory produces some of the most life-saving. We’ll get to the chemistry in a minute. The point here is that the category tracks belonging, not danger.
Douglas had a second observation worth holding onto. Pollution rules tend to intensify when a community feels its boundaries under threat. When a group is anxious about its identity, about who is in and who is out, about whether its way of life is going to survive, pollution rules proliferate. The body becomes a microcosm of the social body. Defending the body against contamination becomes a way of defending the community against dissolution.
It is not a coincidence that purity rhetoric in the herbal world I came up in has intensified over the last twenty years, the same period in which Western herbalism has struggled with its place in a medical landscape that has both absorbed pieces of what we do and dismissed the rest. The community feels embattled. Its boundaries feel porous. The purity framework, with its sharp lines between us and them, between clean and contaminated, between authentic and corrupted, performs the work of holding the boundary. Every refusal of a synthetic intervention is a small ritual affirming that we are still us.
I want to be careful here. I’m not saying anyone who avoids “toxins” is consciously enacting a tribal boundary ritual. I’m saying the structure does this work whether or not any of us can articulate it. M wasn’t thinking about boundary maintenance when she told me she didn’t put that stuff in her body. She was telling me something true about herself, in the moral vocabulary our community had given her. The framework was doing the work behind her words.
The list of “toxins” we refuse changes constantly. Twenty years ago it was aspartame, MSG and saccharin. Then it was gluten and soy. Then it was seed oils. Now it’s carbohydrates and EMF. The list updates almost as fast as fashion. If the framework were tracking actual chemistry, you’d expect some stability: substances dangerous in 2005 would still be dangerous in 2025, and the same evidence would govern the same fears. Instead the list changes with the community’s mood. New threats arise; old ones quietly drop off. This is what pollution rules do. They track the community’s sense of what is threatening it, not reliably what is dangerous, and not in proportion to danger.
Take seed oils, the strong one right now. The biochemistry that gets invoked is not fake. Linoleic acid is a real fatty acid. It enters real pathways. Oxidation chemistry is real. Industrial extraction is real. There is a real conversation to be had about the modern rise in added fats, the displacement of whole foods, repeated heating in restaurant fryers, and the hedonic value of ultra-processed food. That conversation should happen.
But that is not usually the conversation happening. The conversation happening is: seed oils are toxic.
That is a category judgment pretending to be biochemistry.
You can see it because the refusal does not track omega-6 consistently. The same person who will not touch canola oil in a salad dressing may happily eat almond flour crackers, tahini, walnuts, pumpkin seeds, chicken thighs, pork fat, or “ancestral” snack foods made from nuts and seeds. Many of those foods contribute meaningful linoleic acid. Some may contribute more to the day’s omega-6 load than the teaspoon of oil being refused. But they do not feel contaminating in the same way. They are whole, traditional, earthy, ancestral, crunchy, farmer’s-market coded. They belong on the clean side.
The oil does not.
That is the tell. The dose-thinking conversation almost never happens. Total intake, food matrix, what’s being replaced, background diet, what the human evidence actually shows when polyunsaturated fats replace other macros: these are the questions toxicology would ask.
Purity frameworks ask belonging questions, not replacement questions. Canola oil belongs to the factory. Sunflower seeds belong to nature. Tahini belongs to traditional foodways. Almonds belong to clean eating. The fatty acid may be similar enough to deserve comparison, but the moral meanings are completely different.
That is why “seed oils are toxic” is not really a toxicological claim. It is a purity claim with a biochemical footnote.
Sugar works the same way. White sugar is contaminating; maple syrup and honey and coconut sugar are clean, though the body’s metabolic response to comparable doses is broadly similar. The moral difference outruns the metabolic one.
This has been a lot. There’s more. Let’s pause for a breath and stretch. Wouldn’t a cup of tea be nice before resuming?
None of this is easy to write, and changing my beliefs about these things has been difficult. I spent a decade eliminating seed oils from my diet and teaching others to do the same. The omega-6 to omega-3 ratio argument made sense to me. The biochemistry sounded right. I had students who would not touch a salad if there was canola in the dressing because I had taught them not to.
Then I was challenged to review the science again. I did, and wondered if I’d misinterpreted things. So I experimented on myself. Reintroduced seed oils. Felt fine. Maybe a little better, honestly. Then I went back to the research with even more careful eyes, and was forced to admit that what I had been confidently teaching was not what the evidence actually supported. I had been wrong. I’ve been trying to correct that with students for the last five or six years.
After reviewing hundreds of studies and rebuttals and criticisms of studies, I’m more confident than ever that the categorical refusal isn’t doing the toxicological work it claims to be doing, and I still have a mental hangup about canola oil. I know it’s fine. I know it’s probably better than several of the oils I’d reach for in its place. And when I’m in the grocery store, I still grab something else if it’s available. The intellectual position changed. The unconscious reach didn’t, not fully, not yet.
Same for organic produce. The research on health outcomes for people eating conventional versus organic vegetables shows no clinically significant difference. I know that. I have known that for years. I still know which side of the produce aisle I head for first.
This stuff is baked in deeply. Working it out of yourself is slow. It is not a matter of reading one essay and changing your habits the next day. It is a matter of years of noticing what you reach for, asking why, and sometimes choosing the other thing on purpose just to see if the world ends. The world does not end. The hangup loosens a little. Then you notice another one. Slowly, over time, life opens a little. Constraints we didn’t realize the weight of, ease. We say yes more. We fear less.
That is the move I’m asking of all of us. Whatever each of us thinks about sugar, or seed oils, or any of the rest, the question is whether we are thinking about it on chemistry and dose and bodies, or on which side of a categorical line the substance falls on. If a refusal is doing moral work for us, the refusal is the thing to examine. The substance may be doing nothing we actually need to worry about.
What Paracelsus Knew
If we wanted to actually track danger, instead of category, the answer has been around for about five hundred years. What’s strange is that it was given to us by someone we already claim as ancestor.
In 1538, in the third of his Septem Defensiones, Paracelsus wrote a sentence that has been more or less the foundation of toxicology ever since. In modern translation: all things are poison, and nothing is without poison; the dose alone makes it so a thing is not a poison.
Paracelsus was responding to charges. His critics, who were many, accused him of poisoning his patients by giving them mercury and antimony and other metals. His defense was that everything is a poison at sufficient dose, and that the question of whether a substance harms or heals is never settled by what the substance is. It’s settled by how much of it ends up where, in whom, under what conditions.
Paracelsus shows up on our shelves all the time. His central sentence almost never shows up in the conversation. He gets the lineage treatment. The doctrine of signatures, which has had a long and complicated career in herbal medicine, gets attributed to him. He is named as the father of alchemy, of pharmacology, and sometimes the father of modern medicine. The herbal world is generally proud to count him as one of ours, an early voice in the long tradition of working with substances drawn from the natural world. Open most introductory herb books and you’ll find him somewhere in the first hundred pages.
But the thing he is most known for outside our tradition is the thing our tradition has never figured out how to integrate. He did not say that natural substances are safe and synthetic substances are dangerous. He said everything is a poison at the wrong dose, and that this is true of everything. The plants we love. The substances we make. The water we drink and the air we breathe. The categorical distinction was not one he allowed himself, even though he lived in a century that drew categorical lines between the natural and the artful much sharper than ours. He spent his career working with substances that other physicians of his day considered too dangerous, too aggressive, too unnatural to give to patients. He gave them anyway, sometimes badly. He defended himself by saying, look at the dose. It was always the dose.
Paracelsus spent his career transforming substances through human craft, distilling, calcining, working with mercury, antimony, sulfur, salt, the metals and minerals. He coined the word “spagyric,” which he meant as the alchemical processing of plant matter, separation and purification and recombination, into preparations stronger and more refined than what nature handed you. His pharmacy was a workshop pharmacy, not a wild-harvested-tincture pharmacy. He took what nature provided and worked on it, sometimes aggressively, to produce something new. The “natural medicine” identity that the modern herbal world tends to project onto him would have puzzled him. He did not consider the unmodified plant the highest form of medicine. He considered it a starting material. The categorical line we draw between the natural and the human-made would not have made sense to him; he spent his life crossing it.
If we want to claim him as ancestor, we have to grapple with what he said and what he did. Otherwise we are holding his name as a kind of talisman, invoking the authority of the lineage while contradicting its central insight every time we sort a substance into the contaminating pile. Either Paracelsus is in our tradition with his most-quoted line and his actual practice, or we should stop putting him in the books. I’d rather we kept him. But that means letting his sentence and his workshop do the work they’re supposed to do.
The toxicological tradition that grew out of his sentence has been refined enormously over five centuries, but the core insight has held. The relevant variables when you want to know whether something will hurt you are dose, route of exposure, duration, individual susceptibility, and mechanism. They are not natural versus synthetic.
Look at the actual chemistry. Botulinum toxin is the most acutely lethal substance known to science; an amount you could fit on the head of a pin would kill a roomful of people, and it’s entirely natural. Hemlock, which killed Socrates, is a wild plant that grows in damp meadows. Ricin is extracted from castor beans. Aflatoxin, one of the most potent carcinogens we know, is produced by mold growing on natural agricultural products. Tetrodotoxin in pufferfish, batrachotoxin in poison dart frogs, abrin in rosary peas, oleander in oleanders: every one is natural in the strongest sense, and every one will kill you faster than most things in a chemistry catalog. The plant world is full of substances that evolved specifically to harm other organisms, because plants can’t run from their predators and have to settle disputes chemically. We of all people should know this. We work with these plants.
Now look at the synthetic side. Insulin is synthetic. People who need it live because of it; people who need it and don’t take it die. Antibiotics are synthetic, or close enough that the distinction has stopped meaning much. Before antibiotics, a strep infection could kill you. A small cut could kill you. Childbirth fever killed millions of women. Antibiotics changed all of that. They are not less life-saving for being synthetic. Vaccines have prevented an almost unfathomable amount of suffering and death.
If we organized our beliefs about danger and safety around what the data actually says, the natural/synthetic distinction would carry no predictive weight at all. Both categories contain substances that will harm you. Both contain substances that will heal you. The categories don’t track danger. Dose tracks danger. Mechanism tracks danger. Individual susceptibility tracks danger. Route of exposure tracks danger.
Toxicology isn’t perfect. Regulatory science misses cumulative and low-dose effects. The endocrine disruption literature is complex, contested, and hard to study well. Industry-funded research on industrial chemicals deserves exactly the scrutiny you would expect. Real concerns about specific exposures, PFAS in drinking water, certain pesticides, microplastics, are legitimate. I’ll come back to that.
But none of those concerns are well-served by the natural/synthetic binary. The binary doesn’t tell us what dose matters, which exposures are worth worrying about, whether a concentration in tap water is meaningful or trivial, whether the dose a child gets from a vaccine is in any way comparable to the dose that same child gets from environmental contamination. The binary is a moral sorting hat, not a toxicological instrument.
Suppose someone comes to me concerned about pesticide residues on their food. That’s a reasonable concern. There’s good science on it. We can talk about which pesticides have residues that linger, which crops carry higher loads, which washing methods reduce exposure, what the actual measured exposures look like in food surveys, and how to think about the risk in proportion. We can talk about glyphosate specifically, and about the actual evidence on its toxicity at the doses people are actually exposed to. We can locate the concern in a real conversation about chemistry and risk.
Now suppose someone comes to me concerned about toxins generally. We can’t have that conversation. The word “toxins” in their mouth doesn’t refer to anything specific. It refers to the wrong side of the categorical divide. There is no measurement that can settle the question, because the question isn’t a measurement question. It’s a purity question.
This is what should matter to us specifically. Toxicology is what Paracelsus gave us. It is part of our inheritance. When we refuse it, we are refusing the lessons of our own ancestor.
The Body in the World
The relational view Paracelsus pointed toward has a more developed philosophical version, and it’s the formal framework I’ve been working out for years. I call it transactional naturalism. It draws on the work of Georges Canguilhem and John Dewey, twentieth-century philosophers who spent their careers thinking about what living organisms are. Canguilhem’s contribution is that health isn’t the absence of measurable deviation; it’s the capacity to set new norms when conditions change. Dewey’s is that you can’t cleanly separate an organism from its environment; what happens between them he called a transaction. I’ll save the philosophical mechanics for elsewhere. What the framework gives you, clinically, is this: a substance isn’t intrinsically toxic or safe. Toxicity emerges in the relationship between a specific substance at a specific dose meeting a specific body in a specific state in a specific context. Change any of those variables and the toxicity changes.
Salt. Salt is necessary to life. The sodium gradient across cell membranes is what makes nerves fire and muscles contract. Without sodium you die. Take too much salt and you die; acute hypernatremia is a real medical emergency. Take a moderate amount and you live, but if you have heart failure or kidney disease, the same moderate amount can push you into trouble. Salt is not toxic. Salt is not safe. Salt is a substance whose effects emerge in relationship with the body that’s eating it.
The same logic applies across the board. Water can kill you fast enough. Oxygen at high concentrations damages the lungs. Vitamin A in moderate excess is teratogenic. Iron pills have long been one of the leading causes of pediatric poisoning deaths in the United States. None of these are “toxic” or “safe” as adjectives. They have effects in contexts.
The same logic applies to synthetic medications. An SSRI at the right dose, in someone whose depression is being driven by patterns that serotonergic medication can interrupt, has a good chance of helping. The same SSRI in someone whose depression isn’t being driven that way may not. In someone with bipolar disorder it may trigger a manic episode. Insulin, levothyroxine, antibiotics, vaccines: same logic. They are tools whose value emerges in the encounter with a specific situation, not intrinsic goods or evils.
What the purity framework can’t do is think this way. The substance was already morally charged before the person ever met it. The framework tells you what to do before you’ve examined what’s actually happening, and what gets lost is the person, the one whose body is in the relationship.
What the Concern Was Actually About
If I leave the argument where it is, I’ll have done something I don’t want to do. I’ll have left the impression that worry about industrial exposures is silly, that we made this up out of moral panic. That isn’t right. The original concern was a real concern. It got hijacked by a moral framework, but the underlying observation was sound, and it was our community that first sounded the alarm.
Over the last two centuries, and especially in the last seventy years, industrial chemistry has produced an enormous number of novel compounds that human bodies and ecosystems have never encountered before. Some are inert. Some are useful. Some are dangerous. The dangerous ones have done real damage we are still learning to recognize. DDT in the bird populations of the 1960s. Lead in the children of the 1970s. CFCs in the ozone layer. PFAS in nearly every water supply on the planet. Endocrine disruptors at low doses with effects that wouldn’t have been predicted from earlier toxicology models. Microplastics in tissues across the food web. These are real. They matter.
The legitimate concern is that industrial production has moved so fast that regulatory science has not kept up. The doses we are exposed to are the result of choices made by industries with a financial interest in our continued exposure. The health effects are often slow, often subtle, often individual, and very hard to study in the ways that produce confident conclusions. In the absence of good data, ordinary people have to make decisions about what they let into their bodies and their kids’ bodies and their homes. Being thoughtful about that, choosing the less-industrialized option when other things are equal, supporting agricultural systems that minimize exposures, these are reasonable responses to a real situation.
What I want to name is the shift from this reasonable position to the purity framework. They sound similar from a distance. They are not the same thing, and the difference is the load-bearing distinction in this whole essay.
The reasonable position says: let’s be thoughtful about novel exposures, ask good questions, use the toxicology we have, and err on the side of caution where the science is genuinely uncertain. The purity framework says: synthetic is bad, natural is good, the more thoroughly you can purge synthetic exposures from your life the better.
Here’s what those look like in practice. Someone holding the reasonable position buys organic produce when they can afford it and doesn’t worry about it when they can’t. They run their tap water through a decent filter because the data on PFAS justifies it. They avoid non-stick pans because the chemistry on those is concerning. They also take their antibiotic when they have a strep infection, accept the vaccine the math supports, and start the levothyroxine when their thyroid stops working. They make case-by-case decisions because each case is, in fact, a case, with its own evidence and its own stakes.
Someone holding the purity framework cannot do the second half of that list. The categorical commitment forecloses it. The same person who is thoughtfully filtering their water may refuse the antibiotic that would clear an infection, refuse the vaccine that would prevent measles in their kid, refuse the antidepressant that would have brought them back to their life. Not because they did the case-by-case math and concluded the risk outweighed the benefit. Because the substance is on the wrong side of the line.
That is the distinction I want everyone reading this to hold. Thoughtful caution about industrial exposures is good practice. The purity framework that looks like thoughtful caution from outside but operates categorically is what hurts the folks in our clinics. They are not the same thing, even though they often live in the same head.
The first stance is where our community has done its actual work in the world. The pressure to reduce pesticide use in agriculture, the push for safer cosmetics, the attention to indoor air quality, the questioning of food additives, the early advocacy for organic farming, the defense of the small farm against agribusiness, the long argument against the industrial poisoning of soil and water: much of this came from the plant folks and their allies long before “wellness” became a marketing category. That work was real. The world is better for it.
The second stance is what hurts the people in the community. It costs them their medications. It costs them their relationships with conventional care. It sometimes costs them years of their lives.
What we need is not less concern about industrial exposures. We need more refined concern. Concern with units. Concern that knows the difference between meaningful and trivial. Concern that uses the toxicological tools that exist, the ones our own ancestor handed us, and doesn’t pretend chemistry is a moral category.
The Cost
The structure I’ve been laying out has a body count. Folks I know have died inside this framework. Folks have lost years, lost relationships, lost capacities they didn’t know they were going to lose. The framework matters because it has costs, and the costs are paid by people we love.
The first cost is the refusal of interventions that would have helped. The person whose mental illness goes untreated because they won’t take psychiatric medication. The folks with diabetes who refuse insulin. The folks whose hypothyroidism worsens for years because levothyroxine is “synthetic hormones.” The person with high blood pressure who refuses the medication because it’s synthetic. These are not edge cases. They happen in every herbal practice I know of, in every functional medicine practice I know of, in every alternative-leaning clinic I’ve ever heard of. The person sits with treatable suffering for years because the framework says the treatment is contaminating. The years don’t come back.
Then comes restrictive eating. Orthorexia is a recognized clinical pattern now, and the purity framework feeds it directly. Folks who started by trying to “eat clean” end up with a list of forbidden foods that grows and grows. First it was gluten. Then dairy. Then nightshades. Then anything with oxalates. Then anything not organic. Then anything from outside their bioregion. Then anything they didn’t grow themselves. The world of edible food shrinks around them until they can’t eat at a friend’s house or a restaurant or a relative’s holiday table. They become socially isolated. They lose weight they didn’t need to lose. They become anxious around food. They start to develop the nutritional deficiencies the restrictive eating was supposed to prevent.
The framework also reproduces itself socially, in ways that hollow out the relationships closest to the people inside it. The parent who has gone deep into the framework and the parent who hasn’t end up fighting about what to feed the kids, what cleaning products to use, what to do when someone gets sick. The fight is not really about cleaning products. It’s about which categorical system organizes the household. I have folks in my practice whose marriages didn’t survive when one spouse went deep into the framework. I have folks whose marriages didn’t survive when one spouse came back out of it, and the spouse who stayed inside resented them for giving up. And kids don’t choose the framework their parents apply to them. Inside it, a child learns that their body is in a constant state of being threatened by the contaminating world. They learn that conventional medicine is suspect before they are old enough to understand the difference between a bad doctor, a limited system, and a useful tool. The interventions refused on those grounds aren’t always trivial. Vaccines for illnesses still capable of killing children. Antibiotics for infections that actually needed them. The mental health support that would have changed the shape of adolescence. Dental and vision care, treated as suspect because they come from the medical system. Children inside the framework also grow up with a quiet shame about food and products that are normal in other houses, and a low background vigilance about what they’re being exposed to. Some rebel in adulthood and overshoot the other way. Some stay inside the framework and replicate it for their own kids. The bills come due over generations.
The financial cost is enormous and rarely talked about. People inside the purity framework spend astonishing amounts of money. Supplements. Cleanses. Sensitivity tests. Functional medicine workups. Healers. Retreats. Water filters. Air purifiers. Protocols. I know folks who have spent ten or twenty thousand dollars a year, for years on end, chasing the next thing that’s going to make the symptoms go away. The wellness industry takes most of this money. Our community sees almost none of it. The supplement empires and the influencer platforms and the functional medicine clinics with their proprietary panels and their custom protocols are extracting wealth from the same community that came up advocating for the small farm and the local apothecary. A framework that started as a critique of industrial capture has been turned into one of its most efficient extraction mechanisms. The people paying are not the wellness CEOs. They are our folks, the ones in our living rooms and classrooms, the ones spending money they don’t have on protocols that don’t work because the framework tells them their suffering means they haven’t done enough.
There is also the cost to the herbal community itself, which is the one I think about a lot. The herbal medicine I practice, the kind I teach, the kind that has actually helped folks for as long as people have been making teas from plants, is in danger of being smothered by a moral framework that has very little to do with herbal medicine and a great deal to do with identity work disguised as clinical judgment. The reasonable practice of using plants to support bodies through real conditions is being conflated with the categorical refusal of conventional medicine. The two are not the same and have never been the same. But to the public they look like the same thing, because some of the loudest voices in the herbal world are the ones broadcasting the categorical refusal.
A Different Way of Caring
If the framework is causing harm, we need to be able to say what we’d put in its place. What works, when it’s working, isn’t complicated. It’s the slow kind of attention most of medicine has been losing for decades.
I listen first. Not to the framework the person was handed by their last teacher, but to what they’re actually experiencing in their body, in their day, in their relationships. I take the conventional medical workup seriously. If they have labs, I read them. If they have a diagnosis, I ask what that diagnosis means in their case, and I make sure they understand it and what their options are. I don’t sneer at the diagnosis. I don’t tell them their medications are poisoning them. I work with the picture as it actually is.
The tools are several. Herbs are part of the toolkit, and an important part. So is nutrition. So is sleep and movement and stress and connection. So are conventional medications, when those are what’s called for, even though I’m not the one prescribing them. I don’t divide the world into my tools and their tools. I think about which tools the person needs in what combination at what point in their care, and I support whatever combination actually helps.
Real risks I take seriously. If someone is working with industrial chemicals at their job, that’s worth thinking about. If their water supply is contaminated, that’s worth assessing. The toxicological tools that exist, exposure assessment, dose-response thinking, biomarkers when those exist, mechanism analysis, are useful here. I don’t categorically dismiss the concern, and I don’t categorically validate it. I think about what’s actually likely to be happening and what’s likely to help.
I watch the language. The word “toxin” is doing damage in our community, and clinicians can refuse to use it in ways that conserve the categorical framework. When someone tells me they want to detox, I ask them what they think is in their body that shouldn’t be. I ask them what they think detoxing would change. I work with what’s actually there, not with the category.
I stay humble about uncertainty. Most of what folks come to me with is not fully understood by medicine, alternative or otherwise. I don’t know what’s causing their fatigue with confidence. I don’t know whether the herbs I’m suggesting will help. I don’t know whether their condition is going to progress or remit. I tell them what I think and why I think it, and I tell them what I’m uncertain about. I revisit and adjust. I stay willing to be wrong. The framework that pretends to know what’s contaminating you and what isn’t is selling certainty it doesn’t have. Honest practice doesn’t sell that.
The job is to help folks have the information they need to know what they’re actually doing. What their suffering is, what their options are, what each option is likely to cost and likely to give. Then the choice is theirs. If they choose conventional medication, I support them. If they choose to try herbs first, I support that. If they choose to refuse something I think they need, I tell them honestly what I think, stay clear about the risks, and keep caring for the person in front of me.
I stay in relationship with conventional care where I can. Some of the best work I do is in conversation with the doctors of folks I’m working with. We compare notes. We split the labor. We disagree sometimes, and we work through the disagreements. Some doctors don’t want to talk to me. Some are great. None of this is enemy territory. The other clinician is also trying to help. The categorical framework that treats biomedicine as the contaminator is poisoning a relationship that should be one of the most valuable things in the field.
M, A Year Later
What tends to happen, when this works, is something like this.
The first thing was that she went back to her primary care doctor. That took a while. She was ashamed. The doctor was kind about it. They drew labs. Her TSH was high. Her B12 was low. Her vitamin D was low. She had been “supporting” her thyroid with seaweed and ashwagandha for years, while her thyroid had quietly given up. Levothyroxine was prescribed. She took it, with reluctance, because by that point she was tired enough to try anything.
Within two months her cognition came back. The fog she had been calling depression was, in large part, hypothyroidism. The depression pattern was still there underneath, but it was less of everything. She slept. She stopped crying in her car.
About four months in we talked about the lingering depression. She was open to therapy. She was not open to medication. We did what we could with that. I worked with her on the herbs (she had gobs of them left over that we had discontinued, and we went back through them together). I worked with her on sleep, movement, light exposure, and social engagement. The depression got better and stayed harder than she wanted it to be.
Sometime in the second year, her husband lost his job, and the stress triggered a worsening of the depression pattern. We ramped up herbal support. It got expensive fast. After three months of hard work, we had a conversation about what an SSRI would and wouldn’t do. She had spent a long time inside a story about what those medications were. We talked through what the actual evidence shows: modest effects, real for some people, real side effects, real benefits, useful in combination with the other things she was already doing. She thought about it for several weeks. She talked with her therapist. She talked with her husband. She decided to try one.
She didn’t tell anyone in her old community. She still hasn’t, as far as I know. The shame about it is still there. But it helped. She works. She sleeps. She brought her husband to an appointment recently and he cried a little, because the woman he married is back.
The grief about the years is what stays. There’s the family trip in 2019 she barely remembers because she was too tired to be present for it. The friend who stopped calling somewhere around year three because M had cancelled too many times. The years her daughter was in elementary school, which M describes as a blur she watched from inside a fog she didn’t know she could leave. She doesn’t dwell on it. But it sits in her, and sometimes when she’s talking about something else, you can see it.
This is not a story about how she saw the light and became enlightened. It is a story about a person inside a framework slowly finding her way to a different framework that served her better. It took years. It is still happening. There are days when she goes back to checking her supplements with more anxiety than usual, when she gets pulled by an Instagram post into worrying about the levothyroxine, when she has to relitigate decisions she thought she’d already made. The framework she came from is still alive in her. It’s alive in all of us who grew up in this world. We do not get free of it by deciding to be free. We get free of it slowly, by living in different relationships, by paying attention to what actually helps, by extending grace to ourselves when we backslide, by being in community with people who are doing the same work.
She still uses herbs. Of course she does. I’m her clinical herbalist, and herbs are part of what’s holding her together. She’s not less of an herbalist now. She’s a more thoughtful one. The herbs are tools again instead of being a moral position. She uses them for what they actually do. She doesn’t have to refuse the other tools to use these tools.
The belief that everything humans make is contaminating, and that anything they haven’t touched is clean, is not a fact about the world. It is a moral system, and like all moral systems it organizes who we are and how we live and what we will not do. It is durable because it does real work for the people inside it. Work of identity, of belonging, of meaning. And it is costly because the work it does is purchased at the price of the actual bodies and lives of the people it organizes.
We can do better than this. Many of us are already trying. What matters is that we get past the categorical refusal and back to the work of actually caring for people in the world they actually live in, with the tools that actually help them, including the ones that come from outside our tradition, and including the ones, like dose-thinking, that have been inside our tradition the whole time and that we have somehow forgotten to use.
The plants will still be there. They have always been there. They will not be diminished by our willingness to think clearly.
Epilogue
If you’ve read this far, thank you. Also, I suspect you may be feeling some things.
Abandoning a categorical framework removes the error, but also the floor. The natural/synthetic line was doing real work, badly, but really. It gave people a heuristic, a shortcut, a way to know what to reach for and what to refuse without having to think everything through from the ground up every time. Pull it out and some folks land somewhere worse than where they started: in the cynicism of it’s all probably bad, or it’s all probably fine, so who cares. That can feel like freedom. Sometimes it is just a quieter surrender.
Changing a belief this deep is a loss, not only a correction. The framework gave people a world: a way to belong, a way to know they were doing right, a community that knew them back. When it goes, that goes too, at least for a while. I’ve felt the disenchantment that follows, and it is not nothing. I don’t think the answer is to keep a comforting story. But I’m not going to pretend it costs nothing to put one down.
There’s another piece coming, written with my friend and thought partner Forrest Chalmers, on what to build instead. It takes up the question I’ve left open here. Not what’s contaminated, that was the wrong question, but what the word natural was reaching for before it got turned into a border wall.
The moral framework defined natural by what it keeps out. The more useful version might be defined by what it holds. Diversity. Complexity. Relationship. The whole food instead of the extracted fraction. The plant or meal or walk outside whose effects come from a pattern larger than any one isolated constituent. The body in an environment it can recognize and that can recognize it back. That is not a purity rule. It is a different floor. It doesn’t tell you what to refuse. It tells you what to look for. And I think it is one we can build on.
—Thomas Easley, Herbalist
This message is so needed. Thank you for writing this.
Your thoughtful writing has allowed me to put many of my issues with food and medicine in a better place, a balanced place. I'll have to reread this a time or two to let things sink in; to get the full meaning and understand the effects of any changes I make going forward will impact me, my wife, and my grown kids. As you noted, there is a real cost.