Nature as Medicine

Why Waste Valuable Time?

• Trees & Flowers & Oceans & Seashells & Gardens are for tourists & Vacationers & Honeymooners & Dreamers

We Have What We Need for Care

Allopathic Medical Care Clearly Lacks

Many Answers to Treating “Whole Patient”

“The good physician treats the

disease; the great physician

treats the patient who has the

disease.”

-- Sir William Osler, American Physician

Spirituality in Medical CareGallup polls & Studies indicate that:• 91 percent of U.S. adults believe in God or a

universal spirit,

• 81 percent consider religion important

• Up to 94 percent of hospitalized patients believe spiritual health is as important as physical health

• 40 percent of patients use faith to cope with illness

• 25 percent of patients use prayer for healing each year

• Older patients, hospitalized patients, and patients with terminal illness often wish to share their beliefs, and to hear those of their physician

Components of Spirituality

• Personal Religious Practice, Read Sacred Text

• Community Religious Practice

• Meaning & Purpose

• Nature – Sunsets, Horizons, Oceans

• Meditation; Listening to Music

• Sources of Strength, Hope, Peace, Love, Connection

• God or Family Relationships or Legacy

• Works of Art

“Whole Patient” Care Lacking

• Three examples of little things mean a lot –key spiritual care often missing and overlooked:

• Danny’s Story

• Flowers for Steve’s mother-in-law

• Gene Cohen Story lady with Advanced Alzheimers

Anecdote: Effects of Nature on Health

• A middle-aged woman with

cancer made regular trips to her

local hospital for therapy

• She noticed a photograph of a

big oak tree in a summer forest

with morning sunlight streaming

through the

branches,illuminating the forest

floor

Anecdote Continued

• She started coming in early for her

appointments so she could look at the picture

in the waiting room and meditate before

going in for chemo

• She told her cancer nurse that the way the

sun shined through the trees she almost “felt

like God was going to walk out.”

• Whatever she saw there, it brought her

peace and comfort during an incredibly

stressful and frightening time in her life

* World Health Design, April 2010

Audience Survey – City vs Nature

https://www.youtube.com/watch?v=i8WiJgI3N4A

https://www.youtube.com/watch?v=fIlJyZEbrzo

The art of healing comes

from nature, not from the

physician. Therefore the

physician must start

from nature, with an

open mind.

Paracelsus, 16th Century

Physician

Nature Therapy

nature therapy seeks to improve immune function, prevent illnesses, and maintain and promote health

through exposure to Oceans, Lakes, Streams, Rivers, Forests,

Gardens, Flowers, Mountain Horizons - with the consequent

attainment of a state of relaxation

Dangers of Medication

• Marginal benefits – Aricept example

• Serious Side Effects

• Reduced ability to process drugs (Kidney, Muscle)

• Drug-Drug interactions w Polypharmacy

• Drug-Disease Interactions

• Drug Studies exclude Frail Elderly – results not applicable to these folks

Tests & Treatment Risks

• Radiation exposure, Infection, Bleeding

• Incidentaloma – normal variations lead to more risky tests

• Greater risk with aging – Joan Rivers Endoscopy to look at vocal cords

• Tests, like people, are imperfect

• Over-treatments – diabetes control in Elderly led to more hypoglycemia hospitalizations

Hospitalization Hazards

• Each hospital stay chips away at an older adult’s function and independence. These deficits occur even when the illness that sent them there is improved or cured!

• Forced Dependence – Catheters, incontinence, bed sores, Bed Rest (Sarcopenia), Loss Dignity

• Isolation – in room, few visitors, No glasses or Hearing Aids

• Poor Nutrition – No Taste, Poor texture, Loss Appetite, No assistance

• Falls, Nasty Infections, Over-Medication (adverse Drug Reactions), Delirium

• Loss of Function

Two General Categories Nature Tx

• Exposure to INDIRECT sights & sounds of Nature – through window views, images, video, audio, Virtual Reality – Frail elders

• DIRECT Nature engagement – hikes, ocean excursions, walk in forest or park, Gardening

Nature as Medicine - Beginnings

• Research conducted in prison environments suggests that cell window views of nature are associated with a lower frequency of stress symptoms in inmates, including digestive illnesses and headaches, and with fewer sick calls overall by prisoners (Moore, 1981).

• A study examining recovery rates of patients who underwent gall bladder surgery found that those with a natural view recovered faster, spent less time in hospital, had better evaluation from nurses, required fewer painkillers and had less postoperative complications compared with those that viewed an urban scene (Brick wall) [Ulrich, Science Magazine, 1984].

Nature as Medicine - Beginnings

• In 1993 Ulrich and his colleagues at Uppsala University Hospital in Sweden randomly assigned 160 heart surgery patients in the intensive care unit to one of six conditions: simulated “window views” of a large nature photograph (an open, tree-lined stream or a shadowy forest scene); one of two abstract paintings; a white panel; or a blank wall. Surveys afterward confirmed that patients assigned the water and tree scene were less anxious and needed fewer doses of strong pain medicine than those who looked at the darker forest photograph, abstract art or no pictures at all.

Mind-wandering and alterations to default mode network connectivity when

listening to naturalistic versus artificial soundsCassandra D. Gould van Praag1, 2

, 2

-Scientific Reports volume 7, Article number: 45273 (2017)

• The gentle burbling of a brook, or the sound of the wind in the trees can physically change our mind and bodily systems, helping us to relax.

• The positive effects of exposure to naturalistic environmental stimuli extend to health benefits, including improvements in the patient experience of general anaesthesia4, enhanced post-operative recovery5,6, and reduced pain and anxiety in hospice care7.

Horticultural Therapy Clinical Trial

BMC GeriatricsBMC series – open, inclusive

and trusted 2017 17:192https://doi.org/10.1186/s12877-017-0588-z

Effects of horticultural therapy on

elderly health: protocol of a

randomized controlled trial

Horticultural Therapy Clinical Trial• Singapore Study with Control Group. Measure Blood

parameters Interleukins, C- Reactive Protein, DHEA, Brain-Derived Neurotrophic Factor

• 3 main components: 1) Indoor horticultural activities 2) Park visits and 3) Outdoor gardening.

• Vegetables such as ladyfinger, milk cabbage, and choy sum will be planted, Stress knowledge on herbal plants. Participants will be able to prepare a soup dish together to encourage social connectedness amongst them.

• Unfortunately, FRAIL Elders, Dementia, Stroke, non-ambulatory excluded

• 1-h sessions, weekly in the first 3 months, followed by monthly sessions for the next 3 months

• Testing will include Validated Memory, Mental Health and Life Satisfaction Scales

• Compared to the waitlist control group, participants in the active horticultural therapy will have (1) lower depression and anxiety symptomatology; (2) higher life satisfaction; (3) feel more socially connected; and (4) improved cognitive functioning.

Shinrin-Yoku (Forest Bathing)

• SY is a traditional Japanese practice of

immersing oneself in nature by mindfully using

all five senses

• During the 1980s, SY surfaced in Japan as a

pivotal part of preventive health care and healing

in Japanese medicine

• Song and colleagues demonstrated how male

Japanese students who walked 15-min in an

urban park during the autumn season had

decreased stress and heart rates

Shinrin Yoku - Benefits

• Significant empirical research findings point

to a reduction in human heart rate and blood

pressure and an increase in relaxation for

participants exposed to natural green space

• Even research involving the use of nature

videos of the forest or the ocean have the

same physiological effects

• SY as a healing and restorative modality may

support the clinician’s and patient’s whole-

being while promoting a sense of peace,

dignity and comfort.

Shinrin Yoku - Benefits

• Time spent in and around tree-lined streets,

gardens, parks, and forested and agricultural

lands is consistently linked to objective, long-

term health outcomes. The less green a

person’s surroundings, the higher their risk of

morbidity and mortality – even when controlling

for socioeconomic status and other possible

confounding variables

• neighborhood greenness has been consistently

tied to life expectancy and all-cause mortality

Shinrin Yoku

SY specifically hones in on the therapeutic effects on:

• Immune system function (increase in natural killer cells/cancer prevention)

• Cardiovascular system (hypertension/coronary artery disease)

• Respiratory system (allergies and respiratory disease)

• Depression and anxiety (mood disorders and stress)

• Mental relaxation

• Human feelings of “awe” (increase in gratitude and selflessness)

Proposed Benefit Mechanisms

Phytoncides (VOC)• Phytoncides are antimicrobial volatile organic compounds

derived from plants. Some plants give off very active substances which prevent them from rotting or being eaten by some insects and animals.

• Spices, onion, garlic, tea tree, oak, cedar, locust, pine, and many other plants give off phytoncides. Oak contains a substance called greenery alcohol. Garlic contains allicin and diallyl disulfide. Pine contains alpha-pinene, carene, myrcene, and other terpenes.

• More than 5,000 volatile substances defend the surrounding plants from bacteria, fungi and insects. Phytoncides work by preventing the growth of the attacking organism.

• Widely used in Russian, Ukrainian, Chinese and Japanese medicine, including holistic medicine, aromatherapy, and veterinary medicine.

Benefits: Some Details• Many plants give off phytoncides — antimicrobial volatile

organic compounds — which reduce blood pressure, alter autonomic activity, and boost immune functioning, among other effects

• Air in forested and mountainous areas, and near moving water, contains high concentrations of negative air ions which reduce depression, among other benefits

• These environments also contain mycobacterium vaccae, a microorganism that appears to boost immune functioning

• The sights and sounds of nature also have important physiological impacts. Window views and images of nature reduce sympathetic nervous activity and increase parasympathetic activity, restore attention, and promote healing from surgery

• Vegetation filters pollutants from the air

Benefits: Some More Details• Time in nature increases adiponectin, which

protects against inflammation & Heart disease

• Walks in forested, but not urban areas, reduce levels of inflammatory cytokines and Lower blood glucose. Inflammatory cytokines are released by the immune system in response to disease and stress, and have been implicated in diabetes, cardiovascular disease, and depression.

• The experience of nature helps shift individuals toward a state of deep relaxation and parasympathetic activity, which improves sleep, boosts immune function, and counters the negative effects of stress

Benefits: Even More Details

Three psychological effects of nature:

• Experiences of awe

• Enhanced vitality (Being Strong & Active)

• Attention restoration (concentration, mental fatigue)

These offer additional possible pathways between nature and health. Regular experiences of awe are tied to healthier, lower levels of inflammatory cytokines

Benefits: Even More Details

• Contact with nature contributes to both better sleep and stronger social ties

• The gap between natural settings, to which our physiological functions are best adapted, and the highly urbanized and artificial environment that we inhabit is a contributing cause of the “stress state” in modern people

• Exposure to stimuli from natural sources induces a state of hyperawareness and hyperactivity of the parasympathetic nervous system that renders a person in a state of relaxation.

From 2005 to 2015, a physiological experiment was conducted over a one-week period on 744 participants in 62 forests located

all over Japan

• Based on these results, it can be concluded that forest therapy had the following effects: (1) it decreased the levels of salivary cortisol, a typical stress hormone; (2) it decreased the pulse rate; (3) it decreased the systolic and diastolic blood pressures

• These findings show that viewing or walking around a forest environment for a 15 min session of forest therapy induces a state of physiological relaxation.

study evaluated the effects of a forest walk on hypertensive middle-aged participants

• Forest therapy elicited a decrease in pulse rate and salivary cortisol levels. There were substantial physiological benefits of forest therapy

• Another study found walking in an urban park in the spring (1) increases parasympathetic nervous activity; (2) inhibits sympathetic nervous activity; and (3) decreases the heart rate, thereby showing physiological relaxation effects.

Even Views of Nature are Healthful

Do Not Have to be there to get some benefits

Consider Benefits Photos, Videos, Virtual Reality for Frail Elderly

Nature as Medicine - Beginnings

• Research conducted in prison environments suggests that cell window views of nature are associated with a lower frequency of stress symptoms in inmates, including digestive illnesses and headaches, and with fewer sick calls overall by prisoners (Moore, 1981).

• A study examining recovery rates of patients who underwent gall bladder surgery found that those with a natural view recovered faster, spent less time in hospital, had better evaluation from nurses, required fewer painkillers and had less postoperative complications compared with those that viewed an urban scene (Brick wall) [Ulrich, Science Magazine, 1984].

Nature as Medicine - Beginnings

• In 1993 Ulrich and his colleagues at Uppsala University Hospital in Sweden randomly assigned 160 heart surgery patients in the intensive care unit to one of six conditions: simulated “window views” of a large nature photograph (an open, tree-lined stream or a shadowy forest scene); one of two abstract paintings; a white panel; or a blank wall. Surveys afterward confirmed that patients assigned the water and tree scene were less anxious and needed fewer doses of strong pain medicine than those who looked at the darker forest photograph, abstract art or no pictures at all.

The importance of nature in mediating social and psychological benefits associated with visits to

freshwater blue space

Landscape and Urban PlanningVolume 167, November 2017, Pages 118-127

We asked our respondents to identify the most important benefit they felt they received from visiting blue space. Our results are similar to findings from green space studies, where social interaction and psychological benefits have been identified as particularly important

Effects of Oceans, Seashells, Lakes• Fresh Air, change of scenery, sunshine

• Social aspects – friends, family

• Salt water, minerals – arthritis, skin condition (Dead Sea studies)

• AWE Feelings from view, sunset, total experience

• Component Reminiscence – Positive past life experiences and memories on beach

• Exercise: Swimming, walking, running

• Nature: Interacting with fish, stingrays, Jelly fish, Manatee, Dolphins, etc

• Seashells: “Sea Sculptures” “Ocean Art” - same positive effects as museum works of art

Nature’s Perfection: Golden Ratio

There's a common mathematical ratio found in nature that can be used to create pleasing, natural looking compositions in design work

Ratio 1: 1.61

How Shells are Formed: Complex Beauty from Simple Creatures

• Seashells are the exoskeletons of mollusks such as snails, clams, oysters and many others.

• Such shells are composed mostly of calcium carbonate with only a small quantity of protein.

• These shells are not made up of cells. • Mantle tissue located under and in contact with the

shell secretes proteins and mineral to form the shell. Think of laying down steel (protein) and pouring concrete (mineral) over it.

• Seashells grow from the bottom up, or by adding material at the margins. Since their exoskeleton is not shed, mollusc shells must enlarge to accommodate body growth.

Gift from the Sea: Sea Shells in Literature

• “The sea does not reward those who are too anxious, too greedy, or too impatient. To dig for treasures shows not only impatience and greed, but lack of faith. Patience, patience, patience, is what the sea teaches. Patience and faith. One should lie empty, open, choiceless as a beach—waiting for a gift from the sea.” ― Anne Morrow Lindbergh, Gift from the Sea

1955

Feeling Awe

• Unlike other varieties of positive emotion, awe tends to direct attention away from the self and toward the environment (forget ails)

• Awe has been defined as an emotional response to perceptually vast stimuli

• Any stimulus that challenges one’s accustomed frame of reference in some dimension is “VAST”

• Requires Accomodation – an adjustment in frame of reference or understanding

Awe Defined

• Describe feeling small and humbled in the face of the vast awe-inspiring thing, like the self has shrunk

• Feeling transcendent -- like they have been elevated from their mundane concerns and put in touch with something deep

• Emotional quality of awe is captured with words like amazement, elevation, fascination, and wonder

• Chills—visible as goose bumps, usually on the scalp, neck, back, and arms are often present

Awe Defined

• Some people report crying or feeling like crying

• People often describe awe experiences as giving them a sense of perspective on their life, goals, and purpose

• This is consistent with the notion that self-change is brought about when people accommodate the new experience

The most beautiful emotion we can experience is the mysterious. It is the power of all true art and science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead.

-- Albert Einstein

Shells in Art Georgia O’Keefe

Birth of Venus - Sandro Botticelli 1480s

Virtual Reality

• BlueHealth project in Europe and others aim to bring nature benefits through Virtual Reality to those who cannot be there

• Frail Elders in long-term care can perhaps “visit” places of their choosing in VR

Don’t Just Take My Word For It…He doesn't spend all of his time in the back of a bar.

“I love the quiet of being outdoors, in nature,” Jonathan Goldsmith says, like “looking into the woods of my backyard in Vermont.”

Questions? Contact Info

Joel Cohen, MD

Doctorcare

www.doctorcareaz.com

mdroomservice@yahoo.com