"You got to be careful if you don't know where you're going, because you might not get there."
- Yogi Berra -
Nutrition is the foundation of all herbal medicine treatments, and specific nutritional advice should be included in all treatment plans. Herbs themselves are simply specialized food sources. Studies of nutrition clearly demonstrate a direct causal relationship between diet and health. Sensible, healthy dietary habits can help prevent disease. By the same token, poor dietary choices can contribute to the deterioration of general health and lead to many diseases. People who take supplements and herbal medicines are healthier than the general population, as are people who follow healthy diets. However, when forced to choose just one practice, those who eat a balanced diet enjoy better health than those who simply take supplements do. Adoption of both practices is ideal for a long and healthy life.
Examining a patient’s dietary habits is therefore an integral step in herbal diagnosis and treatment. It is a mistake to treat a nutritional deficiency with herbs. If someone is experiencing frequent coughs and colds due to poor nutrition, giving them echinacea is not the answer. Similarly, if someone has constipation because their diet is devoid of fiber, it is a mistake to just give them herbal laxatives. The herbal prescription in such a case should include counseling about the health benefits of a high-fiber diet, and suggestions for increasing dietary fiber.
More Than You Can Swallow
The vast field of nutrition encompasses an enormous range of information—more so than even the field of chemistry. Clive McKay was one of the outstanding nutritionists of the early part of this century--in a series of experiments at Cornell University in the mid-30's Dr. McKay managed to double the maximum lifespan of rats with nutrition. He estimated that a person would have to read one article every three minutes, eight hours a day, seven days a week to keep up with the newly published literature on just the chemical aspects of nutrition. That estimate was made in the 1930's, and back then they ignored the medical aspects of nutrition, as well as any information originating from nations outside of Europe and America (Ballentine, 1978). Today, the information load in nutrition has multiplied a hundred-fold. A quick search of MEDLINE in October 1999 showed more than 150,000 articles on nutrition.
Beyond what is known by food chemists and dietitians, a small sampling of perspectives on nutrition would include psychological, phytomedicinal, energetic, religious, cultural, constitutional, soil chemical, environmental, and ethnobotanical aspects. It is therefore imperative not to hang your flag on a single diet, or on a single aspect of nutrition. I will provide you with functional descriptions here, which will allow you to develop a simplified approach to nutrition based upon the herbal concepts described in this book. This personal approach will allow you to make dietary choices that are complementary to your herbal remedies, enabling you to enjoy a harmonious herbal regimen.
Knowing and Doing
In theory, people may be aware of the various risks and benefits associated with certain diet and lifestyle choices, but they aren’t implementing these healthy practices in their daily lives. Many people resist any new practices that may require them to adapt their lifestyle. Unfortunately, this usually means that changes designed to support or improve one’s health are superceded by other priorities. This unwillingness to adapt or try new things is usually rooted in a patient’s psychological or emotional character, and may require much persistence to overcome. The patient must come to understand that the road to good health involves a willingness to explore and commit to new directions. It’s like the age-old Middle Eastern proverb, “I fear you will never reach Mecca, dear traveler, for you are on the road to Turkestan.” Or, in modern parlance, JUST DO IT.
The Benefits of Exercise
The US Department of Health and Human Services issued a report in 1996 on the benefits of regular exercise. Following are several highlights, with my comments:
• Inactive people can improve their health and well being by becoming even moderately active on a regular basis.
• Physical activity need not be strenuous to achieve health benefits. T’ai Chi and Yoga, for instance, are non-stressful age-old methods of exercise.
• People can achieve greater health benefits by increasing the duration, frequency, or intensity of physical activity.
• Routine physical activity on most days of the week reduces a person’s vulnerability to some of the leading causes of illness and death in the United States. more info.
Regular physical activity can improve health in the following ways, according to the World Hypertension League, the American College of Sports Medicine, the report of the US Surgeon General on physical activity and health, and the US National Institutes of Health Consensus Development Panel on Physical Activity and Cardiovascular Health (Cleroux et al., 1999):
• Reduce risk of premature death.
• Reduce risk of death from heart disease.
• Reduce risk of developing diabetes.
• Reduce risk of developing high blood pressure.
• Lower elevated blood pressure.
• Reduce risk of developing colon cancer.
• Mitigate feelings of depression and anxiety, similar to the effect of anti-depressants.
• Help control weight.
• Help build and maintain healthy bones, muscles, and joints.
• Improve strength and mobility in older adults, decreasing risk of falls and injuries.
• Promote general psychological well being and improve self-esteem.
The Food Store
The first step in keeping your digestive system healthy occurs when you go shopping at the food store, where you select what will eventually go into you mouth. This critical step is often neglected. If you buy candy, you will eat it. If you buy organic carrots, you will eat them instead. If you don’t have good will power, you might need to keep a list and follow it closely when you shop.
The regimen you follow for food preparation and consumption is as important as the foods you choose. Following are a few suggestions for balanced, healthy eating, based upon research in the field of nutrition and traditional dietary practices.
Strive to maintain regular meal times. Your digestive system adjusts the production of digestive enzymes to coincide with meal times. If you eat at the same time every day, you’ll be hungrier then, and your digestive power will be stronger. I often see patients who experience ravenous hunger at bedtime, while others have no appetite at breakfast. Both of these tendencies can exacerbate health problems, so I teach the patients how to retrain their appetite and digestion. I tell those who are ravenous at night that they must not eat at that time for two weeks or so. After about two weeks, they inevitably find that the hunger has disappeared because the digestive system has adjusted. I tell the people with no appetite in the morning that they must eat a small meal for breakfast every day, and just as with the bedtime eaters, within two weeks the problem is resolved. By the way, I explained how to rediscover your morning appetite because you should eat breakfast every day.
Eat your largest meal at lunchtime. Studies have shown metabolism is regulated by pituitary-controlled release of hormones linked to the daily circadian cycle (Davidson and Stephan, 1999, Sinha and Caro, 1998). Ayurvedic doctors hold that digestive energy is highest around noon, and foods eaten at this time are digested more efficiently and are less likely to cause weight gain. Eating late at night can contribute to weight gain.
Eat in a relaxed atmosphere, and allow sufficient time to digest. Sit back and relax after meals for ten or fifteen minutes. Since the practice of relaxing after a meal, although it improves digestion (Morse et al., 1989) is unheard of these days, try this little trick to stretch out your mealtime. Get a glass of water or juice and sit back and sip slowly while you relax after meals.
Learn to cook, and prepare fresh food as frequently as possible. Get a few good cookbooks. When done right, cooking is a form of herbal medicine. For example, I add Siberian ginseng root bark to my juice drinks and pick day lilies for my salads.
Cook vegetables until the colors jump out at you and bite, but no longer. Once you see this vivid color, it means that cellulose has broken down and the carotenes and bioflavonoids are now easier to see, and thus more available to absorb when you eat. Overcooking degrades these and other nutrients.
Don't stuff yourself. Follow the Yogic rule of eating until your stomach is only three-quarters full. Chronic overeating changes your metabolism and leads to obesity (Blundell and King, 1996).
Sometimes people don’t believe there are benefits to following these rules. If you’re skeptical, try doing the opposite. Make sure you stuff yourself whenever you feel tense, try to eat as fast as you can (especially while driving or watching TV), make sure your foods are cooked until they are mush, and pig out right before bed. After a few months of gastric discomfort and weight gain, I think you’ll see the light.
Balance the Micronutrients
Macronutrients are fats, carbohydrates and proteins. Let’s look at these components as the three legs of a stool. If one leg is longer or shorter, the stool is not balanced. If the quality of wood in any one of the three legs is poor, the stool can break. In addition, the quality of each is just as important as the quantity. That’s it. Too much fat is bad for you, too little fat is bad for you, and the wrong kind of fat is bad for you (Jump and Clarke, 1999). Too much protein is bad for you, too little protein is bad for you, and the wrong kind of protein is bad for you (Bruhat et al., 1999). Too much carbohydrate is bad for you, too little carbohydrate is bad for you, and the wrong kind of carbohydrate is bad for you (Leahy et al., 1999). Intake of all three macronutrients should be balanced within each meal to provide the body with the best possible fuel for health maintenance. Too much or too little of any macronutrient disrupts this balance. Listen to this quote from the Case Western Reserve University School of Medicine:
" Adaptation to carbohydrate and fat intake involves changes in a number of biochemical parameters at the cellular level. A change in the concentration of fat or carbohydrate in the blood acts directly to influence metabolic pathways by altering the flux of intermediates into cells. This in turn alters the concentration of hormones and other signaling molecules and changes the rate of expression of genes coding for key regulatory proteins or enzymes in metabolic pathways. These effects occur at different rates and in a tissue-specific manner in response to diet" (Leahy et al., 1999).
In other words, what you eat affects key regulatory processes relating to health. Equally important to understand is that each of us has a unique biochemical individuality that affects how we personally react to foods. Some people do better on higher protein or higher fat diets, and some don't. There is no way to escape listening to what your own body tells you.
Fats and Oils
Fats and oils break down and supply your body with essential fatty acids (EFA’s), which are necessary for normal growth, smooth skin, and healthy membranes. They act as carriers for the fat-soluble vitamins A, D, E, and K. It’s true that excess oil (like excess anything else) is bad for health, but the opposite is unhealthy as well. A very low-fat diet can lead to EFA deficiency, which can lead to a host of physical problems including dryness, skin disease and fatigue.
Illnesses that may respond to EFA balancing and supplementation include acne, AIDS, allergies, Alzheimer’s, arthritis, arteriosclerosis, autoimmune disease, breast cysts, cancer, cartilage problems, cystic fibrosis, dermatitis, diabetes, E. coli infection, eczema, heart disease, hepatitis, hyperactivity, hypertension, inflammation, neurological disorders, psoriasis, rheumatoid arthritis, skin disorders, stroke, vascular disease, and vision problems (Murray, 1996, Holman, 1998)). A sensible course for most of us is to consume moderate amounts of high-quality fats and oils. This is even true for people dieting to lose weight. Intake, of course, should not exceed what is needed to maintain desirable weight. Oils can be divided into two main categories (good and bad) based upon quality and biochemical balance.
Ghee, or clarified butter, is generally good for health, and can be used instead of butter. It has a milder taste, and does not need to be refrigerated. Some of the best oils are canola oil, fish oil and olive oil. Borage, evening primrose and flax oils are most frequently used as nutritional supplements. These oils are balanced in their levels of the two primary EFA’s, Omega-3 and Omega-6, favoring the first. Some people have difficulty processing fats and utilizing these EFA’s, and they can benefit from borage or evening primrose oil supplementation. Most people do not get enough Omega-3 EFA’s from the foods they eat. By the way, many people do better with fish oils.
Omega-3 and -6 oils are incorporated into the cell membrane, and cell membranes are responsible for transporting nutrients. When the membranes contain a balance of these oils they are much more fluid than if formed from animal fatty acids, saturated fats, cholesterol, trans-fatty acids, or excessive Omega-6’s. For example, Omega-3 oils increase insulin transport of sugar into cells. When harmonized with Omega-6 oils, they aid in production of healthy prostaglandins. Along with the EFA’s, prostaglandins regulate steroid and hormone synthesis, eye pressure, joints and blood vessels, pain and inflammation, immune response, secretions, hormone direction to target cells, fluidity, oxygen transport, platelet stickiness, nerve transmission, energy production for the heart muscle, allergic response, and kidney function (Leahy et al., 1999, Murray, 1996). By the way, don't make the mistake of thinking that only Omega-3 oils are good and Omega-6's are bad and to be completely eliminated. Although most Americans get too much of the 6's and too little of the 3's, too little Omega-6 oils is also bad. Both are essential.
The worst oil profile comes from excess intake of either animal fat in red meats, which are low in Omega-3 EFA’s, or the trans-fatty acids found in chips, margarine and processed foods. Other unhealthy oils include overly heated (oxidized) oils such as those found in fried foods, hydrogenated (chemically processed) oils, and oils made rancid through age (commercially sold peanuts are always slightly rancid). Cottonseed oil contains toxic residues, because the plants are sprayed heavily with pesticides during growth. Lower quality oils can exacerbate immune and allergy responses (Weiland et al., 1999). For example, breast milk composition changes according to dietary fat intake, and the milk of mothers whose children have eczema have abnormal or altered fat composition (Wright and Bolton, 1989).
Keep Your Oils Healthy
All the oils you purchase should be cold pressed, otherwise they’ve been heated during manufacture and thereby lessened in quality (made rancid). A rule of thumb—if oil has been cold pressed it will be indicated on the label. If you can’t find this clearly stated anywhere on the label, don’t buy the product. Always store oil in dark glass bottles to avoid oxidation, and refrigerate them if you’re not going to use them up in a reasonable time period. It is wise to buy oils in small bottles and use them within two weeks of opening. Within 5 minutes of cooking, oil is changed from its cis (good) structure to the trans (bad) form. However, the addition of anti-oxidant herbs such as garlic bulb, ginger root or onion will delay this degradation for up to 20 minutes, usually long enough to complete the cooking process. Therefore, always add one of these spices as soon as the oil is hot to preserve its freshness during cooking.
Bad fat is usually hidden in store-bought bread products in the form of hydrogenated vegetable oil, so buy bread in the health food store, and be sure to read labels of all other foods to avoid hydrogenated oils. Many environmental chemicals are fat-soluble, another reason to buy organic foods whenever possible.
To properly absorb oils, two things are important to know. First, vitamin E helps to keep the oils from oxidizing, and secondly, oils absorb more efficiently when emulsified. Oatmeal, corn mush, egg yolks, and tapioca are good emulsifiers (Mitchell, 1998).
Throughout this website I will be referring to the use of omega-3 fatty acid supplements to reduce inflammation. These oil supplements, found primarily in flaxseed, borage, evening primrose and fish are of great clinical significance. Experienced physicians often use a combination of an EPA and DHA supplement (about two 1,000 mg. capsules three times per day), along with a smaller amount of either evening primrose oil or borage oil (about one 500 mg. capsule twice a day). Many controlled studies show benefits for a wide range of inflammatory disorders, such as rheumatoid arthritis and inflammatory bowel disorders (reported in Bland, 2000). Many patients express concerns about the safety of oils due to reports of contamination with heavy metals, so make sure to get your oils from reliable sources.
Carbohydrates and Fiber
Carbohydrates are organic compounds composed of carbon, hydrogen and oxygen. Interestingly, only very small amounts of carbohydrates are found in the human body at any one time, totaling about 1% of body weight. They are found primarily as sugar in the blood, and as glycogen stored in the liver. Carbohydrates are broken down into two types—simple and complex. Simple carbohydrates are sugars, which are quickly utilized by the body. Complex carbohydrates are starches, formed by the combination of simple sugars into more complex molecules. Your body breaks down starches more slowly than sugars. Fruits, grains, nuts and vegetables are the primary sources of complex carbohydrates.
The digestion of starches and sugars begins in the mouth, and continues down through the small intestine. All carbohydrates are converted, with the help of enzymes, into one of three monosaccharides—galactose, glucose or fructose. The body uses glucose in three ways: it yields energy directly, it is stored in the liver as glycogen which is released constantly to replenish blood sugar, or it is converted to and stored as fat. Levels of sugar in the blood must be carefully maintained for proper function of your internal organs, and the nervous system is especially sensitive to blood sugar changes. Alterations in blood sugar can affect memory, metabolism, fat deposition and energy.
Good and Bad Sugars
Natural sugars--found in fruits and vegetables--contain many essential nutrients that aid in their digestion. Refined sugars--found in processed foods such as cakes, pies and candy--lack these additional nutrients, and can therefore potentially disrupt the body’s control of blood sugar. Hypoglycemics, diabetics, and people suffering from intestinal infections must be especially careful to moderate their sugar intake. Food labels often mask extra sugars by using names like sucrose, glucose, maltose, lactose, fructose, corn syrup or natural flavors. They all mean the same thing--sugar, in one form or another.
If carbohydrate intake is very low, the body cannot completely utilize fat. The resulting increase in fat metabolism can produce an undesirable excess of ketones, acid-like molecules which can damage the body tissues. This process can be avoided by consuming the recommended 50 to 100 grams of carbohydrates per day.
I like to distinguish between grain carbohydrates and vegetable carbohydrates. Many people are sensitive to grains (which are relatively new additions to our diet, after the advent of farming). Corn, wheat rice etc. can be problematic if you are allergic. Celiac disease is often hidden, and a common problem.
Carbohydrates also include cellulose, pectins (gel-like substances that lower cholesterol by binding it to promote excretion and drawing it out of the body), and other substances known as dietary fiber or roughage. Most plant cell walls contain about 35% insoluble fiber, 45% soluble fiber, and various amounts of pectin and other substances. The soluble fibers include mucilages and gums, which mechanically coat and protect the intestinal walls. The fiber substances also absorb water and give bulk to the intestinal contents and stimulate peristaltic movement.
A common sign that you are low in fiber is a stool that is thin and pencil-like. Research has shown that people who consume large amounts of fiber (100-170 grams per day), such as rural Africans, have an average bowel transit time of 30 hours and a fecal weight of 500 grams. Europeans and Americans, who typically eat only 20 grams of fiber per day, have a transit time of 48 hours and a fecal weight of only 100 grams. This allows prolonged exposure to various cancer-causing substances in the bowel. Insufficient dietary fiber intake has been linked in epidemiological studies to constipation, diverticular disease, irritable bowel disease, bowel cancer, inflammatory bowel diseases, coronary artery disease, and gall stones (Kushi et al., 1999, reported in Murray, 1996, Walker et al., 1986, Haack et al., 1998, Bingham, 1990).
Proteins are complex organic compounds made primarily of amino acids. Protein is necessary for growth and development, and for heat and energy production. It also helps us maintain the acid-alkali balance in the body. Using the full set of amino acids, and under the direction of DNA, the body constructs all its proteins, a dazzling array including such essentials as hormones, enzymes and antibodies. While we can manufacture certain amino acids ourselves, we need to ingest some (called essential amino acids) from our diet. Without them, our body cannot function properly. Inadequate dietary protein intake is perhaps the most frequent cause of immune deficiency in the world. Protein malnutrition results in a reduced number and reduced functions of T-cells, phagocytic cells and antibody response (Chandra, 1999). Fully one-third of young children in the low-income countries of our world are stunted in growth due of protein-energy malnutrition (Darnton-Hill and Coyne, 1998).
Plants use energy from the sun to synthesize sugar, which they then combine with nutrients from the soil to make amino acids, and finally, proteins. Plants, therefore, are the original source of all the world’s protein. In animals, proteins are concentrated in structural and protective tissues, such as bones, tendons, hair, fingernails and skin, as well as soft tissues such as organs and especially muscles. Animals cannot synthesize their own proteins, and must depend on their dietary intake of plants and other animals.
All protein food sources are not equal. Meats, fish, eggs and milk contain all the essential amino acids, while vegetables are almost always deficient in one or more of the essential amino acids. Fortunately for vegetarians, we can correct amino acid deficiencies by combining foods. For example, we can complement cereals, which are low in the amino acid lysine, with soybeans, lima beans or kidney beans, which are high in lysine. Other beneficial combinations include breads with cheese; beans with corn; wheat with beans; nuts with breads; and cereals with milk. Most traditional cultures utilize these particular food combinations extensively. They offer much-needed alternatives for the many people whose protein choices are restricted by health conditions like allergy and inflammation.
Even though animal products seem ideal as a source of protein, there are some very important considerations. Animal protein sources are more concentrated and contain higher levels of toxins than vegetable proteins, resulting in more work for the liver and kidneys. There is much more protein in a gram of meat than in a gram of vegetable matter, resulting in a higher concentration of nitrogen for the kidneys to process in a typical meal. Excessive consumption of proteins from these sources in lieu of vegetable sources can also lead to relative deficiencies of other necessary plant-based nutritional elements, such as carotenes and bioflavonoids. Therefore, it is usually wise to make sure a good portion of your protein comes from vegetable sources (O'Keefe et. al, 1999). This important consideration is often overlooked in patients with kidney and liver diseases.
The body breaks down protein in the stomach and intestines, and this process leads to the release of energy. Poor protein digestion contributes to many disease processes. If protein digestion is weak, or if there is poor intestinal absorption of amino acids, bacteria can break the protein down into many toxic compounds such as polyamines (Wu, 1998, Bengmark, 2000). Protein digestion can be improved with herbal medicines, hydrochloric acid and/or proteolytic enzyme supplementation.
Eat According To Seasons
Seasonal weather fluctuations affect digestion and the body as a whole. Ayurvedic medicine teaches extensively about this phenomenon, and I have found the following Ayurvedic concepts, taught to me by my teacher Dr. Mana, to be very helpful in understanding how the body reacts to seasonal changes.
When the temperature suddenly drops at the beginning of a cold-weather season, it is very noticeable at first. Everyone finds it difficult to tolerate the cold for a few days until our blood circulation adjusts. In the winter months, the colder weather causes blood circulation to move to the inner parts of the body, away from the extremities. This shift away from the surface creates extra heat in the interior abdominal area, strengthening digestion as well as appetite. During these colder months, the body requires a heavier diet with an increase in caloric intake to maintain heat and warmth. Some people also find that warm drinks such as teas are helpful. Otherwise, a decrease in blood circulation in the extremities can lead to joint pain, and may even contribute to arthritis, pain and slow healing.
In my clinic I often question people suffering from musculoskeletal pain as to whether they experience cold hands and toes. I remember in particular one case of a young man who was always cold, and was having trouble with his martial arts. He was studying a very acrobatic Japanese style, and found that his recovery time and endurance were low. He had strong spiritual beliefs, and was following a strict vegetarian diet, eating no meat, fish or eggs. He was always cold, though he proudly told me his cholesterol level was about 110 (far below normal). I immediately took him out and bought him three fried eggs. Within one hour he began to warm up.
As Spring approaches, blood composition changes as the external air warmth causes the blood to thin. This change causes the body to release accumulated mucus and blood fats into the circulation, resulting in allergies, asthma, loss of appetite, and general sluggishness. Changing to a lighter and drier diet can counteract this.
During the summer, hot air temperatures draw the blood flow toward the extremities and away from the abdominal region. This change can cause weakness, decreased appetite, and digestive disorders in sensitive individuals. A dietary increase in liquids and cooling foods, especially vegetables and fruits, is usually sufficient to correct these ailments. I recommend that you stay away from sour, salty and pungent foods, meats, alcohol, and hot foods during this season, as they simply generate more heat. Instead, make a conscious effort to increase your intake of lighter foods such as fresh salads. A more vegetarian diet in general is better during this time of year. This type of diet naturally cleanses the system and keeps the arteries and other ducts healthy.
Humidity weakens the digestion and the nerves. I follow Ayurvedic principles to aid my digestion when the humidity is high, by changing to a heavier diet with more sour foods. Adding some honey to meal preparations can also help with the digestion of oilier foods (Bajracharya, 1978).