Digestive Support for the Winter Months

Posted on January 18, 2014 by Stephany

The winter months seem to contribute to sluggish digestion which sometimes (not always) manifests itself in constipation.  There are many reasons why this happens.

IMG_00171) First of all, it is dry.   Remember that the condition of your external epithelial tissue likely resembles the internal. If your skin is dry, you need to make a point to increase your fluid intake.   If you are like me and absolutely must have warm things to drink in the winter, make a peppermint latte or an herbal chai or a spiced tomato juice cocktail.   The boys are fans of the almond-oat beverage that I make.  We all like spiced apple cider and  hot lemonade.  Make some sort of  nourishing warm broth and drink it, but you get the point here, stay hydrated.    This includes adding some humidity to your environment.  Like I’ve said before there is a reason Mom kept a kettle going on the woodstove all day, long.    Remember that healthy oils play a role in this, as well.   I think fish oil of some sort during the winter is key.    I’d like to suggest adding it to the diet rather than supplements but I know that is not realistic for everyone.

2)  Some people are trying to eat seasonally for environmental reasons or perhaps due to trying to follow an Ayurvedic diet. Here in Iowa, when you are following that diet you are eating  lot of root vegetables and probably not getting your 8-10 servings of fruits and veggies per day.  This leads to not  getting enough fiber which you need for proper digestion.    (Even all you juice fanatics out there can get constipated if you are using a juicer that strains the roughage out.)

There is definitely not as much green leafy goodness in a local winter diet- my kale is shot after that last cold snap.   A lack of leafy greens can lead to less bitter flavors in the diet during this time of year.   If you haven’t read Jim McDonald’s lovely treatise on how lack of bitters may contribute to sluggish elimination, you can find it here: pdf

I still think we need our greens, even if it means buying them from afar.     Next year you can think of nifty ways to preserve  local fruits and veggies for the winter months.   I will make it a goal to pull more of the preserving recipes off the old database and finding some new ones.   One thing to think about is that fermented vegetables are a good source of probiotics which also help to promote digestive health.

As per the other concerns,    I understand that  winter foods were traditionally supposed to be sweet, warming and maybe a little on the fat laden side to keep us warm when we are all working ourselves to the bone and out in the elements most of our day. Traditionally that was okay, but I think discretion needs to be used in light of modern conveniences like heat, indoor jobs and cars.     If you are slim or frequently exposed to inclement weather for extended periods of time, then a traditional winter diet is desirable.  However, I maintain that those of us who don’t fit that category, given the modern concerns about insulin resistance,  could focus on less starchy vegetables sources.

Think of ways to make  these  fruits and veggies warming.   Soups fit the bill nicely around here because they are warming, moistening and you can stuff them with veggies and barley.  Barley is what they call in nutrition circles a bulk-forming laxative.     Braising greens is a nice way to warm them up.     As an aside,  when you do eat the root vegetables make sure that you are adding healthy fats and lots of warming, stimulating spices.   Squash with butter, or olive oil,  is good.  Squash drizzled with olive oil infused with  nutmeg, mace, saffron, salt and long pepper is AMAZING.  Adding a healthy fat helps to lower the glycemic index.

3)  We all slow down….   Here in the frozen cornfields, people are a little more housebound and so moving even less than normal, which also impacts your elimination processes.   Get moving.

4) A lot of folks are on the  SAD American diet and well really, that is enough said about that. Eat some damn vegetables and fruits, people.  I wonder how many more times I will say that in my lifetime?

There are all sorts of other issues that could contribute to the problem.   Chronic stress has a nasty impact on the digestive system, so an adaptogen might help.   Licorice root certainly has a history of being used for the complaint.     Some medications lead to problems, also.    Holding it when you have to eliminate can result in impaction due to the fact that it stretches the colon which in turn means that more waste has to enter your colon in order to trigger the next bowel movement.

The issue of constipation in little ones came up in a conversation the other day which made me realize I’ve never really addressed that here on the blog-probably due to the fact that I keep the previously mentioned issues in mind and  prefer to talk about proactive self-care than waiting for sick people to call me.

In the days when self-care was household knowledge, all such issues were approached proactively rather than retroactively.  Cod Liver oil was often  administered daily.   Folks who grew up in the  UK may  remember  lining up for  their Brimstone  and Treacle on a weekly basis, if they are old enough or grew up with a grandparent.    This licorice root preparation was so ubiquitous that the phrase was used as a title for a disturbing play in the seventies.   If something did happen, slippery elm gruel was often fed to children or an infusion of senna pods.

Senna is a stimulating laxative, which I tend to avoid due the to the fact that the bowels can become habituated to stimulation.  The same goes for aloe and cascara.  Demulcents are great, but today  I think that you’d have a difficult time getting slippery elm gruel into a child.

So if the issue comes up for your child, or you, first consider  the previously mentioned issues and address any issues of diet and exercise.

For immediate relief an adult might  try 200 mg of magnesium citrate and  1 tblsp of yellow dock syrup three times a day and a nightly Epsom Salt bath.  I might not be able to resist adding a bit of licorice root to the syrup.  I originally made  this recommendation based on the fact that yellow dock syrup had had a stool loosening effect on several of my clients who were taking it for iron related issues and anyone who has ever taken too much magnesium knows what that does.  It has served me pretty well.

For a child you might consider a teaspoon of yellow dock syrup 3 times a day, a few cups of the almond-oat beverage I mentioned above and a nightly Epsom salt bath.

I also racked my brain to come  best way to successfully disguise herb powders so that children will eat  them and I thought of my immune  boosting truffles.     Just a few tweaks and  I came up with something a lot more edible than slippery elm gruel. I hope that some of you out there might give these a try and give me some feedback.  I don’t have anyone around here to experiment on.   After a kind of giggly survey of the household  today, we have determined that we all eliminate once (sometimes twice) daily.

Digestive Support Snacks

Dry Ingredients

1/4 cup  slippery elm  powder
1/4 cup milk thistle seeds finely ground and sifted
1/4 cup licorice root powder
1/4 cup ground  flax  seeds (another one of those bulk-forming laxatives)
2 tbsp raw cacao powder
½ cup ground oats or almond meal.  I probably prefer oats for this recipe.
I also think I would add 1/2 teaspoon of spice here- fenugreek  (another bitter) for sure and maybe cinnamon.

Liquids

1/2 cup tahini
Fruit Puree*
Honey

Mix dry ingredients first and add ½ cup  or tahini to the mix.

If you can’t afford or can’t find the herbal powders:  Just use  1 cup of ingredients you can purchase as food such as flax seed, ground oats and don’t worry about the herbal powders.   Substitute ground sunflower seeds or pumpkin seeds for the milk thistle seeds and add 1/2 teaspoon of fenugreek powder as a bitter and 1/2 teaspoon of cinnamon.

Now mix in your fruit puree, honey or a combination of both until it forms a dough you can work with.

Roll this mixture in balls and roll in a coating of your choice.

Toasted coconut ground with a little nutmeg
Raw Cacao powder
Finely ground nuts or seeds- sesame seeds are good here.
Dark chocolate

I would be completely comfortable offering these to a child who was prone to constipation on a daily basis if they were made with flax seed or  maybe plantain seeds.   Adults too, could eat these as a daily snack.

Dried Fruit Puree

I’ve shared this recipe before but for these particular truffles, I would make sure that some prunes are part of the dried ingredients.   It is important to save the liquid you’ve used to rehydrate the fruits because a lot of your nutrients leech out during the re-hydration process.

Soak  1 cup of  dried fruit in 2 cups of warm water overnight.
Strain; reserving the liquid.
Place re hydrated fruit in food processor or blender.
Whip adding reserved liquid until a creamy paste like consistency is formed.

Posted in Caring for Illness, Winter | 3 Comments

Pudding Evoked Stream of Consciousness

Posted on January 15, 2014 by Stephany

Today,  I taught Trapolin to make a steamed pudding.  He was a great help doing the holiday baking,  he’s been bugging me to learn and well we could use some comfort food around here, this week.

Puddings in their simplest form were a peasant food. Not everyone could afford an oven, but most people could come up with a fire and a pot.  A  black pudding was a medieval delicacy enjoyed when an animal had been recently slaughtered.   The blood of the animal was mixed with cereal and spices and then stuffed in the intestines and boiled until it thickened, because the poor didn’t waste food.  Technically haggis was a pudding, and probably prepared long before it was first published in MacIvers Cookery in 1773.

By the 17th century,  these puddings had evolved to include a few more ingredients.  Special  bags were used for boiling the puddings and they might be main dishes or deserts.  Pease porridge was a pudding according to food historian,  Alan Davidson  which ”consisted only of pease, and a little flavouring: sugar and pepper, and sometimes mint, were commonly used.”   The mixture was then put in a pudding bag and boiled in some water with the bacon it was to be served with. Eventually,  the recipes evolved into the lovely desert I spent my afternoon making but for a good long time they were sustenance food.

And here is where I will digress for a moment… There is a comparison to be made between herbalism and steamed puddings.  In its peasant form  the practice of using healing herbs was simple self-care.  Terribly poor people likely gathered their herbs, while people with a cottage garden might have grown wormwood along side some “caboges.”   The cures were employed by people who could neither read nor write and didn’t  have enough money to pay the village healer.  It was these simple methods passed down through the generations which kept the poorest classes alive, not herbalists. Like pudding recipes, that concept evolved over the years.

The modern practice of herbalism, which finds its roots in the diagnostic methods utilized by Greek medicine, Chinese medicine or Ayurveda, belonged to the upper classes and learned people who could read the ancient texts and write new information down. Even the still-room books and the receipt books of the past were kept by the wealthy families and as such are not representative of the simple cures the peasants likely used, however they do illustrate the fact that every person had some common sense notion of how to deal with injuries and disease. The occasional entry credited as having come from the country folk, give us a bit of insight as to what their cures looked like, but for the most part many of the ingredients used in receipt books were beyond the financial means of the poor.

Today we have an unprecedented situation in which more people have access to the written word than ever before in history, yet we are more wildly dependent on “learned” experts than ever before. Few people have even given a thought to self-care, even though the means to do so in an almost “kingly” manner (by medieval standards) is less financially prohibitive than at any time in history-kind of like the ingredients for my pudding.

As I alluded to the other day,  I started to learn herbalism because I have this deeply ingrained independent streak that will never be content to accept the limitations of the situation above. Of course I had to, as is customary for me as well,  take it to extremes. It is also why teaching appeals to me, not because I want to be the “learned” expert imparting my wisdom, but because I want to make sure that every person who wants to learn has the chance to do so.  If I pursue my masters, it will be with that goal in mind.

And yes, these are the thoughts racing through my head today while I taught Trapolin to make a steamed pudding, so  I will now return to that train of thought.

If you’ve never steamed a pudding, take a look a this video.  Now you do needa small pan to use as a basin.   I found mine at a thrift store likely because someone had no idea what they are.  The only ones I could find on amazon were fancy things with lids and were quite expensive, you don’t need one of those.  Any small baking pan or ceramic bowl will do.  The capacity should be about four and one-half cups. Even a one pound coffee can will work.

Pecan-Maple Pudding with Custard Sauce

Pecan-Maple Pudding with Custard Sauce

175 grams of softened butter
3 Tbsp maple syrup
1 Tbsp ground pecans
1 teaspoon vanilla
175 grams golden caster sugar.
3 large eggs
150 grams self-rising flour*
25 grams ground pecans
2 tbsp milk
1/2 teaspoon cinnamon
1/2 teaspoon nutmeg, mace or allspice whichever you prefer

 

Grease your  mold with some butter.   Now whisk together the maple syrup, tbsp of pecans and the vanilla.  Pour them in the basin and tilt the pan around until the mixture coats the inside of the bowl.

Mix together the butter and the sugar.  Then beat in the eggs one at a time.   Beat in the flour and pecans.  Then beat in the milk.   I have heard that this flour is a decent gluten-free self rising flour, or you can make your own.   Spoon this batter into the mold and then wrap it up according to the video, I posted above.    Put a large soup pot on with water in it and a smaller glass bowl inverted for the mold to sit on.  (Alternately if you have a canner and a rack, you can flip the rack upside down in the canner.)   Fill the pot until the water is half-way up your mold and turn on the heat.  Bring to a bowl and steam for about an hour and a half.  Insert a cake tester in the middle and it should come out clean.    Invert the pudding on a serving plate, spoon a bit of custard over it and sprinkle it with nuts.

Custard Sauce
2 cups milk
1/2 cup sugar
5 egg yolks
vanilla

Heat the milk in the saucepan until it steams and mix 1/2 cup into your egg yolks. Stir this mixture back into the saucepan and stir briskly until the mixture thickens slightly. Remove it from the heat and stir in the vanilla. If clumps form, don’t worry on it just strain the sauce through a fine sieve. Eventually you will get the hang of it.

*Self-Rising Flour
2  cups  flour
3 tsp  teaspoons baking powder
1/2 teaspoon salt

References
Oxford Companion to Food, Alan Davidson [Oxford University Press:Oxfod] 1999

Posted in Caring for Illness, Herbs, Recipes, Reflection | Leave a comment

Community Herbalism

Posted on January 8, 2014 by Stephany

IMG_7752This article was published, in its entirety,  in the September 2013 issue of  The Essential Herbal Magazine.

I  once had someone level the accusation at me that herbalism was a privilege afforded primarily to upper middle class white people and that I was an elitist.   At first I was offended.  But once I listened to his complaints, too numerous to mention here, I realized that I completely understood where he was coming from.   His experience of “boutique” herbalism was very different than mine,  having been self-taught and tutored by the occasional street medic or other ‘renegade’ who was willing to barter a lesson.

I know the herbalists he is talking about.  I first came to herbalism as a very young single Mom with two little girls.   I  started learning to be an herbalist because the closest one I could find, charged $250 for a consultation.  That might as well have been a million dollars back then. He laughed at me when I asked if I could make payments…

I know that not every reader is a practicing herbalist.  Chances are though that once you started dabbling, people started asking for advice.   I’d like to offer some pointers here for thinking about how you can present information in a way that doesn’t discourage people of any income level from taking control of their health.

The first topic that that should up when talking about health is diet.    Yes, I know that organic food is best, but do not dwell on that issue.    Clean food is often not available in stores that accept SNAP (food stamps).  [Or should I say local, organic food vendors rarely accept them. ]   I’ve seen a lot of improvement in people who go from eating McDonald’s every day to making their own meals, even from less than ideal meat, vegetables and fruit.  I recommend that people buy the best quality they have access to and can afford and I NEVER disparage their choices.
Do not assume people have access to fresh fruits and vegetables and are just choosing to purchase convenience food because they are lazy. (I know that’s harsh, but I’ve heard people say it!)  People who live in certain urban areas may truly be purchasing most of their food from convenience stores and fast food restaurants.  [ The sociological term for these places is food deserts.]  If you are going to work in low-income areas, it is a good idea to visit the stores in the neighborhood to see what sorts of establishments operate in the area.   Don’t assume someone has transportation out of their immediate neighborhood.

There are some clean foods that are easier to pick up inexpensively. Soup bones are inexpensive.  Brown rice and dried beans are also cheap.  The thing you have to remember is that people don’t know how to cook.   Sometimes I work with homeless people who don’t even have the means to cook.    Instead of just telling someone to make something, invite them over to teach them how to cook it and send them home with a little bit.  [ Or teach them how to make a rocket stove from bricks]

You can also teach people how to make inexpensive preparations.  While I understand that everyone likes to talk up their organic fair-trade oils and pristine organic grape alcohol, you don’t need those ingredients to make preparations.  Honestly even if you use them, you could downplay things a little because people who can’t afford those ingredients may think that you HAVE to have them.

Essential oils are expensive.  Learn to work without them.   Tinctures are obviously more expensive to make so save them for internal preparations and make liniments for external use.  These have traditionally been made with rubbing alcohol or vinegar.   Oils are also expensive so substitute the use of poultices when possible and save the oils for appropriate use.    Look into local sources of rendered lard.   Sometimes you can pick this up really inexpensively and local is always better.

When making herbal and dietary recommendations, I always try to keep it limited to things that grow in my area.   Don’t recommend the latest ultra-expensive super food that only grows deep in the Amazon jungle to someone who can’t afford a bus pass.  It’s just not cool.

Keep an eye out for accessible plants.    In my town, the Hawthorns growing in the grocery store parking lot have enough weeds at the base of the tree that I don’t think they spray them.  And there are raspberry bushes all up-and-down the bike path on the East side of town.

Don’t recommend protocols that require expensive equipment.    Vitamix and juicers are not affordable.  Low-income individuals might not even be able to swing a crockpot.   I  haunt the thrift stores in my area so that if I do make a suggestion like making infusions in a thermos or thermal carafe,  I can tell them where to find one that only costs a couple of bucks.  Lately I’ve been buying them for 50 cents or less and just giving them to clients.   I also like to keep an eye out for air purifiers, aromatherapy diffusers and other items.

Self-care can be really difficult.   Even going for a walk is not always possible in disadvantaged neighborhoods.  People often keep indoors because they fear for their safety.   Be aware of free options in your community such as community rec centers, but understand these places are not always safe, either. My daughter was twelve when an older man pulled her aside and tried to sell her marijuana at our local rec center. People who voice these concerns are not making excuses.  It is a reality of modern living.

Yoga classes, energy work, massage therapy and all of the other trappings of modern “holistic health” are usually cost prohibitive unless you can recommend providers who will barter or do work-trade.   To my way of thinking they are not necessities.  I mean they are nice for people who can afford them, but don’t assume that someone can.  I have a friend who goes on-and-on to me about her favorite types of massage who has no idea I’ve never had one.

What I do have, is whole bag of self-care tricks that I can do in the comfort of my own home for not very much money, like my herbal foot soak routine.   Those are the types of things you teach people by inviting them to your house for a big herbal self-care party.

For those who are practitioners, we have many opportunities to extend services to under-served communities.  We can offer services on a sliding fee scale or accept other forms of payment such as bartering or work-trade.   We can teach free classes in safe areas that are accessible to people who don’t have cars.  The park next to me is near a bus stop and I like to plan classes there during the summer.   There are even herbalists out there with mobile free clinics.  You can offer free information on a blog, but don’t forget that many people in under-served communities don’t have Internet access so printing newsletters and distributing them is also a good idea.    Building community connections is also a very important part of working in under-served communities.

I’d like to end with a plea for practitioners to consider doing more of this work.   Recently I was in a workshop on Social Medicine.  The message delivered was one that resonates with me clearly.  Your capacity to be well is limited by the wellness of the weakest member of your ecosystem.    You will not be able to achieve health unless the community in which you live is also healthy.    As herbalists and wise people we have the capacity to help create that change in ways that I’ve only begun to touch on in this article.

Posted in Community Herbalism | 14 Comments

Chronic Stress and Modern Holistic Interventions

Posted on January 7, 2014 by Stephany

So 2014 is starting out with a blast of cold air and negativity for a lot of folks,  from what I’ve been reading on the Interwebz. I don’t usually share my school work here on the blog because quite honestly it isn’t my favorite way to communicate my message.  However in light of the general mood, I thought I would share this with everyone. I’ve removed the in text citations in hopes of making it a little more reader friendly, but I left a list of references at the end for people who are interested in reading more.

Pathophysiology of Chronic Stress and Modern Holistic Interventions

The word stress is a frequently occurring term in healthcare.    The human stress response is a natural function of the central nervous system which evolved to protect us in dangerous situations.  This is sometimes termed psycho-social stress but biological stress may also contribute to illness, so chronic stress is truly a bio-psycho-social phenomenon.   Biological stress is generally attributed to oxidative stress.    Oxidative stress results when the body produces more reactive oxygen than it is able to easily detoxify.   This results in inflammation because the reactive oxygen that is not detoxified causes tissue damage which provokes the inflammatory response.    While oxidative stress may play a role in diseases associated with chronic stress, it seems more likely that it is a result of diet.   Pain is also a biologically occurring stressor however it is subjective and it has been found that the “single most salient component to defining the stressful impact of an event appears to be the perception of the event as aversive by the person.”    The focus of this paper will be on the physiological impacts of experience of long-term exposure to psychosocial stress.

Stressors are defined as events that “require a physical, mental or emotional adjustment.”  Stressors vary in level of intensity and they can be positive or negative.     In 1967, researchers Thomas Holmes and Richard Rahe attempted to quantify certain life events such as marriage, personal injury, or change in residence, in order to use them as predictors of psychological and physical illness developed the Social Readjustment Rating Scale which was found to be predictive but with errors.  The model has been criticized because inherently assumes that all people are equally resilient in the face of stressors.   In 1983, Auburn University researchers determined that variables such as “higher levels of income and educational attainment” afforded an individual more resiliency. In recent years, modifications of this scale have shown that “the SRRS may be used as a scale measuring suicide risk.” While this information makes stress seem as though it is a purely sociological concern, it is far from that.  Stress has distinctly physiological impact on the body.

To begin to understand the implications of chronic stress we must first understand the stress response which evolved in order to enable our body to handle “acute physical emergencies.” It is a function of the sympathetic division of the autonomic nervous system which means that these responses are instinctive and involuntary.

The stress response is modulated by the limbic-hypothalamic-pituitary-adrenal system and hormones known as glucocorticoids.    The role of the limbic system is often overlooked in this process, but it is the amygdala which is constantly scanning our environment for dangerous images and sounds.     Sensory information is processed by the lateral nucleus of the amygdala and if it is recognized as a threat, or a potential threat, the lateral nucleus generates an output to the central nuclei (CeA) which is then able to generate outputs which communicate to various components of the hypothalamic-pituitary-adrenal axis initiating the classic stress response.  There is some evidence that the amygdala neurons which secrete noradrenaline and CRF are activated during stress.  Projections sent from the amygdala to the parabrachial nucleus are responsible for increasing respiration.  Projections sent by the amygdala to the hypothalamus are responsible for activating the sympathetic division of the autonomic nervous system. Sympathetic preganglionic neurons then stimulate the adrenal medulla to release epinephrine and norepinephrine and small amounts of dopamine. 

The hypothalamus also releases corticotropin-relasing hormone (CRH)  which results in the secretion of adrenocorticotropic hormone (ACHT) from the anterior pituitary gland.   which then causes the adrenal cortex to stimulate glucocorticoids, such as cortisol.  The pituitary also releases releasing endorphins, vasopressin and prolactin hormones.  The release of other hormones in the body, such as insulin and insulin like growth hormone which slows digestion and growth processes, are suppressed  and that energy is diverted to the limbs.  Release of serotonin may also be suppressed as reduced serotonin levels seem to “increase responsiveness to stress” and the concentration of serotonin in the hippocampus seems to be higher during stress.

Ideally when the fear stimulus has abated the amygdala sends projections to the dorsal motor nerves of the vagus nerve which activates the parasympathetic nervous system and all body systems return to homeostasis. Chronic stress results when this fails to occur and the body exists in sustained periods of daily sympathetic stimulation lasting for weeks or months.

These neurotransmitters and hormones have specific effects on various body systems.    In the cardiovascular system cortisol, epinephrine and norepinephrine cause your heart to beat faster and vasoconstriction which results in a more forceful heartbeat.   These measures increase the oxygen levels in your blood. The arteries that lead to your muscles relax in order to increase blood flow to the muscles.  Vasopressin causes your body to halt urine production and reabsorb the water back into your circulatory system. While these functions serve well on a short term basis, the long term effect of chronic stress create wear-and-tear in your cardiovascular system.   Hypertension (high blood pressure) has the effect of over working the heart muscles and blood vessels causing them to thicken.  Thickening of the heart muscle wall is termed left ventricular hypertrophy which may lead to arrhythmia. It may also lead to injury to the “points of bifurcation” in your blood vessels which leads to systemic inflammation. Inflammation in the blood vessels results in inflammatory aggregates which catch fat, glucose and LDL cholesterol as they travel through the blood stream.   These substances become fibrous and eventually become what is known as atherosclerotic plaque.   Due to this link between inflammation and heart disease, C-reactive protein, a substance secreted by the liver in response to injury, has shown to be the most predictive marker of cardiovascular disease.

Sympathetic stimulation also impacts the metabolic system.   In an attempt to make as much energy as possible available insulin secretion is slowed so energy storage stops. Stress hormones also reverse other energy storage processes, breaking down triglycerides into more fatty acids, glycogen into glucose and non-essential muscles into their amino acid components to be utilized by the muscles that need the energy.   Additionally glucocorticoids work to decrease cellular sensitivity to insulin.  While these measures serve to meet the energy output needs of a situation during which one might need to run or fight, it is has negative health consequences when sustained. The first of these is that the elevated levels of glucose and fat in the blood stream contribute to the formation of atherosclerotic plaque as mentioned above.  The second is the idea that large amounts of the glucocorticoid cortisol (hypercortisolemia) circulating through the body contributes to the chronic diseases related to insulin resistance, including metabolic syndrome and obesity.   Abdominal fat cells are more sensitive to glucocorticoids which has resulted in the recognition of excessive abdominal fat as a symptom of insulin resistance.

In addition to metabolic problem stress induced inflammation and suppressed immune function may work together to contribute to gastrointestinal disorders such as irritable bowel syndrome.    Ulcers are now attributed to the H. pylori bacteria, however not everyone who is infected with this bacteria gets ulcers.  Lifestyle factors such as stress seem to increase susceptibility to ulcers possibly through the suppression of the immune system.

Chronic stress is also known to suppress immune function due to altering the leukocyte distribution in the body and suppressing cytokine and T cells.   Glucocorticoids will stop the thymus from producing new lymphocytes and may even trigger programmed cell-death.   Conversely while stress is known to suppress immunity, it is also known to exacerbate autoimmune conditions.

Additionally stress contributes to a phenomenon termed burnout which is a “work-related stress induced condition associated with memory problems, fatigue, a sense of inadequacy, and depressed mood.”  This set of symptoms is sometimes mistakenly diagnosed as chronic fatigue syndrome.  This set of symptoms has been theorized to occur due to the  suppression of neurogenesis of cells in the adult hippocampus by glucocorticoids released during the sympathetic stimulation.

The preceding is not an all-inclusive list and the links between stress and many other conditions are currently being studied.  Given the many negative impacts of stress, stress management is vital to improving health outcomes.    Many modern herbalists have turned to the use of adaptogens.  It makes sense that adaptogens are probably the most modern category of herbs given their use to treat a truly modern disease. In 1947 Russian scientists coined the term to as a “material claimed to increase nonspecific resistance of an organism to an adverse influence.  In 1958, a Russian researcher, Isreal Brekhman, began researching herbs which might have this effect and meeting the following criteria: “it must be innocuous and cause minimal disorders in the physiological functions of an organism, it must have a nonspecific action, and it usually has a normalizing action irrespective of the direction of the pathological state.”  Many herbs were identified by the researcher and his colleagues as adaptogens including, Eleutherococcus senticosus and Panax ginseng.    Today herbals abound with lists of adaptogenic herbs.    Withania somnifera is often recommended for stress.  According to one study this herb and other adaptogens “counteracts many biological changes accompanying extreme stress including changes in blood sugar, adrenal weight and cortisol levels”

Another holistic approach is to increase parasympathomimetic activity in conjunction with lifestyle modifications and stress management techniques.    According to herbalist Steven Horne, parasympathomimetic herbs work by “directly stimulating the cholinergic receptors [nicotinic and muscarinic] inhibiting cholinesterase and promoting acetylcholine release.”   Unfortunately few of these have been studied, extensively.  Pilocarpine found in a relatively obscure herb known as Pilocarpus jaborandi is a muscarinic cholinergic receptor agonist.  The Veratrum spp. contains the chemical veratramine which also seems to have muscarinic cholinergic activity.   Arecoline from Areca catechu is also a parasympathomimetic which activates the muscarinic receptors, however its use is not recommended due to possible toxicity although this information conflicts with the fact that the herb is commonly chewed on in South America.   Lobeline, a constituent in Lobelia inflata effects the nicotinic receptors as does (obviously) the nicotine in Nicotinia tabacum.

Anti-adrenergic herbs are another category which inhibit the signals of epinephrine and norepinephrine (usually classified as nervines) include among others the Anemone spp. Leonurus cardiac (often a specific in arrhythmia) and Cimicifuga racemosa.   In an animal study a root preparation of Cimicifuga racemosa demonstrated “myometrial relaxant effect which was potentiated after inhibition of excitatory muscarinic, alpha and beta adrenergic, H1-histaminergic and 5-HT receptors.”  Rhodiola rosea has also been classified as an anti-adrenergic herb.

While adaptogens are considered safe for long term use these anti-adrenergic herbs are not and should be used as a short-term intervention allowing clients time to re-evaluate lifestyle choices and learn new coping mechanisms for that stress which is unavoidable. For those providers following a bio-social-psycho approach to herbalism, we find that there other useful adjunct therapies.  Music therapy has been studied extensively for its ability to induce a calming effect in the body.   Exercise has been shown to be a useful adjunct therapy.  Breathing exercises such as those utilized in meditative practices and yoga have also shown to improve the ability to handle stress.

Having a well-established support system, is  vital.   Researchers have determined that “lack of social support and recognition by the environment is one of the most consistent risk factors” of stress related disorders.   The latest research on mitigating this factor seems to be researching how the hormone oxytocin interacts with stress as a means of treating PTSD.  Oxytocin, mostly recognized for its role in breastfeeding, also plays a role in the stress response in that oxytocin system enables us to find “repose and respite” by helping to activate the parasympathetic response.   The release of this hormone also  makes people more likely to seek social affiliation during times of stress   due to the fact that the hormone oxytocin instills “greater confidence in others as well as a feeling of bonding.”  Production and release of oxytocin is stimulated by pleasant social contact such as conversation, massage, sexual intercourse or playing with a pet.   In cases where chronic stress is a concern, building community may seem daunting in light of a busy lifestyle.    Making supplemental therapeutic recommendations that in turn stimulate oxytocin release such as massage, might also stimulate a client’s interest in seeking support networks.

A novel approach which seems to be favored by those who spend their time with plants is to recommend spending increasing amounts of time outdoors.   In recent years a great deal of study has been devoted to the effect of green spaces on human well-being, leading one group of  researchers to coin the term “Vitamin G”  in reference to time spent in green places.    Spending time in nature gardening or forest bathing has shown to mitigate the effects of stress.  Japanese researchers studying the traditional practice of forest bathing or Shinrin-yoku concluded that forest environments promote lower concentrations of cortisol, lower pulse rate, and lower blood pressure, greater parasympathetic nerve activity, and lower sympathetic nerve activity.”   Swiss researchers found that gardening leads to decreases in cortisol which “promote neuroendocrine and affective restoration from stress”.   This may occur due to increased time outdoors or exercise.  The argument could also be made that it is possible to have a pleasant conversation with your plants.

While using herbal preparations and adjunct therapies may alleviate some of the effects of chronic stress, there are still ethical questions concerning this approach.  Alternative care providers may want to consider if mimicking the medical approach of reducing the effects of stress with pharmacological agents and coping mechanisms is truly the best approach for alleviating stress?  

Are there systemic changes which need to occur in the American workplace such as shorter work weeks, longer vacations and higher wages which might better address the problem of chronic stress in our society?   These questions are beyond the scope of this paper, but excluding them from consideration when discussing this topic would be remiss. 

In arriving at answers to these questions,  practitioners should consider the following statement by herbalist Sean Donahue, “Soviet scientists pioneered the use of adaptogens to make factory workers work longer and harder. The marketing of adaptogens to help people power through stressful lives in an economy that demands working two or three jobs to keep afloat is the capitalist equivalent. In both cases, to quote Dorothy Day, ‘Our problems stem from our acceptance of this filthy, rotten system.’ And until we can remove the obstacles to cure our solutions will be palliative at best.”

References

Blasco-Fontecilla, H. D.-G.-G.-R.-G. (2012). Can the Holmes-Rahe Social Readjustment Rating Scale (SRRS) Be Used as a Suicide Risk Scale? ? An Exploratory Study. Archives Of Suicide Research, 16(1), 13-28. doi:10.1080/13811118.2012.640616

Bum Jin Park, Y. T. (2010). The physiological effects of Shinrin-yoku (taking in the forestatmosphere or forest bathing): evidence from field experiments. Environ Health Prev. Med, 18-26.

Chen, X. T. (2013). Psychological responses to sound stimuli evaluated by alpha wave fluctuations. Journal Of Psychophysiology, 124-130.

Davis, M. (1992). The Role of the Amygdala in Fear and Anxiety . Annual Rev. Neuroscience, 353-375.

Dhabhar, F. S. (2008). Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection versus Immunopathology. Allergy, Asthma & Clinical Immunology,, 2-11.

Donahue, S. (2013, February). Plant Magic Class Lecture. (S. Hoffelt, Interviewer)

Ganora, L. (2009). Herbal Constituents: Foundations of Phytochemistry. Louisville, CO: HerbalChem Press.

Kumar, A. R. (2013). Stress: Neurobiology, consequences and management. Journal Of Pharmacy & Bioallied Sciences, 5(2), 91-97. doi:10.4103/0975-7406.111818

Kurt Isselbacher, J. M. (1994). Harrison’s Principles of Internal Medicine 13 Ed. New York: McGraw Hill.

Longenbaker, S. N. (2008). Mader’s Understanding Human Anatomy and Physiology. Boston: McGraw Hill.

Maslova LV, K. B. (1994 ). The cardioprotective and antiadrenergic activity of an extract of Rhodiola rosea in stress. Eksp Klin Farmakol , 61-63.

McGrath, R. V. (1983). Measuring Life Stress: A Comparison of the Predictive Validity of Different Scoring Systems for the Social Readjustment Rating Scale. Journal Of Clinical Psychology, 39(4), 573-581.

Olff, M. (2012). Bonding after trauma: on the role of social support and the oxytocin system in traumatic stress. European Journal Of Psychotraumatology,, 11-31.

P.S. Eriksson, L. W. (2004). Functional consequences of stress-related suppression of adult hippocampal neurogenesis- a novel hypothesis on the neurobiology of burnout. ACTA Neurologica Scandinavica, 275-280.

Peter P Groenewegen, A. E. (2006). Vitamin G: effects of green space on health, well-being, and social safety. BMC Public Health. doi:10.1186/1471-2458-6-149

Rahe, T. H. (1967). The Social Readjustment Rating Scale . Journal of Psychosomatic Research, 11(2), 213-218.

Ressler, K. (2010). Amygdala Activity , Fear, and Anxiety: Modulation by Stress. Biol. Psychiatry , 1117-1119.

Sapolsky, R. M. (2004). Why Zebras Don’t Get Ulcers 3rd Edition. New York: Hold Paperback.

Steven Horne, T. E. (2011, 8 1). Advanced Herbal Training: Module Four Herbs for the Nervous System. Retrieved from Tree of Light: http://www.treelite.com/courses/class/AHT/previews/AHT4-NervousSystemPreview6.pdf

Van Den Berg A.E., C. M. (2010). Gardening Promotes Neuroendocrine and Affective Restoration from Stress January 2011 16: 3-11, first published on June 3, 2010. J Health Psychol, 3-11.

Wallace, E. (1998). Adaptogenic Herbs: Natures Solution to Stress. Retrieved from Patient Media: The Chiropractic Research Organization: http://www.chiro.org/nutrition/FULL/Adaptogenic_Herbs.shtml

 

 

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It is cold out there…

Posted on January 4, 2014 by Stephany

Untitled-1I wrote about hypothermia a few years ago hoping that people would heed all my good advice and never  have to worry about treating frostbite.   However on occasion,   someone will insist on walking the dog without wearing gloves and end up with a bit of a case of frostbite.  Since we are gearing up for actual temperatures of -24 hear in Iowa Sunday and Monday, I thought this would be a prudent time to talk about frostbite here on the blog.

Risk Factors

Some people are more at risk than others for frostbite.  Obviously little babies and elders are at greater risk.  Those with peripheral diabetic neuropathies or cardiovascular diseases which impair circulation should also take extra caution.   Being on beta blockers increases your risk of frostbite, also.   Also any agent ,  prescription or otherwise,  which thins your blood makes you more susceptible to frostbite, especially alcohol.   Dehydration and poor nutrition may also predispose one to frostbite.   The presence of  precipitation  and high winds, along with the cold  can also increase your risk.  Being dumb and going outside without gloves on when it is a windy -6, will also do the trick.

windchill1

I found this nifty graphic to add which tells how long it takes for frostbite to set determined by both wind speed and temperature.

Frostbite causes injury during both the freezing and thawing process.  Freezing temperatures decreases blood flow and causes ice crystals to form in the interstitial fluid.

These crystals may rub together and cause tissue damage or leech fluid from the cells causing dehydration.   As the skin thaws the inflammation process is triggered which results in vasoconstriction and more blood clots which may further reduce circulation to the affected area.

Symptoms of Frostbite Include:
1. Pain or prickly sensations.
2. Numbness
3. Pale-looking skin that feels cold, and possibly hard,  to the touch.
4. Skin may appear swollen.  Steve’s finger almost swelled out of his wedding ring even though he had a fairly mild case. .

Three Categories of Frostbite

Superficial frostbite or frostnip – This is a mild case of frostbite, so mild in fact that it is not considered true frostbite.   Skin may go white, be painful and feel cold to the touch but it is still pliable and springs back after having been touched.

Partial thickness frostbite is more serious. Generally speaking the skin feels harder and  may retain an indentation after it has been touched. In this case the injured party is likely to feel more pain and a prickling sensation verging on numbness. You might also want to assess this person for symptoms of hypothermia and treated for mild-moderate hypothermia.

Full thickness frostbite occurs when the skin is frozen solid. Touching the skin is not likely to leave an ident.   It will feel “wooden” to the person assessing the damage and numb to the injured person. Unless you are in a wilderness situation, do NOT try to handle this on your own. The injured party is almost positively going to be suffering from hypothermia at this point, as well.

Treating Frostbite
Treat frostnip and partial thickness frostbite by submerging the skin in 40-42 degree C water or if water isn’t available skin-to-skin contact. Do not rub the skin or place the frozen skin near a heater. Both of these measures can cause further damage. You also want to be sure not to do something that will further damage already damaged skin like cayenne or some other rubefacient like mustard, on the skin to thaw it out. If you want to warm someone up and increase circulation do that by giving them a warming, stimulation infusion, to drink.  Sage and yarrow are nice for this  or even tea made from pine needles if that is all you can find.

The skin is properly thawed when the  color returns to the skin. The injured party will experience some pain as this happens. In more severe cases the skin may take on a red, mottled look which is referred to as flushing.   This is not by itself, a cause for concern.

Once the skin is thawed, you should treat frostnip like you might a superficial burn. Lavender, chamomile and calendula, or yarrow infusions made into a compress or a soak, might be helpful. Balm of Gilead is an often mentioned traditional preparation for frostbite.  Aloe has been indicated as being helpful, as well.

Partial thickness frostbite blisters sometimes form blisters known as “blebs”. It is good to try to keep these from rupturing. Steve had a very mild case with just a few small blisters. We are using a salve I make with a blend of St. John’s Wort, yarrow and comfrey which seems to be helping but if they do rupture I will probably switch to poultices or soaks because I don’t like to use ointments on open wounds.

I really hope no one ever has to deal with this, but it should go without saying that you should only attempt to treat full thickness frostbite, if you have no way of getting to a hospital. Submerging the frozen body parts in water that is between 40-42 degrees Celsius is still the preferred treatment but you need to be prepared for the fact that this is going to be intensely painful for the injured party and that the skin may take on a black dead look almost immediately upon thawing.  Compounding this problem is the fact that the person is likely to have severe hypothermia, as well.     It really isn’t something to try to tackle on your own, seek immediate medical attention as soon as possible.

I hope that none of you have any need of any of this information over the next few days.  Be safe.   If you must be outside, read up on hypothermia and take appropriate precautions.  Travel with a winter safety kit and keep your cell phone charged at all times.

Center, University of Maryland Medical. Medical Reference – Complementary Medicine. 16 11 2011.

Tilton, Buck. Wilderness First Responder: Second Edition. Connecticut: FalconGuide, 2004.

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