Forest Bathing, Why Nature is Healing

 Kim Niddery - 4th Year Boucher Student

Kim Niddery - 4th Year Boucher Student

Forest Bathing, Why Nature is Healing

Deep breaths of fresh mountain air, rosy cheeks, trickling tickles of sun through the trees, silence broken only by birds singing and twigs breaking beneath your feet. The moments you have outdoors force you to be present, and the thoughts that grab you are, ‘how great this feels’, and ‘why you don't do it more’.  Nature has a calling to us, it does something to us. You feel it when you sit on the grass in your backyard, when you go for a hike, or, like my fellow tree-planters, part of why you feel that draw to go back year after year. 

But what IS that exactly? What is actually going on in our physiology? And why is it something that everyone feels?

Like a mother to her little chicks, mother nature sees us. In our daily rat-race; stressed, depressed, overwhelmed, and overworked. Often we reach for technology, junk-food, medication, or material things to cure us of what we think will ease the pain and pressures of life. Now I do recognize that there are times when medication, or some sort of intervention is needed, but before you dismiss forest walks as an alternative prescription for what might ail you, “imagine a therapy that had no known side effects, is readily available, and could improve your cognitive functioning at zero cost” (Williams 2016), it’s called time in nature, and it’s science.

In a recent article in National Geographic, Florence Williams (2016) interviews cognitive psychologist David Strayer who sates that the antidote to what modern life does to us, is Nature.  Due to large scale public health problems that stem from too much time indoors, such as obesity, depression, and increasing amounts of near-sightedness, more and more scientists are looking at how nature effects our brains and bodies (Williams 2016).  With advances in neuroscience and psychology, scientists are able to quantify things like stress hormones, heart rate, brain waves, or even protein markers that “indicate that when we spend time in green space, that something profound is going on” (Williams 2016).

Nature works mainly by lowering stress, but as I try to emphasize with my patients that I work with as a student clinician, stress is nothing to scoff at. It may seem like cop-out term, but as I will discuss in a blog to follow, stress has the most profound ripple effects in the body. From your immune system, to your brain chemistry, to direct physical effects, relieving your body from stress will change your human experience and abilities.

“Shinrinyoku” is Japanese for a forest bathing trip, which is a short leisurely visit to a forest, and is seen as similar to natural aromatherapy (Li 2010).  A study was conducted to look at the effects of forest bathing trips on human immune function.  Through a series of blood and urine samples taken before, during, and after a 3-day/2-night trip to forest areas, they found that immune markers were significantly higher during their time in the forest, and that some markers stayed high for up to 30 days after the trip (Li 2010).

Beyond the benefits for mild bouts of depressed feelings, or difficult moments, time in nature has proven to be effective even for those diagnosed as having Major Depressive Disorder. Berman et al. (2012), conducted research on if walking in nature would be beneficial for people with MDD, and found that participants showed an increase in memory span, and increases in mood not associated with the memory effects.  Not only do people report these effects subjectively, but they can be measured and seen as well.

Researchers in Korea used a series of MRI images documenting the brain activity of people looking at a variety of different images (Williams 2016).  When volunteers looked at urban scenes, their brains showed more blood flow to the amygdala, which is responsible for fear and anxiety, yet when they saw natural scenes, their anterior cingulate would light up (Williams 2016). This region of the brain is responsible for empathy and altruism suggesting that maybe nature makes us nicer and more calm (Williams 2016).  Another group of researchers at Stanford also scanned the brains of 38 volunteers before and after they went for only a 90 min walk in either a large park, or downtown (Bratman et al 2015). They reported that those who walked in nature had decreased activity in the subgenual prefrontal cortex of the brain which is tied to depressive rumination (Bratman et al. 2015).

Not only can we measure the effects nature has on the brain, but our physiology as well. 

According to a study published in The International Journal of Environmental Research and Public Health, even just 2hours of forest therapy reduces blood pressure, lower cortisol, relieve tension and anxiety, and improve mood (Ochiai et al. 2015). 

In the National Geographic article, Strayer discusses how your brain is not a tireless machine, but something that does get fatigued. He states that after time in nature, it is like your mental windshield gets cleaned, and you perform better, become more creative, and feel restored (Williams 2016).

As the statistics tell us that we spend less and less time as a whole out in nature (Engelmann 2001), and as we spend more and more money as whole on public health initiatives, maybe we should consider that one of the cheapest and most beneficial actions we can take is literally out your back door. 

For some of us access to green spaces is not as easy as it is for others, but for your long-term health goals, it would be something to consider to put in your future plan. “Moving to greener urban areas was associated with sustained mental health improvements, suggesting that environmental policies to increase urban green space may have sustainable public health benefits” (Alcock et al 2014). So whether you budget for taking more trips into nature, or look to move into greener areas in the future, it might be something worth taking a serious look at.

Although science is starting to put these benefits into context and something that is measurable, there is still something mysterious about what being in nature does to us. This mystery is likely personal, and will never be fully tangible or understood, but I think I would like it to remain that way.

Even though we can now better understand what being in nature does to us, why we go out and seek time in nature is not because science tells us it is good for us, but because every single person out there knows how it makes them feel. We are a part of Mother Nature, and she is a part of us, there is no other reason we need to understand why she feels like home. 

She knows, and so do you.

Yours in health, 

Kim Niddery

 

References

Alcock, I., White, M. P., Wheeler, B. W., Fleming, L. E., & Depledge, M. H. (2014). Longitudinal effects on mental health of moving to greener and less green urban areas. Environmental Science & Technology48(2), 1247-1255. doi:10.1021/es403688w

Berman, M. G., Kross, E., Krpan, K. M., Askren, M. K., Burson, A., Deldin, P. J., & ... Jonides, J. (2012). Interacting with Nature Improves Cognition and Affect for Individuals with Depression. Journal of Affective Disorders, (3), 300.

Bratman, G. N., Daily, G. C., Levy, B. J., & Gross, J. J. (2015). The benefits of nature experience: Improved affect and cognition. Landscape And Urban Planning, 41. doi:10.1016/j.landurbplan.2015.02.005

Engelmann, W. (2001). The National Human Activity Pattern Survey (NHAPS): A resource for assessing exposure to environmental pollutants. Journal Of Exposure Analysis And Environmental Epidemiology, (3), doi:10.1038/sj.jea.7500165

Li, Q. (2010). Effect of forest bathing trips on human immune function. Environmental Health And Preventive Medicine, (1), 9.

 

Ochiai, H., Ikei, H., Song, C., Kobayashi, M., Takamatsu, A., Miura, T., & ... Miyazaki, Y. (2015). Physiological and psychological effects of forest therapy on middle-aged males with high-normal blood pressure. International Journal Of Environmental Research And Public Health12(3), 2532-2542. doi:10.3390/ijerph120302532

Selhub, E. M., & Logan, A. C. (2012). Your Brain on Nature: The Science of Nature's Influence on Your Health, Happiness and Vitality. Hoboken: Wiley.

Williams, F. (2016). This is your brain on nature: when we get closer to nature--be it untouched wilderness or a backyard tree--we do our overstressed brains a favor. National Geographic, (1). 48.

 

 

Celiac disease and food restriction: bringing it together for patient-centered outcomes

   Alan da Rocha Brum, BSC (PSYCH), M. Ed   .    Naturopathic medical student at the   Boucher Institute of Naturopathic Medicine  , with special interest in the digestive system.

Alan da Rocha Brum, BSC (PSYCH), M. Ed.

Naturopathic medical student at the Boucher Institute of Naturopathic Medicine, with special interest in the digestive system.

Nowadays, gluten free diets have become popular, but there is a lack of education and a lot of confusion about Celiac Disease. What are the key points when gluten needs to be eliminated?

Have you ever left the doctor’s office with a plan for food restriction? If you have heard “we will need to change your diet” or “you are allergic to a specific allergen and you need to avoid it”, you know how those words can be overwhelming.

Food restrictions can be a challenging adjustment process since they can involve social, economic and medical aspects; however, information, acceptance and education are the keys for a successful new diet plan adherence. Therefore, a new relationship with food needs to be established and it may interfere not just in the patient’s diet, but also in those who are closest to him or her. Food restriction is a broad category that comprises changing the diet by selecting a type of food or avoiding typical allergens, such as: milk, soy, peanuts, wheat and eggs. The reason for the alimentary restriction varies and each condition follows specific protocols.

Gluten has gained special attention in the last few years and the demand for gluten free products has increased substantially [1]. Although gluten has become a very popular topic, there is a lot of confusion and a lack of education about Celiac Disease (CD), especially with regard to cross contamination. The most common misconception about CD is referring to it as a food allergy, which is often how it is seen by the general public.

CD is considered an immune mediated disorder that affects patients that have a genetic predisposition and it is triggered by the consumption of gluten [2]. It is also characterized by inflammation caused by leukocyte infiltration that changes the epithelial tissue in the small intestine [3].

Patients that are predisposed to the onset of CD carry the HLA-DQ2 and HLA DQ8 haplotype, which triggers the development of the pathology when in contact with gluten [4]. CD is also known as Celiac Sprue or Gluten-Sensitivity Enteropathy and is characterized by the malabsorption of nutrients due to intestinal epithelial tissue damage caused by immune response triggered by gluten. The enterocytes that form the lining of the small intestine are affected and damaged in the apical specialization of the columnar cells (villi), compromising the optical absorption of nutrients [2].

The small intestine is an extremely important organ in the digestive system since it is where most of the macro and micronutrients are absorbed. Any damage or dysfunction in the intestinal epithelium tissue can result in many nutrient deficiencies, compromising the functionality of other organs. Some of the non-gastrointestinal manifestations of CD are: osteoporosis, migraines, depression [8], dermatitis herpetiformis, type I diabetes mellitus, infertility, amenorrhea, adenocarcinoma, lymphomas [7], and thyroid problems.

Gluten is a protein found in rye, barley and wheat, which contains a peptide called gliadin; rich in glutamine and proline [6]. When gluten is consumed it is broken down into amino acids and peptides, where one of the resulting peptides is the 33 – amino acid alpha gliadin, which cannot be degraded by gastric, pancreatic and intestinal brush border protease enzymes, causing the immune response in the small intestine [2].

The 33 – amino acid alpha gliadin in contact with the lining epithelial tissue triggers a cascade of biochemical events that promote the tissue damage found in the CD. The figures 1 and 2 are illustrations of the mechanism of the CD.

When 33 –amino acid alpha gliadin reaches the intestinal epithelial tissue and makes contact with enterocytes cells, it promotes the release of IL-I5 in the intracellular environment, which stimulates the expression of CD8 lymphocytes [2]. Once CD8 lymphocytes are expressed, they also promote the formation of natural killer cells, known as NKG2D that attack the intestinal epithelium tissue causing damage to the enterocytes [2].

This first immune response mechanism shown above may allow other peptides of gliadin to cross the epithelium tissue and interact with other molecules, such as HLA-DQ2 and HLA-DQ8, which are involved in the mucosal damage found in CD.

Some of the gliadin that is able to cross the intestinal epithelium tissue undergoes a process called deamination, which is the loss of the amino group from the peptide. Gliadin has a strong affinity to the enzyme transglutaminase-2 (TG2) that converts the glutamine residues of the peptide gliadin into glutamic acid [3]. This change in polarity allows gliadin to bind with HLA-DQ2 or HLA-DQ8 receptors, which will activate T cells. As a result of this mechanism, cytokines are formed, and they are responsible for the mucosal damage in the intestinal epithelium tissue [2].

The HLA-DQ2 and HLA-DQ8 mechanism is one of the genetic components of CD, and recent medical literature has shown that CD involves complex genetic machinery. Therefore CD is characterized as a polygenetic immune based disorder [1].

The mucosal damage found in CD is not a food allergy pattern because food allergy by wheat or any other grain would not cause the severe damage in the epithelial tissue. Thus, CD cannot be referred to as a food allergy, a common mistake often made by the general public [6].

CD can manifest at any time in life and it is recommended that patients that suffer from gastrointestinal problems without direct cause and consume grains should be screened for CD [6].

The classic presentation of CD occurs when food-containing gluten is introduced in the child’s diet where symptoms, such as: irritability, abdomen distension, chronic diarrhea, and weight loss take place [2]. Also, nutrient deficiency, such as iron, is a common presentation [5][7].

In adults CD is often manifested between the ages of 30 and 40 [5][2], and chronic diarrhea, bloating and anemia are often linked [2]. Many of the cases of CD are not diagnosed because of the different presentations of the pathology; Silent CD is characterized by epithelial tissue damage and positive serology but no manifestation of the symptoms [2]; Latent CD is characterized by positive serology and no intestinal tissue damage [2].

Since CD can be in the asymptomatic form (Latent and Silent) it would be important to considerer the screening for CD as differential diagnosis in many other medical conditions [14]

Considering the different types of CD, (symptomatic, Silent and Latent), studies have shown the importance of screening relatives when a patient is diagnosed with CD [6][9]. In 2003 a medical study concluded that there is a high rate of CD in first and second-degree

Intestinal biopsy and specific blood tests are involved in the screening procedure for CD. When someone is under the diagnosis procedure, it is very important to continue consuming gluten until the biopsy and blood tests are done, since stopping the consumption of gluten at that moment can interfere in the test results.  Once the diagnosis of CD is confirmed, a complete gluten free diet needs to take place.

The epidemiology of CD is a complex subject since many cases are not diagnosed because of the asymptomatic presentation of CD. According to Health Canada’s Position on Gluten free claims it was estimated that in June 2012, when the report was published, that 1% of the population of Canada was celiac, which would be approximately 340,000 Canadians at that time [10]. TheCanadian Celiac Association predicts that 1 in 133 people in Canada has CD [11], and studies have shown that CD is a much more common condition worldwide [4][9].

The only treatment available for CD is a gluten free diet; and patients from any type of CD should avoid gluten completely [2][5][6]. A 5-year complete gluten free diet reduces the risk of developing cancer, which is one of the most dangerous complications of CD [6]. Untreated CD has a high risk of developing lymphomas; therefore a gluten free diet needs to be reached in order to reduce the risks at the level of the general public [14].

Medical literature has shown that a complete gluten free diet improves the gastrointestinal symptoms as well the extraintestinal manifestations when irreversible tissue damage is not achieved [14].

In order to support patients throughout the elimination process of gluten from the diet, information is a very important step. Every patient is one singular individual, and they will establish different relationships with the information that they have received.

Psychological aspects should be considered since the change in the diet may affect in the first moment social interactions and family dynamic with food. Medical nutrition and counselling are important aspects of the adherence of the lifelong gluten free diet.

Family education about a gluten free diet and gluten cross contamination should be considered. Cross contamination is characterized by the contamination of gluten free food with gluten particles.

In pediatric cases of CD, orientation of gluten cross contamination should be shared with the school and any other place where kids may have access to food.

Restriction to gluten does not mean social interaction restriction, and the understanding of the disease with information and its acceptance help a celiac patient to have a normal social life free of gluten.

A clear understanding of the role of the lifelong gluten free diet and the knowledge of the implications that a relapse to a gluten diet could have on their health are important aspects for a successful adherence of the gluten free environment.

The persistence of the gastrointestinal symptoms and extraintestinal manifestation in most of the cases are due to the relapse to a gluten diet or because of the implication of cross contamination of gluten in gluten free food [14].

In some cases when the gastrointestinal symptoms are not completely improved when a gluten free diet is incorporated the patient may have food sensitivity to other types of food.  The most common food sensitivities, which also have shown to present villous atrophy are: milk protein, soy and eggs [14].

Another aspect to be considered is gluten cross reactivity which can be a variable involved when gastrointestinal symptoms persist after a gluten free diet has been introduced in celiac patients [15]. Some of the food linked to gluten cross reactivity are: oats, millet, corn, yeast and milk [15].

A gluten-free diet requires special attention, determination and acceptance. Many of the types of foods in a regular diet contain gluten, and many others are often contaminated with gluten when they are processed. Gluten free whole grains can become an unsafe product for celiac patients due to cross contamination during the transport, storage and milling processes [12].

Cross contamination is the most challenging aspect of a life without gluten, for most celiac patients a small amount of gluten such as 50ppm (parts per million) a day causes mucosal damage [14]. A study in 2007 found that even 10ppm (10mg/kg) of gluten a day had a negative effect in one of the patients that relapsed to epithelium damage [13].

Health Canada studied the exposure to gluten in the daily consumption of grains in different age groups and sexes, and they estimate that gluten levels cannot surpass 20ppm (20mg/kg) in labelled gluten free products. Since the rate of consumption varies from patient to patient, it would average out to be lower than 10ppm, making it safe for most celiac patients [10].

In order to illustrate how celiac patients are sensitive to gluten, since some of them cannot tolerate even 10mg/kg a day (10ppm), a simple slice of bread has approximately 1,600mg/kg of gluten [1].

Also, Health Canada has analyzed gluten free-labelled products that were sold in Canada in 2012, as mentioned in the Health Canada’s Position on Gluten free claims, and all of them had no gluten or less than 20ppm, therefore, being safe for most celiac patients [10]. 

Natural gluten free products that are not labeled gluten free may contain a superior value of gluten due to cross contamination and surpass the threshold that is estimated to be safe for celiac patients.

A study published in 2013, which analyzed 604 samples of natural gluten free flour and starch (not labeled gluten free) in 8 cities in Canada during 2010 and 2012, found that 61 samples presented gluten cross contamination [12]. The level of gluten exceeded the limit established of 20ppm of gluten, therefore turning the flour or starch unsafe for celiac patients [12].

Gluten free products also can be contaminated with gluten at home and special attention is required. If the kitchen is not a gluten free environment and it is shared with other gluten products, extra procedures should be considered. Kitchen utensils can carry traces of gluten and can contaminate the gluten free food.

A celiac patient needs to have a toaster and butter dish that is only for gluten free bread, and special labeled containers may be a great option in order to prevent cross contamination.

In order to assure a safe gluten free environment, many other tips can be found on the Canadian Celiac Association’s website[1] in the section of cross contamination.

Education regarding gluten contamination is very important. Many people do not know how celiac patients are sensitive to gluten and may not be careful with gluten traces when cooking a gluten free meal for celiac patients.

Once a life without gluten is established, a medical follow up should be done, since some vitamins can persist in a low level after a gluten free diet is incorporated, however supplementation is often recommended [14].

Medical literature has shown that some vitamins need to be administrated in the beginning of the treatment when CD is diagnosed and further follow up will determine if the patient needs to continue with the supplementation [14].

Common vitamin supplementation in the beginning of the treatment and follow up usually involves folic acid, vitamin B6 and B12, Magnesium, iron, L-cartinitine, vitamin A, E, K and D, copper and selenium [14].

For more information, visit a Naturopathic Doctor who has an extensive medical training in medical sciences and medical nutrition, and who is considered as a primary care physician in British Columbia, Canada.

Welcome back, Boucher!

As your communication managers for the year, we would like to wish you all a warm welcome to the start of this year! We’re super excited to be back and working with the BNSA to keep the student body informed on what’s in store this year. We’ve come up with some exciting new ways to get information out to you guys and we’re looking forward being your means of staying informed with what’s happening this year. If any of you have any suggestions on what you would like to see in the newsletter or on the website please let us know! Looking forward to seeing all of your smiling faces in the coming week at school. 

Wishing you all the best in the coming year, 

Alex & Kayla