Green Rx is a nature-based prescription. It can include 5 (five) parts: A. lower-on-the-food-chain-food (e.g. grown, harvested, minimally processed, cooked locally), B. nature therapy (from forest bathing to surf therapy to therapeutic gardening to time with animals), C. aromatherapy, D. dietary supplements, especially botanicals, and E. bringing the outside in. Like many prescriptions, it has specifics: therapy, intensity, duration, frequency, quantity. It’s nature as medicine.
It’s also a new way of looking at how to improve well-being and live better, happier, healthier, longer.
The importance of nature is obvious, inherent and intuitive, and people are biophilic EO Wilson explained, and yet, as Howard Frumkin wrote 18 years ago”…the idea that exposure to nature can be restorative is almost invisible or nonexistent in health care. Our standard clinical paradigm involves medications more than non-medical approaches, treatment more than prevention. But many people are intuitively drawn to this idea. They feel restored and healthier in a beautiful landscape, for example.”
Green Rx aims to emphasize the possibility of individual treatment with nature, not relying on public health or institutions to make the changes needed. In part, this will be by finding and telling the stories of people who have had serious medical problems and decided to do something about them, usually outside of conventional medicine. Part will emphasize bringing the outside in, as that is easiest for people, and as BJ Fogg writes, “the simpler you can make a change, the more likely people are to do it.” And part will be in finding and highlighting the research, services and products which are showing the way towards using nature as medicine. Nature can change your wellness and well-being, every day.
A. Eating lower on the food chain.
This means eating more minimally processed food and less ultraprocessed food, which the U.S is failing at. Since 1999, US adults under 50 are eating 3% fewer highly processed foods with added sugars; and 42% daily calories from refined grains, starchy veggies and added sugars. Adults over 50, no progress since 1999. Much of this site and my nutrition work has been focused on getting people to make small changes, and the ones who do succeed: cooking more, growing more of their own food, shopping at farmer’s markets. Most often, people do this to look and feel better, to lose weight, and sometimes, because their doctor asked them to do so.
But on average, we are not doing it. Knowing that adopting more plant-based diets could reduce greenhouse gas emissions from the food system by more than half by 2050 could be a motivator…but will it? Will knowing eating more plant-based burgers, sausages and meatballs will be better for the environment, and possibly better for you than the real thing be the right ticket to help us as a nation move in the right direction? Time will tell, but health conscious individuals will always find a way to optimize their diet.
B. Nature therapy and its forms.
This idea of nature as restorative and healing has been around as long as there have been people, I am sure, but when it manages to sneak into health care, it is usually spoken of in preventive medicine or public health. The data for greenness in your neighborhood is overwhelming in health, even if it is not well known:
- Residential proximity to vegetation is associated with lower levels of stress, anger, aggression, diabetes, stroke and cardiovascular disease
- In an analysis of 108,630 participants, it was found that women who lived in areas of highest levels of greenness had 12% lower mortality rates.
- Residential proximity to greenspaces has been associated with higher survival rates after stroke; individuals living is highest level of greenery had 23% lower chance of dying than those living in areas with lowest level of greenery.
- In an analysis of the entire population of England, the rate of cardiovascular mortality in least green areas was twice that of greenest areas.
However, I think there is a similar body of knowledge, case history and experience in clinical care, not just public health. Few people can mobilize themselves to move to a greener area just because it is better for their health (even though it is). Fewer still can alter the greenness of their current area significantly. For better or worse, we are dependent on government, community groups and other organizations to look at these data and do the right thing. Joining those groups is one route. Doing something yourself, in addition to that, is another. I’ve written about this for clinicians in a structured way as well.
Some of the clinical findings are also striking yet not well known or deeply proven. There is good data about
- pain relief with virtual reality nature views for children and hospitalized adults;
- less opioid use and shorter lengths of hospital stay with nature views instead of brick views;
- less pain post bronchoscopy patients undergoing bronchoscopy looking at a mural of a mountain stream in a spring meadow and listening to natural sounds;
- improved immunity with forest exposure and forest bathing;
- less anxiety and fatigue after mountain hiking rather than indoor treadmill walking or sedentariness, randomly assigned;
- lower blood pressure more with outdoor exercise than indoor exercise, and for randomly assigned coronary artery disease patients, with outdoor walking rather than urban walking;
- improved survival after heart attacks and enhanced ability to cope with life stresses experienced by pet owners versus non pet owners;
- myopia correction in children with great outdoor play and more device diminishment;
- reversal of burnout symptoms with specific plants, texts, outside time and breathing exercise are still thought of as nice to have rather than essential, as I think they are;
- anxiety reduction in emergency department patients with exposure to therapy dogs plus handlers; and
- stress reduction and mood enhancement with gardening rather than reading.
Maligned in medicine as evidence-less and feel-good without data, these scents are more than window dressing: they can be therapeutic. I think that’s one reason that specific culinary herbs worked in our burnout and stress management program: they’re not just fragrant, but physiologically active. Aromatherapy fights against the drill of modern living and digital overload, and can help users re-focus. Some products and companies are explicite about this, with nature as the great healer. The calm that can happen in a forest, or gazing at waves, or in a green or blue park or out for exercise can keep inner resources strong…it’s the association of nature that is called upon for stress relief. The detailed science of this is beyond this blog, but for some specific scents, it does exist: see my videos on lavender and makrut lime, for example, and our pilot project on culinary herbs, office plants and time outside for stopping burnout.
D. Dietary Supplements
Another part of the market are dietary supplements that are botanical to alleviate stress, and some have efficacious components. For example, Metagenics offers Adreset for stress-related fatigue which contains several extracts with physiologic and clinical activity:
|Cordyceps Mycelium (Paecilomyces hepiali Chen††) Extract [standardized to 4% (32 mg) cordycepic acid and 0.25% (2 mg) adenosine]||800 mg||*|
|Asian Ginseng (Panax ginseng) Root Extract [standardized to 8% (32 mg) ginsenosides]||400 mg||*|
|Rhodiola (Rhodiola rosea L.) Rhizome Extract [standardized to 1% (1 mg) salidroside and 3% (3 mg) rosavins]||100 mg||*|
Exhilarin, also from Metagenics, uses different botanicals
|A Proprietary Blend of Herbal Extracts:||1.2 g||*|
|Holy Basil (Ocimum sanctum) Leaf 8:1 Extract (containing ursolic acid)|
|Ashwagandha (Withania somnifera) Root 15:1 Extract (containing withanolides)|
|Amla (Emblica officinalis) Fruit 5:1 Extract (containing tannins)|
|Bacopa (Bacopa monniera) whole plant 8:1 Extract (containing bacosides A & B)|
While Serenagen includes others, plus the ginseng of Adreset:
|Total Carbohydrate||<1 g||<1%*|
|Dietary Fiber||<1 g||2%*|
|A 4:1 Proprietary Herbal Extract Blend of:
Rehmannia Root (Rehmannia glutinosa), Schisandra Fruit (Schisandra chinensis), Jujube Fruit (Ziziphus spinosa), Dong Quai Root (Angelica sinensis), Chinese Asparagus Root (Asparagus cochinchinensis), Ophiopogon Root (Ophiopogon japonicus), Scrophularia Root (Scrophularia ningpoensis), Asian Ginseng Root (Panax ginseng), Chinese Salvia Root (Salvia miltiorrhiza), Poria Fungus (Wolfiporia cocos), Polygala Root (Polygala tenuifolia), Platycodon Root (Platycodon grandiflorum)
I take this multiplicity of extracts to mean that each has minor, contributory functions, identified in herbalism, and sometimes supported by Western peer-reviewed, evidence-based controlled trials, to affect mood and improve the body’s many ways of handling stress. Hemp oil, also available through metagenics, has some specific value, especially as preclinical models suggest phytocannabinoids may play a role in mechanisms that support digestive system health and intestinal integrity, as well as acting on diverse central nervous system pathways.
E. Bringing the Outside In
At the moment, there is much more effort about making the inside of buildings greener and healthier than either getting outside or bringing the outside in for health reasons.
The “healthy building” and progressive architectural worlds have made a lot of progress, from the Well Standards to LEED standards. Progressive hotels including Marriott, Four Seasons, Wyndham, 1 Hotels, AccorHotels and MGM now have wellness offerings, from water features and vertical green walls in the lobby to HEPA filters for the room, and aromatherapy on demand.
If you’re serious about indoor pollution of all types, you have all that at home, the stickers on your phone for radiation, EMF detectors, alkaline water filters, essential oil diffusers, only organic cleaning chemicals, no parabens and disruptors in your toothpaste, makeup, clothes and sunscreen. Your cosmetics come from the top of the SkinDeep list from the EWG.org. Yet these are personal, not hardscape changes.
There are many more features of living a safe, more natural life inside that the building can hold, and those will grow, and that’s exciting…including in school classrooms, where the value of the outside-in is going into new design, such as in planned international schools by Chadwick. There are also fantastic closed-loop examples of indoor hydroponic gardens, which have benefits and risks, but still allow you to have greenery in your kitchen.
How does nature work to heal? Is it biophilic design and the connection with the natural world? Attention-restoration theory, so nature can help you focus? Phytoncides, so your immunity improves? At least 21 mechanisms have been put forward, and of course, it is probably multi-etiologic. One common path: its effect on stress: here are several resources I think are helpful to learn more:
Nature therapy (AGreenrx.com)
How Nature Works to Alleviate Stress (American Heart Association)
Sunlight Through Windows at Work Improves Mood (PLOS.org)
Swedish nature-based MSBR course (Int J Environ Res Public Health)
Stress, Burnout, Next Steps
I’ve done a number of presentations on stress and corporate wellness, stress reduction quiz-making, and stress and the bottomline. Our new burnout reversal and prevention program uses nature-based methods in a new approach as well, and it’s essential that we have new approaches, as chronic stress is strongly linked to heart disease, especially for people under 50 and chronic stress means continued, higher levels of obesity. That nature-based approaches can reverse symptoms of chronic stress and burnout, and do so in a workplace having trouble with turnover, and have even better results for executives than for clinicians is remarkable: I plan to write more about it soon, and will give a presentation about it at the University of Chicago next month.
Parts of this site offer you, free, some of what I’ve begun to learn and share about how you can use nature as medicine, personally, individually, for your health. There is a nature deficit quiz, gathered nature therapy resources and organizational links and books, and a short series of nature therapy GreenRx videos explaining nature therapy, and of course the nature therapy blogs on the site describing the components. Many things are missing: one is the stories of change.
An elephant in the room is climate change: health harms from climate change include extreme temperatures, polluted outdoor air and water, extreme weather events, food-related & agricultural infection, water-related infection, mosquito- and tick-borne infections, drought, flood and wildfires. Mental health and well-being are also terribly, horribly impacted by these events, and independently. So why get outside and bring some of the outside in?
Because we must do something to enjoy and save the planet. Because it is inherent in us as part of nature. Because staying inside 93 percent of the time is making us sick and tired and worried. Because if we don’t go outside, it won’t be there for us to be part of and heal with. Because it’s some of our best medicine, and our biggest clinic.