The need for long-term thinking in medicine: Cinnamon as a case study

Here in Vermont, we are approaching the first anniversary of a storm that, over less than a day, poured an incredible amount of rain over the mountains, down the streams, and into narrow river valleys. The hill towns were quickly overwhelmed and literally swept away on huge torrents of water. These types of events are outliers, “hundred-year” floods. We tend not to think about them until they happen. If a river floods one spring, and washes away our garden, we could just build a retaining wall and be fine for years. But in Vermont, it seems that sort of thought process may have contributed to the severity of last summer’s event: narrower valleys, more constrained riverbeds, actually increased the torrent’s force and destructive power. As we rebuild, civil engineers are taking this into account.

In fact, there is a growing realization in many professions and disciplines that we need to approach the world with much more long-term thinking. Perhaps pumping out wetlands and building cities isn’t the best idea. It might be smart to consider sources of energy that aren’t going to run out fairly soon. When educating, connection to long-term curiosity might be better than passing the next test. Social and ecological concerns in market-based economies might trump the need to make a buck.

I dare say that medicine is beginning to embrace this trend, too – or at least people are. People who are interested in real food that may not require contaminating the water supply to cultivate, and who feel like this food might be better for their long-term health (though missing the tasty nacho cheese). People who consider a fever the sign of a healthy reactive response, and watch it for a bit rather than immediately suppresing it. People who are beginning to think that diabetes may be connected as much to ubiquitous, unregulated sugar in the food supply as it is to increased weight, lack of exercise, or “poor self-control”.

Which brings me to cinnamon. A recent meta-review found a small but significant effect from the powdered bark of this fragrant member of the Laurel family in treating the elevated blood sugar levels associated with Type 2 diabetes. I recommend this plant to clients concerned about this disease, either as part of breakfast or – my favorite – mixed with stevia, almond butter and cacao and rolled into “bliss balls”. It is best to take it regularly, as part of a long-term habit that includes real, bitter food and lots of movement. In this context it’s delicious, easy to take (doses are in the teaspoon range), and effective. 

The effect is, indeed, small when observed in isolation and for short periods of time. But diabetes (at epidemic levels) isn’t a problem that develops overnight, folks. I doubt anyone in the food industry, somewhere between the middle of the 19th century and the middle of the 20th, was saying “whoa - wait a sec, guys. I think that all this tasty sweet stuff (and elimination of all botanical biodiversity in the diet) might actually lead to epidemic levels of a sugar-metabolism disease in the next century!” No, that would have required seriously long-term thinking in matters of public health. And a little more knowledge of the human body.

Well, today we have a little more of  both. But research still looks at botanicals for three to four months most of the time – and this is partly because research is still beginning. When more time and interest are devoted to certain plants, such as the 2012 analysis that showed soy food consumption leads to lower recurrence of estrogen-positive breast cancer, striking results are revealed. But even this research only followed ten thousand women for seven years. Would that we had multi-generational followup data for cinnamon, endive, and dandelion roots! We might see a reversal of the grand experiment in carbohydrate refinement that gave us the current diabetes epidemic.

Short-term thinking gives us a need for dramatic, immediate results that might fit within the constraints of our current research model. This is great for many acute and chronic diseases, but not as great for matters of public health or for analyzing cultural patterns that lead to the diseases themselves.  Often, we learn about these matters from retrospective studies – discovering a problem after it’s already well-established. Long-term thinking takes a break and asks “if left alone, what might this situation look like?” Long-term thinking wonders how the river might handle a hundred-year flood if we hadn’t intervened to alter its course, how a population’s blood sugar might look if we hadn’t altered its food supply. 

Type 2 diabetes is a long-term effect of short-term thinking (satisfy my hunger now, and in a way that can be easily produced, stored, transported and packaged!) Its solution has to be based in long-term thinking, and part of that might very well include herbs such as cinnamon. The reason they are important is that, unlike a pharmaceutical solution, they provide an inroad to self-care based on whole plants and food – elements of life which, along with movement, end up being the keys to successful prevention of diabetes. If your mother started making cinnamon bliss balls when you were little, you might grow up eating them and eventually making them for your friends and family. Who knows what other bizarre plants you might consume along the way. Lo and behold, two generations later population levels of diabetes, obesity and heart disease are lower. I’d give you a rose to celebrate, but we all know there’s no research showing roses are effective as mood-lifters.

Some argue that, since the effect of a botanical such as cinnamon is small compared to conventional drugs, it should be rejected as part of our approach to diabetes. Ironically, the argument is that using cinnamon perpetuates a pill-driven, not lifestyle-driven, mentality for handling the disease. Call me crazy, but I’d respectfully argue that it’s probably pharmaceuticals that are driving this mentality, and that the search for a cinnamon capsule as an “alternative” is a first baby-step towards a different way. In the hands of an herbalist, baby steps turn into hikes in the forest. That could be a good thing – and a complex, multi-layered approach to diabetes that includes cinnamon most certainly is. 

Say what you will about an over-reliance on short-term clinical trials to drive therapy (or just read the British Medical Journal). Aside from the caveats (some of which I mention above), the approach is often a good one. But the offhand rejection of botanicals such as cinnamon, especially when they show promise, is actually harmful to public health. It is also a product of very short-term thinking. This is a problem that we need to resolve if we want to advance the cause of medicine and improve global quality of life – and herbalists, as those who, across the world, know what local plants do, are well placed to be part of the solution. Herbalists know the plants, but they also know that moving your vegetables over a little and supporting the community of cattail and calamus by the riverbank might be a better choice than a retaining wall, though it requires a (small) sacrifice in the short-term. Herbalists know that a bouquet of flowers makes you happy even though there’s not a single study out there to prove it. And they are usually inspiring teachers, too – the perfect choice for a diabetic patient. 

All this requires a change in thinking about medicine. We need to be looking further over the horizon, at a future where the advancement of our species sometimes includes a return to older technologies – not because they’re old, but because they’re damn smart in a long-term context. A future where we observe and mimic nature in designing our systems not because it’s “natural” but because, in the end, it’s in our own self-interest (global warming? Hundred year flood?). Herbal medicine fits in perfectly here. It is the precise modality that offers cultural connection, self-empowerment, ecological awareness, and effective remedies! It is both a blueprint for the future and a safety net for the present. As a design element for the next century of medicine, it can bring long-term thinking into a branch of science struggling with its own pressing challenges, helping it to harness the tools of complexity and deep ecology that are driving other industries. Long-term, complex herbal therapy won’t look as flashy in the short term – but that does not mean it has no value. Give it time, and skilled hands – a garden takes a season to come to fruit.


Urban Moonshine's herbal conference report

The recent week of warmth and humidity has taken a turn towards cooler weather today, and the south winds are freshening up and blowing in across the lake from the northwest now. But the full height of Summer’s glory was on display this Saturday, when over one hundred people from across Vermont and beyond attended Urban Moonshine’s first annual herb conference and the evening festivities that followed. I had an amazing time.
Rosemary Gladstar, our friend and ongoing source of inspiration, kicked off the event by describing the success herbal medicine has enjoyed – in our communities and on the national stage – but also by exhorting us to keep up the momentum and find new, creative ways to bring the plants into the lives (and kitchens) of those who need them most. Then we broke into class sessions held in yurts, out in green fields with sweeping views, or on the trail in the forest. Larken shared thoughts on differentiating and applying the nervine herbs; Betzy toured a huge group around the gardens and fields; Jeff shared his knowledge of medicinal herb cultivation; Melanie set loose the herb spirits by crafting flower essences on a truly perfect, sunny day; Mary gave a case-based overview of some herbal strategies for kids; Layla was the diva of essential oils; and Brendan taught how to fit Western herbs into the energetic and spiritual framework defined by classical Taoist Chinese medicine.

Throughout the day, Jovial and the Urban Moonshine crew took complete care of every detail, making sure there was plenty of water, energy tonic, and, of course, herbal bitters. They coordinated classes, showed folks to the pond for a refreshing afternoon swim, and prepared our dinner (along with Woodbelly Pizza, who trucked in their wood-fired oven and baked pies non-stop). And after browsing the herbal products marketplace, Colleen and Peter planted themselves behind the bar and served a range of  home-created cocktails to the assembly of herbalists: drinks such as the “Dreamer”, featuring crushed mugwort leaves, as well as more classic mixes (a great negroni, for instance). A fiery-orange moon came up over the Eastern ridge and the music got turned up.
As is so often the case for me at these types of gatherings, I loved my side-conversations with folks in the in-between times. I especially enjoyed talking with Brendan and his wife Liz, who are acupuncturists practicing at Jade Mountain Wellness and study medicine and philosophy in an ancient Taoist lineage. We mostly discussed how “wood” (as in the phase of change associated with spring) dominates our culture: we are immature, impulsive, infatuated with our newest technological marvels (fortunately, I had just finished swimming so my smartphone was far, far away). While there is nothing wrong with the pursuit of new things, we tend to discard our older ways much too quickly – and, of course, medicine is a great example of this pattern. Nothing wrong with antibiotics, I love the stuff when it’s needed: but do we really have to use them for every little infection? Probably not. You could make the same case for steroids, narcotics, anti-inflammatories – you name it. Brendan’s point was that, in being so “wood”-centered, we are overtaxing “metal”, which is charged with keeping the sprouting wood under control. Metal connects to ancestor wisdom. It connects to wild, animal nature. It connects to bonfires and howling to the moon. Too focused on wood we are, and metal suffers. If we fed our wild side a bit more, if we could learn to retain a measure of ancestor-wisdom, we might not be turning to our internet devices every thirty seconds. Just sayin’.
Of course, that is precisely what this gathering of fine herb-folk is promoting. And while the conference and party were a success, I am also extremely grateful to Urban Moonshine who is donating all the profits to our community clinic, where we work with folks who often have no money and provide them with long-term access to experienced practitioners, along with teas, powders and tinctures as needed, for as long as is needed. You can learn more about this work at the Vermont Center for Integrative Herbalism.
I taught a little class on herbal extraction and the distillation of herbal spirits. It was fun. Here’s the handout if you are interested.


Aromatic plants – cultivating the scented garden within.

It is legend that, some twenty-five hundred years ago, a ruler of  Babylon (or was it Niniveh?) commissioned a wondrous garden, terraced up from the flat plains between the rivers of the Fertile Crescent. Its levels were built of huge slabs of stone, elaborately carved and supported by high vaulted colonnades. Huge amounts of soil were transported to create hills and fields in this garden many, many feet above street level. Sundry species of trees, shrubs, flowers and herbs were brought in to plant its winding paths. Using giant corkscrew pumps, thousands of gallons of water were moved against gravity on a daily basis to keep the garden lush and green. The ancient historians named it one of the seven wonders of the world, and marveled at this oasis, high above the incessant bustle of the city, smoothed with endless marble and steeped in a deep, seductive fragrance from the constant bloom of aromatic plants. 
 It is also said that it was in fact the queen who, longing for her homeland in the rich, flowering hills of the north, had pleaded with her husband for a retreat that could remind her of her younger days, of her family, and of what brought her joy. Watching her languish in the hot, humid, noisy city at the heart of his kindgom, he met her request in grand style - and her Hanging Gardens have been the stuff of myth ever since. But while some may wonder at the choice of such a garden to appease the restless spirit, it makes perfect sense to me: a retreat of roses and jasmine, lavender and linden is the perfect prescription not only for bringing a quiet respite in the middle of a hectic life, but also for re-inspiring and re-awakening the joy and creativity of childhood. Furthermore, the fact that it was literally floating above the day-to-day activity of the city serves as a fitting metaphor for the scented garden itself: a time apart, uplifted, serene.
Think of the last time you received a bouquet of flowers, or brushed past a patch of mint in a field, or simply stood in the deep part of a forest and smelled, just smelled, the earth, the spruce, the moss. Chances are you experienced a moment where you lost track of your responsibilities, your desires, your plans and just existed in the fragrance. If even for a second, you tapped into a very primeval state of being: it is childlike, flowing, and free. In such a state, it is difficult to be judgemental, anxious, rigid, sad, or angry - and this may be why we so often give gifts of scented flowers when we want to nurture an atmosphere of love, understanding, and joy. 
 This fact may also underlie the nearly universal practice of burning scented plants, resins, and oils to alter the "energy" of a room or space: it clears the mind, sets the stage for creative, spiritual work, and attunes us to the present moment. Cultural rituals have harnessed the power aromatic plants hold over us and have embedded their use into the peak times of our lives: at birth and death; during marriage celebrations; as a cornerstone of purification ceremonies; during the dark, wintry months when the light is low; as part of meditative practice. Perfumery and aromatherapy have long recognized the power scent has on the human spirit - even real estate marketing suggests that a home, when appropriately scented, may put prospective buyers in a relaxed, comfortable mindset. In the ancient world, a thousand years before the Hanging Gardens were built, priests in the old stone temples along the Nile were mixing kyphi, the sweet and spicy incense sacred to the pharaos. 
 But the Egyptian ceremonies didn't only involve smoke and scent. Often, the priests leading the rituals would also ingest a good amount of kyphi, powdered and dissolved in wine, as a sort of primitive herbal extract. Here the truest power of scented herbs is revealed: when they are ingested, their action is magnified and lasts much longer. The smell may awaken us, bring us into the present moment, and help us flow through change more gracefully: but once the aromatic plants enter our bodies, their volatile constituents first relax our bellies, then disslove into our bloodstream and reach all of our internal organs. If there is underactivity in an organ or tissue, fragrant plants can "wake it up" (think of ginger, or peppermint). Conversely, if a tissue is overly tense, aromatic herbs "loosen the knot" (like fennel seeds after a huge meal, or lavender oil during a massage). Net result: a more balanced state of internal tension. Since forever, herbalists have called many of these plants “nervines”, loved the scented brews they yield, and prized them as stress-tamers, tonics for the nerves. 
 More modern research gives us two interesting pieces of information to help understand how this works: first, the chemicals in highly scented plants (specifically, their volatile oils) have the ability to alter the way smooth muscle contracts, depending on its current state of tension. Smooth muscle is found in the lining of all our hollow organs - lungs, gut, bladder, and uterus - as well as in the heart and blood vessels. Plants that affect smooth muscle can thereby affect how we perceive our internal state - and anyone who has experienced a spasming, crampy belly knows what a dramatic impact this can have. It is fascinating to note, however, that the place in the brain tasked with assessing this "internal state" is exactly the same place most affected by the perception of smell itself! The limbic system, a complex of brain structures known for its processing of emotion and its ability to guide "executive function" (our ability to flow through tasks efficiently and productively), is where all of this information is integrated. Aromatic plants thus have a dual effect: their smell immediately awakens and engages the limbic system, and if consumed, their chemistry helps adjust internal tension, removing the distractions that keep us from the present moment. When they are ingested, clinical research always shows the same results: more balanced mood, more restorative sleep, better attention, and an ability to move through challenging tasks more smoothly (and joyfully).
If you are seeking respite from the demands of the modern world and the bustle of the city, the scented garden and incense-filled temple may well be the answer. But fragrant herbs are the way to take your garden with you, to suffumigate your own internal temple. There are so many options available to help with the milder cases of restless or despondent spirit: sedatives for anxiety and insomnia, stimulants for apathy and sluggishness, narcotics to escape, concentrated extracts of botanicals like kava or St. Johnswort, and designer drugs for depression and the mental malaise of today's life. Unlike all of these, aromatic herbs are not strongly mind-altering, are safe and non-habit-forming, and quite easy to grow and use! They are part of a very old toolkit available to humans, and many animals before us, to enter more fully into the flow of life. When led by scent, we follow a path through a garden where intuition and emotion, more than analysis and control, dominate the landscape. 
For now, happy Full Moon, happy First Harvest. Our gardens are in fullest bloom. But since I so often turn to these gifts during the darker months of the year, when night is deep and one can't often see the path to brighter days, I leave you with the words of Margared McKenny, recalling her own garden on a January dawn:
                "The snow still lies upon the ground,
                And yet I feel
                The shadow of the scent of flowers;
                Breathless the firs against the gray -
                So still the air
                That hung upon a bare rose spray
                Are drops of rain
                Left there by midnight showers -
                Black head atilt
                A chickadee
                Whistles the first love-notes of the year."