Clinician Wellness—Self-Care for Staying Healthy: How Nature and Horticultural,Culinary,and Botanical Medicine Can Improve Clinicians' Health

A plant-forward dietary pattern may benefit physical and emotional health. ^{1 –7}

Sprouting: Spouting, the process of germinating seeds, nuts, beans or grains through rinsing and draining, can be an opportunity to harvest health-benefiting phytochemicals, improve nutrient-dense food access, and boost mental wellness. ^{8 –13}

Clinical studies have assessed the merits of sulforaphane in cancer, autism, hormonal health, metabolic disease, infectious disease, and environmental health. ^{14 –22}

Guidance on cooking techniques and food combinations to maximize nutrient bioavailability can save time and cost. ²³

Including herbs, botanicals, and spices such as garlic, ginger, mushrooms and/or star anise into broths can be immune supporting. ^{24 –28}

Enjoy cost savings (family food budget, total medical expenses) while reducing food insecurity even among lower-income populations. ^{28 –33}

Essential oils (concentrated plant extracts) can be used externally through direct or indirect inhalation. An example of direct inhalation would be use of drops of oil placed in hot water or a bath while an example of indirect would be a room diffuser or drops placed on a tissue or pillow.

Essential oils can be used topically (often diluted in neutral carrier oil or cream) for antimicrobial, anti-viral and anti-fungal effects. ^{35 –37}

A benefit of aromatherapy is the ability to tailor individual treatments; however, the high variability inherent in the approach results in lack of consistency in research and evaluation of individual essential oils. ³⁸

Benefits have been suggested for conditions including infantile colic, acne, anxiety, depression, nausea, needle insertion pain, insomnia, smell loss, cancer palliative care, and dentistry. ^{36,39 –53}

While generally well tolerated and safe (classified by the US FDA as GRAS [generally reorganized as safe]) when used at normally recognized concentration levels, possible risks may include dermatitis due to allergy in some patients and phototoxicity especially with certain citrus oils.

Some odors can trigger unpleasant or traumatic memory for certain patients. While there are reports of repeated exposure to lavender or tea tree oil causing reversible gynecomastia in three prepuberal boys ^44,54,55 this theory has been challenged in medical literature and requires more study. ⁵⁶

Aromatherapy and essential oils when individualized and used appropriately, can provide a safe complementary approach to a number of conditions including stress and pain. ^38,57,58

Tea drinking especially when paired with mindfulness, intuitive eating or journaling can be a soothing stress-reducing ritual. ^{59 –62}

Herbal teas and spices such as hibiscus, chamomile, ginger, peppermint and curcumin have been associated with symptomatic relief for conditions such as hypertension, nausea, anxiety, metabolic syndrome, irritable bowel syndrome, premenstrual syndrome, and inflammatory bowel disease. ^{63 –78}

Biophilic design ⁷⁹ refers to the practice of increasing connectivity between people and the natural environment through mindful design of interior spaces. For example, visual connection with nature using natural lighting and ventilation, natural landscape features, sensory stimuli, textures, materials, aromas, and shapes that allude to nature, is known to improve both staff and patient well-being. ⁸⁰

A horticultural therapist works with any group that can benefit from interaction with plants, including veterans, children, elderly, and those dealing with addiction and mental health problems. ^81,82

Working with essential oils, fresh flowers, propagating plants, arranging flowers, and engaging in nature craft projects provides patients a chance to socialize, learn new skills, develop mindfulness, reduce stress, improve mood, elevate well-being.

3D Nature-based therapy glasses reduced pain, nausea, and anxiety in pediatric/adolescents in ICU. ⁸³

Ulrich: Natural views and garden spaces in hospitals may result in positive effects for patients, families and employees. Effects may include:

○ Reduced stress and improved blood pressure, heart activity, brain activity and muscle relaxation.

○ Fewer post operative complications, shorter lengths of hospitalization, drop in health care costs.

○ Improved patient, family, and healthcare provider satisfaction.

○ Improved overall quality of care. ⁸⁴

Outdoor time has beneficial effects on sleep, circadian rhythm, blood pressure, cortisol stress levels, immune function, anxiety, self-esteem, focus, and attention. ⁸⁵

Outdoor nature-related activities have effects on gut microbiota, fecal serotonin, and perceived stress in preschool children and adult wellbeing. ^{86 –89}

Probiotics and microbiome shifts may play a role in treatment of overweight/obesity. ⁹⁰ While probiotic supplements can be costly, soil and outdoor play (including gardening) are typically free. ⁹⁰

Nature has been shown to be beneficial for attention deficit hyperactivity disorder symptoms. ^91,92

The benefits of light on mood are appreciated both as monotherapy and in potentiated combination with pharmacologic medication. ⁹³

Nature and the immune system:

○ Phytoncides from trees increased human NK cell function in healthy subjects. ^94,95

○ Forest adjuvant anti-cancer therapy (including a relaxing morning walk) enhanced natural cytotoxicity in urban women with breast cancer. ⁹⁶

○ Women with newly diagnosed breast cancer post-surgery and before chemotherapy/radiation who engaged in homebased nature-based restorative experiences had significant improvements in memory, focus and concentration. ⁹⁷

○ Urban nature experiences reduce cortisol levels ⁹⁸ and greening of vacant lots are linked to improved health. ⁹⁹

While the average American spends 93% of time indoors, ¹⁰⁰ just 120 min/week of outdoor time (17 min/day) is associated with improved well-being. ¹⁰¹

Associations peaked at 200–300 min/week with no further gain past 300 minutes (>42 min/day).

Daily step count of 3500–10,000 steps/day (30 min/day) is associated with reduction in incident dementia, cardiovascular disease, cancer, and all-cause mortality. ^{102 –104}

Prep your plant-forward dishes in bulk (smoothies, overnight oats, baked oats, salad-in-a-jar, grains, legumes for bowls/stews/soups).

Try sprouting broccoli seeds, peas, lentils, onion, alfalfa, chia, and grains. It only takes a few days of adding water. Minimal counter space and no soil is required.

Hydrate with spa water (water plus berries, citrus, spices, herbs).

Experiment with the beautiful colors of hibiscus and butterfly pea flower tisanes (teas) while enjoying the cost savings from purchasing soda, juice, and other sugar sweetened beverages.

Explore food combinations and cooking tips for maximum nutrition bioavailability. ²³

○ Combine leafy greens and avocado for increased lutein absorption.

○ Add vinegar to a high carbohydrate meal to reduce a spike in blood sugar, insulin, and triglycerides.

○ Eat turmeric-containing dishes with both a tiny sprinkle of black pepper and a few drops of a healthy fat to improve the bioavailability of curcuminoids.

○ Chop garlic and let rest for 10 minutes before cooking it for allicin antiplatelet aggregation benefits.

○ Add a little bit of a fresh brassica (e.g., broccoli, kale, watercress, cauliflower) to a cooked or previously frozen brassica dish to reactivate the detoxification effects of the sulforaphane.

Consider decorating one's office with small plants (rosemary, oregano, basil, parsley, aloe, garlic, shallots).

Break off a leaf, rub, and smell (aromatherapy).

Add herbs to water, tea, or food.

Enjoy the visual biophilic pleasure of seeing greenery.

Plant a garden (container garden if space is limited). ¹⁰⁵

Consider including various essential oils in the office for aromatherapy.

Consider nature-inspired activities such as cream/lotion making (e.g., calendula, aloe) for self-massage or acupressure.

Explore herbal teas for symptomatic support.

Pair mindful sipping of tea with other stress reducing and self-care rituals such as journaling, conversation, intuitive eating, and pre-bedtime routine.

Consider aromatherapy diffusers with essential oils in the office.

Consider scent-free lotions with essential oils for moisturizing.

Consider including fresh flowers, plants, succulents, mini-Zen sand gardens (or home-made glass jar with sand and shells) in your office.

Consider pictures of natural views or garden spaces.

Consider 3D nature-based therapy glasses.

Take a walk during a lunch break—aim with a starting goal of 17 min/day.

Try a grounding exercise when outdoors—five things you can see, four things you can feel, three things you can touch, two things you can smell, one thing you can taste.

Start a community walk or hike for your patients or your community.

Adopt a dog that requires daily walking.

Include mini “movement snacks” throughout the day.

In inclement weather, walk to and around a museum with friends. ¹⁰⁶

Find something active you enjoy doing and do it together with others. ^107,108

To add resistance training to the cardiovascular benefit of walking, try carrying water bottles/light weights or wear a weighted vest.

Employ temptation bundling (pairing a pleasurable indulgence with a behavior that provides delayed reward) to boost willpower. (Listen to your favorite podcast or sip your favorite tea while walking). ¹⁰⁹

Try forest bathing (Shirin-Yoku) utilizing the five senses. Notice the colors, fragrance, bird sounds, touch the bark/moss/foliage, taste the fresh air or safe fruits. ¹¹⁰

Avail oneself of national park passes. ^111,112

Find a nearby park resource. ¹¹³

Consider joining or starting a “Walk with a Doc” chapter. ¹¹⁴

Book List:

○ The Nature Fix by Florence Williams

○ The Nature Principle by Richard Louv▪