Another question I get asked a lot is whether there is a point in buying meat substitute products. Organic supermarkets are full of soy schnitzel, seitan burgers, or tofu sausages. If it’s hard to refrain from eating the meat version, these products may be a little prop. I, too, eat some of them occasionally. But ultimately, it’s not only about omitting meat from your diet in the long run, but to eat vegetables and fruit instead of seitan or tofu.
However, a diet without animal products is not automatically healthy. Vegetarian or vegan food can also be quite unhealthy, if it consists mainly of pasta, desserts, and ready-made meals. This phenomenon is called “pudding vegetarianism.” But if you have a diverse vegetarian or vegan diet (learning to cook is fun!), it is exceptionally healthy—so healthy, in fact, that one has to be careful when taking additional medication. This was pointed out by Kim A. Williams, former president of the American College of Cardiology, who has been adhering to a vegan diet since 2003. His own LDL cholesterol (Low Density Lipoprotein, aka, the “bad cholesterol”) levels fell from 170 to 90 milligrams per deciliter. In the beginning, this can even cause hypoglycemia and circulation problems, because insulin levels drop significantly.73 But you can be mindful of that.
The extent to which a vegan diet lowers the levels of LDL cholesterol in the blood is truly impressive. This was confirmed by another study from 2003 published in the American journal JAMA.74 Unfortunately, since then the belief has prevailed that only lipid-lowering medications are potent enough to lower cholesterol levels sufficiently. These medications are not actually more effective than a vegan diet. In addition to lowering cholesterol levels, a vegan diet also reduces important inflammatory factors in the blood, which contribute to the occurrence of heart attacks.75 Once again, this presents the opportunity to recommend a healthy diet instead of resorting to medication immediately.
It’s a good thing that we have statins—they do help many people. But they have side effects; 10 percent of patients experience muscular pains because of them and are thus deterred from undergoing therapeutic exercise, which represents the second big pillar of heart therapy.76 Additionally, people who take statins have a worse diet in the long run than they did before they took statins.77 Medications like these influence the way we think: Oh well, it doesn’t matter what I eat, after all, I’m taking the pills. I tell patients what the medical guidelines say and recommend that. But if they are reluctant to take even more medication (because for hypertension, diabetes, and heart diseases doctors often prescribe multiple pills to be taken simultaneously), and if they experience severe side effects, I suggest trying a vegan diet for a change.
In hotels I always pay attention to what guests put on their plates for breakfast. Usually it’s scrambled eggs and sausages. When you’re standing in front of an inviting buffet, start with the plant-based part—fruit or raw foods. Then you’ll have satisfied the biggest hunger before you give in to temptation at the other end of the table.
Men are a special risk group. They often eat twice as much meat as women. The consumption of meat is even considered an attribute of masculinity. But actually, testosterone levels are lowered by meat consumption.78 I myself have been eating lacto-vegetarian for ten years and my experience was similar to that of quitting smoking. The first three months were hard, and I had to rein myself in a couple of times when I saw something delicious in a restaurant. But after those three months I stopped craving meat and today I don’t even like the smell of meat anymore. In my own family, I have observed that children become accustomed to a vegetarian diet easily.
ORGANIC SAUSAGES ARE NOT THE ANSWER
A short while ago, I saw a father and his son shopping for what seemed to be a “boys’ weekend” in an organic supermarket: Their shopping cart was filled with pretty much everything that is unhealthy—meat, sausages, chips, cookies filled with marzipan, frozen pizzas, and french fries—though it was all organic. But by no means does “organic” mean that the products are healthy, even though naturally produced meat may indeed be of higher quality than meat produced in a factory farm—and thus has fewer harmful consequences.
Even though Germans love meat, they place—with the exception of the example I just mentioned—no great value on quality. In surveys, large parts of the population state that they oppose industrial livestock production and would be willing to spend more money on high-quality meat. However, this attitude is not reflected in reality. You could say, the spirit is willing, but the flesh is . . . well, you know. Most populations in the Western world, with the exception of Mediterranean countries, spend very little money on food, only 10 percent of the per capita income. They are, however, strident in demanding more animal protection. And yet they buy cheap meat. Bigger and bigger animal factories are built in order to supply this demand. The argument for animal protection reinforces the case for a vegetarian diet.
For some time now, it’s not only vegetarian food that has been trending, but vegan food in particular. A vegan or plant-based diet is, when done right and supplemented with vitamin B12, the healthiest form of nutrition according to current scientific knowledge.79 Unfortunately, this realization is overpowered by ideological battles. “Vegan” is often used as a battle cry. Scientists like the cardiologist Kim A. Williams, whom I cited earlier, make themselves unpopular rather quickly when they add a vegan diet to the recommendations for their patients. When I visited Stanford in 2000, I asked a professor at the Preventive Medicine Research Institute to put me in touch with the physician and vegan Dean Ornish, who advocates changing your diet and lifestyle as a means to treat and prevent heart disease and who was and is a hero to me, to do a research project on heart health. This professor, however, just looked at me grimly and said, “We don’t like him.”
But dogmatism isn’t getting us anywhere. Simply reciting studies and facts doesn’t help most people change their lifestyle—we must build bridges to make these changes more accessible and attainable for all. Of course, wanting to make the entire population of America vegan is completely unrealistic. The philosopher and cultural scientist Harald Lemke, who worked a lot on the ethics of nutrition and gastrosophy, makes the case for moving toward a revolution in food culture using culinary curiosity rather than dogmatism: “What happens to a celery root when you vacuum-pack it or poach it at low temperatures?” he writes. “What do we have to do to shepherd’s purse and bishop’s weed in order to change the world? Those who know how to handle artichokes or sweet cicely don’t need veal bones to get some zest into a stock.”80
I would be glad if this has stirred up some of your own curiosity.
CHAPTER SIX
Stagnation Is Cause for Illness
The Importance of Exercise
It took many decades for the entire medical world to come to the realization that physical activity stimulates important processes of protection, repair, and development in the body that have a health-promoting effect. Today, we know from scientific data that physical activity has proven itself to be an effective treatment in almost all illnesses. During my years of training as an internist, it was still standard for heart attack patients to remain in bed, more or less motionless, for three days or more. Today it’s become clear that absolute bedrest is completely wrong and that rest in general is counterproductive in most illnesses.
In naturopathy, physical activity has always been among the most important therapies. Otto von Bismarck’s recovery, aided by his personal doctor Ernst Schweninger, who was the head of the first naturopathic hospital in Berlin at the time, provides an early success story.
Germany’s first chancellor was in frail health—plagued by rheumatism and diabetes, bad blood values and obesity, and on top of that, depression. The physicians at the Charité Hospital wanted to prescribe bedrest and a nourishing diet. Instead, Bismarck listened to Schweninger, who advised him to take daily walks and adhere to a low-calorie diet. Bismarck regained his health and to thank Schweninger, helped him gain a professorship at t
he Charité Hospital in 1884.1
HOW MUCH PHYSICAL ACTIVITY IS IDEAL?
Naturally, in centuries past, the benefits of physical activity were not taken into consideration by conventional medicine because the ailment of our time, immobility, was rare back then. The working population moved a lot, because the level of motorization and automatization was still low. The majority of people were dealing with entirely different problems, such as, for example, infectious diseases. By now, though, there is an overwhelming number of studies that prove how important physical activity is, not only as a means of prevention, but also for treatment of diseases. Only in severe feverish conditions or ailments that are accompanied by great weakness is bedrest actually appropriate.
Other than that, the list of the diseases that can be positively influenced by physical activity is impressively long. It spans from cardiovascular afflictions—prevention of strokes and heart attacks, as well as the lowering of accompanying risk factors like diabetes, hypertension, obesity, and lipid metabolic disorders—to rheumatic diseases. In painful arthroses in particular, physical activity benefits the synovia and trains the supportive muscles. Likewise, in inflammatory rheumatic diseases like Bechterew syndrome, physical activity is the most important course of treatment since it helps maintain the flexibility of the spine. In osteoporosis, physical activity strengthens the microstructure of the bones through the accompanying vibrations.
Even depression is successfully treated with physical activity—in mild and intermediate cases it’s as similarly effective as psychotropic drugs.2 For cancer patients, physical activity is essential: Based on many studies, it’s estimated (unfortunately, the range of assumptions is quite large) that about 15 to 25 percent of breast cancer cases can be avoided through regular physical activity.3 For intestinal cancer, this figure is at 30 to 40 percent,4 for aggressive types of prostate cancer it’s 50 to 65 percent.5 And finally, even pain diseases like migraines, neck or back pains, as well as fibromyalgia, can be contained successfully through physical activity.
Unfortunately, we have not succeeded in getting people moving thus far. In the 1970s, fitness trails were created in nature and since then there have been countless attempts to motivate the population to exercise and engage in more physical activity. The numbers were and are, however, depressing. Scientifically speaking, this is called kinesophobia—the fear of physical activity. This is not limited to the proverbial weaker self, the inability to motivate yourself to exercise. Many patients also experience pain when they move. During each of my rounds, I work at convincing them that movement is still good for them, even though they initially feel like they should rest instead.
How much physical activity is ideal? There are prudent guidelines that recommend three rounds of 45 minutes of aerobic exercise a week (135 minutes)—physical activity, that is, which is dosed in such a way that you don’t even run out of breath. Some recommendations include, depending on the illness, five hours (300 minutes) a week, favoring almost double. All of this has been scientifically proven, but what use is it to us if those are completely unrealistic goals? Many naturopathic physicians, but also one of Germany’s “popes of prevention,” Martin Halle, professor at the Technical University of Munich, believe that we must lower the threshold for beginners in order to make the targets for physical activity achievable. And since many people have been traumatized by PE lessons in school, a moralistic appeal only accomplishes the opposite of the desired effect.
FIND AN ACTIVITY YOU ENJOY
Ultimately, it’s not all that important to measure “performance”—and counting calories when you are suffering from diabetes doesn’t work either. The most important thing is to leave it up to you to take the initiative instead of fulfilling some kind of external goal. That’s why you should choose a form of exercise that is fun for you. When I meet with patients who are limited in their ability to move, I ask them what sorts of things they enjoyed doing before. This is called remembered wellness. The memory of how you felt after a day of moving in the fresh air helps with motivation. Often, conversations like these lead to an impulse, an idea. Additionally, we always talk about what the patient’s daily routine and the finances allow. Exercise has to bring joy, otherwise it is pointless.
Maybe the fact that you don’t have to start a fitness training program takes away your fear of exercise. It’s not necessary to go running; on the contrary, jogging or high-performance sports often lead to orthopedic problems. Marathon runners often suffer from gastric ulcers and a heightened level of atherosclerosis in the coronary vessels—this shows that their strain is too high, and the benefits of the exercise have turned into damage. That’s why the so-called couch potatoes stand to gain the most: When they are able to motivate themselves to exercise a little, maybe thirty minutes once or twice a week, they profit from this enormously.
For people to find motivation, they need to see hope for improvement. We can provide them with that—it’s not that hard. For example, every kind of everyday activity is useful, like going for walks, which is something that can’t be praised enough. Walking upright is our natural form of movement, as it corresponds to our physical preconditions. My most important recommendation is this: Use every opportunity you get to walk a few steps. Ignore elevators or escalators and use the stairs; ride your bicycle to work; don’t wait for the bus at the stop, but walk the three stops for which you were going to take it. It takes a while to reprogram yourself—I know this from personal experience. Before, I was satisfied when I was able to snatch a good parking spot and drive right up to where I needed to go with my car. Today, I appreciate it when I have to walk three blocks to my destination. Because I know it’s true: Every step counts.
On weekends or on other free days, you should plan for longer periods of physical activity at a time: Two hours are ideal, preferably outside. In Japan, there is a tradition of “forest bathing”—Shinrin-yoku—which is by now an integral part of preventative health care in Japan and South Korea. This is also where initial studies on the subject have been conducted. Qing Li, a medical doctor at Nippon Medical School in Tokyo and one of the world’s experts in forest medicine and immunology, was able to prove that forest bathing stimulates the activity of natural killer cells and anticancer proteins, thus strengthening the immune system.6 In South Korea, thirty-four more “healing forests” are being created in addition to the three existing ones.
When comparing walking in an urban environment to walking in a natural setting, i.e., in a forest or a park, we find that important physiological parameters that are under the influence of the autonomic nervous system—such as the heart, blood pressure, and heart rate variability—improve in nature. Tension, fatigue, and depressiveness decrease.7
The stimulating and invigorating effect of nature even applies in a clinical setting. Roger S. Ulrich, an architect who specializes in building hospitals at the Chalmers University of Technology in Sweden, has followed patients whose gallbladder had been removed for nine years, from 1972 to 1981. Those who lie in hospital rooms with a window overlooking trees had significantly shorter convalescing periods than those who stared at nothing but walls.8
Findings like these show our evolutionary past, our connection to nature. Being in contact with nature reduces stress and relaxes us, according to a study from 2015. In a meta-analysis, Diana Bowler, at the Senckenberg Biodiversity and Climate Research Centre in Frankfurt, summarized the findings of twenty-five studies on the experience of nature and health and found clear indications for a positive mental effect. Accordingly, we suffer when we are estranged from nature, consciously or unconsciously.9 In the United States, the term “nature deficit disorder” was created to reflect the consequences of increasing urbanization. Cities cause stress: The physician Kristina Sundquist and her team at the University of Lund were able to demonstrate that the numbers for depression and even psychoses are on the rise in this setting.10 In an environment close to nature, on the other hand, activity in the pr
efrontal cortex, which is responsible for judgment, contemplation, and worry, decreases—after as little as ninety minutes outside.11 Studies have shown that people who make long visits to green spaces have lower rates of depression and high blood pressure. Even visiting outdoor green spaces for thirty minutes or more during the course of a week has clear beneficial health effects.12 Simply looking at forest scenery on a plasma screen for ninety seconds activates brain centers for relaxation, compared to looking at urban scenery.13 We are currently conducting a study with Stefan Brunnhuber, the Medical Director of the Diakonie Kliniken in Zschadrass near Leipzig, in which we are investigating whether it’s possible to treat psychological diseases with daily, ninety-minute walks in nature. The study is called “A Walk in the Park.”
Since roughly 5 percent of adults in Germany suffer from depression that requires treatment, such findings are not trivial. The way we treat our natural environment has consequences, and in any case, there need to be sufficient public green spaces available in cities. Nature offers pleasant sensory impressions, “soft fascinations”—the greenery, the movement of the clouds, or the sounds of water don’t exert the brain and allow it to recover. In cities, however, the stimuli are complex and concentrated and require permanent attention. Interestingly, merely looking at images of nature leads to relaxation—even though forest wallpaper may be totally out of fashion. Maybe you’re not a fan of the outdoors, but natural materials in your apartment, like coconut coir matting or wood, calm the senses. But nothing comes close to the effect of taking a walk in the woods. Considering all physiological parameters, walking in the woods is notably superior to walking in the city or in a gym.
The Nature Cure Page 16