How Not to Die

  Maybe not. Genetic studies of more than twenty-five thousand participants who reported their coriander preferences discovered an area on chromosome 11 that seemed to be a match. What’s there? A gene called OR6A2 that enables you to smell certain chemicals like E-(2)-decenal, which is both a primary constituent of coriander and a defensive secretion of stink bugs. So maybe coriander does taste like insects! Coriander lovers may just be genetic mutants who have an inability to smell the unpleasant compound.45

  This may actually be an advantage, though, because coriander is healthy stuff. Mother Nature has been described as the most comprehensive pharmacy of all time, and coriander is one of her oldest herbal prescriptions.46 About twenty sprigs of coriander daily for two months reduced inflammation levels in arthritis sufferers and cut uric-acid levels in half, suggesting that lots of coriander may be useful for people suffering from gout.47

  Cayenne Pepper

  In a study published as “Secretion, Pain and Sneezing Induced by the Application of Capsaicin to the Nasal Mucosa in Man,” researchers found that if you cut a hot pepper and rub it inside your nostrils, your nose will start running and hurting, and you’ll start sneezing. (Capsaicin is the burning component of hot peppers.) Why would they perform such an experiment? People who have handled hot peppers know that if they get some up their nose, they can experience an intense burning sensation. (And it doesn’t even have to get up your nose, which I was chagrined to learn after I once failed to wash my hands before using the bathroom!) However, the researchers noted that “these phenomena have not been investigated.” So they decided it “appeared worthwhile to study the effects produced by topical application of capsaicin in the human [nose] . . .”48

  The researchers enlisted a group of medical students and dripped some capsaicin in their noses. The students started sneezing, burning, and snotting, describing the pain at about eight or nine on a scale of one to ten. No surprise. But it gets a little more interesting. What happened when they repeated the experiment day after day? You’d think the students might be more sensitive to capsaicin, with their nose still irritated from the day before, causing even greater pain and discomfort, right? Actually, the capsaicin hurt less. By day five, in fact, it hardly hurt at all—they didn’t even get a runny nose anymore.

  Were the poor medical students permanently numbed? No. After a month or so, the desensitization wore off, and they were back in agony whenever the researchers tried dripping capsaicin back in their noses. What was likely happening is that the pain fibres—the nerves that carry pain sensation—used up so much of the pain neurotransmitter (called substance P) that they ran out. Exposed day after day, the nerves exhausted their stores and could no longer transmit pain messages until they made more neurotransmitter from scratch, which takes a couple of weeks.

  How could this be exploited for medical purposes? There’s a rare headache syndrome called cluster headache, which has been described as one of the worst pains humans can experience. Few, if any, medical disorders are more painful. It’s nicknamed the “suicide headache” because patients have taken their lives because of it.49

  Cluster headaches are thought to be caused by pressure on the trigeminal nerve in the face. Treatments involve everything from nerve blocks to Botox to surgery. But that same nerve goes down to the nose. What if you cause the whole nerve to dump all its substance P? Researchers tried the daily capsaicin experiment with cluster headache sufferers. Unlike the wimpy medical students who rated the nose burning as an eight or nine on the ten-point pain scale, those used to the violence of cluster headache attacks rated the pain caused by capsaicin at only a three or four. By day five, they too became desensitized to the pain of the capsaicin. What happened to their headaches? Those who rubbed capsaicin in the nostril on the side of the head where the headaches occurred cut the average number of attacks in half. In fact, half the patients were apparently cured—their cluster headaches were gone completely. All in all, 80 percent responded, which is at least equal to, if not better than, all the current available therapies.50

  What about other pain syndromes? Irritable bowel syndrome is thought to be caused by a hypersensitivity of the lining of the colon. How do you determine if someone’s gut is hypersensitive? Innovative Japanese researchers developed a device to deliver “repetitive painful rectal distention,” which is basically a half-liter balloon hooked up to a fancy bicycle pump that is inserted and inflated until you can’t stand the pain anymore. Those with IBS had a significantly lower pain threshold, significantly less “rectal compliance.”51

  So how about trying to desensitize the gut by depleting substance P stores? It’s bad enough to have to rub hot peppers up your nose, but where would you have to stick them for irritable bowel? Thankfully, researchers chose the oral route. They found that the enteric-coated capsules of red pepper powder were able to significantly decrease the intensity of abdominal pain and bloating, suggesting “a way of dealing with this frequent and distressing functional disease . . .”52

  What about red pepper powder for the pain of chronic indigestion (dyspepsia)? Within a month of taking about one and a half teaspoons’ worth of cayenne pepper a day, stomach pain and nausea improved.53 The frequently prescribed drug Propulsid (cisapride) worked almost as well as the red pepper powder and was considered generally well tolerated—until, that is, it started killing people. Propulsid was pulled from the market after causing fatal heart rhythms.54

  Ginger

  Many successful natural treatments start like this: Some doctor learns that a plant has been used in some ancient medical tradition and figures, “Why not try it in my practice?” Ginger has been used for centuries for headaches, and so a group of Danish physicians advised one of their migraine patients to give it a go. At the first sign of a migraine coming on, the patient mixed quarter of a teaspoon of powdered ginger in some water and drank it. Within thirty minutes, the migraine disappeared. And it worked every time for her, with no apparent side effects.55

  This is what’s called a case report. Though they’re really just glorified anecdotes, case reports have played an important role in the history of medicine, from the discovery of AIDS56 to a failed chest-pain drug with a billion-dollar side effect—Viagra.57 Case reports are considered the weakest form of evidence, but that’s often where investigations begin.58 So the case report of successfully treating one migraine patient with ginger isn’t so much helpful in itself, but it can inspire researchers to put it to the test.

  Eventually, a double-blind, randomized, controlled clinical trial was performed comparing the efficacy of ginger for the treatment of migraine headaches to sumatriptan (Imitrex), one of the top-selling, billion-dollar drugs in the world. Just one-eighth of a teaspoon of powdered ginger worked just as well and just as fast as the drug (and costs less than a penny). Most migraine sufferers started with moderate or severe pain, but after taking the drug or the ginger, ended up in mild pain or were entirely pain-free. The same proportion of migraine sufferers reported satisfaction with the results either way.

  As far as I’m concerned, ginger won. Not only is ginger a few billion dollars cheaper, but it caused significantly fewer side effects. While on the drug, people reported dizziness, a sedative effect, vertigo, and heartburn, but the only side effect reported for ginger was an upset stomach in about one out of twenty-five people.59 (A whole tablespoon of ginger powder at one time on an empty stomach could irritate anyone, though,60 so don’t overdo it.) Sticking to one-eighth of a teaspoon is not only up to three thousand times cheaper than taking the drug, you’re probably less likely to end up as a case report yourself, like the people who have had a heart attack after taking sumatriptan for a migraine,61 or have died.62

  Migraines are described as “one of the most common” pain syndromes, affecting as much as 12 percent of the population.63 That’s common? How about menstrual cramps, which plague up to 90 percent of younger women?64 Can ginger help? Even just one-eighth of a teaspoon of ginger powder three times a day dropped
pain from an eight to a six on a scale of one to ten, and down further to a three in the second month.65 And these women hadn’t been taking ginger all month; they started the day before their periods began, suggesting that even if it doesn’t seem to help much the first month, women should try sticking with it.

  What about the duration of pain? A quarter of a teaspoon of ginger powder three times a day was found to not only drop the severity of menstrual pain from about seven down to five but decrease the duration from a total of nineteen hours in pain down to about fifteen hours,66 significantly better than the placebo, which were capsules filled with powdered toast. But women don’t take bread crumbs for their cramps. How does ginger compare to ibuprofen? Researchers pitted one-eighth of a teaspoon of powdered ginger head-to-head against 400 mg of ibuprofen, and the ginger worked just as effectively as this leading drug.67 Unlike the drug, ginger can also reduce the amount of menstrual bleeding, from around 125 ml per period down to 60 ml.68 What’s more, ginger intake of one-eighth of a teaspoon twice daily started a week before your period can yield a significant drop in premenstrual mood, physical, and behavioral symptoms.69

  I like sprinkling powdered ginger on sweet potatoes or using it fresh to make lemon-ginger apple chews as an antinausea remedy. (Ever since I was a little kid, I’ve suffered from motion sickness.) There is an array of powerful antinausea drugs, but they come with a nausea-inducing list of side effects, so I’ve always striven to find natural remedies whenever possible for myself and for my patients.

  Ginger has been used for thousands of years in traditional healing systems. In India, it’s known as maha-aushadhi, meaning “the great medicine.” However, it wasn’t proven to reduce nausea until 1982, when it beat out Dramamine in a head-to-head test in blindfolded volunteers who were spun around in a tilted, rotating chair.70 Ginger is now considered a nontoxic, broad-spectrum antiemetic (anti-vomiting agent) effective in countering nausea during motion sickness, pregnancy, chemotherapy, and radiation, and after surgery.71

  Try making my lemon-ginger apple chews: In a blender, liquefy one peeled lemon with a palm-sized “hand” of fresh gingerroot. Use the mixture to coat thin slices of four apples, and then place them in a dehydrator until they reach desired chewiness. I like them a little moist, but you can dehydrate them further to make lemon-ginger apple chips, which store longer than the chews. For me, a few pieces eaten about twenty minutes before travel works wonders.

  Note: Ginger is generally considered safe during pregnancy, but the maximum recommended daily dose of fresh ginger while pregnant is 20 grams (about four teaspoons of freshly grated gingerroot).72 Any more may have uterus-stimulating effects. Women using my apple chews recipe to combat morning sickness should spread out the four apples’ worth of chews or chips over several days.

  Peppermint

  Which herbs have the most antioxidants? The most antioxidant-packed herb is dried Norwegian bearberry leaf. (Good luck finding that!) The most antioxidant-packed common herb is peppermint.73 That’s why I add mint to my favorite hibiscus cocktail recipe (see here) and why I try to add it to food whenever possible. Mint is a traditional ingredient in Middle Eastern salads like tabbouleh, Indian chutneys, and Vietnamese soups and fresh summer rolls. I like to put it into anything chocolaty as well.

  Oregano and Marjoram

  Oregano is such an antioxidant-rich herb that researchers decided to test if it could reduce the DNA-damaging effects of radiation. Radioactive iodine is sometimes given to people with overactive thyroid glands or thyroid cancer to destroy part of the gland or mop up any remaining tumor cells after surgery. For days after the isotope injection, patients are so radioactive that they are advised not to kiss anyone or to sleep close to anyone (including their pets), and to maximize the distance between themselves and children or pregnant women.74 The treatment can be very effective, but all that radiation exposure appears to increase the risk of developing new cancers later on.75 Hoping to prevent the DNA damage associated with this treatment, researchers tested the ability of oregano to protect chromosomes of human blood cells in vitro from exposure to radioactive iodine. At the highest dose, chromosome damage was reduced 70 percent. The researchers concluded that oregano may “act as a potent radioprotective agent.”76

  Other petri-dish studies with oregano suggest anticancer and anti-inflammatory properties. In a comparison of the effects of various spice extracts—bay leaves, fennel, lavender, oregano, paprika, parsley, rosemary, and thyme—oregano beat out all but bay leaves in its ability to suppress cervical cancer cell growth in vitro while leaving normal cells alone.77 Of 115 different foods tested for anti-inflammatory properties in vitro, oregano made it into the top five, along with oyster mushrooms, onions, cinnamon, and tea leaves.78

  Marjoram is a closely related herb and also shows promise in laboratory studies. It appears to significantly inhibit the migration and invasion of breast cancer cells in vitro.79 None of these studies on oregano family herbs was done on people, though, so we have no idea how, if at all, these effects will translate to a clinical setting. One of the only randomized, controlled trials I’m aware of is a study of marjoram tea for polycystic ovary syndrome (PCOS). The tea was purportedly used in traditional herbal medicine to “restore hormonal balance,” so researchers decided to put it to the test. They instructed women with PCOS to drink two cups of marjoram tea on an empty stomach every day for a month. Beneficial effects on hormone levels were observed, which, the researchers concluded, “may justify the improvement claimed by traditional medicine practitioners and patients.”80

  Cloves

  The most antioxidant-packed common spice is the clove.81 It has an exceptionally strong flavor, so try adding just a teensy pinch to anything you’d normally put cinnamon or ginger on. Ground cloves are great on stewed pears and baked apples, giving them a pleasant, mulled cider taste, and a mug of chai tea is a fantastic way to pack in a bunch of high-impact common spices at once.

  Amla

  The most antioxidant-packed uncommon spice is amla,82 which is powdered dried Indian gooseberry fruit. As a Western-trained physician, I had never heard of amla despite its common use in Ayurvedic herbal preparations. I was surprised to find four hundred articles on this lesser-known spice in the medical literature, and even more surprised to find papers with titles like “Amla . . . a Wonder Berry in the Treatment and Prevention of Cancer.” Amla is arguably the most important plant in Ayurvedic medicine, used traditionally as everything from a neutralizer of snake venom to a hair tonic.83 I eat it because it’s apparently the single most antioxidant-packed green-light food on Earth.84

  Using an argon laser, researchers can measure and track human carotenoid antioxidant levels in real time. The most important finding from this body of work is that antioxidant levels can plummet within two hours of an oxidatively stressful event. When you’re stuck in traffic breathing diesel fumes, deprived of sleep, or suffering from a cold, for example, your body starts using up some of its antioxidant stores. What may only take two hours to lose can take up to three days to build back up.85

  Even ordinary body processes, such as turning food into energy, can produce free radicals. This is okay as long as the food you eat comes prepackaged with antioxidants. But if it doesn’t—if you chug straight sugar water, for example—the level of free radicals and oxidized fat in your bloodstream rises over the next few hours, while vitamin E levels drop as your body’s antioxidant stores are expended.86 If you were to eat the same amount of sugar in the form of an orange, though, you wouldn’t get a spike in oxidation.87 Researchers concluded: “This argues strongly for the need to include high antioxidant foods in each and every meal in order to prevent this redox [free-radical versus antioxidant] imbalance.”88

  The standard American diet (SAD) isn’t exactly antioxidant packed. Here is the antioxidant content (in modified FRAP assay daμmol antioxidant units) of some typical American breakfast foods: bacon (7) and eggs (8), a bowl of corn flakes (25) with milk (10), an Egg McMuffin
(11), pancakes (21) with maple syrup (9), and a bagel (20) with cream cheese (4). A typical breakfast may average about 25 antioxidant units.89

  Compare those to the smoothie I had for breakfast this morning. I started with 250 ml water (0), 60 g of frozen blueberries (323), and the pulp of a ripe mango (108). I added a tablespoon of ground flaxseeds (8), along with 15 g of fresh mint leaves (33) and a palmful of bulk white tea leaves (103). (For more about tea leaves, see here.) While the typical SAD breakfast may give you only about 25 antioxidant units, my breakfast smoothie offered more than 500. And, when I add the final ingredient, a single teaspoon of amla, I get an additional 753 antioxidant units. That’s about 2–3 pence worth of amla, and it just doubled the antioxidant content of my entire smoothie. Before I’ve even fully woken up, I’ve already consumed more than 1,000 antioxidant units. That’s more than the average person may get in an entire week. I could drink my smoothie and eat nothing but doughnuts for the rest of the week, and most people still wouldn’t catch up. Notice that even though I packed the blender with amazing foods like blueberries and tea leaves, fully half the antioxidant power came from that single, 2–3 pence teaspoon of powdered goose-berries.

  You can buy amla online or at any Indian spice store. Ayurvedic herbal supplements are typically something you’d want to stay away from, as they have been found to be heavily contaminated with heavy metals,90 some of which are actually added intentionally.91 But none of the samples of powdered amla tested so far has been found to be contaminated. You can find whole Indian gooseberries in the frozen section of Indian supermarkets, but frankly, I find them inedible—astringent, sour, bitter, and fibrous all at the same time. The powder isn’t much tastier, but it can be disguised in something with a strong flavor, like a smoothie. Alternatively, you could pack amla into capsules like the turmeric. Whenever I’m out on the road on a speaking tour, I try to take daily capsules of turmeric and amla until I can get back home and wrest back control over my diet.