 Puma, clinical director and founder of Chef Clinic, the healthy eating and fitness program to prevent and treat obesity, maintain weight loss, and measurably promote wellness. John is a professionally trained chef, organic farmer, and a two-time New York Times bestselling author on healthy aging, nutrition, and wellness. Dr. Lapuma speaks on diet, health, stress management, healthy aging. Nature therapy and culinary medicine has led clinical trials of nutritional interventions designed to improve obesity, hypertension, osteoarthritis, insomnia, and diabetes. Dr. Lapuma also co-taught the first nutrition and cooking course at a U.S. medical school. Additionally, he co-hosts Lifetime TV's Health Corner and hosts PBS's Chef MD, Short and PBS Specials on Diet and Fitness. He's also served for many years on the board of the Food Bank of Santa Barbara. Today, Dr. Lapuma will give a talk entitled Plants, Entries, and Autonomy, Make Yourself Happier with How You Live. Please join me in giving a warm welcome to Dr. John Lapuma. Thank you everybody for staying Friday afternoon. This is a departure for me as well, although from my bio that you just heard, I'm sure you're wondering how I got into ethics and what it has to do with this. So I hope to show you that. And Laini, thank you for the introduction, and Mark, thank you for the invitation. It's always a privilege to be here. I have some conflicts of interest, unlike Sophie. I have, among other things, TV shows and farm that you just heard about. And of course, I wrote these four books and I get royalties when they're sold, so I hope you buy them. This is why we are here. Do you find yourself longing for the apocalypse? I did. I was looking for a reason to live. Hi. Are you feeling tired, irritable, stressed out? Well, you might consider nature. From the people that brought you Getting Outside comes prescription strength, nature. A non-harmful medication shown to relieve the crippling symptoms of modern life. Nature's recommended for humans of all ages, and it's great for pets, too. Nature can reduce cynicism, meaninglessness, anal retentiveness, and murderous rage. In clinical studies, nature is proven to decrease work-induced catatonia. Caution, nature may cause you to slow down, quit your job, or seriously consider what the f*** you're doing with your life. If you are overly cynical, jaded, or emotionally numb, you may need to increase your dose of nature. If you have trouble being even mildly uncomfortable, nature may not be right for you. Side effects may include spontaneous euphoria, taking yourself less seriously, and being in a good mood for no apparent reason. So ask your doctor if nature is right for you. I wish I could take credit for producing that, or I only just discovered it on the web. There's a marketing firm in Colorado that believes that this is a mission for them, and a number of other productions called NatureRx. You can find them on YouTube. Here are three parts today. The first is a little bit about why we don't get into nature and nature deficit and climate change. The second is how nature might be able to heal in new ways. And the third is how you might be able to participate in that directly both for yourself and for your patients. Who's heard of nature deficit disorder? One, two, three, four, five. Maybe 10% of us, if that. Nature deficit disorder is a thing. It's so little time outdoors that cognitive, behavioral, and social problems result. It's a description of this kind of problem, a cognitive, behavioral, and social problem by Richard Louve, who's a journalist who described it in 2005. His first book about this was called Last Child in the Woods. He found that it reduces attention and the use of the senses and increases vulnerability to negative moods. I'm going to talk a little bit more about what causes it more specifically. But he's specifically declined to define it as a clinical problem because he felt he wasn't qualified and because he wanted to gather people who were interested in these other aspects. However, I think that actually is a clinical problem. And moreover, I think it's a clinical ethical problem and I want to tell you a little bit about it and why I think you might want to be able to participate in it and study it. One way to think about this is that the EPA has catalogued in a 10,000 person study how much time we spend inside and outside and actually 87% of our adult life in America is spent indoors, plus 6% in the car if you live in Chicago or Los Angeles, it's probably more like 8%. But that's a heck of a lot. 93% of our time is spent indoors. That seems out of balance to me and I think it has clinical and clinical ethical effects. What I don't realize is that nature disorder Louve argued are these three things, electronic excess and anybody who has children or is around children knows that it's hard to get them off a screen. Kids under the age of 8 spend a little under 2 hours looking at a screen, teens almost 8 hours and 11 hours for adults. On average we look at a screen 77 times a day. That too seems out of balance to me and of course distracts us from what might be outside. The second argument he made was that we have urbanization without ringing and happily Chicago at least in pockets is a big exception to that although in other pockets it's not an exception at all. We are increasingly in urban society, one that is building more and more urban spaces without the benefit of trees or tree cover. And then thirdly and not having that we miss a connection to nature. We forget that there's more than urban canyons. And then third we have an increased awareness of, especially as our politics have become more divisive and hostile, stranger danger. It's one thing of course for kids to go out and play like I did when I was a little kid on a street. Now when that happens mom is worried, dad is worried, the man across the street might be evil, don't go over there. That kind of suspect behavior or suspected behavior of the part of the unknown people keeps us away from nature as well. There's also the fear of bugs. That sounds funny but in fact a third of us give this as our primary reason for not going outside. We have crazy work hours, everybody in this room knows what those are like. And of course we have climate change which Lori really a lovely demonstrated the notion that climate change is not only real but has infectious disease effects. In fact it has dramatic effects in many different kinds of health care problems and its increased frequency and severity of extreme events including in my home of Southern California today has really dramatic ways of making people fearful of nature and of course nature itself is a double-edged sword. It happens to affect the most vulnerable people the most because they're least likely to be able to create an adaptive response from their own homes and to escape floods and fires as well. So why do adults with nature deficit disorder and I think that constitutes many of us actually need nature therapy? What could nature therapy provide and what is nature therapy? I think it's because nature deficit disorder contributes as an unnamed factor to these two factors on the slide. First that most of us are overweight or obese and have associated chronic diseases. And that can range from causes like air pollution which increases probably responsible for about 30% of stroke because environmental air pollutants that particularly particulate matter that is 2.5 micron or less causes accelerated atherosclerosis. And the second group of conditions that nature deficit disorder promotes are psychological ones. This is just ADHD but anxiety and depression and this goes as often an unnamed kind of therapy for patients who are extremely anxious and yet might benefit from something that takes them completely out of their head as it were. I'm not the only one who thinks this. Dr. Frumpkin at the University of Washington created this excellent paper called Nature Contact and Human Health, a research agenda published in 2017 in environmental health perspectives. Dr. Frumpkin has just moved on from the University of Washington which just received a grant from REI to create a nature center for human health of a million dollars. But many of these researchers are still there. They've catalogued 143 different conditions that both physical and psychological that had been studied in the medical literature for the effects on those conditions from a nature environment or natural environment whether they are blue which is water or green which is landscape. So that's the end of part one. Here's part two which is how nature can heal in new ways. I think nature therapy and these are my definitions and mission and vision is the prescriptive evidence-based use of natural settings. I think its mission is to prevent and improve signs and symptoms so I think of it as a clinical intervention much like clinical ethics consultation for example and clinical conditions and improve well-being which I think actually is the general purpose of medicine. And then thirdly it ought to be available to every family regardless of proximity to blue or green space and as I alluded to it's the underprivileged to live in urban environments particularly in inner cities who are unable to access nature and suffer disproportionately. There are eight specialty fields at least in nature therapy like many new fields or relatively new fields. Nature therapy is somewhat fractionated. Eco-therapy is around the notion of psychotherapy. Green exercise is outside. Animal assisted therapy is dogs and llamas and cats. The cat salon in Santa Barbara is very busy. But everybody knows that dogs actually provide unconditional love not just for those in assisted living but also for those with chronic conditions. And there is some data although it's mixed to back that up. Forest bathing has become a popular term. Who's heard of forest bathing? Only also about 15% of this. Forest bathing is the immersion of your senses in a natural setting. It has nothing to do with water or even with forests. It's the idea that if you sit quietly in a natural setting a forest a meadow without sounds of cars or anything else and use your senses to one by one to get in touch with what you're hearing and seeing and touching you can reset your brain so that you can feel and be more of yourself. And the studies of this which have largely been done in Japan and there are about 30 period studies show that the dramatic change in natural killer cells and lowering of cortisol levels that are salivary blood pressure and pulse have reduced rate of cardiovascular disease and have reduced rates of stroke. Primarily among Japanese executives who as you know are under high stress conditions often the same is true in Seoul, Korea which has also invested serious money in merging its forest system with its healthcare system. There's wilderness immersion which many people are familiar with. I recently read a study of bouldering which is in store rock climbing to treat moderate depression versus standard SSRI treatment over eight weeks, a three hour treatment not three hours a week but three hours total which showed statistically significant improvement. And then there are care farms which I'm going to let Rachel brag to you about. The first base shows us that contact with nature in any way shape or form has a multiple effect on health and well-being. Things like helping to protect you from future stresses, it helps you to recover from any stresses you're suffering from at the moment, helps people concentrate more and research that we've done at Essex shows improvement to mood and self-esteem for people taking part in nature-based activities. There's evidence specifically on care farming that's starting to show all sorts of things added as well. So it's not just the contact with nature but there's the farmed environment that all of these activities take place in that adds another dimension to health and well-being and also in terms of reintegrating people into society. And it's an ability for people to take part in something that really is meaningful and they're helping to nurture very often rather than being nurtured themselves. And for a lot of people that's a completely new experience. There's been a lot of public health work about nature therapy. This was from JAMA in July showing that cleaning up lots in Philadelphia reduces symptoms of depression that are self-reported as well as other mental health problems. Here in Chicago which surprisingly perhaps to some of you but amazingly and really wonderfully is a leader in this area. Ming Kua at the University of Illinois showed that the cover trees in Chicago public schools that were the greatest in surface area helped to improve standardized tests of math by children independent of poverty and minority status. She's also largely responsible for the $10 million planted tree initiative here in Chicago and did pioneering work with the Robert Taylor Homes and improving crime rate by planting trees. This is a Green Heart project I heard somebody from Louisville here in Louisville which is a $14.5 million five-year project to plant thousands of trees in a 22 square block area of Louisville to reduce cardiovascular disease. Aruni Batnagar who is a senior professor of cardiology and a scholar believes that they may be more effective than statins in absorbing parts of ozone and air pollution to reduce risk for cardiovascular disease. Amazon has a half block long biosphere which invested $4 billion in Seattle to try to increase creativity and productivity among its workers. There are no cubicles or desks. There are only 40,000 plants and pathways for it and natural light which actually improves ethical behavior. As does the creative boosts and collaboration and relaxation of these plants. This is a rooftop garden I designed with my colleagues at MBBJ which is a landscape architecture firm that designed the Amazon gardens biospheres and this is a sketch of the children's garden, the cardiovascular garden and the immunity garden that we designed together. I helped them choose the plants and they helped choose the layout for Loma Linda University. We have not had a chance to present this to the board but we are looking forward to being able to do so. And then finally how you yourself can create a green RX. This is a medical student who has common problems. So being a medical student right you know that I'm always anxious about my grades because it starts building, building, I'm not sleeping, I'm kind of worrying about things that are going to happen in the future all the time. So a couple years ago when I was in medical school I started hiking and I started going outside and then I was like oh wow I'm actually losing weight, I'm actually sleeping better, I'm feeling really good so part of the exercise thing. But I went out and I used to suffer from generalized anxiety disorder and would get panic attacks and wake up in the middle of the night and yeah I'd be like tachycardic and I'd be sweating in the middle of the night and you know I haven't had any of that since I started hiking. Did you ever take medicine for generalized anxiety disorder? Oh yeah, taking all kinds of fun stuff. Any good legal? Yeah yeah yeah so you know when I was in high school they put me on things like yeses arise and then as a founder you know things just like that volume. Really? Yeah just you know like if you're having a panic attack here take this. Did it work? Yeah you know for 30 minutes or an hour or whatever. Yeah but the anxiety came back. Anxiety always kind of came back. And what else did you try before other than the pharmaceuticals and before you started hiking? I mean I kind of tried the meditation thing and I would do essential oils and do the you know the little vaporizer in my room with a lavender and try to relax and you know deep breathing exercises and meditation you know that kind of thing in the morning which is helpful. I mean I think honestly I'm like the hiking has been the best thing ever. So how do you start writing a green prescription? One, ask for a window for your patients. In 1984 Ulrich did a study of post-operative patients who had colisostectomies for eight years on award and published it in Lancet and found that those patients who had a window and a view out from trees instead of at bricks had needed less opiate pain medication. Alexia and chose aspirin instead more often had a shorter length of stay and a better hospital experience. We're still building hospitals without rooms without windows but that's a mistake. Second stop using microwave plastics yourself. Most of you know that I have a culinary background as well and the endocrine disruptors in these things in synthetic artificial pesticides and herbicides are as alluded to recently in the UT lecture both persistent and disruptive. Third get outside just five minutes a day daily with your device off. That's hard for a lot of us but it's really important because if you're not distracted by the insistent one, two, three of your phone or of the list that you have to make your brain refocuses so that you're kind of softly fascinated by the beauty of the leaves by the way the wind is blown instead of being preoccupied and ruminating on your own problems. For eating organic herb daily, Josie Behedry, my loved one, packed a hundred of these which I grew their bay leaves and a sprig of rosemary. Ophelia in Hamlet said that rosemary is for remembrance and actually there have been quite a bit of probably half a dozen studies about the scent of rosemary. It's an essential oil and it's memory performance, memory quality and speed of memory. In addition you can put it in a marinade and reduce heterocyclic amine and PAH formation if you grill meats. And bay leaves are some of the highest anti-oxidant, anti-inflammatory herbs as almost all herbs are, but they're some of the highest. New bay leaves are not as potent, pungent as older ones. These are older ones that we picked for you. And then finally, keep an air cleaning plant inside. These are eight of NASA's 16 plants that they identified in the middle 90s and then are having validated through the University of Louisville again that will detoxify the air in your home to remove benzene, trichloroethylene, formaldehyde and xylene. It's widely known that having plants inside cleans air and does so importantly because indoor pollutants are two to five times higher than outdoor pollutants in most communities in America. So thank you for your attention and I appreciate it. Incidentally these are on a table outside after David's remarks which will close the session. Please go and pick one up. There are a hundred of them.