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10 reasons to drink green tea

Posted on February 12, 2012 by Jamie

When I started eating a paleo/primal diet, the hardest thing for me was giving up black tea with (skimmed) milk.  This great British staple is such a way of life for many of us that to even consider giving it up seems intolerable.  We have a cup of tea to get us going in the morning.  We collapse with a cuppa in the afternoon to enjoy a moment’s peace in a frenetic day.  If we have a friend or loved one in a crisis we will offer: “How about a cup of tea”.  But to folks in other countries this is a strange and unfathomable habit.

Now, while this was one of the most difficult aspects of my new diet, in the long term it has been the most rewarding.  In trying to find an alternative I discovered the wonderful array of Chinese teas.  This was inevitable really.  I couldn’t drink coffee all day or I’d be totally wired.  I loath herbal teas, especially fruit flavoured teas.  I haven’t drunk sweetened soft drinks in decades.  Tea was the way to go.

Tea drinking in China is alleged to go back to the mythical Shen Nong, ‘the Father of Agriculture’ and herbal medicine.  Legend has it that one day Shen Nong was poisoned by some wild plants he was tasting to see their effect on the human body.  He brewed some tea leaves and the toxins were cleared from his body.  Although tea (Camellia sinensis) was originally drunk as a medicine, it became a popular drink amongst China’s wealthy and educated classes.  Today it is the national drink of China, especially green tea.

During the Tang dynasty (618 – 907)  teas was attributed the properties of:

  • Improving health, relieving fatigue and headaches.
  • Dispelling hunger.
  • Counteracting the effects of alcohol.
  • Preventing drowsiness.
  • Cooling the body in summer.
  • Clearing the Shen (mind) and banishing worries.
  • Helping the digestion of fatty foods.
  • Clearing evils (toxins) from the body.
  • Promoting long life.
  • Promoting self-knowledge.

Modern scientific research has also found many good things to say about tea drinking.  The healthy properties of green tea, for example, are attributed to anioxidant compounds called polyphenols.  The active polyphenol in green tea is epigallocatechin and research is focused on proving that it protects healthy cells in the body by clearing damaging free radicals (that is, a negatively charged reactive molecule, not a single anarchist).  The research suggests that drinking tea can reduce the risk of developing serious illnesses like heart disease, cancer and Alzheimer’s.

Tea in general, and white and green teas in particular, contain less caffeine than coffee.  Green tea contains an amino acid called theanine.  Theanine is an analog to glutamine and glutamate and can cross the blood-brain barrier.  It has psychoactive properties and and has been shown to reduce physical and mental stress and improves cognition and mood.  It has multiple effects in the brain, including increasing GABA and dopamine.  Its ability to promote a relaxed but alert state of mind was utilised extensively by both Chinese and Japanese monks (Buddhist and Daoist).  Indeed, modern research suggests that L-theanine is able to promote alpha wave production in the brain, which is associated with this relaxed but alert state.

A small study has suggested that theanine may help the body’s immune response to infection.

So it would seem that modern research does back up the claims of the ancient sages of the Tang dynasty of China.  There are many different tea varieties in China which I will discuss in a future post, but it is fair to say that they all taste delicious without the addition of milk.

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Paleo & Chinese medicine.

Posted on February 6, 2012 by Jamie

Paleo and Chinese medicine.Paleo and Chinese Medicine

Does Chinese medicine support the paleo diet?

I think most people imagine not.  The contemporary Chinese diet emphasizes the importance of  ‘fan’, or staple foods such as wheat and rice.  These are thought to have a neutral energetic (being neither cooling or warming) which balances the other elements of the meal – such as cai (vegetable dishes) and any proteins such as meat or fish. The typical proportions would be around half a plate of grains or root vegetables, around another half of a variety of vegetables with the rest being ‘wei’ food; wei is ‘taste’.  Wei foods are said to have a dense taste and to be rich and nourishing, such as fish, meat, organ foods, egg, oils and fats and dairy products.   Certainly the average Chinese takeaway meal is a high-carb, insulin spiking nightmare.  Anyone who has read T. Colin Campbell’s book, “The China Study”, will have come away thinking that any benefits the Chinese diet may have are because it is an almost vegan, plant-based diet; and therefore highly rich in carbohydrates.  This view-point has been aggressively debunked by Denise Minger.

Yet Chinese medicine is abundantly clear in its support of the value of animal protein in the diet and it was a doctor of Chinese medicine who persuaded me to give up vegetarianism (despite a solid 12 year commitment).  I embraced a Chinese style diet with moderate protein, high vegetable content with plenty of low-glycaemic carbohydrates (much the same as the popular Mediterranean diet)  I was doing what conventional wisdom advises but was gaining more weight year by year.

Then earlier this year I read, “How to Regulate Yin and Yang through Diet”, by “Peter Torssell” in the Journal of Chinese Medicine, issue no 94, October 2010 (I know, it took me a while to get around to reading it),  which compared different dietary models from a Chinese dietetics perspective.  One of these was a paleo diet composed of “one part varied vegetables to one part animal wei foods such as meat and fish”, which was suggested to have the following benefits: to reduce damp-phlegm, damp-heat (if hot spices, fried foods and alcohol are avoided), strengthen yang, especially Spleen yang.  According to the author – “Dampness is yin and retards the circulation of qi, creating turbid stagnation, disrupting the function of the Spleen and making it difficult to produce clear yin.  By adding spices, which are very much qi (and light) in comparison to wei foods, the circulation of qi is stimulated, which counteracts dampness and creates a better atmosphere for yin to be nourished by the cooling and moistening vegetables.”  He suggests that this model of eating can be further adapted to tonifying yin by eating a low-carb high- fat, or ketogenic diet.

The roots of this dietary approach lie in evolutionary biology, anthropology, and so on.  The theory goes that we evolved over millions of years and evolved to eat a hunter-gatherer style diet.  Whilst this would have varied in different geographical locations and time periods it would have been uniform in not containing grains and legumes in any appreciable quantities.  It certainly wouldn’t have contained any industrially processed foods such as vegetable oils, sugar, low-fat products or any of the chemicals added to processed foods.  Food wouldn’t have had traces of pesticides, hormones, growth-promoters or the like.

I read more books on this dietary style; “The Paleo Solution”, by Robb Wolf;  “The New Evolution Diet”, by Prof Art DeVany;  “The Primal Blueprint”, by Mark Sissons and many more.  Having embarked upon this ancestral health diet/lifeway I have had numerous health benefits.  I’ve dropped 2 trouser sizes, I’m not hungry all the time, I don’t get the afternoon blahs, I can think clearer and don’t get brain fog anymore.  From the Chinese medical perspective my Spleen Qi and Yang are much stronger, my stomach is harmonized, I get less Liver Qi stagnation, and more.

But what about the Chinese veneration of fan (staples)?  It seems that classical Chinese thought was, as is so often the case, way ahead of us.  According to qigong master and China scholar  Kenneth S. Cohen, most of the ancient writings on “qigong diet” advise the avoidance of grains.  Qigong is the ancient Chinese practice of cultivating energy qi (energy).  There are three main energy centres in qigong theory: the third eye, the chest/heart and the lower abdomen.  These centres are dantiens; elixir or cinnabar fields; terms taken from Chinese alchemy.  In his book, “The Way of Qigong”, Cohen writes, “According to Daoist mythology, the three dantiens……are infested by three worms.  These worms live on the impure breaths (qi) created by immoral behaviour, putrid food, and the Five Cereals, which are the basis of Chinese cuisine: rice, millet, wheat, oats and beans”.  Cohen goes on to quote a Daoist text (1), “The Five Cereals are scissors that cut off life, they rot the five internal organs, they shorten life”.  However, Cohen does point out that some of the same Daoist sects required “five pecks of rice” for joining them, suggesting that they were advocating carbohydrate restriction rather than complete abstention.

A paleo-diet is not necessarily low-carb but rather puts its focus on the quality of foods, and allows macro nutrient ratios to suit individual needs and health conditions.  Individuals with Type II diabetes, metabolic syndrome, obesity and so on would generally be better with carbs in the range of 50 to 100g per day.  Most of these would come from non-starchy vegetables and a little fruit.  Insulin sensitive individuals with good body composition and an active lifestyle might do better with higher levels of carbohydrates such as sweet potato, potato, and white rice.  According to Mark Sissons, keeping in the 50 to 100g per day of carbohydrates, “Minimizes insulin production and ramps up fat metabolism. By meeting average daily protein requirements (.7 – 1 gram per pound of lean bodyweight formula), eating nutritious vegetables and fruits (easy to stay in 50-100 gram range, even with generous servings), and staying satisfied with delicious high fat foods (meat, fish, eggs, nuts, seeds), you can lose one to two pounds of body fat per week and then keep it off forever by eating in the maintenance range.”

Grains and legumes are problematic because they irritate the bowel, block mineral absorption, provoke the immune system and generally wreak havoc with our body; there is ample evidence mounting to support this.  All grains are quickly converted to glucose in the bloodstream, whether they are so called ‘safe’ carbs or not, and so are best not over-consumed, especially by insulin-resistant people.

In conclusion, Chinese medicine does support the use of a low-carb paleo diet.  We have seen there have been proponents of this approach of avoiding grains and limiting carbohydrate consumption both in antiquity and in modern times.

(1) Da-yu Jing, in Henri Maspers, ‘Taoism and Chinese Religion’ ( Amherst: University of Massachusetts Press 1981, p. 333).

 

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Acupuncture benefits mystery illnesses?

Posted on February 5, 2012 by Jamie

Acupuncture benefits mystery illnesses.Acupuncture benefits mystery illnesses.

One in five patients has symptoms which are undiagnosed by medicine. The cost of treating them is twice that of a diagnosed patient. A new study has been carried out to asses if acupuncture benefits this group of patients.

Researchers from the Institute of Health Services Research, Peninsula Medical School, University of Exeter, carried out a randomised control trial and a linked interview study regarding 80 such patients across London, to investigate their experiences of having acupuncture added to their usual care. They found that acupuncture had a significant and sustained benefit for these patients and consequently acupuncture could be added safely to the therapies used by practitioners when treating frequently attending patients with medically unexplained conditions. Dr Charlotte Paterson, who managed the randomised control trial and the longitudinal study of patients’ experiences, commented, “Our research indicates that the addition of up to 12 five-element acupuncture consultations to the usual care experienced by the patients in the trial was feasible and acceptable and resulted in improved overall well-being that was sustained for up to a year.” She added, “Such intervention could not only result in potential resource savings for the NHS, but would also improve the quality of life for a group of patients for whom traditional biomedicine has little in the way of effective diagnosis and treatment.”

Acupuncture benefits patients by looking at them from a different perspective.

Now I don’t want to get into the pros and cons of this study but rather pick the ball up and run in a slightly different direction. If I were to don the ‘NLP’ hat my first question would be, “mystery illness to who”? Clearly mysterious to modern medicine. The primary reason that Eastern medicine excels in treating such conditions is that there is no mystery. The traditional Chinese medical intake is able to “pattern differentiate” such illness and come up with a plan of therapeutic intervention. It is the broader view of traditional medicine that allows this. Ayurvedic medicine would have no problems in this regard either.

One illustration of this would be the Chinese view of the organ system. Modern Western thought is reductionist. The body is reduced down to its smallest constituents. For example, the liver is understood at the molecular, biochemical level. Doctors diagnose the liver initially from a ‘liver function’ blood test. This method is hugely useful for many problems, but for others it just isn’t subtle enough. On the contrary, classical Chinese thought was syncretic and holistic.

The Liver in Chinese medicine is represented by both the physical organ and the Liver acupuncture channel. The Liver is in complex relation to all the other organs, both directly and indirectly. The Liver is a yin organ paired to the yang Gall Bladder. The Gall Bladder channel originates just lateral to the eye on the temple, travels around the head, down the neck and sides of the body to the outside of the foot. One of the most common patterns of Liver dysfunction that I see in the clinic is Liver Yang Rising pattern. The predominant feature here is recurrent headaches. The Liver energy is rising (a yang tendency) to the head and blocking the Gall Bladder channel, causing pain; a headache.

Another feature of this holistic view is that the mind and body aren’t viewed as separate in Chinese medicine; a view in agreement with the latest biomedical research. Each organ/channel is associated with certain emotions. The Liver is a very yang organ and when its free-flow of energy is blocked there is tension, irritability, outright rage and anger or a low-grade depression. Can you think of anyone you know that gets regular headaches? Can they be a little tense or crabby? The liver helps the smooth flow of energy through the whole body, including the rhythmic menstrual cycle. Here, the Liver energy is most likely to stagnate just prior to menstruation; just when there might be some premenstrual tension – which you now know is a manifestation of Liver qi (energy) stagnation. It is also a common time for a woman to get a headache or migraine.

Each aspect of our physiology in Chinese medicine is linked to the environment. The Liver is affected by the Wind. Ask any primary school teacher and they will tell you that children are more difficult on a windy day. The environmental associations aren’t limited to climactic conditions but to times of the day and year. The Liver relates to spring time. Spring is a very yang time of the year – the days are getting longer, trees are budding, things get more green; the colour of Wood – the element associated with the Liver (the elements are Wood, Fire, Earth, Metal and Water). A person with a Liver/Wood imbalance may have a greenish hue around the mouth; a clue to the acupuncturist to look for Liver patterns. When we are well Spring can be a joyous time full of hope for the year ahead. We make plans for the coming year. But if a person’s Liver Qi (energy) is constrained they may feel depressed and hopeless. More suicides occur in early Spring than any other time. I could go on with many more examples just with the holistic associations of the Liver and the Wood element; let alone the other Elements, the six energies, the eight extra-ordinary vessels, yin and yang, etc.

Functional impairment.

To get back to the mysterious illnesses which Western medicine is unable to diagnose; these illnesses are actually very common and make up a large proportion of any general practitioners caseload. They are often pre-illness states. Someone might feel vaguely ill for years before their complaint advances enough to be picked up on blood tests.  Often these illnesses are functional.  They relate to a subtle breakdown of control rather that to overt structural changes. Eastern medicine is always able to differentiate these conditions. It is always able to come up with a therapeutic plan. Now, obviously, it won’t always bring healing and resolution of the illness. So often these relate to patient lifestyle and behaviours. We can make recommendations but these aren’t always followed. There can be psychological blocks to healing. But we can come up with a plan and have a chance of bringing healing.

The strangest mystery illness I have had in my clinic was early in my career. I had a middle-aged woman who was a professional dowser. She was well in every way, but had simply lost her ability to dowse. All I could do was make a subtle observation of any patterns of imbalance and analyze her 5-element constitution; using subtle signs such as pulse qualities and volumes, facial colour, tone of voice, emotional balance and so on. It took one or two treatments and she was back to practicing dowsing. A skeptic would argue that this was mere placebo. I wouldn’t necessarily argue. Placebo can be the gentlest and most effective medicine there is.

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Should acupuncturists specialise?

Posted on February 3, 2012 by Jamie

A hot topic here in the UK is over whether acupuncturists should specialise.  On the one hand, therapists argue that certain areas call for specialist knowledge over and above standard college teaching.  On the other, people argue that acupuncture is a holistic system that is antithetical to specialisation.  So, should acupuncturists specialise?

The British Acupuncture Council (BAcC), the lead professional acupuncture body in the UK, has been considering an application from a group, specialising in paediatrics (the treatment of children), to argue that this should be an area of specialisation.  The BAcC has concluded that:

” This time feedback reveals that there is no ‘resolution’ to the generalist/specialist debate. Members’ opinions fall in either camp, depending upon their beliefs about acupuncture practice and their own clinical experience. The BAcC works not to restrict members’ practice but rather to promote best practice and make sure that patients are in receipt of the best care possible. In the absence of statutory regulation, we still have the dual role of protecting the public as well as representing members’ interests.  The paediatrics guidance notes will be rewritten based on your feedback, bearing in mind that practitioners are committed to working within the limits of their competence, know when to refer to a practitioner with more experience when necessary, and that some guidance on self-assessment to help answer the question ‘How do I know what I don’t know?’ may be helpful.”

My own feeling is that there is certainly scope for specialisation in acupuncture and Chinese medicine, and as the BAcC say, we should be aware of our limits of competence.  I have a special interest in the areas of pain and fertility.  Around 5 years into practice we held a joint audit at my main practice.  We had 5 acupuncturists working there at the time, and a very large percentage of our patients were presenting with pain conditions.  This motivated me to go on a long  journey of studying the understanding of pain from both a Western medical and traditional Chinese perspective.  This has certainly made me a more effective practitioner in this area.  As an example, in the past, if a patient presented with pain on their shoulder, I would have treated the points over the pain; say L.I. 14 and L.I.15.  Nowadays I might still needle these points, but I would check for and treat myofascial trigger points in muscles which might refer pain to this area, such as the scalenes, supraspinatous, pectoralis major & minor, biceps brachii, and corabrachialis.  Many of these trigger points will correlate with traditional acupuncture points, but classical acupuncture might not suggest that they could be helpful for this patient’s presentation of shoulder pain.

Fertility is another area ripe for specialization.  The methods of treating women according to the phase of their menstrual cycle, supporting IVF cycles, etc are not taught at college.  A lot of specific technical knowledge about the process of IVF is required.  My interest in this area is a personal one, having had to overcome my own problems with infertility.

Paediatrics is another area requiring specific extra knowledge.  Children’s energetics are very different to adults and I invariably refer any children to my colleague, Colin Rogers, who has undertaken substantial extra training in paediatrics.

So do I believe acupuncturists should specialise?  Well, yes and no.  On a practical level, for many acupuncturists, there just isn’t the demand, in their area, to be able to work full-time and specialise in one area.  I think for acupuncturists working in large cites this might be an attractive option though, and it could work well for their patients.

Personally I love working as a generalist with certain areas in which I have a special interest.  The model I think which is relevant to this is that of the medical General Practitioner (GP).  At least in the UK it is common practice for GP’s to have an area of specialisation; whether that be orthopaedics, dermatology or whatever.  They will do one or two sessions a week at the local hospital working in a specialist capacity.  The rest of the week they work as a generalist in their own practice.  This, in my view, is a great model for us as acupuncturists.

I initially published this post on my ‘All about acupuncture’ blog, but now that I’ve added this WordPress blog to my website I’m closing that blog down.  I posted ‘Should acupuncturists specialise?’ as a discussion on Linked In and it generated a terrific response.  You can see the comments here.Should acupuncturists specialise?

 

 

 

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Acupuncture Placebo

Posted on January 27, 2012 by Jamie

Acupuncture placeboAcupuncture placebo – does acupuncture work?

 

 

As an acupuncturist I dread talking about it socially, at least with the uninitiated.  I get asked

  1. Does it hurt and,
  2. does it work.

The answers to both are more complex than they might appear but my pat answer is that most people find it surprisingly comfortable to receive an acupuncture treatment and that it certainly works for some, but not everyone or for everything.  I’m then invariably asked, “Do you have to believe in it for it too work?”  In a sense, this question is asking, does acupuncture have a specific verifiable effect?  Does acupuncture placebo account for it’s perceived benefits?  According to Wikipedia, a placebo is a:

“simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient. Sometimes patients given a placebo treatment will have a perceived or actual improvement in a medical condition, a phenomenon commonly called the placebo effect.”

Now, I find this a rather more interesting question.  Over many years of practice I now recognize two polar opposite patients.  I will get one of the following extremes every once in a while.  I’ll have a quite, unassuming, usually female patient who says she loves acupuncture, loves alternative medicine, and is sure its going to work for her.  Generally this will play out over 3 sessions along the lines that whilst there is some small improvement  she is worried it is causing side effects such as a bad nights sleep, feeling tired and so on.  We’ll agree to call it a day.  The opposite patient is yang to the first’s yin.  This patient is usually male (sorry, this does happen like this), usually in business.  He’ll loudly declare he doesn’t believe in acupuncture and explain he’s only here because his partner made the appointment.  He’ll come back the next week 90% better and I’ll give him a treatment to consolidate the improvement and won’t see him again (at least for a few years).  I’ll get a host of referrals from him though because he’s excited to recommend acupuncture to his friends who are impressed because they know he thought it was a load of old tosh.

Placebo acupuncture research.

So, do we need to believe in acupuncture for it to work?  Recent research shines a light on this question.  This was a randomized controlled trial (RCT) designed to investigate the placebo effect of acupuncture (reported in (1) below).  262 patients with irritable bowel syndrome (IBS) were divided into three groups and compared over a six week period.  Group 1 patients received no treatment but had to complete a long list of research questions at the start, middle and end of the 6 week period.  28% of these reported adequate relief on a validated IBS measure.  This could be put down to natural fluctuation or improvement in symptoms or a response to the sympathetic attention of the researchers.

Group 2 received sham (fake) acupuncture, the same questions (at beginning, middle and end) and a limited patient-healer interaction with the acupuncturist.  They were told the RCT was testing acupuncture so they weren’t allowed to engage in conversation (with the acupuncturist).  Patients in this group had a 44% adequate relief.

Group 3 patients received the same questionnaire and sham acupuncture but this time the acupuncturists took the time, as they usually would, to engage with the patients and ask about their illness, medical history, family background, etc whilst demonstrating compassion, support and attentive listening.  They showed 20 seconds of thoughtful silence and expressed confidence.  Group 3 reported 62% adequate relief.  The effect of this ‘augmented placebo’ was as large and significant as any drug ever test for IBS.  “An analysis of biomarkers in the serum of all patients revealed that changes in immunological biomarkers were associated with symptom improvement and provides a possible molecular signature of response to placebo” (1).  Remember, none of these patients had received real acupuncture!

27 patients within this trial were interviewed (at beginning, middle and end) by a medical anthropologist.  This qualitative nested study found these patients had already seen numerous specialists, were desperate and whilst not having positive expectations, “consistently expressed hope and an openness to see what could happen”.  This chimes well with my ‘yang’ patients, who whilst having no expectation of acupuncture working, nevertheless were open to change; successful business people have to be flexible, confident and open.  Furthermore, an overall psychological analysis of all patients found that patients in group 3 who were extroverted and open to new experiences were especially likely to responsd to the augmented ministration.

According to T J Kaptchuk, “A subsequent RCT of 450 patients with knee osteoarthritis also examined placebo acupuncture in the context of an augmented versus a neutral patient-practitioner relationship.  Again it was found a more persuasive clinical interaction positively affected clinical outcomes” (1).

Going back to the IBS study, it was also found that patient response ‘varied significantly’ among the four acupuncturists performing in this trial, even though each followed a scripted procedure which was recorded for ‘fidelity to treatment protocols’.

So, do you have to believe in acupuncture for it to work?  Do you have to expect it to work?  Well, according to my clinical experience, and the acupuncture placebo research discussed in this post, no, you don’t.  But it does help, as a patient, if you are hopeful and open to change.

Before I finish I just want to make two short points:

Placebo medicine research.

Positive applications in the application of modern medicine, such as taking a drug, can also be mediated by placebo.  According to Kaptchuk again, “While some of the amelioration observed in placebo groups in RCT’s is related to the natural course of an illness…., recent sophisticated laboratory studies of placebo treatment point to a genuine placebo effect beyond natural processes” (1).

How to choose an acupuncturist.

Secondly, for prospective patients, choose your acupuncturist carefully.  On the one hand, make sure they are qualified from a bona fide college and belong to the top level of professional body.  On the other, have a chat with a short-list of practitioners.  The different responses to each of the four acupuncturists in the IBS study could be related to the charisma of the acupuncturist.  Is the acupuncturist believable, positive, engaging, concentrated and compassionate?  You’ll know after chatting to them which the best practitioner is for you.

Ted J. Kaptchuk

Philos Trans R Soc Lond B Biol Sci. 2011 June 27; 366(1572): 1849–1858.

PMCID: PMC3130398
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