BOW Forest Bathing with Suzanne Bartlett Hacken-Miller, MD Dr. Victoria Maizes: Hi Andy Dr. Andrew Weil: Hi Victoria. Dr. Victoria Maizes: I am really looking forward to speaking with one of our graduates, Dr. Suzanne Bartlett Haken-Miller. And we're going to be talking about Shinran Yoku or Forest Bathing. Dr. Andrew Weil: What a wonderful concept, you know, just spending time in forest and letting us influences wash over you. Dr. Victoria Maizes: Yes. I actually had an opportunity to have a forest bathing, although I should probably say a desert bathing experience, uh, with Suzanne when she was in Tucson in January, before we had to stay socially distant and it was really quite wonderful. Dr. Victoria Maizes: Before we jump into this episode we want to answer a question we received from a listener. Andy he has a question for you about foraging for mushrooms. Listener Voicemail: I just listened to the episode with Paul Stamets, I was curious what wild mushroom harvesting can be done in Tucson specifically - I think murrells appear after fires… so with our recent fires is there a possible growth of mushrooms can be harvested to eat? If someone is a beginner how would they go about finding someone they can go with to learn about what they can pick and not? Dr. Andrew Weil: Well I wouldn’t do that unless you are with a knowledgeable expert. It’s hard to use books to guide you to mushrooms, but if you find people who know them that really is the best way. There are people who know mushrooms in the Tucson area. I believe there is a Tucson mycological society that you could check with. The desert is not the best places for mushrooms and there are odd mushrooms that come up from the desert floor when we’ve had a lot of rain but those are not always the best mushrooms to eat. The best foraging I’ve found is on Mount Lemmon after good summer rain usually July. So quiet a variety of mushrooms that grow in mixed Aspin conifer woods usually you can’t find them in great quantity but usually you can find king bolete mushroom and other mushroom that are fairly easy to find. But my main advice is to go with someone who knows the mushrooms. Dr. Victoria Maizes: Thanks Andy. And remember you can call and submit questions for us or our upcoming guests. Intro music Dr. Victoria Maizes: So it's my pleasure to introduce our listeners to Dr. Suzanne Bartlett Hacken-Miller Suzanne is an OB GYN, and also a fellowship graduate of the University of Arizona Andrew Weil's Center for Integrative Medicine. In addition, she holds certifications in herbal medicine and she's a certified forest therapy guide. She's also the medical director for the Association of Nature and Forest Therapy and is a medical advisor for All Trails. She wrote a wonderful book that has won awards called the Outdoor Adventure’s Guide to Forest Bathing. Welcome Suzanne. Dr. Suzanne Bartlett Hacken-Miller: Thank you, Victoria. Such an honor to be here with you both. Dr. Victoria Maizes: Well, we're delighted. I want to start with you Andy. I'm wondering if you could just begin by talking about the importance of creating a relationship with nature. Dr. Andrew Weil: Well, as you know, there's like a condition that's been talked about recently called the nature deficit disorder. Um, and this especially applies to kids who were raised on devices and indoor spaces. And, uh, the feeling is that disconnection from nature really undermines emotional and mental wellness. Um, I think that's true. There also, there is research, for example, showing that, uh, patients who've had surgery, uh, who have a hospital room that has a window recover faster than those who don't. So, you know, we have a lot of information like that. Dr. Victoria Maizes: This idea of forest bathing. It's such a wonderful term, and I know there's a Japanese word for it. And the Japanese were some of the first folks to research it called Shinran Yoku. But, um, Suzanne tell our listeners, what is forest bathing? Dr. Suzanne Bartlett Hacken-Miller: Yes. I get a lot of questions about this, although fewer and fewer all the time now it's the term has started to be a little more well known, but forest bathing is a literal translation from the Japanese terms Shinran Yoku, which was coined in the early eighties in Japan. By a couple of doctors, Dr. Lee and Dr. Zaki who recognized that people in Japan or extremely stressed out had very high levels of mental illness and very, very high suicide rates. And so they wondered if they just took these people out into nature about an hour outside of the city of Tokyo if that might help their mental health and perhaps even their physical health. And so these doctors did, they started taking people outside of the city to a dense forest area and took them through a mindful practice where they were able to just take the natural surroundings in through the various census. And they started with, uh, typically a couple of days for their experience, sometimes a two night, three day excursion. As they were doing this, they took it a number of did a number of tests on their subjects, so to speak. To see if it really did have any benefit. And so they did questionnaires asking the participants about various mental health, um, symptoms, whether they noticed that if they felt any better with regard to their self-esteem or their vigor or depression or anxiety or things like that, they ask them about their concentration levels and things. Then they also even did tests on their blood pressure and pulse and their heart rate variability. And even then sort of looking at markers of stress, like salivary cortisol and salivary alpha amylase, and they found that they were seeing benefits after taking people out into nature in this mindful, quiet, contemplative way, um, and found that, uh, that it benefited them both mentally and physically. Dr. Victoria Maizes: So that's pretty incredible. You're a guide. You guide people on these forest bathing experiences. What does that mean? Why can't you just walk in the forest by yourself and get this benefit? Or can you? Dr. Suzanne Bartlett Hacken-Miller: Yeah, of course we can just walk in the forest and get these benefits. And I would say that probably anybody who's ever done that has noticed some benefit, whether they sleep better at night or, um, that they just feel more refreshed afterwards. Um, but yes, this notion of a guided walk is similar to the way that you wouldn't just embark on a yoga practice without some sort of a teacher. And so that's kind of the idea that a guide can help kind of open the doors to this experience. Um, and so, so a man named Amos Clifford brought the practice to the United States and started formalizing it a little bit more and training guides in this practice and founded the association of nature on forest therapy. And so, um, with the practice with a guide, then it is just that we take people out into nature. It doesn't have to be in a forest. It can be in the desert, for example, and Tucson even, it can be in any kind of natural environment, but the idea, being that the guide then helps to take people from their everyday monkey mind stressed out state into more of a mindful state, even perhaps kind of a dreamlike state. So the idea then is to take people through this practice in a systemic way helping them again take nature. And through the various senses, we typically refer to this as invitations where people are invited to try these different things, just to see if it helps to improve their experience. Dr. Victoria Maizes: Yeah. You know, Andy, I remember when you wrote Spontaneous Happiness, um, you talked about the importance you wrote about the importance of going green and being aware that you're a part of nature and that one of the advantages of that awareness was the almost self-transcendent experience that you're part of something much larger than yourself. And I'm wondering if you can talk a little more about that? Dr. Andrew Weil: Yeah. Over the years in my work with patients, I frequently wrote down a diagnosis of disconnection syndrome that is people who were isolated that really had lost connections to them. Your people to animals, to nature of plants. And I would give them suggestions to remedy that, uh, you know, I don't think you have to live in a forest or go to a forest. Even if you have houseplants, companion animals, if you can get out to a park in the city and all those are ways of just realizing that you're part of something larger than yourself. I think that's critical for wellbeing. Dr. Victoria Maizes: And we're taping this during the coronavirus pandemic when many people are feeling more isolated than ever. So maybe you can expand a little on some of these ways, as you said that you couldn't have the advantages of nature without necessarily driving to a national park. Dr. Andrew Weil: Yeah, well, I have friends in New York city right now you’ve had a very hard time over the past months, although things are used up there, but, uh, one of my good friends, uh, makes a point of going to Central Park every morning and walking for an hour. And that I think New York city without central park would be a much different place. I mean, that is really a big piece of nature right within the city. And it's accessible to everyone. Dr. Victoria Maizes: Yeah. And then, you know, you mentioned the much smaller things one can do, and I know Suzanne, that's been something you've been talking with people about. Dr. Suzanne Bartlett Hacken-Miller: It really is. I've been thinking about this so much because during this time of the pandemic, we know, I think we know even inherently intrinsically that we need nature and we need to get outdoors. Um, and yet you're right. So many people are in places where going to a park is not possible. And so I've been trying to apply these ideas of forest bathing to the tiniest little examples, and I've been experimenting with it even myself. And that might be as simple as spending time with an indoor pot plants. We have a practice in forest bathing called sit spot where we just take 20 minutes and just sit in nature with no agenda, no expectation to you know, practice a breathing technique or meditate or strike a yoga pose or a prayer or anything like that, but just simply to be in nature for 20 minutes. And I found that practice would be very powerful. I typically go out with the expectation that, well, there's nothing to see here. And then of course immediately I'm just overwhelmed with what happens and what I noticed simply notice in 20 minutes, journaling afterwards can be very powerful. And so I've applied this during this period of the pandemic to, like I said, the tiniest little unexpected glimpses of nature, and I've experimented with an indoor plant. I've experimented with looking out the window at my tree out the window for 20 minutes. I've taken myself to some urban areas. In fact, one was a construction zone to see if I could just find some nature solas there. If you have no access to what we consider, you know, big nature during this time for hops, you can find some nearby nature and find a better if it there. And I, again, I have found that when I journal afterwards, I am able to have an experience. I take note of my emotions and my mental. State before and after I'll sometimes even check my pulse. I haven't gotten out my heart math yet to check my heart rate variability, but I need to do that. And I do think that we can find nature even in unlikely places right now. Dr. Victoria Maizes: What I hear you describing is slowing down, using all your senses, appreciating, reflecting on the experience afterwards. Uh, anything else that you think our listeners might be able to attend to and, and how's it different than mindfulness. Dr. Suzanne Bartlett Hacken-Miller: Yeah, I think, I think all of those are the important factors. So mindfulness is this idea that we just witness without. Attaching any emotion to what we're experiencing, um, being, being one with nature, perhaps, but in forest bathing, instead of not experiencing the full effect, we do celebrate the idea of awe and wonder and connection. I find that when people do this, it's impossible not to realize, um, that we're not separate from nature. We are nature. And I find that that's healing just in and of itself. Dr. Andrew Weil: It seems to me that paying attention to nature in some ways it's opposite to paying attention to the virtual and artificial reality that comes to us through devices. And that has become a greater and greater, uh, factor in people's lives today, even more so during the pandemic. Dr. Suzanne Bartlett Hacken-Miller: Most definitely. And I think if we can just separate from that, even for short periods of time, we can kind of reset. Dr. Andrew Weil: I think the big concern is that, uh, time spent on devices, changes brain function, and we don't yet know the full ramifications of that either. Maybe some good that comes out of that, but we know we certainly see an undermining attention span. I think it can increase anxiety and anger and contribute to depression. And I think we'll have to wait and see how all this plays out, but you know, an awful lot of kids today grow up with a tremendous amount of time on devices. And that's a really new thing in human history. Dr. Victoria Maizes: So you mentioned, um, a few things that, um, forest bathing are thought to specifically counteract, and that includes depression and anxiety and, uh, there are studies that show, uh, improvement in mental, emotional wellbeing. I don't know if there's one in particular, Suzanne, you want to point to. Dr. Suzanne Bartlett Hacken-Miller: Well, there are so many, and I just need to back up for a second because it has been over 300,000 years of our development and evolution on this planet, that humans have been outdoors. It's really only been in the last couple hundred years, less than one point. 1% of our human experience has been all of this indoor time. And so I think, again, we, we know deep down in our DNA that we need to be outdoors. So I, I very much agree with that whole concept about the too much technology. Uh, there was one study, that found that when college students took five minutes connected from their devices being outdoors they noticed improvement in almost all parameters of mental health. And then when they replicated that study, adding increased durations of time, up to 15 minutes, they found that increasing beyond five minutes, didn't really have added value. So that's something I share a lot with people, especially kids just detached disconnect from your devices. Even five minutes a day has benefit. Dr. Victoria Maizes: I think it's so astonishing that the dose is so small because a lot of times, as doctors, when we talk to patients, they say, “I don't have time”. Right. That's such a common response when you suggest that people, um, exercise for example. So it'd be able to say, you know, five minutes spent outdoors, right? Is clearly of benefit across so many studies is I think really exciting and heartening. Dr. Suzanne Bartlett Hacken-Miller: Yeah. You know, and then there was another study. That's an excellent study showing that 20 minutes of time improved our salivary cortisol levels and our salivary alpha amylase levels, which are both markers of the stress response. And, you know, so again, 20 minutes, that's very doable. And again, as they added more time to these studies, they didn't find that necessarily more time had greater benefit. Dr. Andrew Weil: I think the subject really speaks for itself and I think there's many, many ways to do it, but the whole concept of forest, but anything I like it, you know, it's a nice idea. And as you know, I spend, I have a forest where I live in British Columbia, so it's right out my back door. Dr. Victoria Maizes: You have forest and sea. Dr. Andrew Weil: Forest, and ocean. But the forest is magnificent and that's 120 acres of mature. Second growth [00:16:40] far as the trees are about a hundred years old, mostly a Western red Cedar and Douglas fur, and it's a fabulous place. A few years ago, there were bad forest fires in British Columbia. And we had a few days when the air was really smoky I mean, almost to the point that it really felt unhealthy to even breathe it at all. And I found that, yeah, he entered the forest. It was so much better. Yeah. You can just feel the oxygen that was company out of the trees, you know, it was a great relief. Dr. Victoria Maizes: One of the other experiences I have when I'm in forest, especially with old trees, is the silence the way the trees almost seem to absorb all sound. And I've had that experience even when my children were little and we would take them camping in the redwoods. And even though there were all these kids running around, shrieking making a lot of noise, there was this profound silence at the same time, I just loved it. Dr. Suzanne Bartlett Hacken-Miller: There's nothing like that, you know, and I have to throw out there that there is some. Early evidence out of Japan about this notion of fight insides. And you may have heard of that. The phytocides are these cases, goals that are emitted from the essential oils of plants, particularly evergreen and pine and redwoods and things. And these phytocides have all of these amazing properties for the plants where they help to fight and protect the plant and the tree against inflammation and against viruses and bacteria and fungi and stuff. So it's now believed that as we're out in a forest, that we're inhaling these phytocides while we're interacting with nature. And so that, that is thought to confer health benefits on us as well, as far as anti-inflammatory anti-microbial. And even there are some studies by Dr. Lee out of Japan, finding that interacting with these fight insides and inhaling them into the body increases our natural killer cells in the body. And so these NK cells sweep around the body and gobble up my microbes and also, um, are able to help against the production of tumor cells. And so to just imagine that spending time in nature helps us by reducing inflammation, fighting viruses and bacteria, and other microbes, and could even help us against production of tumor cells and against cancer to me, there's really no better medicine than that. Dr. Victoria Maizes: So for each of you and I'll answer too, what's your favorite tree? Dr. Suzanne Bartlett Hacken-Miller: I have a list. Dr. Victoria Maizes: Okay. Give us your, your top three. Dr. Suzanne Bartlett: I know my top three, my top three trees. This is tough cause it changes regularly. But um, I love the Ponderosa pine. I love the sequoias and lately I've had a thing for a number of different varieties of Oaks. Victoria Maizes: Thank you. what about you, Andy? Dr. Andrew Weil: Oh, that's a really hard one. I would say certainly giant sequoias, uh, Ponderosa Pines too. And I love to stick my nose in the crack bark on a hot day and they smell like vanilla, great vanilla trees. Dr. Victoria Maizes: I'll share an early, uh, fellowship memory. Um, when I was a fellow back in 1998, uh, we had a retreat up on Mount Lemmon, which has many Ponderosa Pines. And I well remember Andy walking around. I'm scratching at the bark so that he could get the scent of the vanilla to emerge and all of us fellows sticking our nose up to that ponderosa pine to catch a whiff of it. Dr. Suzanne Bartlett Hacken-Miller: That is my favorite thing to do as well. Dr. Victoria Maizes: Well, my favorite tree is, um, uh, Redwood. Um, although I have to say giant Sequoia is, are pretty close. Uh, thank you so much, Suzanne, for coming on and for sharing your wisdom about forest bathing. And, um, I hope that our listeners have gotten some, uh, ideas, some creative ideas about new ways that they may spend in nature. So, uh, maybe if you have a last tip for our listeners, um, just either how to get started or how to, or creative, we'd love to hear it. Dr. Suzanne Bartlett Hacken-Miller: Sure. Well, there are a number of books on the topic. Um, there are virtual walks being offered all over the place. If people would like to connect with me on that, I'm happy to share more information on how they can do that. Um, but it doesn't have to be difficult. I think the best prescription, I guess I would offer would be to just invite people to take the 5 minutes, the 10 minutes, the 20 minutes, whatever it is, just allow yourself that guilty little pleasure of getting outside and, and spending some time with no agenda. Dr. Victoria Maizes: Wonderful. Thank you so much. Dr. Suzanne Bartlett Hacken-Miller: Thank you so much for having me.