Slippery Elm

A while back I saw a patient on an acute basis who was coughing up a lot of fresh blood for about a week. Although it wasn’t the first time in her life that she had experienced this symptom, it had never lasted this long and the amount of blood had never been this heavy. Needless to say, coughing up significant amounts of blood is a pretty serious thing and I wanted her to have a diagnostic work-up done. For a number of years, she had been going through menopause and also had separated from her husband 6 months earlier. So, her symptoms of night sweats and low appetite with a subsequent loss of weight were not unusual in that context. But with fresh blood apparently coming out of her lungs, they took on another meaning – or more accurately, one of two meanings: cancer or tuberculosis.

Alarmed at what seemed the most likely possibilities, I encouraged her to get a diagnostic work-up as soon as possible and wanted to give something to soothe her throat since it had become rather raw from the coughing. Beyond that, I didn’t want to begin any treatment until the diagnosis was clearer.

Not yet having done the comprehensive consultation necessary to decide on a deep acting constitutional homeopathic remedy and not wanting to suppress her symptoms with a local or symptomatic remedy, I decided to use an herbal approach for the throat and wait for the diagnostic results.

To this end, it occurred to me that a commonly used an herb native to North America about which coincidentally, or maybe not so coincidentally, I had just be reading.

The Red Elm tree, a relative of the American Elm otherwise known as Indian Elm, Moose Elm or Gray Elm, had long been highly valued by both Native Americans and the European settlers for a number of purposes, such as the construction of baskets, kettles, canoes and homes, as a food as well as a food preservative, and as a medicine. Nutritional and medicinal preparations use the tree use the inner bark, and are known as ‘Slippery Elm’. The bark is peeled from the tree in long strips and the outer layers then shaved off; the mucilaginous inner bark, which is about 1/8 to 1/4 inch thick, is then dried and put away for use.

In the 1830’s a European traveler to the New World described how he saw witnessed Slipper Elm being used: “The bark, if chewed or softened for a moment in water, … dissolves into a viscous slime, and is found very useful in dressing wounds, as it is cooling, and allays the inflammation. It is said to have been applied, in powder, with success in cholera, and is now apothecaries' shops. A teaspoonful of this bark, in boiling water, makes a very useful beverage, which is sweetened with sugar, and has the same effect as linseed."

The plant was also researched and adopted by American homeopaths in the 19th century, but was considered to be only a minor remedy with limited scope of action for certain cases that exhibited symptoms like numbness, tingling and pain in the arms and legs.

The Native Americans and the herbalists who subsequently learned from them considered it a very powerful healing agent, applicable for numerous conditions and for all sorts of persons including infants, pregnant women and the elderly.

Its viscous nature noted above is due to high mucilage content. Mucilage, produced by most plants to one degree or another, is a gelatinous substance that contains protein and polysaccharides and is similar to plant gums, and has demulcent properties. Herbalists use Demulcents, - the word derives from the Latin demulcere, "caress"- are used by herbalists for their ‘calming’ properties because they form a soothing film over mucous membrane, relieving pain and inflammation of the membrane.

Slippery elm is a demulcent par excellence and it was for this action that it occurred to me to suggest it to the patient in order to soothe the irritation in her throat. Of course, there are many other mucous membranes throughout the body such as the intestinal and urinary tracts, and lungs which all respond favorably to it’s properties.

In addition to being a demulcent, Slippery Elm is also quite nutritious, easily tolerated by those with compromised digestion, and is considered a “survival food” that reportedly was eaten by Revolutionary War soldiers lost in the woods. It is a wonderful food for poorly nourished infants, invalids, aged persons, or any cases where a person may be unable to eat due to lack of appetite, nausea or weakness.

In modern times, Slippery Elm has become an invaluable aid for people undergoing radiation and chemo- therapies. Not only does it soothe the tissues irritated by the treatments, but it also can antidote the common digestive side-effects such as constipation, diarrhea and nausea.

In larger doses, Slippery Elm acts like a bulking agent to promote bowel motions. In smaller quantities, it calms the intestines down, stopping diarrhea. It ought to be noted, though, that since it absorbs large amounts of water, anyone taking Slippery Elm needs to also increase water consumption.

Another common use of Slippery Elm is as an expectorant, that is, as an agent to promote the discharge of mucous from the respiratory tract. It is widely used from phlegmy coughs and any number of inflammations or infections of the bronchi and lungs where phlegm needs to be raised and cleared.

Back to the patient who I had suspected her of having tuberculosis or lung cancer, my hope was that while awaiting a diagnosis the Slippery Elm would merely sooth her throat that had become quite irritated from all the coughing. But the effect far exceeded expectations. Her throat did feel better, but the bleeding stopped, the coughing stopped and her menopausal symptoms like heat flashes and dryness cleared up in short order.

Fortunately, it turned out that the results were negative for both the TB and the cancer and it was surmised that perhaps the bleeding was in fact due to damage to the lining of the throat due to all the coughing. That would make sense of the efficacy of the Slippery Elm in stopping the bleeding, and its well known effect as an expectorant might explain why the coughing stopped altogether. But the action on the hormonal system is still something of a mystery.

Be that as it may, needless to say both of us were quite relieved at the results of both the testing and the Slippery Elm prescription. Since the patient was now without symptoms, she elected not to follow up with the suggestion of the medical doctor to visit a throat specialist, and instead, opted to just continue taking the Slipper Elm for a while longer.

One of the appealing characteristics of this herb is that it can be thought of and consumed as food, not merely a medicine. In the ancient Chinese medical texts, it is written that the purest and highest form of therapy comes from our food and that it is only in the ‘degenerate modern times’ (meaning 3 or 4 thousand years ago) that mankind has become so weak as to need specialized medicines. Although we have come to think of Slippery Elm as an herbal preparation, it could just as well be thought of as a wonderful form of nourishment.

Here are some ways to prepare Slippery Elm, variations of the same basic recipe:

1. Mix one teaspoon of the powder and mix well with same amount of honey or syrup. Add one pint of boiling water, soya milk, nut milk, or cow’s milk. Slowly mix as you add the liquid.

2. Put 2 –3 Tablespoons of the bark powder in 16 ounces of cold water for 6-8 hours, then heat slowly, being careful not to boil. Stir constantly while heating. Strain and drink.

3. Add 1/4 cup of slippery elm bark powder to 2 cups of cold water. Let stand 30 minutes. Slowly heat mixture for 5 minutes, gently stirring to prevent clumping. Let cool, and add sweetener such as honey (highly nutritious) and any spice that appeals to the person. Add peppermint leaves for their cooling action to lungs, ginger root to increase circulation, apple juice in place of water, rosemary leaves for their antioxidant properties. If constipation is a problem, try adding a pinch of clove, fennel or ginger.

3. Slippery Elm Food is generally made by mixing a teaspoonful of the powder into a thin and perfectly smooth paste with cold water and then pouring on a pint of boiling water, steadily stirring meanwhile. It can, if desired, be flavoured with cinnamon, nutmeg or lemon rind.

4. Another mode of preparation is to beat up an egg with a teaspoonful of the powdered bark, pouring boiling milk over it and sweetening it.

5. Slippery elm "gruel": Slowly add fresh, cold water, a little at a time, to the finely powdered bark. Stir until the mixture reaches the consistency of a thick porridge. Sweeten with honey and add cinnamon and ginger to taste. Refrigerate unused portions. Milk may also be used in place of water.

6. In cases where they may be unable to eat due to lack of appetite, nausea or weakness, this may be an option. One to three teaspoons of the powdered inner bark can be added to oatmeal and taken as a food.

Curry

I just can’t get enough curry. Ever since reacquainting myself with India 3 years ago, my craving is just about insatiable. Now, it isn’t just the taste that I’m hungering for, it is also the way it makes me feel. Before my trip in 2003, I actually was quite concerned that my finicky digestive tract would not appreciate the sometimes fiery combinations of spices that are the signature of Indian cuisine. But quite to the contrary, I was surprised to find that as long as they weren’t too oily, curried dishes were easy to digest and I’d go so far as to claim that they imparted to me a general sense of well-being. Any experienced traveler will probably agree that an ethnic or regional cuisine never is quite as good outside its own locale, no matter how authentic the recipe, the ingredients or the restaurant. You never can quite bring it home – as if there is some ‘X factor’ missing. Maybe it’s the air or the cultural ambiance and energy, maybe it’s the state of heightened awareness when traveling in a foreign land, or maybe it’s the irreplaceably deft hand of a native chef… Or, maybe it’s a result of an unrealistic expectation that an appropriately prepared meal will transport not only the palate, but one’s entire being to a distant place.

Nevertheless, after returning home, I decided to incorporate a steady regimen of curried dishes into my diet. That meant learning to make them myself because restaurants are at best an occasional treat -besides which Indian restaurant fare in this country generally offers only a narrow regional cuisine (from the northern state of Punjab). So, I picked up a few books, scoured the internet, queried a few Indian friends and even took a class once. But mostly, I began to practice a lot, with family and friends serving as willing (mostly friends) or unwilling (mostly family) guinea pigs. While by no means a gourmet cook, I can at this point make a passable dish or two.

Now, the first lesson in Indian cooking is to find out what ‘curry’ really is. In the West, we associate it with a yellowish powder made up of various spices. In India and Sri Lanka, the word indicates a dish made with sauce or liquid. So, aside from rice, various types of flatbreads, and a few other items, most everything served is in fact a curry. People therefore might refer to the ‘curries we had at supper’ or ‘the special eggplant curry’, etc.

Although a number of theories about the origins of the word ‘curry’ exist, it is generally believed that it comes from India and was incorporated into English during the British colonial era (1757-1947). The most commonly cited derivation is from ‘kari’, which means a ‘spiced sauce’ in the south Indian language of Tamil. (An interesting alternative explanation makes reference to an Old English word ‘cury’, derived from the French ‘cuire’ (to cook), which has been found in cookbooks dating back to the 14th century.)

However the word came into our lexicon, the curry powders used in the West are thought to be a convenience invented by the British to approximate the taste and simplify the cooking of Indian ‘curries’. Instead of stocking a wide variety of spices and learning how to use each individual one as native cooks do, one merely adds a teaspoonful or two of a flavorful, balanced blend.

A common implement in an Indian kitchen, equivalent to our spice rack, is a round stainless steel tray on which is placed a number of small stainless containers filled with the most common spices. These are usually used at the beginning of the cooking process. In addition, there is a wide variety of powdered spice blends, known as ‘masalas’, each specific to a certain type of dish, which are used in addition to the basic spices and tend to consist of heat sensitive spices added toward the end of the cooking process. The make-up of curry powders found in the West varies both in the type and number of spices. Of the six to fifteen or so ingredients found in most blends, nearly all them will contain as core constituents coriander seeds, cumin seeds, turmeric and fenugreek seeds. Additional spices are generally added from the following: cloves, garlic, curry leaves (These are small green leaves with a slight bitter taste that are almost impossible to find in this country as a separate spice, either fresh or dried. I took to stuffing a fresh bunch in the depths of my baggage when returning home from my last trip and freezing them.), fennel seeds, ginger, mustard seeds, chili pepper, black pepper, cassia, poppy seeds, anise, cardamom, cinnamon, and nutmeg.

While each spice contributes its own taste, as well as nutritive and therapeutic qualities to the blend, the ‘core four’ are a balanced combination that stabilize the flavor and energy of the food. They enhance digestion and calm the ‘dosha’, the three basic energetic qualities of Vata, Pitta and Kapha (sometimes translated as wind, fire and water) described in Ayurveda, the ancient indigenous medicine of the Indian subcontinent.

In recent years, turmeric especially has been the focus of great interest amongst medical researchers. Its properties appear to range from antibacterial, anti-inflammatory, anti-cancer and antioxidant to protecting the cardiovascular system and promoting mental acuity.

PART II

Last night I watched the charming movie “Spellbound”, a documentary focusing on eight early adolescent contestants in the 1999 national spelling bee championship. One of the many interesting things that caught my attention was that out of the 249 regional winners who made it to the nationals, a disproportional number were of East Indian descent. What’s more, they seemed to be the elite even amongst this select group. The odds on favorite to win was an Indian, as well as two of the eight documentary ‘stars’ – one of whom turned out to be the eventual champion.

It is well known that in India, families place a strong emphasis on education, academic competition is fierce and students are generally highly motivated. When Tom Friedman of the NY Times cautions us in his book ‘The World is Flat’ that the United States is fast losing its premiere position in the global market economy, this is one of the factors that he cites. But I am wondering whether there is something more than cultural priorities at work here.

Simply put, I come away from so many of my own interactions with Indians, which admittedly are mostly with the educated strata of Indian society, struck with their mental acuity. I know this might be treading on thin ice in terms of the political correctness of stereo typing an ethnic group – even in a positive light. But, in fact, I am consistently left with this impression.

This notion was recently reinforced when I learned that India has some of the lowest rates of Alzheimer’s Disease in the world. According to a joint study conducted by the UCLA Medical School and the Veterans Administration originally published in the Journal of Biological Chemistry in December of 2004, among adults ages 70-79, the rate of Alzheimer’s in India is only 25% of that in the United States.

It got me thinking that perhaps there really might be some correlation between this research and my own observations. But what could be the reason? Any number of possibilities come to mind: genes, cultural habits, educational priorities, environmental factors… Or maybe it is just in the water.

That isn’t as tongue and cheek as it might sound. The scientists who conducted this study, in fact, believe it probably is in the food. They posit that a substance found in one of the spices used in curry acts to protect the brain. It not only prevents the formation of the amyloid plaques that devastate normal brain function, it also prevents them from forming. It was found that in studies with mice, the isolated active ingredient is more effective than many drugs being touted for the treatment of Alzheimer’s.

Turmeric is the stuff that makes curry yellow, the stuff that makes a stain from curry sauce so indelible. In fact, aside from its culinary function, it is commonly used as a yellow dye. As a medicinal herb, it has been used by both Ayurvedic (traditional Indian) and Oriental physicians for several thousand years. Turmeric contains a family of bioactive compounds called ‘curcuminoids’, one of which is curcumin (or ‘diferulyl methane’).

Curcumin, which makes up some 2 to 5% of turmeric, is the substance that has been the focus of this research. Its medicinal action has been the subject of much scientific study for many years. For instance, in 2001 the same researchers published an article in the Journal of Neuroscience describing it as a powerful anti-oxidative and anti-inflammatory.

These properties make it valuable not only for the prevention and treatment of Alzheimer’s but also in a host of degenerative and /or inflammatory diseases such as cancer, heart disease and arthritis.

It is worthwhile to emphasize one need not use pure curcumin to gain its benefits. One older person was so impressed by her response to adding turmeric to her diet, mostly by way of curry powder, that she created an entire website dedicated to it. (http://www.lionsgrip.com/curintro.html) She reported that (my) “Memory, word recall, handwriting (which had become shaky), and rather large need for sleep, all improved greatly in this near-instantaneous time. Most importantly, the ability to keep several things in mind returned to mid-adult level.”

Scientific research notwithstanding, the capacity to stimulate brain function has been understood for centuries. As one old herbal compendium puts it, turmeric is useful “for getting rid of vapours in the braynes".

Turmeric is an invaluable herb both as a prophylactic and for the actual treatment in a myriad of disorders. It is an anti-fungal and anti-bacterial, and therefore is useful for treating candidiasis, HIV and many other infections. It stimulates digestion and coats the stomach lining with a protective layer of mucous thus increasing absorption, eliminating gas and reducing acidity. In a similar way, it also soothes the respiratory tract and is useful for coughs and asthma. In the cardiovascular system, it lowers cholesterol and stimulates circulation.

Curry, of course, has much more to it than just turmeric. Each ingredient contributes not only to the overall flavor, but also to its therapeutic value. As just one example, Fenugreek aids in digestion, regulates blood sugar levels, expectorates mucous reducing congestion in the sinuses, and soothes inflammation, amongst other things.

All the other spices commonly found in various curry powders, such as cumin, coriander, ginger, mustard, cloves, garlic, fennel, cayenne possess their own specific actions.

Best of all, this delectable seasoning is readily available to us at little cost and no the side-effects – except an occasional stain on the shirt.

Herbal Speed

This past spring, a 23 year old Major League baseball pitcher keeled over and died in the heat of the Florida sun. From published reports, it appears that the athlete in question had used a “natural supplement” containing the herbal stimulant ephedra to get down to an ideal playing weight in a hurry. His death elicited a lot of news coverage and commentary while once again bringing attention to that dark side of professional sports: the use of drugs and stimulants to enhance performance by increasing strength, increasing endurance or losing weight.

Now, the commissioner of the Food and Drug Administration, in response to this and other incidents, is asking that Major League Baseball ban the use of ephedra and is suggesting that perhaps it would be best that it be banned nationally.

The logic behind this idea is understandable, but it sure would be a shame. It reminds me of an ornery elementary school teacher I had who would punish the entire class for the misdeeds of a single kid. In this case, there are a few naughty parties that clearly need to be disciplined, beginning with the player’s union.

The Major League Players Association, hiding behind the issue of personal privacy and infringement of personal rights, will not agree to a ban for professional baseball players. The priorities seem a tad skewed, but onlly in proportion to the salaries of the ballplayers.

The companies that market and manufacture ephedra supplements bear a large part of the blame, too. They take advantage of the absence of regulation in the industry to sell something as “natural”, thus implying it to be safe. Safer perhaps (than steroids), but not necessarily safe.

The shame of it is that lost in all the hoopla, is the fact that ephedra is an herb that has been used in China for somewhere going on four thousand years. Known in China and often written on the side of the supplement bottles as “ma huang” (meaning yellow hemp), its most common traditional application has been to stimulate the respiratory tract.

Properly used it enables people to get over flus, allows asthmatics to breath, and reduces the discomfort of allergies. It also has both a diuretic (increasing urination) and a diaphoretic (increases sweating) effect. Today, it is known that the active ingredient of this herb is the chemical compound ephedrine and many related derivatives.

Pure ephedrine is a powerful stimulant, currently used as a bronchodilator and decongestant in conventional medicine. It stimulates the release of chemicals from the nerve endings, the adrenals and the entire sympathetic nervous system. Thus ephedrine or ephedra effects the body systemically. Basically, it puts the entire body on alert — into a fight or flight mode. It stimulates the cardiovascular system, constricting the blood vessels and thus increasing blood pressure. Digestive activity is slowed down, the pupils are dilated, and increases the flow of blood to the muscles.

The herbal combinations containing ephedra in Oriental Medicine have been well tested over time having passed down to us through the centuries. They are formulas that I have regularly used with patients for years without untoward side effects. But, as with any type of prescription, the medicine needs to fit the patient.

The ancient chinese texts warned against using “ma huang” with people who were too weak or don't have symptoms that fit its usage. Even when they prescribed the herb, it was always in a carefully crafted formula that usually consists of four or more other herbs. This combination of ingredients creates a a synergistic effect and balance which lowers the possibility of side-effects.

But recent commercial products for performance enhancers and weight loss enhancers are a totally different animal. They are designed to do one of two things, neither of them particularly healthy. One is to push the body beyond its natural capacity for physical activity, the other is to remedy a complex metabolic imbalance by through overstimulation of the body.

Using stimulants in this way, whether they are natural or not, is a very questionable idea. In a pinch, a crisis when you can't breath or you’re escaping from a charging grizzly, using stimulants in this way, whether they are natural or not, is a very questionable idea. This is a wonderful effect in a pinch, in a crisis when you can't breath or you’re escaping from a charging grizzly, it is helpful to be able to turn to a stimulant. Otherwise, it is not such a wonderful thing to do to your body on a continual basis.

In the old days, amphetamines were the pharmaceutical industry's contribution to the war of the bulge. They too had the capacity to fires up the metabolism and they were appetite suppressors to boot. Like many other wonder drugs, they were all the rage until it was discovered how dangerous and addictive they could be.

It is disappointing to walk into a health food store and see how the nutritional supplement industry has succombed to the same irresistible lure of profit making. It almost makes one sympathetic to the FDA’s efforts.

And, by the way, what happens when the person stops taking herbal speed anyhow? One can only assume that the metabolism will slow down — maybe to an even lower rate than before. The weight will come right back. The muscles will turn to flab.