The need for long-term thinking in medicine: Cinnamon as a case study

Here in Vermont, we are approaching the first anniversary of a storm that, over less than a day, poured an incredible amount of rain over the mountains, down the streams, and into narrow river valleys. The hill towns were quickly overwhelmed and literally swept away on huge torrents of water. These types of events are outliers, “hundred-year” floods. We tend not to think about them until they happen. If a river floods one spring, and washes away our garden, we could just build a retaining wall and be fine for years. But in Vermont, it seems that sort of thought process may have contributed to the severity of last summer’s event: narrower valleys, more constrained riverbeds, actually increased the torrent’s force and destructive power. As we rebuild, civil engineers are taking this into account.

In fact, there is a growing realization in many professions and disciplines that we need to approach the world with much more long-term thinking. Perhaps pumping out wetlands and building cities isn’t the best idea. It might be smart to consider sources of energy that aren’t going to run out fairly soon. When educating, connection to long-term curiosity might be better than passing the next test. Social and ecological concerns in market-based economies might trump the need to make a buck.

I dare say that medicine is beginning to embrace this trend, too – or at least people are. People who are interested in real food that may not require contaminating the water supply to cultivate, and who feel like this food might be better for their long-term health (though missing the tasty nacho cheese). People who consider a fever the sign of a healthy reactive response, and watch it for a bit rather than immediately suppresing it. People who are beginning to think that diabetes may be connected as much to ubiquitous, unregulated sugar in the food supply as it is to increased weight, lack of exercise, or “poor self-control”.

Which brings me to cinnamon. A recent meta-review found a small but significant effect from the powdered bark of this fragrant member of the Laurel family in treating the elevated blood sugar levels associated with Type 2 diabetes. I recommend this plant to clients concerned about this disease, either as part of breakfast or – my favorite – mixed with stevia, almond butter and cacao and rolled into “bliss balls”. It is best to take it regularly, as part of a long-term habit that includes real, bitter food and lots of movement. In this context it’s delicious, easy to take (doses are in the teaspoon range), and effective. 

The effect is, indeed, small when observed in isolation and for short periods of time. But diabetes (at epidemic levels) isn’t a problem that develops overnight, folks. I doubt anyone in the food industry, somewhere between the middle of the 19^thcentury and the middle of the 20^th, was saying “whoa - wait a sec, guys. I think that all this tasty sweet stuff (and elimination of all botanical biodiversity in the diet) might actually lead to epidemic levels of a sugar-metabolism disease in the next century!” No, that would have required seriously long-term thinking in matters of public health. And a little more knowledge of the human body.

Well, today we have a little more of  both. But research still looks at botanicals for three to four months most of the time – and this is partly because research is still beginning. When more time and interest are devoted to certain plants, such as the 2012 analysis that showed soy food consumption leads to lower recurrence of estrogen-positive breast cancer, striking results are revealed. But even this research only followed ten thousand women for seven years. Would that we had multi-generational followup data for cinnamon, endive, and dandelion roots! We might see a reversal of the grand experiment in carbohydrate refinement that gave us the current diabetes epidemic.

Short-term thinking gives us a need for dramatic, immediate results that might fit within the constraints of our current research model. This is great for many acute and chronic diseases, but not as great for matters of public health or for analyzing cultural patterns that lead to the diseases themselves.  Often, we learn about these matters from retrospective studies – discovering a problem after it’s already well-established. Long-term thinking takes a break and asks “if left alone, what might this situation look like?” Long-term thinking wonders how the river might handle a hundred-year flood if we hadn’t intervened to alter its course, how a population’s blood sugar might look if we hadn’t altered its food supply. 

Type 2 diabetes is a long-term effect of short-term thinking (satisfy my hunger now, and in a way that can be easily produced, stored, transported and packaged!) Its solution has to be based in long-term thinking, and part of that might very well include herbs such as cinnamon. The reason they are important is that, unlike a pharmaceutical solution, they provide an inroad to self-care based on whole plants and food – elements of life which, along with movement, end up being the keys to successful prevention of diabetes. If your mother started making cinnamon bliss balls when you were little, you might grow up eating them and eventually making them for your friends and family. Who knows what other bizarre plants you might consume along the way. Lo and behold, two generations later population levels of diabetes, obesity and heart disease are lower. I’d give you a rose to celebrate, but we all know there’s no research showing roses are effective as mood-lifters.

Some argue that, since the effect of a botanical such as cinnamon is small compared to conventional drugs, it should be rejected as part of our approach to diabetes. Ironically, the argument is that using cinnamon perpetuates a pill-driven, not lifestyle-driven, mentality for handling the disease. Call me crazy, but I’d respectfully argue that it’s probably pharmaceuticals that are driving this mentality, and that the search for a cinnamon capsule as an “alternative” is a first baby-step towards a different way. In the hands of an herbalist, baby steps turn into hikes in the forest. That could be a good thing – and a complex, multi-layered approach to diabetes that includes cinnamon most certainly is. 

Say what you will about an over-reliance on short-term clinical trials to drive therapy (or just read the British Medical Journal). Aside from the caveats (some of which I mention above), the approach is often a good one. But the offhand rejection of botanicals such as cinnamon, especially when they show promise, is actually harmful to public health. It is also a product of very short-term thinking. This is a problem that we need to resolve if we want to advance the cause of medicine and improve global quality of life – and herbalists, as those who, across the world, know what local plants do, are well placed to be part of the solution. Herbalists know the plants, but they also know that moving your vegetables over a little and supporting the community of cattail and calamus by the riverbank might be a better choice than a retaining wall, though it requires a (small) sacrifice in the short-term. Herbalists know that a bouquet of flowers makes you happy even though there’s not a single study out there to prove it. And they are usually inspiring teachers, too – the perfect choice for a diabetic patient. 

All this requires a change in thinking about medicine. We need to be looking further over the horizon, at a future where the advancement of our species sometimes includes a return to older technologies – not because they’re old, but because they’re damn smart in a long-term context. A future where we observe and mimic nature in designing our systems not because it’s “natural” but because, in the end, it’s in our own self-interest (global warming? Hundred year flood?). Herbal medicine fits in perfectly here. It is the precise modality that offers cultural connection, self-empowerment, ecological awareness, and effective remedies! It is both a blueprint for the future and a safety net for the present. As a design element for the next century of medicine, it can bring long-term thinking into a branch of science struggling with its own pressing challenges, helping it to harness the tools of complexity and deep ecology that are driving other industries. Long-term, complex herbal therapy won’t look as flashy in the short term – but that does not mean it has no value. Give it time, and skilled hands – a garden takes a season to come to fruit.

Plant medicine heals more than just people

We often discuss how effective plants can be at supporting and gently bringing human beings back to a state of "wellness" (meaning that resiliency, vibrancy, passion are maximized). I've spent a lot of time exploring how this happens, reading through the historical record and perusing modern research, and on balance it seems pretty clear that medicinal herbs, trees, mushrooms and more are good at helping folks in need. But that's not what I want to discuss today.
Rather, I'd like to posit the idea that working intimately with the botanical world alters our lives in ways that transcend individual health. Of course, this is not a surprising idea: reality mirrors itself, and the skin is barely more than an illusory boundary. Nevertheless, as a person whose life was redirected, and perhaps saved, by trees and herbs, I want to share three ways in which these allies can have powerful effects beyond the individual.

First, the people. Herbalists, gardeners, and other plant folk are consistently the most cooperative and compassionate people with whom I've had the pleasure of working. They share knowledge freely, contributing to a vibrant living oral (and now digital) tradition. They are often excellent communicators, speaking easily in language of metaphor and myth, forest and field. Even the most "beginning" herbalists have taught me amazing lessons and come up with amazing insights - which is why I avoid ranking plant people based on experience, training, or whatever else. Nature's gifts aren't reserved for the well-learned - and those of us who have spent a lot of time studying may find that, in the end, we return to the simple source of life for lasting truth, and books fall away in the light of the green world. This engenders gratitude, and may be the reason plant people are generally gentle, compassionate, and giving. They are often amazingly creative, too - coming up with new pictures, herbal formulae, and solutions where science falls short. I don't mean to disparage any way of "knowing", as all ways are necessary. I simply feel that knowing through plants is so very beautiful, and makes its people beautiful, too.

Next, herbal medicine has a way of reconnecting our species to nature. Clearly a no-brainer: we get outside more, we tend to eat differently, we appreciate a woodland walk differently when we have an intimate knowledge of the green folk living all around us. This gets into our heads slowly, insidiously, and deliciously. Before we know it, we may find ourselves kneeling on a city sidewalk looking at plantain (the horror)! But I feel like the gift of reconnecting to nature that herbal medicine offers us is most clearly evident in what happens when nature and wild plants are removed from human life: this is what, in Western culture, we've been working on for a few hundred years. The results are dramatic: epidemics of chronic disease affect the population, not because of the rise technological medicine, but because of a removal of traditional medicine! Additionally, to support homogenized, un-wild, unchallenging food systems we are also creating epidemics of chronic disease in the environment: new chemical signals that affect fertility, waste material that alters climate and ecosystem balance, disorganized living arrangements that sprawl over the landscape. I may be overly optimistic, but I believe that we don't need to remove technology to fix these issues: we simply need to bring plants back in to daily life. Once we develop the botanical habit, herbs begin to mess with our heads (where we all too often live). As we lose our heads, we save our spirit - and spirit being all-encompassing and transcending the human species, we participate in a more sustainable dance with the rest of nature.

Which leads me to my final point of appreciation for herbal medicine: mystery. Anyone who has seen a plant effect a cure knows that there is something magical about this process, as it may never be able to be replicated again. The herbalist, plant, and client have somehow managed to work together, in that one timeless moment, and the feeling all (plant included!) are left with is similar to what you feel when you run in to a random friend in a random place at just the right moment. It is synchronicity beyond coincidence, and we glimpse for an instant what it is like to be the immortal Universe. A healing modality that respects and welcomes mystery is my kind of medicine: because in the end, no matter how much we dress it up or understand its details, a human physiology brought back in to balance always reveals an awe-inspiring mystery. All good scientists know this. Einsten, for instance, tells us:

The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science. Whoever does not know it and can no longer wonder, no longer marvel, is as good as dead, and his eyes are dimmed.

I have great faith in the power of herbal medicine to heal not only people, but also culture, species, and ecology. It's really pretty simple: we really need plants in our lives. Even only a little bit. And once their green tendrils begin to grow in our hearts, like the first pea vines of spring, there is no turning back. Thank goodness - thank greenness.
In gratitude, I leave you with the words of Peter Conway, English herbalist, philosopher, and erstwhile humorist.

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