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A Cuisine for Medicine
The challenge we face today is figuring out how to escape the worst elements of the Western diet and lifestyle without going back to the bush.
MICHAEL POLLAN, IN DEFENSE OF FOOD
While I was growing up in Ferrara, Italy, my father would pick up my sister and me from school almost every Wednesday in a small, yellow Fiat 500. This was usually right before lunchtime (school days were short in Italy, but you didn’t get Saturday off). We would bump along cobblestone streets for a while and then stop outside a small shop that sold fresh-made pasta. I remember the smell of flour, and you could see some cooks in big white aprons mixing it with oil, eggs, and a little water to make noodles, lasagna sheets, or hand-shaped cappellacci (“bad hats,” usually filled with squash). Others were grinding whole cuts of prosciutto to mix with herbs and parmesan cheese. This would serve as the filling for cappelletti, a delicious dumpling similar to tortellini that was a local specialty. It was for these we had stopped. We would pick up a pound or so, wrapped in waxed paper, take it back to the car, and head home.
For lunch, the cappelletti were cooked in a vegetable stock my mother had prepared ahead of time (she taught English on Wednesdays) by simmering carrots, celery, onions, and garlic. Sometimes we’d eat the leftover vegetables—soft and juicy, barely holding together, but delicious and salty—as part of the meal. Other times, we just ate the pasta in a steaming bowl of broth, seasoned with a little grated parmesan. There would often be a salad, and my dad might have a glass of wine. Dessert was a cup of sweetened chamomile tea. We would talk or listen to the radio and all clean up together. All simple things, really—but very meaningful. Nothing too special, either: variants on this ritual were taking place all over the city.
Cuisine means “kitchen.” Kitchen, as opposed to restaurant. Kitchen, as opposed to supermarket. Kitchen, as opposed to gas station (where all too many find their food these days). By extension, cuisine is a set of kitchen habits that yield meals—meals usually prepared from simple, whole ingredients. Cuisine has matured over thousands of years and connects us to food, family, and our environment as few other things in life do. It is heartening to see a powerful movement in the United States that, at the beginning of the twenty-first century, seeks to reawaken (and reinvent) a strong, rooted cuisine that marries old ways of cooking with great new ideas on food production, distribution, and preparation.
One of the strongest voices articulating the case for a plant-centered, omnivorous cuisine in the United States is Michael Pollan. In The Omnivore’s Dilemma he explores how we manufacture what we eat, visiting farms that embody the pinnacle of modern industrialized agriculture and also farms that offer a much more diversified, organic vision of how to produce and consume food. His analysis gives us clarity: in order to achieve good health, we need not focus on the complexities of food refining, processing, and nutritional reenriching (based on what Pollan calls “nutritionism”). Rather, we need to eat real food and prepare it in real ways, ways that involve simple recipes with simple ingredients. In the end, we get to health without overthinking, because, as we’ve found out, when it comes to nourishing ourselves, overthinking the process hasn’t been at all helpful. And once we build a cuisine back into our lives, all sorts of other things change as well. You can’t find the best tortellini without getting to know the shopkeeper. The best vegetables come straight from a farmer at a market stand, not from a regularly misted cooler. You’ve got to spend some time hanging out and talking with your kids while you make and share a meal. All these changes foster relationship and connection, and the results become evident in our environment, in our villages and neighborhoods, and in our homes.
I am particularly keen on this analysis because it comes from someone whose perspective includes the idea that, somehow, plants are driving human behavior and culture. One cannot read Pollan’s account (in The Botany of Desire) of the tulip craze that swept Holland in the 1630s and not marvel at how these organisms, which have no feet and certainly no brains (as we know them), have employed us to serve their ends. They harness our desires. So when Pollan advocates for plants as a major, important component of cuisine, it’s coming from a person who knows that they are our active partners and not just commodities. Again, we see a relational view of the world.
The “Slow Food” movement (proposed as an alternative to a common type of restaurant) began in Italy and has become another leading voice advocating for a real cuisine. Carlo Petrini started this global phenomenon by standing up to McDonald’s in an effort to prevent it from opening a restaurant in historic, downtown Rome. Since then, the idea of regional food that celebrates traditional cuisine and is prepared with care has swept the Western world. In the United States there are myriad local chapters of Slow Food USA. They share recipes, gardening tips, and dinner-party schedules. At a national level, the organization is active in shaping legislation that affects food, such as the farm bill. It is a tangible manifestation of a shift that is happening in modern Western cuisine.
Another conscious food choice many people are making involves where their food is grown and made. The locavore movement seeks to support local agriculture and production, both for fruits, vegetables, meats, and grains and for value-added products, such as breads, sauces, cheeses, and beverages. Part of the concern here is the heavy investment in petrochemicals that centralized food production entails. But local food doesn’t just have a smaller carbon footprint. If you support local production, you support smaller farms, farmers’ markets, and local employment. You foster a community that comes together in the central square instead of the big-box-store parking lot. You might even get to know your farmer personally—or start raising chickens in your backyard. Nourishing ourselves with the plants and animals that breathe the same air, drink the same water, and walk on (or grow in) the same land as we do might have crucial repercussions for our individual health, too. Ultimately, the locavore movement strives for connection between people, land, and food—relationshipbased eating at its best.
Our culture’s understanding of the importance of real, whole food and where it comes from is increasing, and a new cuisine is being born. But I also hope to convince you that we might need to use some of these same ideas in our approach to achieving health and treating disease. Why do so many folks who buy all their food at the farmers’ market also purchase dietary supplements that are packaged in plastic and shipped from far-flung corners of the country (or the world)? To say nothing of the centralized, industrialized production of conventional medication.
Our food certainly is the foundation of medicine, to paraphrase Hippocrates. But throughout history, human beings (and animals, too) have supplemented their diet with a range of substances to prevent illness, treat disease, and feel vibrant, inspired, and connected. It’s sometimes hard to draw a line between what we eat and the medicines we use. Was that cup of chamomile tea at the end of lunch part of the meal or was it a therapeutic intervention? If you know anything about chamomile and its power to calm kids down, you might lean toward the latter categorization, but that’s not necessarily a given. Other times the distinction is clearer. No one would consider a simmered pot of willow bark tea, perhaps used to treat arthritis, to be food or even a pleasant addition to a family meal. And it might even be lethal to approach a substance such as acetaminophen (Tylenol) with the same relaxed attitude on dosing that we see with carrots.
These, then, are my questions: Might there be a cuisine for medicine? Can the kitchen serve as a pharmacy, a place where we cook up what keeps us healthy alongside what keeps us fed? These are not unreasonable questions, nor do they imply that modern medicine is something we need to eschew. I support local food systems, but I still love a well-made cappuccino. So while a good meal is the foundation of health, I think that we can take the concepts of whole foods, organic foods, and local food production and apply them to medicine as well. In so doing, we might uncover safe, effective, and easy strategies for managing the malaise of modern life, empower ourselves to become more involved in our well-being, and discover local, whole remedies we can grow and prepare ourselves instead of consuming a machine-manufactured pill.
TRADITIONAL HERBAL MEDICINE
Of course, such a “cuisine” for medicine already exists: it is called herbalism. This practice of using whole plants as medicine is actually the dominant form of primary care around the world. Three-quarters of the global population relies on herbs to treat disease.1 Modern innovations, such as surgical procedures and pharmaceutical agents, are useful complements to this age-old way of doing things, but in the United States they have supplanted it almost completely, much as the Western diet has supplanted real food. I think we can, and should, strive for a model where modern health care technology is used to supplement, rather than replace, traditional plant-based “slow medicine.”
On every populated continent, there are ways of healing that are driven by the local flora, and they are as diverse as the cuisines with which they share a kitchen. Some have coalesced into nearly monolithic systems, though every valley still has its own variant on the classic recipes. Even in Europe, where, in the sixteenth century, Paracelsus began applying solvent extraction techniques to plants and may thereby have started us down the path to modern pharmaceuticals, traditional whole-plant remedies are still widely used. So modern medicine is not simply today’s version of traditional European herbalism; it is a completely new and different phenomenon.
In the short term, contemporary medicine is unrivaled. Powerfully life-threatening imbalances, infections, and trauma are tended to systematically and effectively in ways that would have seemed magical or miraculous in Paracelsus’s time. The process of research associated with modern medicine continues to generate new insights into and understanding of physiology, biochemistry, and pathology—all the while providing the tools for the effective management of more long-term, deadly diseases, such as cancer, HIV, and advanced heart disease. Babies born prematurely, some weighing less than two pounds, can survive and go on to full, healthy, engaged lives. Diseases such as polio have been eradicated—eradicated!—from vast sections of the planet. I cannot comment on the long-term ecological implications of these changes, but no one can doubt that their public health impact in the twentieth century has been huge.
The purpose of incorporating traditional herbal medicine into modern life is to try to find an accessible system for addressing much more common (and less scary) complaints, a system that is understandable and can be easily implemented. As we shall see, herbalism satisfies these criteria while also positing a relational approach to healing and, more importantly, to health itself. In this sense, it is much more like cooking: something we all can learn, something that connects us to the garden. Pharmaceuticals are often like sledgehammers swatting mosquitoes; I am simply proposing that there may be a point to the techniques of more traditional medical models. For some of the more complex diseases of twenty-first-century life, these techniques may offer real solutions where modern medicine all too often lacks a gentle enough touch.
People will always desire some measure of involvement in their health. Even the most uninterested among us still practice basic hygiene (mostly). I hope to convince you that simple herbal medicine offers an effective way to enhance health and that when it is used this way it poses no risk, while yielding real benefits. These qualities make it useful as a model for the modern consumer desiring health care empowerment. It reconnects us to a whole-plant ecology and provides clarity in a sea of “nutritionism”-based (to borrow Pollan’s term) supplements, megadose vitamins, and druglike extracts. Its remedies stem from plants. They are real, they grow out of the soil, and they are alive. As we explore these plants, it will be worth examining the folk traditions to see what they have to say—both to get some guidance on how to best employ the herbs and also to see if traditional applications resonate with our modern understanding. In so doing, we might get some new ideas about what health really means.
One of the key strengths of a traditional medical system is the simplicity of the preparations that are used. Sure, there are some exceptions—just as there are in cooking. But crafting a simple distillation apparatus to make herbal spirits is just about as complex as it gets and certainly requires neither a chemistry lab nor analytical tools. A good soufflé might actually be more difficult to execute (at least for me). This immediately makes such a system accessible to a wide range of folks. You can grow, or often find wild, many of the remedies you might need for simple home care. And after you harvest them, it is very easy to prepare them for use.*1
First and foremost, herbal medicine is interwoven into cuisine itself. Thyme, often used to season fish and seafood, warms the digestion and improves the “feel” of the meal as we assimilate it. Chicken soup with a lot of extra garlic supports the body when it’s struggling with a respiratory infection. The roots of Astragalus and burdock, along with mushrooms, can be simmered into that same soup stock along with chicken bones and vegetables to promote resilience and help speed recovery from illness. And chocolate is divine taken hot in water, with a little local honey, and perhaps a pinch of cayenne pepper. Are these medicines or foods? Both! These few examples give us a feel for the role that medicinal plants have played in food preparation and should immediately give food lovers a new and exciting frontier to explore: recipes for our favorite dishes can be amended to include ingredients that have an application in keeping us healthy, vibrant, and inspired. Beyond that, it might be interesting to those who are passionate about their heirloom recipes to find that there is a strong physiological and medicinal basis for using the spices and combinations those recipes feature. It’s not just about flavor.
Though I’ve been lucky enough to sample some tasty lemon balm–lavender cookies, these plants are usually reserved for another type of preparation that sits in the gray area between food and medicine—the infusion, or tea. More than just a beverage, tea can have profound effects when taken habitually, week after week.*2 This is another incredibly simple way to bring plants into your life. Herbs are harvested and dried, or purchased dry, and four or five tablespoons are steeped in a quart of hot water, covered, for anywhere from five minutes to five hours (it depends what you’re going for). The infusion is then strained and taken with or without a little honey, hot or iced. Couldn’t be easier—and many of the plants I’ll explore in detail make delicious tea.
A more medicine-like preparation, though still quite simple, is the tincture. From the Latin tingere, meaning “to turn color” (the root of our word tint), it is simply an infusion that uses high-proof spirits instead of water. Herbs are steeped in 100 proof vodka and sealed tightly in a mason jar for three or four weeks (herbalists usually wait one full cycle of the moon). Then they are strained out, the fluid is retained, and it is taken at doses that range from a few drops to a teaspoon or so. This is certainly a little closer to a pharmaceutical (and just one hundred years ago, that is precisely what it was). But these preparations still cross over into cuisine, primarily behind the bar, and we are starting to see them used in custom “medicinal” liqueurs and cocktails that claim to be useful for digestion, mental health, coughs and colds, and even spring allergies.*3
All these simple ways of using plants can be incorporated into daily rituals that are performed in the kitchen. A drink before dinner may be custom-blended from a homegrown apothecary to suit the mood and complaints of the day. Afternoon tea may be a medicinal experience. And family meals can do more than simply nourish us with vibrant, local foods. With just a little attention to the recipe, they can help restore health and keep us well, using special ingredients that grow side by side with the tomatoes. It isn’t hard to do, nor, as we shall see, is medicinal activity tied only to one rare, exotic, magical plant. There is broad crossover between species, and this fact leads us to one of the central arguments of this book: even if you only learn to use one of each kind of plant (an aromatic, a bitter, and a tonic), you will experience benefits. Though the full science and art of herbal medicine may be quite complex, it is also incredibly simple to get started and begin to see results.
Just as cuisine brings friends and family together and gathers threads of local food production, terroir (the unique flavor of the place where food is grown), and history, using herbal medicine opens up a relational view of health and well-being that ends up changing how we see the world. For example, it is hard t...