Transform Your Self-Care and Health Care Through Ayurvedic And

ELDER

PICTURE OF HEALTH: TRANSFORM YOUR SELF-CARE AND HEALTH CARE THROUGH AYURVEDIC AND INTEGRATIVE MEDICINE is a user-friendly manual for patients seeking to improve their health by integrating the best of both holistic and conventional medicine.

Learn how and why to incorporate diet, daily routine, exercise, herbals, meditation, and other PICTURE OF HEALTH PICTURE modalities to enhance allopathic medical care to reverse disease and maximize wellness. • Fresh insights into how to maintain and improve your health OF HEALTH • When and how to eat to optimize digestion and health • Recipes and menu options for busy people who want to eat well • Answers to commonly asked questions about food and nutrition • Understand the different types of mind-body techniques, and which may be best for you Transform your self-care and health care through • Ideas and tips for improving pain and function that put you in control of your health • An overview of specific approaches tailored to particular health concerns Ayurvedic and Integrative Medicine

What makes this book particularly of interest is that the author is a conventional medicine provider, working in a large, comprehensive Charles R. Elder, MD, MPH, FACP, is a primary care internist and medical center, who has successfully integrated the physician lead for the complementary and integrative medicine alternative modalities into his practice. program at Kaiser Permanente Northwest, with a clinical faculty through Ayurvedic and Integrative Medicine and Integrative through Ayurvedic health care Transform and self-care your — Douglas Hanes, PhD, Associate Professor, School of Research appointment at Oregon Health & Science University. He advises and Graduate Studies; Chair, Master of Science in Integrative patients in the areas of diet, exercise, herbal medicine, mind-body MedicineL Research, National University of Natural Medicine practices, and other complementary medicine modalities. Q … In this book … one finds the presence of Leslie D. Elder, MD, practiced urgency care medicine for 15 years, two physicians with a good bedside manner and had a private integrative medicine practice focused on ayurvedic —or better said “life-side” manner—guiding herbal and dietary therapeutics. A talented visual artist and member of one to the potential for ayurvedic choices and the Oregon Society of Artists, she has participated in exhibits through tastes in one’s own health and healing. ORA Northwest Jewish Artists, the Oregon Watercolor Society, etc. — John Weeks, The Integrator Blog News & Reports; Editor in Chief, Journal of Alternative and Complementary Medicine COVER ART IMAGES BY LESLIE D. ELDER, MD COVER DESIGN BY LYNETTE LEISURE

$29.95 $29.95 ISBN 978-0-9770463-8-6ISBN 978-0-9770463-8-6 52995>

PRINTED IN THE USA PRINTED IN Charles R. Elder, MD, MPH, FACP, & Leslie D. Elder, MD The Permanente Press Portland, Oregon • Oakland, California 9780977 046386

Q What makes this book particularly of interest is that the author is a conventional medicine provider, working in a large, comprehensive medical center, who has successfully integrated alternative modalities into his practice. — Douglas Hanes, PhD, Associate Professor, School of Research and Graduate Studies; Chair, Master of Science in Integrative Medicine Research, National University of Natural Medicine Q Clinicians interested in the topic, or discouraged by vexing problems in clinical practice (as Drs Elder have been) would also like to have the material in this book as part of their tool kit, as would clinicians trying to come up with an appropriate and helpful way to assist their patients in navigating all the different care systems available. The most interested will be the consumer who wants to improve their health or self-management of chronic conditions and is open to an Ayurvedic approach. And there certainly is a need for clinician-focused books on this topic. — Keith H. Bachman, MD, Internal Medicine, Northwest Permanente; Medical Director for the Kaiser Permanente Northwest Severe Obesity/Bariatric Surgery program; Lead Physician for Weight Management for Kaiser Permanente’s Care Management Institute Q The audience should be individuals and health care providers with interest in healthy life style and approaches to chronic pain, based on Ayurveda and other complementary and integrative medicine approaches. It is palpable that the authors have worked with these recommendations with many patients, and this makes the reader feel confident to try out the approaches. — Tido von Schoen-Angerer, MD, MPH, Research, Associate ARCIM Institute, Filderstadt, Germany, and an Attending Pediatrician, Fribourg Hospital, Switzerland Li Q The techniques and approaches reviewed in this chapter are experiential. It is helpful to report more experiences with each treatment prescription, with case studies, to make those experiences more accessible, which the authors have done. With increased interest among my Kaiser Permanente colleagues in plant-based diets, I think there would also be an increased interest in Ayurveda, which I think is the main strength of this book. — Lonnie J. Lee, MD, L.Ac, Family Medicine, Integrative Medicine Specialist, Mid-Atlantic Permanente Medical Group Q Dr. Elder has a unique vantage point among medical doctors. He is ensconced in the values and practices of a medical delivery organization committed to examining what it does then seeking adjustments to get it right for patients. At the same time, he is an ayurvedic medicine practitioner imbued with decades-long commitment, with his physician spouse and co-author, to what may be called an ayurvedic lifestyle. I first came to know of Dr. Elder’s work when he published outcomes of an ayurvedic medicine intervention in the peer-reviewed literature. His whole-system research approach remains a beacon in the research community for those wishing to respect traditional medicine principles. In this book, one senses all of these rivers of interest at play. Gratefully, one mainly finds the presence of two physicians with good bedside manner—or, better said, “life-side manner”— guiding one to the potential for ayurvedic choices and tastes in one’s own health and healing. This book will be a life-enhancing resource for many. —John Weeks, The Integrator Blog News & Reports, Editor in Chief, Journal of Alternative and Complementary Medicine (Paradigm, Practice and Policy Advancing Integrative Health) PICTURE OF HEALTH

Transform your self-care and health care through Ayurvedic and Integrative Medicine

Charles R. Elder, MD, MPH, FACP, & Leslie D. Elder, MD Illustrated by Leslie D. Elder, MD

The Permanente Press Portland, Oregon • Oakland, California © 2019 by The Permanente Press Published 2019 by The Permanente Press Portland, Oregon • Oakland, California The Permanente Press is owned by The Permanente Federation, LLC Oakland, California PICTURE OF HEALTH: TRANSFORM YOUR SELF-CARE AND HEALTH CARE THROUGH AYURVEDIC AND INTEGRATIVE MEDICINE 23 22 21 20 19 1 2 3 4 5 ISBN: 978-0-9770463-8-6 Library of Congress Control Number: 2019944271 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, without permission in writing from the publisher. Permissions may be sought directly from The Permanente Press Publishing Office, 500 NE Multnomah Street, Portland, Oregon, 97232 USA; phone 503-813-3286, fax 503-813-2348. Artwork by Leslie D. Elder, MD Book design by Lynette Leisure Printed in the United States of America K TABLE OF CONTENTS

INTRODUCTION 1 A FEW THINGS THEY NEGLECTED TO MENTION IN MEDICAL SCHOOL How did two primary care physicians become interested in complementary and integrative medicine, and how do we use it in our practice?

PART I: THE BASICS 7 The basics of self-care everyone needs to know. CHAPTER ONE: A BRAND NEW OLD IDEA 9 Ayurveda, an ancient system of holistic health care, provides fresh insights into how to maintain and improve your health. CHAPTER TWO: WHEN DO WE EAT? 19 When and how to eat to optimize digestion and health. CHAPTER THREE: WHAT’S FOR LUNCH? 29 Recipes and menu options provide practical guidance for busy people who want to eat well. CHAPTER FOUR: GLUTEN, DAIRY, AND A FEW MORE SURPRISES 47 Answers to some of the most commonly asked questions about food and nutrition. CHAPTER FIVE: SHOW ME THE MENU! 59 Menus specifically tailored to individual constitutional types. CHAPTER SIX: EARLY TO BED, EARLY TO RISE, EXERCISE 67 IN THE MORNING, AND HAVE A DECENT LUNCH How and why to optimize your daily routine.

PART II. GENERALLY SPEAKING 73 An overview of approaches we recommend to most patients, and a review of contemporary topics in the field of complementary and integrative medicine. CHAPTER SEVEN: MIND YOUR BODY 75 Understand the different types of mind-body techniques, and which may be best for you. CHAPTER EIGHT: DRUG, SUPPLEMENT, OR FOOD? 83 Which herbs work, which don’t, and who’s to say? CHAPTER NINE: IS ACUPUNCTURE JUST PLACEBO? 95 Do acupuncture, chiropractic manipulation, and massage work for pain management? Explore what’s really behind the science. viiiL K

CHAPTER TEN: MODALITY OR SYSTEM? 105 Naturopathy, homeopathy, functional medicine, and more. Why is it so difficult for your primary care physician and naturopath to work together, and what can be done about it?

PART III. LET’S GET SPECIFIC 113 An overview of specific approaches tailored to particular health concerns. CHAPTER ELEVEN: MORE TO DIGEST 115 Practical guidelines for improving common digestive problems, including constipation, irritable bowel syndrome, food intolerances, and heartburn. CHAPTER TWELVE: MANAGING WITH CHRONIC PAIN 123 Ideas and tips for improving pain and function that put you in control of your health. CHAPTER THIRTEEN: TO STATIN OR NOT TO STATIN? 133 Holistic approaches to help with high blood pressure, obesity, diabetes, and cardiovascular disease, including how to make the smartest choice about statin medication. CHAPTER FOURTEEN: IMPROVING CANCER CARE 143 How integrative medicine can help you take better care of yourself during cancer treatment. CHAPTER FIFTEEN: HORMONAL CHANGE 147 Healthy alternatives to pharmaceutical and hormonal therapies for women’s health and menopause. CHAPTER SIXTEEN: LOSE YOUR TV 153 Topics related to the care of children, including ADHD, vaccinations, and respiratory congestion. CHAPTER SEVENTEEN : CONCLUSION 157 The Picture of Health. RESOURCES 161 GLOSSARY 163 BIBLIOGRAPHY 165 ACKNOWLEDGMENTS 173 INDEX 175 ABOUT THE AUTHORS 182 ixL K INTRODUCTION

A FEW THINGS THEY NEGLECTED TO MENTION IN MEDICAL SCHOOL

How did two primary care physicians become interested in complementary and integrative medicine, and how do we use it in our practice? I, Charles Elder, was one of those guys who was born with stethoscope already in hand. Ancestors and fate apparently had preselected my career track in medicine quite some time before I was even conceived. After a 17-year incubation period in Northeast Ohio, and having finally completed high school, I grabbed my stuff, hopped into the family Buick, and headed East. The next day, my dad dropped me off at Warren Towers at Boston University. This enormous dormitory housed 1800 students, 600 apiece in each of 3 adjacent towers. The location was excellent, with convenient access both to university resources and to all of Boston’s amenities. However, with the Massachusetts Turnpike on the one side, and Storrow Drive, a major crosstown parkway, on the other, it presented, compared with my small hometown in Ohio, an intensely urban environment. On top of that, although at my Ohio high school I was a star student, the academic atmosphere in college was extremely competitive, and in my medical studies program at Boston University, I was just one of the pack. Needless to say, I felt highly stressed and wondered to myself, “Am I in over my head?“ Desperate for a creative solution, I sought out training in a wide variety of mind-body and stress management techniques. I visited the Zen Center, the Kundalini Yoga Center, and the Transcendental Meditation Center. I enrolled in a Tai Chi class at the University. I studied, or experimented with, a large number of other more obscure approaches and techniques as well. Many of these techniques I found to be compelling and beneficial. For me, the one most beneficial, and the one that stuck with me, was Transcendental Meditation. I found that if I had a tension headache, I would meditate, and the headache would go away! After hours of studying, I’d get brain fog and couldn’t concentrate. Then I would meditate, clearing the cobwebs from my head, and I could again concentrate on L1 PICTURE OF HEALTH

my studies. “My gosh,“ I thought to myself, “this is really benefiting me.“ I have continued to meditate on a regular basis since, and as relates to medical education, would offer two comments: 1) I surely would not have survived the rigors of medical training without this valuable stress reduction tool and 2) the experience of regular meditation practice radically shifted my perspective on medical training. Although I was very fortunate to receive an excellent education in biomedicine, I retained a nag- ging awareness that the model of care I was learning was fundamentally incomplete. We commonly managed patients with chronic dosing of potentially dangerous and addictive drugs, offering no attempt at or even mention of self-care approaches that I knew from personal experience to be extremely effective. “This patient has been into our emergency room 3 times during the past 2 weeks for demerol injections for his headaches. Why isn’t anyone advising him to learn to meditate?” I would wonder. “This patient is taking 15 mg of valium daily to manage her anxiety, why isn‘t anyone telling her to meditate?” I found all this especially perplexing because I had been taught to value scientific evidence as a basis for therapeutics, and at that time there was already data in the literature supporting the use of mind-body approaches for such conditions.1 When I was a student, the fact that safe, noninvasive, effective approaches were available but going unmentioned in favor of potentially hazardous drug therapy impressed me as strange. Today, having accrued 3 decades of clinical experience, it still impresses me as strange! After graduating from medical school, I began my internship and residency training in internal medicine at the University of Michigan Hospitals in Ann Arbor, where I met my wife (LE), who was a resident physician in the family medicine program. Toward the end of our residency training, my wife said to me, “Hey, Charles, the Cleveland Transcendental Meditation Center is sponsoring a weekend meditation retreat at Oberlin next month. We should go.” We attended the retreat and found it relaxing and enjoyable. As it turned out, one of the speakers at the retreat was a prominent physician from the faculty at The Ohio State University School of Medicine, who gave an engaging talk about the research program in his laboratory investigating the antioxidant and antineoplastic properties of some traditional ayurvedic herbal formulas.2,3 I found the talk fascinating. This was the first time I had heard about ayurveda, the traditional health care system of India. The experience inspired my wife and me to seek additional clinical training in ayurveda to supplement our conventional medicine skills. During the following years, through continuing education and fellowship training, we gained invaluable knowledge 2L Introduction

and skills in areas in which our conventional medicine training had been sadly lacking: diet, daily routine, exercise, mind-body medicine, herbal supplements, and the like. After completing residency, we moved to Portland, Oregon, where I joined the medical staff at Kaiser Permanente Northwest. This has been a terrific place to practice, and I have had the privilege of serving as primary care physician to many thousands of Kaiser Permanente patients during a span of more than 25 years. But there is more to that story. After 5 or so years of full-time clinical work, I grew exceedingly frustrated with conventional primary care internal medicine practice. Burnout was setting in. In retrospect, I attribute this not to the work hours, but rather to the mismatch between the tools in my conventional medicine toolkit and the types of problems my patients actually presented with. Conventional medicine can be compelling and effective for the acutely ill patient, but for those with more chronic conditions, the paradigm often falls short. In addition, a substantial percentage of patients present to primary care medicine clinics not with a solitary crisp and clear concern, but rather with multiple complaints of a more vague or uncertain nature, and/or unrecognizable patterns of symptoms to which no diagnosis can be confidently assigned. (This is another important fact about medical practice that is not mentioned in medical school!) After about 5 years I finally had to ask myself, “Why are these patients coming to see me?” On many days, patients with chronic problems, such as musculoskeletal pain, depression, fatigue, irritable bowel, or fibromyalgia, represented the lion’s share of the work, and yet these syndromes remain poorly understood, and are often inadequately managed, using a narrow, conventional medicine toolkit. At the same time, I had gained skills in a different paradigm, ayurveda, which I knew from my training, personal health practice, and the literature, to be potentially effective for such cases. Yet the conventional medicine system viewed the ayurvedic paradigm, and the types of holistic interventions it offers, as unorthodox. If, out of the blue, I started using them, I might land myself in trouble. Eventually I submitted a written proposal to my supervisors. First, I pointed out that many patients presenting to primary care internists bring problems that are not always well managed using the prescription drugs we offer. This fact is obvious enough to most anyone spending significant clinical time in an outpatient internal medicine practice. I then described the ayurvedic approach to a number of these conditions, the prescribed interventions along with their rationale, and suggested a pilot program introducing this approach into my primary care practice. For specific subsets of patients, when clinically L3 PICTURE OF HEALTH

appropriate and with the patient’s consent, we would attempt an ayurvedic dietary, behavioral, and herbal protocol. I developed a questionnaire instrument to be sent to patients a month after the consultation to find out if they were satisfied with their care, and if their condition had improved. During the period of a couple of months, I gathered data on about a dozen patients, with rave reviews. These data favorably impressed my leadership team. The pilot project morphed into a referral-based clinic, where I provided integrative medicine consultations, coordinat- ing ayurvedic prescriptions with conventional medical therapeutics, to a wider group of patients. Initially, I staffed this integrative medicine clinic one half-day a month, then a half-day a week, and over time the clinic has grown to encompass a substantial percentage of my practice. I am grateful to Kaiser Permanente Northwest for providing the oppor- tunity to develop this program, which has been essential for both the welfare of many of our patients as well as my own professional satisfaction. There remained, however, a significant logistic hurdle. Ayurveda is radically different from conventional medicine. The concepts, approach, and paradigm are foreign to the community we serve. How can a physician, during the course of a typical 20-minute office visit, orient the patient to understand the rationale and approach underlying a multimo- dality ayurvedic prescription? To solve this dilemma we introduced a unique program featuring group clinics. At our integrative medicine clinic, the patient’s first appointment is not an ordinary visit with the physician, but rather a 2-hour group visit, attended by the physician (CE) along with typically 6 to 10 patients. At this group appointment, patients learn the fundamental vocabulary and paradigm of ayurveda, and receive a set of general dietary and lifestyle recommendations. Each patient returns home and begins implementing the self-care instructions. Then, a few weeks later, the patient returns for an individual consultation with the physician, at which time a full assessment takes place, and the physician prescribes an individually tailored treatment program. Drawing upon our experience with thousands of patients, we developed this book to provide both a manual for patients seeking complementary and integrative care, and a source book for their physicians. The material in Chapters One through Six reviews and expands the curriculum from the introductory group visit, with the remaining chapters providing information, resources, and protocols to support each patient’s individualized therapeutic program. Although many publications are available on both integrative 4L Introduction

medicine and ayurveda, this book offers timely contributions. The narrative reflects more than 2 decades of clinical experience practicing integrative medicine and ayurveda in a conventional managed care setting. How can health care organizations best integrate ayurveda, acupuncture, and other compelling approaches in ways that are authentic, feasible, useful to both patients and physicians, compatible with the conventional medicine culture, and scalable? This book provides new direction. We aim to empower both patients and physicians to evolve beyond the prevailing confusion in the complementary and integrative medicine arena. We believe you will find inspiration, clarity, insights, and ideas that will enable you to relieve symptoms, reverse health challenges, and optimize wellness. Finally, although the text reflects our integrative medicine practice in Oregon, we cre- ated much of the content, including most of the artwork (by Leslie Elder), in 2017 while on sabbatical in Jerusalem. We wish to express our gratitude to Northwest Permanente for sponsoring the sabbatical, and for making this project possible.

— Drs. Charles & Leslie Elder

L5 K INDEX

A ayurveda abhyanga, 127–129 adopting gradually, 158–159 achiness. see chronic pain authors’ early experience with, 2–4, 157 acupuncture, 95, 97–104 definition of, 163 ADHD (attention deficit hyperactivity disorder), 153–154 doshas. see doshas aging, 150–152. see also lifetime cycle; menopause health (balance) as defined in, 10–11, 19 agni. see digestion imbalances in. see imbalances (vikriti) air element, 13 integrating with conventional medicine. see integrative alcohol consumption, 56 medicine Alexander Technique, 129 modalities in, 10. see also diet; exercise; herbal supplements; yoga allopathic medicine. see conventional medicine overview of, 9–11 alphalipoic acid, 87 alternative medicine, 163. see also complementary medicine B ama. see toxins Bacopa (Brahmi), 90, 130, 152 ama pachana, 123–126 beans (legumes) Amalaki, 119 combining with grains, 34–35 amrit kalash, 144 kapha-pacifying, 65 anger, 14 pitta-pacifying, 64 anti-inflammatory medications, 123, 129 preparing, 35–38 antioxidants, 87, 144–145 recipes for, 37–38, 40–43 anxiety vata-pacifying, 62 with chronic pain, 130 behavioral rasayana, 80 with menopause, 150 beverages patient testimonials regarding, 81–82, 121 recipes for, 50, 51, 144 treatments for, 2, 79, 80, 130 temperature of, 24–25 as vata imbalance, 13 bidoshic, 15 aromatherapy, 130 “billiard ball” approach, 9 arthritis. see also chronic pain biofeedback, 133 acupuncture for, 102 birth control, 148 ama resulting in, 20 bitter gourd, 135 fasting for, 124 bitter taste, 59–61 herbal supplements for, 84, 87, 88, 89–90 black cohosh, 89 naturopathic treatments for, 108 Blissful Joy supplement, 130 Tai Chi for, 79 bloating, 118 asafetida (hing), 32 blood pressure, high. see high blood pressure Ashwagandha, 90, 130, 148 blood sugar, rising after meals, 23. see also diabetes aspirin, 83–84 body types. see constitutional types astringent taste, 59–61 Boswellia, 89–90 attention deficit hyperactivity disorder (ADHD), 153–154 bowel movements automatic self-transcending meditation, 77–78 constipation, 14, 115–118, 129–130 Avipattikar Churna, 119 irritable bowel syndrome, 89, 96–97, 108, 118 loose, 68, 118 sticky, 118 175L PICTURE OF HEALTH

Brahmi (Bacopa), 90, 130, 152 conventional medicine brain fog, 1, 21 contrasting with complementary medicine, 9 breakfast definition of, 163 content of, 24, 26, 27 integrating with complementary medicine. see integrative as optional, 22, 23 medicine butter, 51–52 limitations of, 2–3 cooking, 25–26. see also recipes C cooking oils, 52 caffeine, 57, 157 cooling foods, 60–61 calcium, 150–151 coronary artery disease, 135, 139 cancer care, 143–145 cramping, 118 cancer prevention, 145 cranberry concentrate, 89 Caraka Samhita, 9 Crockpot Apples recipe, 26 cardiovascular disease, 79, 88, 139–142 celiac disease, 47–48 D cheese, 50 daily menus. see diet Chinese medicine, 9, 79, 105–106. see also acupuncture; daily routine, 67–71, 115, 158–159 qigong; Tai Chi dairy chiropractic care, 103 guidelines for consuming, 27, 48–52 cholesterol levels, 139 kapha-pacifying, 65 chromium, 135 pitta-pacifying, 64 chronic pain. see also arthritis; headaches; low back pain recipes for, 50, 51 ama resulting in, 20–21, 123 vata-pacifying, 62 case study regarding, 131 dementia, 17, 152 patient testimonial regarding, 121 depression treatments for, 83–84, 89–90, 102–103, 106, 123–130 ama resulting in, 21 cinnamon, 135 with chronic pain, 130 circadian clock, 22–23 as kapha imbalance, 14 coenzyme Q10, 87–88, 142 with menopause, 150 cold (illness), 61, 89 patient testimonial regarding, 121 cold foods and beverages, 24–26, 48–49, 56, 61 treatments for, 80, 87, 126, 130 complementary medicine detoxification authors’ early experience with, 3–5 hot water for, 25 contrasting with conventional medicine, 9 menstrual period as, 148 definition of, 163 panchakarma, 126 integrating with conventional medicine. see integrative treatments for, 123–126 medicine diabetes types of. see ayurveda; Chinese medicine; functional medicine; diet for, 24, 92, 135–139 homeopathy; naturopathy as kapha imbalance, 14 constipation, 14, 115–118, 129–130 neuropathy with, 87 constitutional types (prakriti) treatments for, 134–135, 141–142 definition of, 163 diagnostics, 4, 16–17 determining, 11–16 diarrhea, 89 menus for, 62–66 diet. see also foods contraceptives, 148 beverages, guidelines for, 24–25 contrary foods, 136 changing gradually, 158–159 176L Index

cooking, guidelines for, 25–26 elements, doshas associated with, 13–14 for diabetes, 24, 92, 135–139 endometriosis, 148 eating environment, 54 energy, life force. see qi (vital life force) effects on the mind, 53 energy, low, 21, 126 kapha-pacifying menu, 65–66, 120 esophageal reflux, 118, 119–120 light diet, 143–144 exercise mealtimes, guidelines for, 21–23 for cardiovascular health, 139 for menstrual disorders, 148 for chronic pain, 126 patient testimonial regarding, 152 for depression, 130 pitta-pacifying menu, 63–64, 119–120 eating before or after, 69 snacks, guidelines for, 23–24 for high blood pressure, 133 types of, options for, 10 times for, 68, 70 types of, recommended, 27, 52–53 types of, 69 vata-pacifying menu, 62–63, 118–119 for weight management, 134 digestion (agni) health defined with, 19 F mealtimes affecting, 21–23 fatigue, 21, 108, 120, 123, 126 pitta dosha governing, 10, 14 Feldenkrais method, 129 time required for, 23–24 fenugreek, 135 digestive problems fibromyalgia, 20. see also chronic pain constipation, 14, 115–118, 129–130 fire, digestive. see digestion food allergies, 120 fire element, 13–14 irritable bowel syndrome, 89, 96–97, 108, 118 fish, 27 kapha imbalances, 118, 120 fish oils, 88 pitta imbalances, 118, 119–120 flax seed oil, 88 vata imbalances, 118–119 focused-attention meditation, 77–78 dinner, 21, 24, 26, 27, 45, 117 food allergies, 120 doshas. see also kapha dosha; pitta dosha; vata dosha foods constitutional types based on, 11–16 contrary foods, 136 daily cycle of, 67–70 qualities of, 59–61 definition of, 163 types of. see beans (legumes); fruit; grains; meat; oils; spices; exercise based on, 69 sweeteners; vegetables imbalances associated with, 13–14, 16, 118–120 Fosamax, 151 lifetime cycle of, 17–18, 67 fructans, 48 overview of, 10–11 fruit seasonal cycle of, 15, 17, 67, 149, 151 for constipation, 116–117 drugs. see medications freshness of, 54 dry foods, 60–61 kapha-pacifying, 66 dryness, 14 pitta-pacifying, 64, 119 preparing, 26, 57 E recipes for, 26 earth element, 13–14 for snacks, 23, 27 eating environment, 54 vata-pacifying, 63, 118 Echinacea, 89 functional medicine, 110–111 eczema, 108 eggs, 27 177L PICTURE OF HEALTH

G safety of, 85 Garbanzo and Potato Indian Stew recipe, 43 spices as, 92 garnishes, recipes for, 44–45 used in ayurveda, 89–90, 91–92, 144 gas, 118 high blood pressure, 14, 78, 79, 133, 139 gastrointestinal problems. see digestive problems high blood sugar. see diabetes ghee, 51–52 hing (asafetida), 32 ginger, 44 Hingavashtak Churna, 119 gingko biloba, 89, 152 holistic health care, 163. see also ayurveda; Chinese medicine; glucosamine, 88 functional medicine; naturopathy glucose tolerance, 69. see also diabetes homeopathy, 110 gluten, 47–48 honey, 57 grains hormonal balance, 151 kapha-pacifying, 65 hormone replacement therapy (HRT), 149–150 pitta-pacifying, 63 “hot flash relief” tablets, 150 portions of, 29 hot flashes, 149, 150 preparing, 33–34 HRT (hormone replacement therapy), 149–150 recipes for, 34 hyperacidity, 118, 119–120 vata-pacifying, 62 hyperglycemia. see diabetes grazing, 23–24. see also snacking hypertension. see high blood pressure Green Sauce recipe, 44 guggul, 139 I imbalances (vikriti). see also specific illnesses or conditions H definition of, 11, 16, 163 headaches diagnosing, 4, 16–17 causes of, 116, 129–130, 148, 157 doshas associated with, 13–14, 16, 118–120 treatments for, 1–2, 102, 108 inflammation, 14, 20, 83, 89–90 health (balance), 10–11, 19–20 insomnia, 14, 79, 88 heart disease. see cardiovascular disease insulin, 24. see also diabetes heart palpitations, 14 integrative medicine heartburn, 14, 119–120 authors’ early experience with, 3–5 Hearty Lentil Stew recipe, 40 with complementary medicine modalities. see modalities heat, dosha governing, 13 definition of, 163 heating foods, 60–61 with other systems of care, 106–111 heavy foods, 60–61 irritable bowel syndrome, 89, 96–97, 108, 118 herbal supplements Italian White Bean Soup with Sage recipe, 42 for chronic pain, 129 compared to drugs, 83–84 J for diabetes, 135 jetlag, 88 effectiveness of, 84, 92–93 forms of, 90–91 K interactions with medications, 85–86 Kanji Water recipe, 144 limiting number of, 93 kapha dosha list of, 86–89 definition of, 10, 14, 163 for lowering cholesterol, 139 exercise recommended for, 69 mixtures of, 91–92 imbalances associated with, 14, 118, 120 quality of, 84–85 menu that pacifies, 65–66, 120 Khichari recipe, 38, 144 178L Index

L menopause lactose intolerance, 49 postmenopause, 94, 150–151 lactovegetarian diet, 27, 52–53, 61–66 symptoms of, remedies for, 89, 108, 149–150 lassi, 50–52 as transition from pitta to vata, 17–18, 149 leftovers, 54 menstruation, 130, 147–149 legumes (beans) mental functioning. see also ADHD; mind-body techniques combining with grains, 34–35 affecting physical outcomes, 75, 95 kapha-pacifying, 65 with aging, 17, 151–152 pitta-pacifying, 64 circadian clock affecting, 69 preparing, 35–38 foods affecting, 53 recipes for, 37–38, 40–43 herbal supplements for, 90, 152 vata-pacifying, 62 menus. see diet Lemony Vedic Pesto recipe, 45 metabolism, pitta dosha governing, 10, 14 lifetime cycle, 17–18, 67 microwave oven, avoiding use of, 55–56 light diet, 143–144 migraine headaches, 84, 86, 129–130 light foods, 60–61 MigreLief, 86, 130 low back pain, 79, 99–100, 103 milk, 48–50 lunch mind, functioning of. see mental functioning content of, 26, 27, 29–38 Mind Plus supplement, 130 as main meal, 21–23, 24 mind-body techniques recipes for, 31, 34, 37–38, 39–45 behavioral rasayana, 80 meditation. see meditation techniques M overview of, 81 massage qigong, 79, 81 Ayurvedic oil massage. see abhyanga Tai Chi, 79, 151 benefits of, 103, 130, 149, 152 yoga, 79, 126 with panchakarma, 126 Mindfulness-Based Stress Reduction (MSBR), 79 mealtimes, 21–23 modalities meat, 27, 35, 53, 61, 144 in ayurveda, 10. see also diet; exercise; herbal supplements; medications yoga acid-reducing, 119 in Chinese medicine. see acupuncture; qigong; Tai Chi blood pressure medications, 133 compared to systems of care, 106 compared to herbal supplements, 83–84 integrative medicine using, 105–106 insulin injections, 24 monodoshic, 15 interactions with supplements, 85–86, 87, 93 movement, vata dosha governing, 10, 13 for osteoporosis, 151 MSBR (Mindfulness-Based Stress Reduction), 79 pain medications, 83–84, 123 mucus, excess, 15, 17, 118 statin medications, 87–88, 139–142 meditation techniques N benefits of, 75–76 napping, 71 Mindfulness-Based Stress Reduction (MSBR), 79 nasya, 127 patient testimonials regarding, 81–82 naturopathy, 105–110 Transcendental Meditation (TM), 1–2, 78–79, 133–134, 139 nausea, 118 types of, 76–78 neuropathy, 87 melatonin, 88 nutrients (ojas), 19, 163 Mellow Slow-Cooking Grains recipe, 34 179L PICTURE OF HEALTH

nuts Q kapha-pacifying, 65 qi (vital life force), 79 pitta-pacifying, 64 qigong, 79, 81 for snacks, 23, 27 vata-pacifying, 62 R rajasic foods, 53 O rasayana, 44, 80, 91, 144 obesity, 14. see also weight management rashes, 14 oil massage. see abhyanga recipes oils for beans (legumes), 37–38, 40–43 for cooking, 52 for beverages, 50, 51, 144 kapha-pacifying, 66 for dairy, 50, 51 pitta-pacifying, 64 for fruit, 26 spiced, 31–32 for garnishes, 44–45 vata-pacifying, 63 for ghee, 51 oily foods, 60–61 for grains, 34 ojas. see nutrients for vegetables, 31 open monitoring meditation, 77–79 red yeast rice, 139 opioid medications, 123, 129 religion, 80 organic foods, 56 resperate device, 133 osteoarthritis, 20, 84, 87, 88, 102, 108 respiratory conditions, 15, 17, 21, 155–156 osteoporosis, 17, 150–151 rheumatoid arthritis, 124 overweight, 14. see also weight management risk reduction, 140–141 routine. see daily routine P pain, chronic. see chronic pain S panchakarma, 126 salty taste, 59–61 Parkinson disease, 79 sattvic foods, 53 peppermint oil, 89 saw palmetto, 89 pitta dosha schedule. see daily routine definition of, 10, 14, 163 seasonal cycles, 15, 17, 67, 149, 151 exercise recommended for, 69 sinus conditions, 14, 60–61, 127, 129, 155 imbalances associated with, 14, 118, 119–120 skin rashes, 14 menu that pacifies, 63–64, 119–120 sleep, 69–71 transition to vata time of life, 17–18, 149 slow cooker, recipes for, 39–43 placebo effect, 95–99 “smooth cycle” tablets, 148 postmenopause, 94, 150–151 snacking, 23–24, 49 poultry, 27, 61 sour taste, 59–61 prakriti. see constitutional types space element, 13 probiotics, 88–89 Spiced Steamed Vegetables recipe, 31 protein. see also gluten spices complete, 34–35 kapha-pacifying, 65 portions of, 29 for milk, 50 sources of, 35, 48, 53 pitta-pacifying, 63 psychometabolic principles of ayurveda. see doshas vata-pacifying, 62 pulse diagnosis, 16–17 for vegetables, 31–32 pungent taste, 59–61 Spicy Milk recipe, 50 180L Index

Split Mung Dal recipe, 37 V St. John’s Wort, 87, 130 vaccinations, 154–155 statin medications, 87–88, 139–142 vata dosha stiffness, 21, 123 definition of, 10, 13–14, 163 stress reduction, 75, 78–79, 80, 90 exercise recommended for, 69 strontium, 151 imbalances associated with, 13–14, 118–119 structure, kapha dosha governing, 10, 13 menu that pacifies, 62–63, 118–119 supplements. see herbal supplements; vitamin supplements transition from pitta time of life to, 17–18, 149 sweet taste, 59–61 vegan diet, 52–53, 94 sweeteners vegetables honey, 57 guidelines for consuming, 26 kapha-pacifying, 65 kapha-pacifying, 65 pitta-pacifying, 64 pitta-pacifying, 64 vata-pacifying, 63 portions of, 29 systems of care, 106. see also ayurveda; Chinese medicine; preparing, 29–32 functional medicine; homeopathy; naturopathy recipes for, 31 spices for, 31–32 T vata-pacifying, 62 Tai Chi, 79, 151 vegetarian diet, 27, 52–53 tamasic foods, 53 vikriti. see imbalances tastes, types of, 59–61 vitamin supplements, 93–94, 135, 150–151 Tasty Fast-Cooking Grains recipe, 34 temper flares, 14, 157 W temporomandibular joint dysfunction, 108 water element, 13–14 Thermos-Cooked Lunch recipe, 55 weight management, 14, 21, 33, 60, 133–134, 143 thermoses, 39, 55 Western medicine. see conventional medicine thyroid disorders, 108–109 women’s health TM. see Transcendental Meditation birth control, 148 toxins (ama). see also detoxification endometriosis, 148 definition of, 163 menopause, 17–18, 89, 108, 149–150 overview of, 19–21 menstruation, 130, 147–149 traditional medicine postmenopause, 94, 150–151 of China. see Chinese medicine vaginitis, 148–149 of India. see ayurveda Worry Free supplement, 130 Transcendental Meditation (TM), 1–2, 78–79, 81–82, 133–134, 139 transformation, pitta dosha governing, 10, 14 Y tridoshic, 15 yoga, 79, 126 Trikaru Churna, 120 yogurt, 50–51 triphala, 91, 149 turmeric, 87 Z Zesty Split Pea Soup with Carrots recipe, 41 U zinc lozenges, 89 urinary tract infections, 89 181L ABOUT THE AUTHORS

Charles R. Elder, MD, MPH, FACP, received his MD and MPH degrees from Boston University School of Medicine, and completed residency training in internal medicine at the University of Michigan hospitals. He has served as a primary care internist at Kaiser Permanente Northwest (KPNW) for 26 years and has been the physician lead for the complementary and integrative medicine program at KPNW for 18 years. In this capacity, Dr. Elder offers a referral-based integrative ayurvedic clinic for KPNW patients, advising patients in the areas of diet, exercise, herbal medicine, mind-body practices, and other complementary medicine modalities. He has also provided leadership in shaping and implementing policy related to management of chiropractic, acupuncture, naturopathy, and other complementary medicine benefits. Dr. Elder holds a Senior Investigator appointment at the Kaiser Permanente Center for Health Research, where he has served as principal or co-investigator on a range of federally funded studies evaluating mind-body and other complementary medicine interventions in the setting of chronic disease management. He also has a clinical faculty appointment at Oregon Health and Science University, and for more than 2 decades has mentored and taught residents and students in both internal and integrative medicine settings. He has published 59 articles and abstracts in peer-reviewed scientific journals, and his research has been widely publicized in local, national, and international media outlets.

Leslie D. Elder, MD, received her MD degree from the University of Nevada School of Medicine, and completed residency training in family medicine at the University of Michigan hospitals. She practiced urgency care medicine for 15 years, during which time she also maintained a private integrative medicine practice focused on ayurvedic herbal and dietary therapeutics. Dr. Elder is both an accomplished gourmet vegetarian cook as well as a talented visual artist (www.leslieelder.com). Her work has been displayed in multiple venues through ORA Northwest Jewish Artists, the Oregon Watercolor Society, and in other settings. She is a member of the Oregon Society of Artists. 182L ELDER

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