Introduction to traditional Chinese medicine food therapy (Proceedings)

Western Nutrition

Besides water, the most critical component considered in a diet is energy.

• Gross Energy → Digestible Energy → Metabolizable Energy

o Gross Energy: Caloric value of food

o Digestible Energy: Energy that is available for absorption across the intestinal mucosa

o Metabolizable Energy: Amount of energy available after losses in urine and feces. Value most often used to express energy content of pet food ingredients

• Energy Density (number of calories/volume or weight of food)

o Most important factor in determining the quantity of food an animal should eat/day

Food broken down into components

• Carbohydrates

• Fats

• Protein and Amino Acids

• Vitamins

• Minerals

Sources of these components not necessarily evaluated

• Differences in bioavailability

Digestion and absorption start in the mouth and continues throughout the GI system

• Small intestine (duodenum, jejunum, ileum)

o Most of chemical digestion and absorption of nutrients

• Large intestine (colon)

o Mostly involved in water absorption and certain electrolytes, most notably sodium

Two sets of published standards that provide nutrient requirements for dogs and cats

National Research Council (NRC)

• Lists of minimum nutrient requirements

Association of American Feed Control Officials (AAFCO)

• Nutrient Requirements of Dogs and Nutrient Requirements of Cats

o Lists of minimum daily requirements of nutrients for dogs and cats

Traditional Chinese Medicine

Complete system of medicine

• Diagnosis, treatment and prevention of disease

• Promotion of better health

Synergism between the five branches

• Acupuncture

• Chinese herbal medicine

• Tui-na

• Food therapy

• Qi-gong, Tai-chi

For the body to retain its balance and harmony requires only following a proper diet." Sun Si Miao, Qian Jin Yao Fang (Prescriptions Worth a Thousand Gold Pieces for Emergencies)

"...diet is such an important part of our daily life that, unless one's diet is well adjusted, no amount of herbs, acupuncture, or other medicines or treatments can achieve a complete and lasting cure." Bob Flaws, 1998, The Tao of Healthy Eating

What is TCVM Food Therapy?

• In TCM, herbs and food follow the same principles and are often from the same sources

• Art and science combined to treat an individual for their current disharmony or disease process, on a daily basis, using food and herbs

o Treatment & prevention of disease

o Promotion of better health

• In many cases, complete resolution of clinical signs cannot be achieved without changes in the diet

• Selection of foods/herbs based on

o Energetics of food/herbs

o Species +/- breed

o Food preferences/aversions

o Current disharmony

o Geographical location

Why is Food so Important?

• Where Qi exists there is life, but the absence of Qi is death" Zhuang Zi

• Food is transformed into Gu Qi

o Transformation by the Spleen (pancreas)

• Gu Qi (Food Qi or Food Essence)

o Replenishes Yuan Qi and Jing

o Origin of Ying Qi and Wei Qi

Gu Qi: Replenishes Yuan Qi and Jing

• Yuan Qi (Primary Qi, Source Qi, Original Qi)

o Active form of Kidney Jing

o Derived from Jing and requires supplementation by Gu Qi

o Essential for proper function of Zang-Fu organs

– If abundant

Yuan Qi

, there will be good organ function and illness will occur less frequently

• Jing (Kidney Essence)

o Prenatal Jing and Postnatal Jing

• Prenatal Jing

o Congenital

– Lifetime supply is inherited from parents and is stored in the Kidney at birth

o Foundation of life.

– Basis for all growth, development, sexuality and reproduction

o Easily depleted and very hard to replenish

• Postnatal Jing/Acquired Jing

o From Gu Qi

o Excessive Acquired Jing can be saved or transformed into Congenital Jing

– Can only partially decrease depletion of Congenital Jing

Gu Qi: Origin of Ying Qi and Wei Qi

• Ying Qi (Nutrient Qi)

o Circulates in the blood vessels

o Produces Blood and nourishes the entire body

o Hemoglobin and other serum proteins are a part of Ying Qi

o AKA Nutrient Blood or Ying Blood

• Wei Qi (Defensive Qi)

– First line of defense against external pathogens

o Circulates outside of blood/lymph vessels in superficial parts of the body

o Rules opening and closing of pores

o Regulates body temperature

o Part of Yang Qi

– Warms up body

– Deficiency results in cold limbs and/or trunk

• Gu Qi and Qing Qi (Cosmic Qi or Universal clean air) are combined in the chest to form Zong Qi

• Zong Qi (Gathering Qi, Ancestral Qi, Chest Qi)

o Formed, gathered and stored in the chest

o Promotes control of respiration by the Lung

o Promotes governing of Blood and vessels by the Heart

It's all about the Middle Jiao

• Middle Jiao comprised of Stomach and Spleen

• Stomach

o Receives and ripens food

o Digestion is aided by anything that helps to create a "body-temperature soup"

o Separation into:

o Pure part of food which goes to Spleen

o Impure part of food which goes to Small Intestines (for excretion via the "Back Door")

• Spleen (pancreas)

o Responsible for metabolism of food to create Food Essence

o Transformation and Transportation of food and water (Double T)

o Transforms food (digestion and absorption) into Gu Qi or Food Essence

o Transports Food Essence (Amino Acids, Glucose, other nutrients) to the upper jiao

o Lungs: where transformation into Qi occurs; subsequent distribution to the rest of the body

o Heart: where transformation into Blood occurs

• Middle Jiao is like a Teeter Totter

o Ensures Spleen Qi moves upwards and Stomach Qi moves downwards

o Spleen Qi generates Essence so it must ascend

– Downward movement can result in diarrhea, prolapse of stomach, uterus, intestines, kidney, bladder, rectum, vulva or vessels of the rectum or vulva (hemorrhoids)

o Stomach Qi generates "bad stuff" so it must descend to facilitate elimination

– Upward movement can result in nausea, hiccups, belching, vomiting

– "Wife always ascends, Husband always descends"

TCVM Food Therapy

• In TCM, herbs and food follow the same principles and are often from the same sources

• Designed to bring the body back into balance and works synergistically with the other TCM modalities

• Diet is formulated for an individual to address the current disharmonies and diseases, to enable the body to come back into balance

• Diet is balanced over time, not at each meal, every day

• Websites to help balance home-cooked diets

o

www.balanceit.com

o

www.stlzoo.org/animals/caremanagement/animalfoodnutritioncenter/zootrition.htm

o

www.nal.usda.gov/fnic/foodcomp/search

• Multi-vitamin/mineral supplementation often recommended

• Food Therapy is based upon two fundamental principles

o Food Energetics

– The effect food has on digestive, metabolic, and physiologic processes

– Xing or Thermal Nature

– Five Energies – Hot, Warm, Cool, Cold, Neutral

– Five Tastes – Sour, Bitter, Sweet, Pungent, Salty

o Bian Zheng (Pattern Differentiation)

– Eight Principles

– Zang-Fu Organs

Thermal Nature of Food

• Fast growing plants tend to be cooler than slower growing plants

o E.g., lettuce vs. root vegetables

• Foods with high water contents are usually cooling

o E.g., watermelon

• Fresh foods are cooler than their dried counterparts

o E.g., grapes and raisins

• Husbandry affects thermal nature of food

o Addition of growth hormones and other stimulants increases thermal nature of food

o Grain based diet increases thermal nature of livestock

o Crowded containment, stressful environment

• Discrepancies among food therapy sources

o Observe your patients' response and decide for yourself

Five Energies

Hot/Warm Foods

• Action: Tonify Yang Qi and activate channels

• Indications: Cold pattern. Coldness, aversion to cold, cold syndromes (Cold or Painful Bi)

• Caution: In excess, creates heat which injures Yin and dries out Body Fluids

• Examples:

o Meat: Lamb, venison, chicken, shrimp

o Grains/beans: Oats, quinoa, spelt

o Vegetables/Fruit: Sweet potato, garlic, squash, cherry, raspberry

o Others: brown sugar, olive oil, wine

Cool/Cold Foods

• Action: Clear heat, drain fire, cool blood, supplement Body Fluid

• Indications: Heat pattern. Cough, hot flashes, anxiety, flushed face, red eyes.

• Caution: In excess, damages Qi and Yang

o Examples:

o Meat: Turkey, deep ocean fish, rabbit (farm raised), crab, oyster

o Grains/beans: Millet, barley, brown rice, tofu

o Vegetables/Fruit: Celery, spinach, broccoli, mushroom, kelp, watermelon, banana, pear, orange

o Others: Honey, green tea, salt, flax seed oil

Neutral

• Action: General Qi or Blood tonic, builds up Body Fluids, stabilizes and harmonizes the body

• Indications: Any condition; Qi + Yin deficiency, Blood Deficiency

• Examples:

o Meat: Pork, beef, rabbit (wild), salmon, sardines, trout, chicken eggs

o Grains/beans: Corn, white rice, soy beans, black beans

o Vegetables/Fruit: Yam, Chinese cabbage, carrot, asparagus, apple, grapes

o Others: White sugar, peanut oil

Sour - Wood

• Properties

o Yin, cooling

o Stimulates absorption and contraction

o Benefits digestive absorption

o Stimulates gall bladder and pancreatic secretions

o Lowers intestinal acidity

o Astringent effect

o Prevent abnormal leakage of fluids and energy

o Dry and firm up tissues

o Uses: Urinary incontinence, hemorrhage, diarrhea, weak and sagging tissue (flabby skin, hemorrhoids, rectal/vulvar prolapse

• Caution:

o dampness, constipation, heaviness of mind or body

• Examples: Lemon, hawthorn, plum

Bitter - Fire

• Properties

o Yin, cooling

o Antipyretic – drains heat

o Causes contraction

o Dries fluids and drains damp

o Improves appetite

o Stimulates digestion

• Uses

o Heat conditions and heat toxins (inflammation, infection, fever), damp, constipation (some bitter foods have purgative effect)

• Caution: Deficient, cold, weak, thin, nervous, dry, bone disease

• Examples: Bitter melon, rhubarb, alfalfa

Sweet - Earth

• Properties

o Yang

o Moistening

o Builds the Yin of the body (tissues and fluids)

o Strengthens weakness and deficiency

o Harmonizing

o Full Sweet - more tonifying and strengthening

o Empty Sweet - more cleansing and cooling

• Uses: General weakness, deficient pattern (Qi, Blood, Yin or Yang deficiency)

• Caution: Sluggish, overweight, dampness, tumors

• Examples: Yams, corn, rice, apple, cherry, fig, date

Pungent – Metal

• Properties

o Yang

o Disperses stagnation

o Stimulates circulation of energy and blood

o Tends to move energy upwards and outwards

• Uses

o Stimulate digestion

o Stagnation: phlegm (tumors), edema (Damp), pain (Blood)

o Promotes circulation of energy and blood

o Some can destroy or dispel parasites

• Caution

o Dry, windy, nervous, thin

o Examples: Ginger, mint (mentha), cloves, all hot peppers, horseradish, turnip

Salty - Water

• Properties:

o Yin

o Cooling

o Move energy downward and inward

o Moistens dryness

o Softens hard lumps and stiffness

o Aids digestion

o Detoxification

• Uses: Lumps, nodules, masses, cysts, cataracts

• Caution: Damp, overweight, lethargic, edematous, high blood pressure

• Examples: Seaweed, sea cucumber, miso, pickles, soy sauce

Bland - Extra Taste

• Properties

o Drains damp

o Diuretic

o Promotes urination

• Uses: Edema

• Caution: Dehydrated, fluid imbalance

• Examples: Pearled barley

Direction of Food

• Food influences the movement of Qi in the body

• Foods that direct energy UPWARD and OUTWARD tend to be Yang

o Warms from the inside out

o Tends to speed us up

o Use for Exterior conditions

o E.g., Arthritis

• Upward: Upbearing

o Move Yang upward

o Warm, neutral. Mostly sweet-acrid/pungent.

o Examples: Asparagus, beef, sugar, carrot, chicken egg, corn, honey, garlic, green onion

• Floating: Upward and Outward

o Move Qi upward and outward, expel external pathogenic factors, dissipate cold & wind

o Warm, hot. Sweet and acrid/pungent.

o Examples: Cinnamon, pepper, garlic, ginger, mustard, nutmeg

• Foods that direct energy DOWNWARD and INWARD tend to be Yin

o Cools upper and outer parts of body first

o Tends to slow us down

o Use for internal conditions

o E.g., endocrine, renal

• Falling/Downward

o Move Qi downward, laxative/diuretic effect, cooling

o Mostly cold. Salty or bitter.

o Examples: Crayfish, duck, barley, chicken egg white, pork, sweet potato

• Downbearing/Downward and Inward

o Moves Qi downward and inward, keeps Qi

o and Body Fluids inside; tend to be Yin.

o Cool to neutral. Sour, partly bitter and salty

o Examples: Lemon, clam, crab, kelp, salt

• NEUTRAL

o Examples: Tofu, mushrooms, duck egg

Zang Fu Organs

• Heart/Sm Intestine

o Bell pepper, chicken egg yolk, mung bean, mushroom, salt, spinach, wheat

• Spleen/Stomach

o Barley, chicken, chive, clove, garlic, ginger, lamb, lettuce, licorice

• Lung/Lg Intestine

o Carrot, corn, honey, mushroom, peanut, licorice, rice, spinach, tofu, vinegar

• Kidney/Bladder

o Chicken egg yolk, cinnamon, duck, kidney, lamb, mussel, pork, salt, wheat

• Liver/Gall Bladder

o Brown sugar, clam, crab, eel, liver, oyster, wine, yam

Methodology of TCVM Food Therapy

• Eight Methods

o Diaphoresis

o Purgation

o Warming

o Resolving Stagnation

o Regulating Qi

o Eliminating Damp

o Clear Heat

o Tonifying

Food Tonics

• Yin: Black beans, clam, duck, egg, rabbit, tofu

• Yang: Venison, lamb, raspberry, shrimp, walnut

• Qi: Beef, chicken, coconut, corn, fig, mackerel, molasses, shiitake mushrooms, squash, yam

• Blood: Barley, beef, beet, liver, black bean, bone marrow, molasses, oats, rice, salmon

Food Preparation

• How food is processed or cooked can change its "thermogenic" properties

• The more processing a food undergoes, the warmer it becomes

• Fine cutting, grinding, pounding, pressing all release more heat and energy from foods

• Whole grain foods are cooler than their fractionated or ground counterparts

• Cannot change overall category i.e., a cool food cannot become warm from food preparation

• Cooking breaks down food for easier assimilation

• Cooking methods can add moisture, dryness and warmth to foods

• Longer cooking time, higher temperature, greater pressure and dryness will add more warming qualities to foods

o Raw, chilled = Most Cooling

o Steamed, blanched, poached = Cooling/neutral

o Boiled = Neutral to warming

o Braised, stir-fried = Warming

o Stewed, pressure cooking = Warming

o Baked = More warming

o Deep-fried, roasted = Heating

o Grilled, broiled = More heating

o Barbecued = Most heating

• Slow-cooker or Crock Pot slow boils food so the Xing of the food items is not significantly changed

• Can also cook in heavy stock pot over low-med flame

• Creates stews which are similar to the "stews" the stomach creates

o Easy to digest

o Flavorful

One Pot Cooking

• Cooking all ingredients together in one pot with ample water creates harmony between foods

o E.g., Congees, stews, soups

• In a one pot meal, "... the various foods have settled their differences in the pot, fought out whatever needed to be fought out, and come to some conclusion, which you then consume." -Robert Svoboda, Prakruti, Your Ayurvedic Constitution, 1989

Diet Formulation

• Nutritional demands

o Bioavailability

o Balanced OVER TIME, not at each meal

– Varied in terms of color, fragrance, flavor

– Do not feed a monotonous diet

• Disease

o Etiology

o Stage of disease

– Pattern and manifestations change during development of disease

• Pattern identification

o Regulate Zang-fu organs

o Restore internal balance

o Don't forget

– Constitution, age

– Environmental factors

– climate, geography, household

• Rough guidelines

o Protein: 50-60%

o Carbohydrates (mostly low glycemic index): 15-25%

o Lightly cooked vegetables: 25-35%

• Susan Wynn, DVM, RH (AHG) Clinical Resident in Small Animal Nutrition University of TN

o Protein (Fish/poultry, organic preferred): 50%

o Mixed frozen or fresh vegetables: 50%

o Flax or olive oil as a source of fat calories

o 1tsp/20# BW

o Human daily vitamin-mineral supplement

o 1 dose for animals over 20#; ½ dose for animals <20#

o Calcium carbonate source - 250 mg/15# BW

o Cats: Meat 80%, Veggies 20%, taurine 250-400 mg/day

• Other supplements

o Vitamin-mineral supplement

o Antioxidants (controversial)

o Fish oil (engenders Damp)

o Calcium

o Digestive enzymes

o Probiotics

o Colostrum, Transfer Factors

o Microalgae

o Amino Acids

– Arginine – 500-3000 mg/day

– Reported to decrease tumor growth and spread

– Glutamine – up to 250 mg/lb/day

– May retard muscle wasting and help protect against intestinal injury

– May help with chemotherapy or radiation therapy induced nausea, vomiting, diarrhea

– Not with brain tumor

• Monitor nutritional status

o Periodic ratio adjustments

o Supplemental oil for weight loss or intolerance to fish oil

– Olive oil

– Flax seed oil

– Borage oil

– Camelina oil

A Little Something Extra

• Chicken/turkey necks

• Chicken wings

• Chicken/turkey gizzards

• Organ meats

• Hooves

• Raw meaty bones

• Marrow

• Sardines packed in water

Food Storage

• Air tight containers, preferably glass or stainless steel

• Frozen

o Freeze prepared food in sealable plastic bags with air evacuated; lay flat to freeze

o Can freeze individual food components to create a "food library"

o Use ice cube trays for smaller quantities

o Freeze individual pieces of meat or bone on cookie sheet.

o Once partially or fully frozen, place in plastic bags

Getting Ready to Feed

• Thawing

o Refrigerator overnight

o Warm water bath

o In sealed container at room temperature

o Be sure to monitor

o Do not leave out for prolonged time

o Do not recommend microwave

Feeding

• Food should never be served cold from the refrigerator

• Heating methods

o Leave at room temperature briefly

o Gently heat in a skillet (non-Teflon preferred)

o Place sealed container of food in warm water bath

o Do not recommend microwave

Switching to a Homemade Diet

• Gradually introduce new food in ¼ ratios

o Increase ratio every 2-4 days if no GI upset

o Day 1: 25% new diet, 75% old diet

o Day 4: 50% new diet, 50% old diet

o Day 7: 75% new diet, 25% old diet

o Day 10: New diet only

o May take 2 weeks to switch

• Gut flora established according to diet

• Typically no GI upset when switch to fresh, wholesome, homemade diet

How Much Do I Feed?

• Volume relative to dry food will vary

• May feed more if on super-premium food kibble due to increased moisture

• Typically feed less home-cooked due to increased bio-availability

• Metabolic need varies significantly between individuals

• can vary by factor of 4

• Others considerations: breed, activity level, age, diseases, climate

Probiotics

• Lactobacillus

o L. acidophilus – proximal gut

o L. sporogenes - distal gut, Bacillus coagulans

o L. bulgaricum – traveling transient bacteria; aids L. acidophilus and Bifidobacter

• Bifidobacter - colon

• Saccharomyces

• Enterococcus faecium

• Especially after antibiotics or with chronic diarrhea

References

Flaws, Bob, The Tao of Healthy Eating, Blue Poppy Press, 1998.

Jilin, Liu, Chinese Dietary Therapy, Churchill Livingstone, 1988.

Kastner, Joerg, Chinese Nutrition Therapy, Thieme, 2004.

Leggett, Daverick, Helping Ourselves: A Guide to Traditional Chinese Food Energetics, Meridian Press, 1994.

Ni, Maoshing, The Tao of Nutrition, SevenStar Communications Group, 1987

Pitchford, Paul, Healing with Whole Foods: Asian Traditions and Modern Nutrition, North Atlantic Books, 2002.

Schwartz, Cheryl, Four Paws, Five Directions, Celestial Arts Publishing, 1996.

Xie, H, Ferguson, B and Dinatale, C. 2006. Veterinary Food Therapy Training Program, Chi Institute of Traditional Chinese Veterinary Medicine.