Nature As Medicine – Dr. Melissa Sundermann

Dr. Sundermann is a plant-based Internal Medicine physician and a Diplomate of the American Board of Lifestyle Medicine and has been practicing medicine for the past 20 years. She also has training in Integrative Medicine through the University of Michigan and has completed a Professional Training Program in Mind-Body Medicine through the Center for Mind-Body Medicine based in Washington, DC. She has been featured in several Lifestyle Medicine articles and podcasts as well as an invited speaker for health/medical events. Dr. Sundermann strongly believes in fostering a partnership with her patients and helping to guide them to a healing pathway through self-care utilizing Lifestyle Medicine principles.

We talked about nature, medicine, the seven pillars of health, and even the gut biome.

Her pillars of health include a whole food/plant-based diet, daily movement, exposure to nature, social connection, and a sense of life purpose. She does her best to practice what she preaches and enjoys running, biking, hiking, skiing and spending time outdoors and creating adventures with her husband, 2 college-age children and rescue dog. Dr. Sundermann is a 9x Boston Marathon finisher, 3x Full Ironman Triathlon finisher, and will be running her 4th 50K Ultrarunning event this April to celebrate her 50th Birthday. She truly believes that age is just a number and is passionate about spreading this word to all of her patients, family, and friends.

This was an interesting conversation.

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Full Transcript below

BIll [00:00:00] Welcome to Northern Latitudes. I’m Bill Ault.

Melissa [00:00:29] Hi, my name is Melissa Sundermann and I am super excited to be here. Bill I think we connected on social media on LinkedIn because we both love nature, so I like to refer to myself as a doctor outdoors. Someone coined that to me when I was speaking, giving a presentation at a medical conference, and they said, We’ll just call your doctor outdoors. And I said That fits me perfectly. So I’m passionate about what I do. I’ve always loved being outdoors, and now we’re finding more and more reasons to be outdoors, particularly in relation to overall health and well-being.

BIll [00:01:05] Yeah, that’s been a fairly recent development. Development in the medical field, right? It’s been all of a sudden that we’re paying attention to what the outdoors can do for us.

Melissa [00:01:16] Right. And as you know, being in this field and loving the outdoors, as we’ve always known, being outdoors is helpful. Right. And sometimes it’s the simplest things that medicine lags behind. We think we have to have these fancy procedures and these big, fancy, expensive pills. And really some of our best prescriptions are the simplest ones. And hypocrisy is one of his many quotes that I love. But one of them is a quote that says, the physician treats, but nature heals. So hip hop parties way back when already knew that. And so how we’ve gotten away from that and now how I feel we’re coming back to that. And I’m very a very strong voice and a very strong passion to get more and more physicians and health care professionals to be prescribing nature.

BIll [00:02:07] And part of that prescribing is a good word here because we have all kinds of medicines, but at the same time, we have doctors telling us, hey, it better get outside, get some exercise, but we still revert to enlarge to a large degree, people do anyways. They revert to medicinal solutions. Is that just is it laziness? Is it ease of access? What is it?

Melissa [00:02:35] I think mostly based on our training. So I went to medical school back in the nineties, so a long time ago and practicing medicine for about 25 years. And back in medical school, you know, I had wonderful training. I went to Michigan State University and I had wonderful, wonderful training, and amazing professors. But we really didn’t have an emphasis on nutrition. We didn’t really have an emphasis on physical activity. Definitely didn’t talk about nature. So we were very much taught in a disease model like this is a disease, this is how you treat it. And there’s definitely a space and a need for that too. Right? When I was working in a hospital on acutely ill patients, I wasn’t going to say, okay, I’m not going to give this patient outdoors and they’re going to get better. No, we had, you know, really good medications and we had surgeons and we had procedures and diagnostic tests. But really, when we’re looking at true preventative care, we know that 80 to 90% of chronic diseases are lifestyle driven. That’s huge. So that’s where I became board certified in lifestyle medicine in 2019. And I’m board certified through the American College of Lifestyle Medicine, which is a growing field. We now have I think about 3300 physicians across the world are board certified in lifestyle medicine. We are a small but mighty group. We are growing. And really it just takes it down to we can start downstream when we talk about things like mammograms and colonoscopy, which are needed, which I advocate for my patients. It’s really about early detection. Lifestyle medicine looks to get to the root cause of disease, and we identify six pillars, official pillars of the American College of Lifestyle Medicine that really can contribute to lifestyle driven diseases, chronic diseases such as blood pressure, cholesterol, heart disease, strokes, type two diabetes, obesity, dementia, and those six pillars of lifestyle medicine, the six official pillars. Our food is medicine, just like a poverty said again, let food be that medicine and medicine be like food. And so we encourage a very plant, strong dietary pattern full of fiber, rich in antioxidants, fruits and vegetables and beans and whole grains, nuts and seeds. We promote pillar number two, which is movement. Getting movement every day and movement doesn’t mean going to the gym every day. Some people enjoy that, but some people like to go birdwatching or gardening or riding their bike or hiking in the mountains. So many different types of movement. And third is the importance of sleep and that we need restoration during our sleep. And I think we’re now realizing more and more that sleep is our superpower. Fourth pillar is avoidance of risky behaviors such as tobacco, excessive alcohol, drug use. Fifth is Pillar is managing our stress, and we all have stress in our life. And it’s how we learn to manage that, whether it’s through mindfulness or breathwork or meditation counseling. And the sixth pillar is social connection and that we are all social creatures and we we need our sense of being of our tribe or connection, whether that’s family or friends or colleagues or hiking buddies or pets is our place of belonging. So I tell my patients, I say, But Dr. Saunderson has a seventh unofficial pillar of lifestyle medicine, and that’s daily exposure to nature and fresh air. So my goal is to get the American College of Lifestyle Medicine to make that an official pillar, because I really feel that nature and fresh air is one of the most important component. It’s of well-being. And I come from Michigan. I’m now living in Massachusetts. We have this season called Winter that tends to last a really long time. And I feel like every season is ideal for it. So it’s just how you view it. So one of my favorite quotes that I tell my patients and my friends is that there’s no bad weather, just inappropriate clothing. So it’s like you got a good coat and some good hats and gloves. I even have spikes from my shoes. When it’s icy out, you get outdoors because the benefits of nature are abundant.

BIll [00:06:38] To have some sort of idea of what we need on a weekly, weekly basis.

Melissa [00:06:42] Right. So the great thing about people paying attention to nature now is people are doing research on it. I think a lot of times in science and medicine, they’re like, Well, does that really work? Let’s put it to the test. So we’re getting some good data outcomes. And what I have seen through the research is it’s pretty much aligned and the nature dose is trying to get at least 20 minutes of nature fresh air on a daily basis and or 120 minutes per week. Okay, So 20 minutes per day or 2 hours per week. There’s some people that during the week between jobs and family life, maybe they just can’t get outdoors. Right? So if you want to take a Friday, Saturday, Sunday and sort of do an hour Saturday, an hour on Sunday and get that 120 minutes per week, that’s also effective. So in getting those 20 minutes, we see those positive effects of decreasing our cortisol levels or stress hormones, decreasing our heart rate, decreasing our blood pressure. And from the very early studies on children, yoku and forced bathing with Dr. King Lee, we saw increase in natural killer cell activity, which is integral to our immune system. So whether that’s helping to prevent you from getting a cold to helping to boost your immune system so that you don’t have cancer down the road. Not that just being outdoors in nature is not going to prevent you from ever getting a cancer, but just boosting our immunity any way that we can is really important with COVID, right? The more we get outdoors, perhaps we can avoid getting COVID. So the consistent measure that I’m seeing is that 20 minutes per day, 120 minutes per week.

BIll [00:08:18] And does it matter? Like what qualifies as being outdoors, a walk in the park, you know, etc.?

Melissa [00:08:25] So good question. And I think we want to make this is accessible for everyone. I happen to live in the Berkshire Mountains, and so I like mountains and woods really close to me. But some people live in York City. So what we know is that the benefits of just being outdoors around green space and blue space, we don’t want to leave out blue spaces like lakes and rivers and streams and oceans. But when we are around anything, green trees, shrubs, anything, those green living organisms will emit something called fighting sides. And fighting sides are these volatile organic compounds that actually work to protect the plant itself. And so it has antiviral antibacterial properties. So if we’re around anything green, we inhale spiked insides. So you can do this by simply if you live in Central Park and you are if you live in New York City, you go to Central Park. And just being around those trees, it’s wonderful. If you live in a neighborhood that has a little park, if you have a courtyard. So really finding any pocket that you can get if you’ve got access to a large park and mountains and national parks, go for it. But it doesn’t have to be like that. And even if you have a small balcony on your apartment and you can get some green plants, that’s going to be a benefit, too.

BIll [00:09:44] It was just an article published in England, correct, about the fight inside.

Melissa [00:09:48] Right. Because there have been some studies. And the question is, can we just view nature could be just like watch like, you know, streaming video or do we actually have to be in nature? And so for the fight and sides certainly being in nature and healing those fighting sides. But there is one study that looked at how people were viewing nature versus being out in nature. And for some individuals who maybe really struggle with really high anxiety and just leaving their house or apartment would be really intimidating or scary for those people. Probably just viewing nature would actually be better than leaving their apartment or being out in nature. But I think the majority of us were more just looking for well-being. Feeling good is, you know, to get outside and be in nature itself.

BIll [00:10:36] Now, you’ve been a doctor for, as you said, quite a while now. Did nature play a part as you were growing up and deciding what you wanted to do? I think I heard in another podcast with you that you pretty well knew you always wanted to be a doctor. Was nature a part of that? Was nature part of growing up, or is it something that, you know, as you became a doctor and you started to look into things, it became more and more important?

Melissa [00:11:04] Yeah, that’s a great. Question. Thanks for asking that. So I grew up I mean, not that I, I didn’t grow up like hiking with my parents and going camping. I think my mom’s listening to this. I think her idea of camping was probably going to the Holiday Inn, but so I was a ballet dancer, so I was definitely an outdoors. Well, maybe I was outdoors dancing, but I was a lot of times in the studio dancing. But when I went to college, I sort of dabbled in mountain biking and trail running and did camping. And I just felt like, wow, this is just I feel so good when I’m out here. And so I just sort of followed picking up activities that just felt grounding to me that I could. I love to move my body. I’m very adventuresome, pretty much. If you ask me to do it, I’ll be like, Sure, I’ll give it a try. So I just sort of gravitating towards that and met my husband and we share that same love for adventure and being outdoors. I don’t think that it necessarily drove me to go into medicine. I think that, you know, I wanted to go into medicine to become a doctor. Then I found what nature did for me, and I just felt so good and it was just part of what I needed every day, you know, It was just like some people say, okay, I have to have my coffee every day. I’m like, I need my fresh air every day. And throughout the course of practicing, you know, for 25 years, I just kept building upon that. And then I decided, you know, to be truly authentic to to who I am and what seems to work for me as far as wellness, I’m in my fifties. I feel great. It’s not that I you know, my body doesn’t quite feel like what is it is twenties, but I’m still able to pursue the activities I want to do. I sort of, you know, sort of check into the research and then finding other people who really were passionate about this. And I feel like I was hit the sweet spot and being true to myself and being authentic and saying like, nature is important. And then I’m finding like other people are saying the same thing. So it’s really been a great combination for me to align both personally and professionally. Lifestyle, medicine and nature is medicine, so I feel really grateful that I discovered it. And now I want my patients to know about this too.

BIll [00:13:20] And you are definitely a mover because you’ve done triathlons. And what else have I seen here? Marathons. So for you, because you’re still doing that, correct? Like you scope and so does nature or being in nature provide you or help assist in your recovery at best? I guess that’s a better question because after you do something like that, it’s not, you know, 90% of the population never does. So it’s a pretty stressful body experience. Do you use nature in your recovery or is just nature such a part of your life now that it’s just, you know? Yeah.

Melissa [00:14:01] And I think when you look at recovery, particularly as we age, you know, there’s a lot of components to that, right? Food for recovery. Food is medicine. It’s a lot of antioxidants. I am myself very plant forward, a lot of fiber rich to optimize my gut microbiome. We know that 70% of our immune system resides of our gut microbiome, 90% of our serotonin receptors. So that’s really integral to my overall well-being, is that I nurture my gut microbiome. Certainly sleep, I think for years when I was in residency and getting like no sleep and doing 36 hour shifts, I was like, Oh, I did residency, I really don’t need sleep. And I’ve come to learn that that’s completely wrong and that sleep is so integral. What happens while we sleep and the lymphatic system that kicks in to rid our brain of toxins and amyloid proteins and things like that. So I think that I’m really very focused and diligent about my sleep hygiene. I aim to get 7 hours of sleep every night, so I always work backwards. If I have to be up at five in the morning, that means I’m in bed by ten. Even if there’s a really good Netflix I want to watch, I’m like, Nope, turn off. Like I have to really aim to get that 7 hours. So I think there’s a lot of things that to intentional as I get older that for recovery. But certainly what I love to do is after a long run I’m training for an ultra run and I’m doing in a couple of weeks in Florida and I’ll use nature to just go for a nice walk on trails afterwards. You know that if the trails are soft, I can just, you know, really focus on an act of meditation, focus on my breathing, focus on things I’m seeing and hearing and touching. Even so, it’s really just a good recovery for my mind if I’m just gone for a long run and sort of just need to unwind both physically and mentally. I think that nature always can provide that.

BIll [00:16:00] You mentioned the microbiome.

Melissa [00:16:01] Yeah.

BIll [00:16:02] That’s really interesting and that’s really. Come to the forefront in the last little while as well.

Melissa [00:16:09] Absolutely.

BIll [00:16:10] Talk a little bit more about microbiome.

Melissa [00:16:12] Okay. Yeah. So when I when I talk about this, I said, well, the gut microbiome is kind of like when someone, you know, hundreds of years ago put something to the chest and they heard something in there and they’re like, you know what? This thing beating in the chest, I think it’s going to be important. So that’s what the gut microbiome is. You know, we discovered the gut microbiome, what, 12, 13 years ago. So I’m like, it’s like still an adolescent. And whoever sort of started checking into it was like, this is going to be important. And every single day we’re finding out more and more, you know, there’s the brain that’s really important. There is the heart, the gut microbiome. You know, there’s about over 37 trillion organisms that live and our gut microbiome, which is mind blowing because that’s more than our body. So we actually are like hosts of our gut microbiome. Like, that’s just our function, right?

BIll [00:17:02] I heard that. I heard that stat the other day on a podcast or not. And so, like we’re more than 50% not Yeah, not us. Yeah.

Melissa [00:17:15] And the you know, the thing about the gut microbiome, we have the power to manipulate that. And like your gut microbiome is totally different from mine. You know, even if you had an identical twin, it would be totally different. And that’s we’re learning how to optimize that gut microbiome, cause the health of the gut microbiome. Like I said, our immune system majority lives their serotonin receptors living there, the health of the gut microbiome, not people think about digestion, but it’s so much more than that. You know, this is affecting, you know, insulin resistance or brain health or metabolic rate. And so those lifestyle pillars like the food that’s on our fork that goes into our mouth, either can optimize the gut microbiome or it can harm the gut microbiome. You know, when you take antibiotics, that wipes out a lot of the gut microbiome. So that’s where we are really cautious about not just handing out, you know, biotics like candy, right? Because you’re really not only creating resistance, but you’re really wreaking havoc on your gut microbiome, How we Move our body. There’s a great study that shows just sedentary behavior to more moderate intensity will optimize your gut microbiome and cause an increase in the good short chain fatty acids like Butyrate production. How we sleep just by, you know, whether we’re getting restorative sleep or not can alter our gut microbiome. Stress can alter our gut microbiome, all of these things. And there’s actually been some studies, of course, with nature, and there was a study called the Play and Growth Study that looked at preschoolers and it was six weeks program. And basically their study participants played in the dirt like these kids were just like, Hey, you’re in preschool, go play in the dirt. And after six weeks, they did some some questionnaires to look at overall well-being. And they found that these kids seemed to be happier or less angry and irritated, a little bit more focused. And then they took poop poop samples because why not? And so they took poop samples and found that the kids, after playing in the dirt and being outdoors in nature, actually had a higher level of fecal serotonin. That makes sense because they’re playing out that doors or playing in the dirt. They’re digging in the in the biome of the soil, the biome of the soil is, you know, they probably got some on hands at like their hands and it actually optimized their own gut microbiome by being so close to the ground biome. So just by being out in nature, we can help to optimize your gut microbiome as well.

BIll [00:19:45] I’m going to ask you to predict the future or at least look into the future a little bit. Where do you see medicine or sorry, outdoor prescriptions as medicine going in, say, the next decade or so?

Melissa [00:19:57] Yeah, So we’re seeing motion forward already in other countries. So in Canada they recently the Canadian Medical Association. So that’s like we have the American Medical Association, the Canadian Medical Association, actually adopted and is, you know, promoting nature prescriptions. And in Canada they have this great program where a physician can write a nature prescription for a patient. And that patient can go to I think there was like 50 or 60 national parks and get free access, Right. So take away that barrier of like, oh, it’s too expensive to get an annual pass. A nature prescription gives them access. I’m over in the U.K. with social prescribing. They’ve got a big movement. They have a program called Dose of Nature that does the same things that GP’s are writing prescriptions. And this will provide actually nature therapists that work with them on one on one for I think that’s a ten week program over in Scotland and Nienaber, they did a nature prescription trial, so we’re seeing good evidence behind it. I am working with. Some people about getting prescriptions more and more. I’m working with a woman, Iris Rosen, who has a new app coming out called Nature Time. And within her Nature time, after just a lot of education about the benefits in nature and within that, there will be a nature prescription. Jared Hanley, who is from Nature Quant in Nature Dose, is doing quite a bit of great work in that realm as well and actually doing a lot of research and mapping out green spaces. And he’s got a cool app that you just have on your phone and it’s kind of like a garment. Instead of tracking your steps, it tracks your amount of time and.

BIll [00:21:41] It’s it seems to be really becoming mainstream, which was kind of neat because it hasn’t been we have been talking about it that long.

Melissa [00:21:48] No. And I as part of the miracles of lifestyle medicine, we have a yearly annual conference, the conference. And so we had been virtual for a couple of years. And this year, in November of 2022, we’re locked down in Orlando and we had 2000 attendees kept it up, 2000 more would have come. But we also went virtual in my abstract that I submitted was the event. The title of my talk was Moving Mountains The Benefit of Movement in Nature to Reach the Peak of Well-Being. So an abstract was accepted and I was one of the main speakers there, but I got really great feedback and people like so funny because that was such a different talk. That was just wonderful. I didn’t know that stuff about nature. So even as physicians, we’re trained in a lot of things and other things were not. And so just the awareness and I think in lifestyle medicine, what I really love is that all of the lifestyle medicine providers that I know, they really do their best to practice what they preach. So if they’re telling people to eat a healthful diet, they’re doing it too. If they’re telling you to move your body, they do it too. So I think that if we can get more and more physicians to realize the benefit of being outdoors, they’re going to be more apt to prescribe it to their patients.

BIll [00:23:08] As doctor, what would you prescribe to somebody?

Melissa [00:23:12] Well, I think it’s always important to meet patients where they’re at. Right. So and when if we’re going to be just because I could go into all seven pillars with you, but I’ll just focus on movement and nature. So I would say, well, you know, is there anything you like to do outdoors? Like, do you like fish? Do you like to birdwatch you have a garden? Do you do you like to go hiking? Ski So yeah. Oh yes, yes. Oh, easily. You know, saying I think, you know, I see. So a lot of people just don’t even consider going outdoors. They maybe work remote. They’re like, Well, I’m on my computer all day long, you know? And I’m like, well, could you just go outdoors and take a little walk in between meetings or in between clients? And they’re like, Well, I guess so. But does that even matter? Like, it matters hugely. So I think, first of all, like meeting patients where they’re at, like what does your life look like right now? Like, you know, what time you get up, What’s your routine, What’s your work routine, What’s your after work, your family life? When I have patients that have families, I said, this is going to benefit you guys as a family. Could you, you know, check out local parks Metroparks. You know, maybe plan a trip to go to a state park and make that a family activity. That’s really fun, right? And is exploration. And I think a wonderful thing about nature and curiosity and wonder.

BIll [00:24:39] Yeah, are.

Melissa [00:24:40] Right. I think a lot of people don’t even like I try to see I run most mornings and so I almost always try to catch the sunrise is gorgeous and where I work, these coast sunsets pretty early, not this year, but I make it a point. It was on a meeting yesterday and I was like, Hold on, stop, stop the meeting. I need to look at Sunset. And I said, Right. So so the appreciation that I think that some people just don’t even they’re even aware of that. So to be curious and appreciate the gifts of nature that are simple but absolutely transformative and being outdoors and maybe, you know, saying, hey, why don’t you look for like mushrooms and fungi and like all of a sudden, like you’re your whole being or, you know, start looking for birds or. So I think it’s just making it enjoyable because I think so many behaviors, healthy behaviors we perceive as like not being enjoyable and boring and, you know, like, why would I want to do that? So I, I try to find out more about my patients, individual interests and what their lifestyle looks like and then cultivate joy, I think is really important because for me, going outdoors brings me joy, brings me grounding, brings me or brings me, you know, like the other day I was running and I was running a certain direction and I turned a corner and all of a sudden. The sun was rising and I literally had to stop and just look and be like, Oh my gosh, like that guy. It’s like a colorful palette. So I think just becoming in tune and, you know, there’s this, you know, term biophilia that E.O. Wilson is known for, and that’s the innate connection of all living things. So we all are made of carbon, right? Whether over a tree or a flower or grass or, you know, an animal. And so fundamentally, we’re meant to connect. And technology and conveniences have really forced that connection away. And I think it’s really so powerful to come back to those simple connections.

BIll [00:26:50] Yeah. And you mentioned AR, and it’s funny because when I talked to Dr. Lam, we talked about odd because there’s been some studies into our right and the effect of our and I think that’s the one thing that most people kind of I don’t know how they they don’t they don’t recognize it as much as we used to or when we when we didn’t have as much social media, we didn’t have as many distractions. I use it, like you said, the sunrise every morning and a thousand other things when you’re outside that. Wow, that’s really cool. I think that’s that’s awesome.

Melissa [00:27:26] Distractions particularly that our phones right that if you know our people were out taking a walk in nature they didn’t have anything to distract them or if they were having a campfire or sitting around with friends. Jeffrey Davis has a wonderful book called Wonder. He does a lot of research into that. And I think it’s you need to get back to that just very, you know, just to be because that’s what makes life what is being curious about things. Right. And wanting to learn and experience what life has to offer.

BIll [00:27:57] Yeah. And learning is what this is all about. I’m going to thank you for your time. That was amazing. Very informative. And maybe we’ll do it again sometime. That’s it for this episode. Thanks to producer Sarah Simpson and social media director Elina Simpson for their help this week. Our theme, Music and Sound logo are by John Sanfilippo from Titan Sound. Make sure to tell a friend about the podcast and send them over to the podcast page at Northern Latitudes. Okay, I’m Bill. Find your way to northern latitudes.