Nature RX: The Best Medicine

About the Author

John LaPuma M.D. is board-certified in internal medicine. The Wall Street Journal has called him “a secret weapon," and his TEDx and TEDMED talks helped to pioneer culinary medicine. Founder of ChefMD and, his seven books have sold over a million copies and been translated into eight languages.

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The late neurologist and author, Dr. Oliver Sacks, was a true believer in the power of nature to heal. Sacks, who would take his patients to gardens whenever possible, described two patients for whom nature was literally the best medicine.

One patient, a friend of Sacks’, had moderately severe Tourette’s syndrome. The condition forced hundreds of grunts and tics daily. But one day when the two men were hiking in a desert, his friend’s tics had completely disappeared. Sacks wrote that “the remoteness and uncrowdedness of the scene, combined with some ineffable calming effect of nature, served to defuse his ticcing, to “normalize” his neurological state, at least for a time.”

Another patient, a woman with moderately severe Parkinson’s disease, was frozen and immobile when indoors. But outside, she was mobile and agile on terrain, in a rocky garden.

Like Sacks, I believe the effects of nature are emotional, spiritual, physical and physiological. I also think that nature therapy will, within a generation, take its place beside nutrition and exercise as a type of medical intervention which can have both immediate and long-lasting health benefits.

Just as in culinary medicine, a field I helped to begin in medicine, the existing research in nature therapy/green medicine is in disparate fields: horticulture, interior design, architecture, forestry, wildlife management, education, auditory and color science, botanical medicine, medical science. But it is being read by those of us keen on making nature therapy a health care tool that everyone can use.

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Nature therapy is a new field in medicine defined as the prescriptive, evidence-based use of natural settings and nature-based interventions. Its mission is to prevent and improve signs, symptoms, clinical conditions and well-being. Its vision is to be readily available to every person regardless of proximity to blue or green space.

Walking in nature seems to boost short term memory significantly better than walking elsewhere. A meta-analysis of 143 studies and 290 million participants (nearly all since 2008) showed statistically significant reductions in diastolic blood pressure, salivary cortisol and heart rate, and in the incidence of diabetes, stroke, and all-cause and cardiovascular mortality…with nearly any green space exposure.

Kids with ADHD concentrate better after walking in a park rather than downtown or in a neighborhood. The improvement is as if they have been given extended-release methylphenidate (which is a stimulant medication used to treat ADHD and sold under the trade name Ritalin, among others).

Greater proximity to parks and recreational programs could help almost 10 percent of kids go being clinically overweight to normal weight.

There is not just one way to experience nature’s therapeutic effects. My colleagues Zoe and Mark Silverberg, MD and I created a virtual reality (VR) nature pilot program, with virtual scenes of beach, water and sky, for kids getting flu shots. Patients in the VR group used a free App (Aquarium VR) for approximately 30 seconds total, before and during vaccination. Children using VR reported 48% less pain than controls; staff thought they had nearly 75% less pain than controls.

We believe nature views may engage parasympathetic and biophilic impulses. In this era of measles resurgence, nature VR may be one way to help kids overcome fear and pain with vaccination.

Co-founder and author Richard Louv introduced the term Nature-Deficit Disorder (NDD) in his 2005 book “Last Child in the Woods.”  Louv believes that, among other factors, increasing urbanization without greening, digital distraction and fear of strangers and the danger they may present may be responsible for NDD.

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I believe NDD is a clinical problem, not just a social or behavioral one, in both children and adults. Those who are working inside constantly, especially in urban centers, tethered to their devices and relatively sedentary, are among those at greatest risk. NDD has many associated clinical conditions. And ADHD, anxiety, insomnia. hypertension and myopia are five of which below that have been shown to benefit clearly from time spent outside.

It is important for clinicians to think about prescribing nature whenever they identify a nature deficit or encounter one of the above conditions.  My own two question assessment includes: ”Been outside yet today?”; and “Been outside in nature in the last week to walk, hike, play with a pet, listen to birds, garden, or have a picnic?”

Many kids need a Green Rx, or nature prescription. For example, an estimated 30 percent of U.S. kids are nearsighted or myopic.  In the East and Southeast Asia, the incidence is nearly 90%. High myopia can lead to retinal detachment and blindness at a young age. In 2012, about 4 percent of U.S. kids had high myopia and about 20% of kids in East and Southeast Asia.

One likely cause of this surge in myopia is too much screen time. In 2018, Pew reported that “95% of adolescents reported access to a smartphone, and 45% said they were online almost constantly.” Sleep and exercise, never mind brain rest and mindfulness, can be displaced by the always-on/aware siren call of mobile media.

To prevent myopia, spending time outdoors without devices, in both bright and dim light, should be standard, as should unstructured, outdoor free play in a natural environment. Studies show that just eleven hours weekly of time outside (94 minutes daily), with 1000 lux exposure or more reversed myopia in a study of 693 myopic kids in 16 schools. Both myopic shift and axial elongation were significantly reduced, and risk of rapid myopia progression dropped by 54%.

Interestingly, having and caring for house plants can offer some of the same benefits as caring for plants outside. Houseplants can improve the microbiome of the built environment and individual respiratory and neurologic conditions. At least 16 common houseplants can clean dust, allergens and petroleum products from the air, according to NASA.

The evidence-base for nature as medicine is strong and growing. For me, hortophilia, which Sacks defines as “the desire to interact with, manage and tend nature,” calls even more clearly than biophilia, or the innate love of being outside. Both can be nurtured and revived in those whose natural, innate feelings have been shadowed by workism, urban canyons, institutionalization or other environments. You can let nature be your medicine too.

This article is adapted and excerpted from La Puma John, Alternative and Complementary Therapies Vol. 25, No. 2 Nature Therapy: An Essential Prescription for Health: 1 Apr 2019 and

Photo Credits: Pexels

Additional Reading & Resources
Learn more about Dr. John LaPuma here.
Outdoors for all, Sierra Magazine
BALANCING SCREEN TIME WITH GREEN TIME: Attention Retention Theory Helps Explain Why Nature Play Helps Learning
The Nature Cure, Outside Magazine
Vitamin N: The Essential Guide to a Nature-Rich Life by Richard Louv
Balanced and Barefoot by Angela Hanscom



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1 Comment

  1. Thank you for this great article, John. As a psychotherapist and ecopsychologist, I’ve been ‘prescribing nature’ to my patients for several years. This is especially important for family work since children are so directly impacted by their parents’ behaviors and values.
    My own research has also shown how even nature videos shown to inmates in solitary confinement tap the biophilic needs we all have, and resulted in decreased violence among the population who viewed these videos regularly.
    I agree with you that as a healing community (physicians, nurses, psychologists, and mental health providers) we are returning to a deep understanding of the necessity of nature connectedness, and we will do well to broaden our scope of treatment to include the human-nature relationship.


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