By Kathleen Bell, RN, MSN, CNM, AHN-BC™ and Tammera Karr, PhD, BCHN®, CDSP™, CNW®
Is nourishment limited to nutrients extracted through digestion? Or does nourishment also include components from one’s environment, culture, beliefs, and social connections, and surrounding wavelengths, and not just calories? This literature review shows that food alone is insufficient to generate or sustain vibrant health and well-being. Holistic health and well-being are outcomes of constant interaction between and among many dimensions of human life. We, the authors, reviewed more than 750 scientific papers and historical texts related to well-being, health, diet, culture, anthropology, archeology, natural sciences, microbiomes, and philosophy, then developed a set of six essential ingredients that comprise an expanded definition of nourishment. Goethean ,  and quantum science ,  recognize the effects of and relation between multiple influences that nourish the whole person, promoting health from conception to the end of life. By redefining the concept of nourishment, we intend to illuminate the deficiencies remaining within the confines of a reductionist paradigm and to highlight possibilities available in the quantum era for persons to develop and regenerate health.
For the purposes of this review, we have selected the following definitions:
A state or habit of mind in which confidence is placed in the reality of some person, thing, or phenomenon, especially when based on an examination of evidence. Beliefs are the initiator for biochemical responses in the body that release neurotransmitters, hormones, and other chemical mediators resulting in health and a sense of well-being. Health is defined as being well or free from disease, good overall condition of body/mind/spirit, thriving, hearty, robust, and fit. Well-being is a positive outcome that is meaningful for both individuals and society., 
Wavelength is the distance between successive crests of a wave, especially points in a sound wave or electromagnetic wave. Wavelengths depend on the medium (water, air, vacuum) through which they travel. Examples of waves include: sound, light, water, and periodic electrical signals via conductor.
Nutrition derived through diet refers to the process of obtaining and consuming food and drink daily, which is necessary for health and growth, along with the mental and physical circumstances connected to eating. Diet influences biochemical responses through macro and micro ingredients that feed the microbiome and human cell energy. Nutrition’s inclusive definition is “gastronomy”, the art or science of good eating, custom, or style. Gastronomy is inseparable from history, culture, and tradition and strongly contributes to social identity.
The collective phenomena of the physical world, including plants, animals, fungi, the landscape, and other features and products of the earth, as opposed to human creations. Being outside in the natural world produces a myriad of biochemical responses, such as activating neurotransmitters, endorphins, and immune reactions, including killer T-cells.
A body or object is said to be moving if it changes its position with respect to its immediate environment. Movement is necessary for adequate circulation and balanced neurotransmitter function in the human body; without movement, failure to thrive and death result.
Social definition: Customs, arts, social institutions, and achievements of a particular group of people. , 
Biological definition: Conditions suitable for the growth and sustainability of living organisms.
We agree with the works of Drs. Bruce Lipton, Candace Pert, and Deepak Chopra, which support the theory that each of the approximately 50 trillion human body cells has its own innate intelligence. Research by Dr. Bruce Lipton and others demonstrates that individuals with some form of belief system recover more readily from illness and retain greater social connection, leading to healthy longevity.,  In her international study of cancer patients who made full recoveries, Dr. Kelly Turner found strong spiritual beliefs to be one of nine essential elements in the ‘formula’ for healing.
Beliefs are the initiator for biochemical responses that release neurotransmitters and hormones that affect digestion, behavior, sleep, and immune responses. The complex chemical signaling pathways between the human brain and body are made possible by healthy physiologic functioning of the central nervous system and bloodstream, which can be regarded as an “information superhighway.” Unless each particular cell receives information regarding its activity/lifespan and is kept informed about the activities of trillions of other cells, there can be no organization of the body into functional systems., 
Dr. Candace Pert’s groundbreaking studies in the late 20th century mapped neuropeptides and their receptors throughout the brain and body, paving the way for the emergence of a new paradigm that views the human being as a singular entity, which she and Dr. Deepak Chopra refer to as the bodymind. The bodymind is a holistic entity encompassing the physical body, psyche, and a level of reality and humanity referred to as spirit or consciousness. The chemistry of beliefs, or molecules of emotion, acts as an integral communication network in continual and elegant conversation throughout the bodymind. This prompted Dr. Pert to propose that “your body is your subconscious mind.” 
How a person sees themselves in the present makes a real and measurable difference in what their body will be like tomorrow. Caroline Myss, who began her career as a medical intuitive working with Harvard-trained neurosurgeon Dr. C. Norman Shealy, learned that what drains the spirit drains the body, and what drains the body drains the spirit. In the 1980s, Dr. Ellen Langer, the first woman psychologist to be tenured at Harvard University, performed a famous time-capsule experiment on aging men that demonstrated statistically significant changes in multiple physiologic outcome measures: grip strength, dexterity, flexibility, posture, and even eyesight. The researchers replicated the findings again in 2019. The primary intervention involved in this experiment was directing the beliefs of the men to change their perspectives about their actual ages, which led to measurable physical changes in their bodies. In addition, sixty-three percent of the subjects in the time-capsule group scored higher on an intelligence test as compared with forty-four percent of the control group. 
A study from 2007 looked at the relationship between exercise and health moderated by one’s mindset in 84 females. The results support the hypothesis that exercise affects health in part or whole by mindset. ,  Cancer patients in a 2019 study reported “a better sense of controlling health” and “improved overall health and feeling better” when employing complementary therapies, including movement, diet, cultural practices, and lifestyle.
Made up of light (biophotons),  and sound, wavelengths are elemental organizational forces of the universe. Exposure[KB1] to biophotons, sound vibrations, and color transforms human biochemical responses. In his comprehensive study of the biological effects of sunlight, Dr. Michael Holick delineates many health benefits, the most well-known of which is the manufacture of vitamin D and its relationship to the use of calcium in the body. Sunlight exposure is the primary source of vitamin D for humans, as very few foods naturally contain vitamin D. People have a feeling of well-being when exposed to sunlight because ultraviolet A and B wavelengths lead to increased expression and production of beta-endorphins. For women of childbearing age, vitamin D and calcium insufficiencies were found to increase associated risks of bacterial infections and cardiovascular disease in a series of systematic reviews and meta-analyses published in 2022. Sunlight deprivation is associated with depression, and seasonal exposure variations dramatically influence cardiovascular events and mortality, such as stroke, heart attack, and autoimmune and infectious diseases.
According to Dr. John Ott, 98% of the sun’s energy enters the body through the eyes, regulating brain chemistry and circadian rhythms that control appetite, energy, mood, sleep, libido, and many more functions. Light also affects muscle movements, enzyme reactions, food digestion, fat burning, and energy storage. Dr. Ott and Dr. Fritz Albert Popp of the International Institute of Biophysics agree that light is a nutrient much like food, publishing this statement on the Ott website: “We can now say emphatically that the function of our entire metabolic system depends on light.” Research published in 2019 indicates that long-term memory may be stored in biophotons through the light-conductive protein molecule tubulin., 
The understanding of how color can affect health is called color psychology. Without being aware of color’s effect on health, individuals may miss out on ways to improve responses and reactions within their surroundings. Dr. Deanna Minich, a leading expert in color and food, published a literature review in 2019. “My study of colorful carotenoids and phytonutrients in graduate school had shown me that there is an important color connection in nutrition science … I began to realize that color, nutrition, and life issues were intertwined … I started to see correlations rather distinctly.”, 
Sounds of all kinds surround humans; the human ear can only hear some sounds, and many are outside the conscious hearing range.  Sounds are perceived by humans and other living creatures as mechanical waves of pressure, which are measured – similarly to light waves – in frequencies. Sounds are characterized by regular fluctuations in vibration, as differentiated from noises containing irregular fluctuations. Sound vibrations have been shown to change body chemistry, altering the hypothalamic–pituitary–thyroid axis (HPTA), which governs stress responses., 
Music impacts humans more than any other human-made sound. Researchers believe simple music predated speech and played a vital role in human development. Music plays a central role in the U.S. food and restaurant industries, affecting marketing strategies, shopping behavior, and eating environments. It “has been used for thousands of years in healing ceremonies and as a digestive aid; each country across the world has traditional music to connect the threads of life and lift the spirit.” 
Gastronomy and Nutrition
Nutrition refers to the assimilation and incorporation of substances necessary for health and growth, and the mental and physical circumstances associated with ingestion. Nutrients are absorbed and digested, providing components of biochemical responses that feed the microbiome(s) and fuel human cellular development and energy. Elements contained within vegetables, fruits, fungi, and herbs provide volatile compounds and color[KB2] [TK3] [TK4] [TK5] to stimulate the brain, activate the immune system, and nourish the microbiome. In their natural state, these energy sources create an array of synergistic responses within DNA. These chemical activators stimulate and down-regulate DNA receptors associated with multiple sought-after health traits: reducing cancer, heart disease, allergies, and autoimmune conditions. A 2017 breast cancer research study revealed the importance of natural food sources of phytochemicals with anti-oncogenic properties on multiple cancer-related biological pathways and breast cancer prevention. These same naturally occurring food sources improved cognitive function and physical performance, and increased fertility., 
The enduring effects of nutrition have also been demonstrated on fetuses as related to their future health. A 2020 study of pregnant women by Kings College faculty illustrates how the mother’s diet and lifestyle during pregnancy directly affect their childrens’ future development of cardiovascular disease.
Epidemiological research done in 2019 by Srour and Kesser-Guyot reported a significant association between eating whole, unprocessed, or minimally processed foods and lower risks of all reported diseases. Research on chronic pain from 2021, done on veterans with Gulf War Illness (GWI) placed on a low glutamate diet, produced a measurable reduction of symptoms from chemical toxins.
Gastronomy is the primary vehicle for foods that provide nourishment. UNESCO describes gastronomy as one of the most universal cultural and creative contributors to social identity and an inherent carrier of tangible and intangible heritage. Gastronomy represents the cultural knowledge of preparing foods for the highest nutritional value. Traditional understandings of nutrition in Asian culture are documented in texts dating back over 6000 years. Ayurveda, known as the oldest comprehensive medical system in the world, contains extensive nutrition that emphasizes the body/mind/spirit relationship with foods as a whole. Traditional Asian understandings of nutrition come from Taoism, which underlines the individual and their foods’ specific properties to support health and longevity. All forms of Eastern nutrition utilize harvesting and preparation methods to enhance nutrient compounds while reducing or removing naturally occurring toxins. Research on chronic illness among aboriginal/native/first peoples supports the hypothesis that returning to traditional foods reduces chronic diseases and increases lifespan. Worldwide, traditional diets are higher in nutrient diversity; research on the Mediterranean and Nordic diets illustrate that traditional foods beyond those of Asian and native peoples provide health and longevity benefits.
Nature and Environment
Within the past decade, the body of evidence associating time spent in natural surroundings with improvements in health, wellness, and longevity has grown from a few dozen studies to hundreds. Nature is very much a form of nourishment, feeding human biochemistry in various ways that affect physical, mental, and spiritual satisfaction. “Being in nature, or even viewing scenes of nature, reduces feelings of anger, fear, and stress along with their associated neurochemicals while increasing pleasant feelings and their many beneficial biochemical responses in the body.”,  Exposure to nature contributes to physical and spiritual well-being by reducing blood pressure, heart rate, muscle tension, and the production of stress-related hormones.,  It may even be associated with reduced mortality, according to scientists Stamatakis and Mitchell., 
Many plants and trees secrete organic compounds called phytoncides into the surrounding air. These chemicals were studied in 2008 by Japanese researchers for their beneficial health effects on cancer expression in women. On a three-day, two-night forest bathing trip, participants’ daily activity level and NK (natural killer) cells significantly increased in blood and urine samples along with perforin, granulysin, and granzymesa/b-expressing cells, while the concentrations of adrenaline, noradrenaline, and T-cells decreased. Additionally, the positive effects of the trip were found to last at least seven days after the end of the trip. Serial studies done since 2004 on the effect of forest environments on human health have been conducted in Japan, leading to the formation of the new interdisciplinary science (integrative medicine, environmental medicine, and preventive medicine) of “forest medicine”.
A 2017 study published in The Lancet Planetary Health suggests that people residing in “green” neighborhoods live longer than those in urban settings. Transdisciplinary researchers from Drexel University have investigated how nature relatedness ̶ simply feeling connected with the natural world ̶ benefits dietary diversity and fruit and vegetable intake in a study published in the American Journal of Health Promotion. “Nature relatedness has been associated with better cognitive, psychological, and physical health and greater levels of environmental stewardship. Our findings extend this list of benefits to include dietary intake,” according to Brandy-Joe Milliron, PhD, an associate professor in Drexel’s College of Nursing and Health Professions and lead author of the publication. “We found people with higher nature relatedness were more likely to report healthful dietary intake, including greater dietary variety and higher fruit and vegetable consumption.” Research on mental health conditions related to the strict indoor isolation mandated by the Japanese government during the COVID-19 pandemic reveals that outdoor exposure and views of green space and natural surroundings make a measurable difference in reported levels of depression, anxiety, and loneliness.
Children are highly sensitive to environments and especially need to spend time outside in green spaces. A study published by the American Academy of Ophthalmology reported that chances of developing myopia (near-sightedness) were reduced by 2% for every hour a child spends outside in the garden, yard, or park. The leading conclusion was that increased exposure led to higher vitamin D levels, significantly improving their sight. According to another study, children with attention deficit and hyperactivity disorder (ADHD) were able to concentrate better after taking a walk in a park than after a walk through an urban area. In 2014, researchers at the University of Colorado demonstrated that time spent in green spaces outdoors had immediately measurable effects on children’s stress levels, which were reduced overall when outdoor playtime was a part of their daily routines. The first nature-based clinic in the U.S. to be associated with a major hospital is located at the University of California San Fransisco’s Benif Children’s Hospital. The clinic collaborates with the East Bay Regional Park District in a program called ‘Stay Healthy in Nature Every Day’, with participating doctors offering nature outings for families. In June 2018, the clinic began billing insurance companies for patient visits that included time in nature as part of the treatment plan.
Human bodies are designed to move and remain in a state of constant change and activity, even when “at rest”. Movement is one of the most basic functions of the human body, and severe health problems/disorders result from immobility, even for a fetus in utero. At any age, inactivity is often more to blame than other health factors when ability declines. A recent British Journal of Sports Medicine study highlights the synergistic effects of a good diet and regular exercise. The cohort study assessed data from almost 350,000 Australian participants over 11 years regarding relationships between physical exercise, diet quality, and all-cause mortality. Over that time, 13,569 people died: 2,650 from cardiovascular disease (CVD) and 4,522 from adipose-related cancers (CA). Vigorous physical activity lowered the risk for all causes of mortality.,  Diet quality was not found to be statistically significant for all-cause mortality or CVD deaths, but a high-quality diet was associated with decreased risk of adipose-related CA mortality. People who ate a high-quality diet, including at least 4.5 cups of vegetables and fruits a day, and had regular physical activity, had the most significant reductions in risk of death. Physical activity, including walking, was associated with benefits, but a vigorous activity that led to sweating was especially protective against CVD risk, even for 10 to 75 minutes per week.
The American Heart Association states that stroke is the 5th most common cause of death in the U.S. and a leading cause of long-term disability. Taiji (similar to qigong) is an intervention used in Chinese medicine. Both practices involve controlled movements and breathing techniques, although taiji is usually done while standing. These practices are powerful mind-body integrative skills meant to train the individual to regulate body/breath/mind to bring about the optimum state for healing and maintain healthy functioning.
A recent study was conducted at two Chinese medicine hospitals in Kunming, China. Researchers recruited 160 adults (average age of 63; 81 men and 79 women) who had suffered their first-ever ischemic stroke within six months of joining the study and retained the use of at least one arm. Among the study participants, half were randomly assigned to a sitting taiji program, and the other half were part of the control group that practiced a standard stroke rehabilitation exercise program (hospital-recommended upper limb movements). Sixty-nine people in the sitting taiji group and 65 people in the control group completed the 12-week program and 4-week follow-up. The findings were as follows:
Those in the sitting taiji group had better hand and arm function and sitting balance control compared to those in the standard stroke rehabilitation group.
The participants in the sitting taiji group had significant reductions in symptoms of depression, better shoulder range of motion, and showed significant improvements in activities of daily living and quality of life compared with the control group.
More than half the people in the taiji group continued to practice after the 12-week intervention. Improvement in outcome measures continued during the 4-week follow-up period for the taiji group.
One of the limitations of the study is that it was conducted at only two centers. In addition, the Chinese centers’ physicians and healthcare professionals are trained in Chinese medicine and are supportive of its principles, so the results may not be generalizable to stroke survivors who receive rehabilitation care at other hospitals.
Throughout the entirety of this paper, cultural aspects have been present within each segment. Research has illustrated that the wavelengths of sounds forming spoken language and the taste of foods are introduced via the mother to a fetus in the womb. Elements of nourishment enter the body through multiple cutural pathways. Gathering a community around traditional feasts or ceremonies involving song and color benefits individuals’ mental well-being, immunity, and longevity. Research supports reduced stress response as well as improved immunity and longevity through time spent in cultural activities. Aspects of cultural foods, environment, and lifestyle often determine the development and resiliency of an individual’s microbiome.,  The individual’s culture affects a diverse diet of nutrient-rich foods, community support, and a place of purpose. In contrast, a lifestyle devoid of the multiple elements of nourishment for the body, mind, and spirit–one of isolation and disconnection from the larger world, can result in an overall increase in morbidity and mortality. Anthropologists Margaret Mead and Franz Boas affirmed the vital role of culture in human survival in the early 20th century;,  these pioneers of science challenged how individuals and their culture were viewed, then and now.,  The question of how a supportive culture, ancient or modern, brings nourishment to an individual is yet to be fully researched or understood.
This review shows that food alone is insufficient to generate or sustain vibrant health and well-being. If it is true that nutrition involves more than simply eating a “good diet,” it is also true that defining nourishment is highly dependent upon the paradigm through which it is viewed–reductionist or holistic.  East Asian, Ayurvedic, and indigenous cultures have deeply rooted beliefs, practices and gastronomy supporting body, mind, and spirit nourishment. Much of the scientific community in the Western world continues to make choices based on the limitations of the science of the past. We believe this review demonstrates ample scientific evidence and rationale to change the way we think, practice, and operate beyond our former paradigms.
Making conscious decisions to eat healthy foods
Keep our bodies moving
Spend time in nature and with our chosen communities
Limit the ingestion of disrupting or harmful substances
And becoming aware of the power of our beliefs
These all constitute nourishment for bodies, minds, and spirits, resulting in well-being that supports thriving health.
Tammera J. Karr joined Pacific College of Health Science’s Master of Science in Health and Human Performance faculty in 2020. She is the author of Our Journey with Food, Our Journey with Food Cookery Book (with contributions from PCHS students and faculty), and Empty Plate: Food-Sustainability-Mindfulness (available through the PCHS library).
Kathleen Bell is a retired Certified Nurse Midwife (CNM), Advanced Holistic Nurse (AHN-BC), and Certified Meditation Specialist (CMS1_BC). She trained in Primordial Sound Meditation and Ayurvedic principles for health/dietary practices with the Chopra Center and is certified to teach meditation by the Center for Meditation Science. Kathleen has been part of the American Holistic Nurses Association’s (AHNA) Integrative Healing Arts Program faculty since 2018.
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