Podcast 046: Caring for Eldercaregivers & Botulism

Episode Transcript

Katja: 00:00:11 Hi, I’m Katja.

Ryn: 00:00:11 And I’m Ryn.

Katja: 00:00:12 We’re here at the Commonwealth Center for Holistic Herbalism in Boston, Massachusetts.

Ryn: 00:00:16 And on the internet everywhere, thanks to the power of the podcast. We are not doctors; we are herbalists and holistic health educators.

Katja: 00:00:26 The ideas discussed in this podcast do not constitute medical advice. No state or federal authority licenses herbalists in the United States, so these discussions are for educational purposes only. Everyone’s body is different, so the things we’re talking about may or may not apply directly to you, but they will give you some information to think about and research more.

Ryn: 00:00:45 We want to remind you that your good health is your own personal responsibility. The final decision when considering any course of therapy, whether it’s discussed on the internet or prescribed by your physician, is in fact always yours.

Katja: 00:00:57 Elsie Dog has chosen this moment to decide that she really needs to have a tug on the rope, so you can hear that in the background.

Ryn: 00:01:10 Her little mouth sounds and grumbles. [laughter]

Katja: 00:01:13 It’s like, “I don’t know, you guys–I don’t know what you’re doing, but it’s time to play”.

Ryn: 00:01:19 Elsie is very helpful to have around. She prevents us from sitting down for too long at a stretch. I feel very grateful to her for that.

Katja: 00:01:29 Well hey, this week we’ve got some shout outs. We’ve got shout outs to: Angelina, who found an airpot at a thrift shop for $7; Alexandra, who’s interested in the business program; Katie, who’s interested in the Lyme disease online course; Nettle_Farmer, who has questions about energetics and constitutions, which I was pretty excited about. Also, nettle_farmer contacted us on Instagram about that, but you guys don’t hesitate to email us directly if you have questions. We’re just right at info@commonwealthherbs.com, so feel free.

Ryn: 00:02:07 You know, we did just release (or make available) our Energetics and Holistic Practice course. That’s available in our online course catalog right now, so check that out.

Katja: 00:02:21 Yeah, it’s really exciting.

Ryn: 00:02:22 If you’re already enrolled in our Foundations Program, then you may have noticed that there’s new material for you.

Katja: 00:02:30 Also, I wanted to give a shout out to Citizen Cider, because they make an amazing tulsi infused apple cider that we discovered this week–actually, I guess it was last week–and it is awesome. So, thank you guys, thanks so much for making that.

Ryn: 00:02:45 That is some good stuff. Cool. Another announcement: we mentioned previously that we have a student we’re working with right now who is currently incarcerated and a number of you had written in to ask if there was a way that you could help out. So, if you want to help, the time is now. What we have to do is to transcribe and print all of our lessons, because we weren’t able to arrange access to a computer for him. That means that if you type fast and if you would be interested in transcribing some of our lessons, this is a great way that you could help out. If so, contact us, let us know. Also, we’d like to send him some books. We sent him our book already and a deck of Katja’s herb cards to get started along with the first couple of lessons, but we’d also like to send a few other books so that he has access to more than just our perspective. I think you might have heard us say before that we think everybody should have lots of teachers when it comes to herbalism, so we’d like to make that happen here as well. If you’d like to sponsor a book for the student, then go ahead and get in touch with us, or again, if you want to transcribe stuff then reach out to us; you can do that by info@commonwealthherbs.com.

Katja: 00:04:04 Speaking of the herbal oracle and study cards, on Monday I’m launching an Instagram giveaway of a deck of the cards and I’m super excited about it. It starts on Monday and I’ll pick the winner on Friday. If you don’t follow us on Instagram yet, you should! Look us up at Commonwealth Herbs and watch for the giveaway details on Monday. But actually I’m sure I’ll be posting details about it all week. So, if you’re listening to this podcast and it’s like Tuesday, you’re not too late, there’s still time.

Ryn: 00:04:34 Alright, so what’s on your mind this week, Ladybird?

Katja: 00:04:40 Well, (not last week, but the week before) I can’t remember what I was talking about, I just remember that I said pretty soon I’m going to talk about elder caregivers, because it was really on my mind. It’s something that’s kind of on my mind a lot, but a bunch of stuff had come up with students and clients around that, too, so it was something I really wanted to talk about. I know we had mentioned a little bit of this stuff back in episode 18.

Ryn: 00:05:13 Way back six whole months ago! ‘Back in the misty days of yore…’ [laughter]

Katja: 00:05:20 It feels like it was a long time ago. But I really wanted to expand on those thoughts. I’ve watched all three of my mothers–by that I mean my own mother, my mother-in-law, and my mother-in-law from a previous marriage–and also many other women go through this, and as my parents are getting older, it’s definitely on my mind. I feel really lucky because my parents are 70, but you would definitely think they were at least 10 years younger than that. They’re really active and my father still can lift ridiculous amounts of weight. He’s always been the strongest man I ever knew, I think because at age seven he started shoveling coal after school and in the summer. My parents are just really, really active and my brother and I are really fortunate about that. But sooner or later, that day is going to come for me too, and it’s intimidating. It’s intimidating because of the way that elder care happens in our country. So, I wanted to talk a little bit about women caring for their parents. I know that there are men out there who care for their parents too, but it’s actually much less common. Seventy percent of all in-home family eldercare is provided by women, and often when men help, it’s not the same type of work. Often, men do (I know this even from my experience) more around the financial and legal sorts of things and women are doing a lot more of the care, or the sort of day-to-day care. That’s different I’m sure in every family, but the statistics are around women doing this. I’m really lately in love with a website called Daughterhood.org, and they answered the question around the women and men issue really beautifully. They included this quote from Lisa Miller, which she had written in an essay that she published in NewYorkMagazine.com. The quote from her is, “Try harder. That’s the message that women hear all around. Try harder to be happy, try harder to be skinny, try harder to be a good employee, mother, wife, daughter, friend. Try harder to feed your family nutritious meals and to give your child every possible opportunity. Try harder to find flow at work. Try harder to succeed…when there’s a whole lot of trying without commensurate succeeding, then you have to start to consider that the game is rigged.” I really love that quote because that jives with my experience a lot. She goes onto describe some common frustrating situations that people face in caring for their elderly parents, and at the end she explains that facing these experiences, “A typical woman responds, ‘I failed’. What’s worse, the woman will perceive herself to have failed her parent. There should be a whole psychological therapeutic category for this. It’s a toxic blend of self-reproach and a dysfunctional eldercare system that warrants a website dedicated to women.” So, this is why Daughterhood.org focuses on women, but it’s not like their resources can’t be used by men or any other people caring for their parents.

Ryn: 00:08:52 It’s really good stuff.

Katja: 00:08:54 Women really do get this message that if we were just thinner, our problems would be solved, and we’re told all the time that whatever it is that’s upsetting us is because we’re not enough, and that stinks. So, I think that since most of my clients are women, the clients that I’ve worked with who have gone through this are women, and that my experience in this society is as a woman, I’m going to talk about it from that perspective. But if you’re a man listening, I hope (and I think) this will still be helpful for you, so here we go. There are some issues that seem to happen for every woman I’ve known engaged in the care of elderly parents, and the first one is chronic respiratory infections. Chronic infections, really of any kind (or sort of chronic low-grade inflammatory crud going on) but really in particular chronic respiratory infections, have literally been an issue for every single woman that I’ve worked with in this situation. Although not every single one of them has had pleurisy, it is super common, and the funny thing is it is the only time that I see pleurisy. I’m sure that other people in this country get pleurisy, but I only see it in women who are caring for elderly parents. That is the eldercare disease to me in my experience. Pleurisy is when you’ve had a bronchial infection for so long and not been able to attend to it, that the inflammation finally dries out the lubricating fluid in between the layers of the sac that holds the lungs, and that sac is called the pleura. Those layers are lubricated because every time you breathe, they rub against each other, and if there’s no lubricant, then that is ridiculously painful. That’s what happens when you get pleurisy–it is ridiculously painful because that lubricant has dried up. But there’s an herb for that! It’s actually commonly referred to as pleurisy root. Many people prefer to call it butterfly weed. It is Asclepias tuberosa, which is a relative of milkweed.

Ryn: 00:11:13 I think milkweed is Asclepias syriaca.

Katja: 00:11:16 The way that I remembered is that milkweed is pink and pleurisy root is orange (the flowers). But they’re very, very similar. We work with the root of this plant in a long decoction, maybe mix it with cinnamon for flavor. It makes an enormous difference really, very quickly in this situation. I’m going to make a strong decoction of this and drink like a quart a day, but it really is wonderful. I’ll say all three of my mothers had this as well as many clients, but I have never seen a case of pleurisy go away while the elder parents were still alive. All we’ve ever been able to do is palliate the situation, but they literally had to drink the tea every day in order to breathe without pain. I’m glad that they were able to do that, but it makes me want to back up a few steps because if we know that this is a really big problem in caring for elders, then this is something that I really want to target as a risk and I want to take action against it. But a huge problem for people caring for elders, especially if you still have children at home, a job, and whatever else, is that there’s just no time for you. Lots of people will tell you, “oh, self care”, and honestly that word has sort of become an indictment in our society.

Ryn: 00:12:46 Yeah, and it’s happened fast. I think even just in certainly the past 10 years, but maybe the last three or four years, there’s been some weird thing where self care has been monetized and commodified, and it’s really gross. The things that have advertisements or whatever and they’re framed in that way, that is not what we’re ever talking about when we talk about self care.

Katja: 00:13:10 No, it’s been monetized, commodified, and also obligated, like “What? Don’t you want to take care of yourself? Buy this thing.”

Ryn: 00:13:25 “Have you meditated today?!”

Katja: 00:13:27 “Well, then you’re just not good enough.” So, I don’t want to go down that road at all here, but I would say that if there is one single thing that you (as a caregiver for elderly parents or elderly people you love) make time for, it would be taking care of your lungs. Because if you end up with pleurisy, you’re going to have to make time to care for it every day and you’ll be in ridiculous pain. Since this is one that comes up so frequently, my feeling is it’s better to squeeze out a little bit of time for this ahead of time so that you can at least avoid the part with the ridiculous pain. It’s not actually as hard as you think. It can be as simple as taking elecampane tincture a few times daily. That can really make a huge difference, and it’s a thing that you can do really quickly; you don’t even have to make a decoction, it’s totally okay to take tincture. Elecampane strengthens the lungs, it fights respiratory infection, and frankly, if I get a respiratory infection, I do immediately make a big strong decoction of elecampane root. It does not taste good (just as fair warning). I take a shot glass of the decoction every hour that I’m awake and then I drink a nice cup of some other good tasting tea. But it really does the trick and it’s worth the peppery mud flavor. Maybe for an herbalist that’s appealing, but if you’re not, I just want to be clear that it is a really weird flavor. You will kind of get used to it over time, but it’s worth it. It works so well that you won’t care, even if you never get used to the flavor. The tincture doesn’t taste that bad, and if you’re taking it prophylactically as a self care thing, you just need one or two droppersful a few times a day. That flavor is over pretty fast because it’s just the tincture.

Katja: 00:15:24 So, that is one super fast thing that I recommend, and another is a thyme steam. In this case, especially because I’m recommending that you would do this every day or as often as possible, you don’t actually have to take the time to sit over it with a towel tent. Here’s my trick if you are caring for elderly parents, have a sick kid at home from school, or just a sick anyone in your household, this still works. If it’s cold and flu season, one thing that you can do is boil up a pot of water and then take it into the room where your elders, any of the sick people, or people you don’t want to get sick are and set it on the dresser or someplace where they won’t accidentally burn themselves, put in the thyme, and just let the steam fill up the room. You can do it when you’re going to be in there doing some other thing, like maybe helping them get dressed or helping them get up and get ready for the day, and that way you’re both breathing in that aromatic steam. It is not as intense as putting your head right over the pot, but as a preventative it’s really not bad. It’s so much faster and you’re getting two for one: you’re taking care of the elders that you’re caring for and yourself, because you don’t want them to have a respiratory infection either. That’s also not good. Again, this is a quick thing and that’s totally key in this situation. If I give a bunch of solutions that take a lot of time, they’re not going to happen, so I’d really rather something quick that’s not perfect over something perfect that takes a lot of time. If you’re doing this every day, then it’s okay that you’re not getting the full intensity, because you’re still getting something. Obviously, if you feel yourself coming down with something, that’s the time to make a little bit of time to sit down for a thyme steam and really get your face right up to the pot and breathe it in deep a couple of times a day. Even though it’s hard to make time for that, really take the care of your lungs seriously because that is such a place where people get sick. But if you’re not sick and you’re just doing it preventatively, it’s fine to just have it in the room with you. Those are some suggestions there.

Katja: 00:17:54 The next thing after respiratory infections, the next most common thing that I hear of, is fear in the adult daughters of developing dementia or Alzheimer’s themselves. Every woman I’ve ever worked with whose parent was affected by dementia or Alzheimer’s has been really afraid of developing it themselves and what that would mean for their own children eventually who would have to care for them. So, I wanted to share some preventatives that can help here. I see women have so much anxiety around this issue and there are things that you can do. Obviously, there’s all of the recommendations that you hear about staying active, playing Sudoku, and all that stuff, but A) you’ve already heard that and B) you’re too busy to play Sudoku. Plus, trying to navigate eldercare is way more complicated than any mental games you can play, so I think you’re probably covered in that area already. There has been some very interesting work around the concept of Type 3 Diabetes. There’ve been a bunch of studies that show a strong link between diabetes and insulin resistance and the development of dementia and/or Alzheimer’s later in life. While it’s not always easy to keep a low sugar diet, especially when you’re stressed and when you’re short on time, it is really exciting that there are herbs that can help. The first that I’m thinking about is cinnamon and also adaptogens, like ashwagandha and tulsi. All three of these can really help the body cope with sugar. As a matter of fact, cinnamon is helpful enough that if you’re going to start working with it in therapeutic doses (which is really only a couple of teaspoons daily, or if you’re taking it by capsules, a couple of capsules) and you’re already medicated for diabetes, you need to very carefully check your blood sugar levels because it might change your levels enough that it affects the dose of your medication. So, if you’re taking diabetes medications, talk to your doctor about this before you start. But if you’re not, it’s not unpleasant to add cinnamon to your daily routine and it can really help your body a lot. Yes, it is totally okay to take capsules, but if you like cinnamon, then you can just add a teaspoon into your morning oatmeal, some applesauce, or whatever and have it that way, too. Then those adaptogens I mentioned–ashwagandha and tulsi–both of these help the body with sugar and stress, and both have some interesting research around their effects on the hippocampus and being able to stimulate the regrowth of the hippocampus after damage, specifically damage caused by too much cortisol in the system, which goes right along with too much insulin in the system. We don’t have studies around other brain regeneration, but if we already know that something is happening in the brain because of cortisol, cortisol is a reaction to insulin, and this herb can stimulate the repair of that, then I feel like it’s not too far to imagine that it might be able to stimulate other kinds of repair in the brain as well. Even if it doesn’t, it is still doing great things for the part of your brain that processes the experiences that you have, helping you get over stress, and helping you deal more effectively with sugar that you eat. All of those things are really, really excellent. Tulsi in particular has such beneficial effects on mood and can really help you get through some tough times. I don’t mind tulsi and ashwagandha in capsules for brain health, but I really do love tulsi as tea, especially from the mood aspect. Organic India doesn’t pay me to say this, but they do make a very high quality tulsi tea bag that you can get at the grocery store or on Amazon. If you keep that handy in the kitchen or at work, then all you have to do is add hot water, which is a lot faster than getting out all the paraphernalia to make an involved herbal tea, which is awesome and good. I wish everyone had the time to do that, but if you don’t, Organic India has you covered. They have all different flavors of tulsi tea, like tulsi with rose, tulsi with ginger, and they’re really excellent.

Katja: 00:22:46 Lion’s mane is another–it’s a mushroom, but I was going to say it’s another herb, but it’s a mushroom. We sort of categorize it as an herb medicinally.

Ryn: 00:22:56 Our definition of “herb” is broad enough to include the fungal kingdom. [laughter]

Katja: 00:23:02 Yes. It is fantastic for boosting brain and nervous system health. Although it is delicious in your dinner, this is another one that is totally fine to take in capsules. Do you sense a theme here? I am definitely working on a plan here for a person who just does not have a lot of time. I really liked the Fungi Perfecti [Host Defense] brand. They also don’t pay me to say that, it’s just the one that I use.

Ryn: 00:23:29 If anybody over there is listening and would like to start… [laughter]

Katja: 00:23:31 Yes! Yes–feel free to. I would take sponsorship from them, they’re a great company. Paul Stamets is really an amazing person. Lion’s mane stimulates nerve growth factor, and that helps keep brain tissue healthy, helps with memory, helps with overall nervous system function. It is really pretty amazing. Even if you’re not worried about dementia and Alzheimer’s, these are all herbs that can just help you keep going through marathon times and help you function the way that you need to. So, even if that’s not a concern for you, feel free to add these into your routine, especially when you’re in the marathon of elder care.

Katja: 00:24:16 I also just want to say that it’s really important to recognize that you can’t do it alone. If you are doing it alone right now, first off, you’re a superhero, and secondly, try to take a little time to figure out how you can get some help. Even though that will take a little bit of time, it’s going to pay off and it’ll really be worth it. There are programs in many states that provide visiting caregivers a certain number of days per month for free or at low cost, and the local senior center and may also have some options. If nothing else, maybe you have a friend in a similar situation and you could schedule like play dates for your parents just like we did with our children when we were young. If you don’t have a friend in this situation, you might be able to find someone in your community and make friends, which could be great because, frankly, it’s good for elders to have community. They still want to hang out with people and not always with their family, and it can also be really good for you to have somebody in your life who’s also taking care of elder parents to talk with and who understands what you’re going through. This can be kind of a fun way to work it out so that everybody gets something out of the deal.

Ryn: 00:25:54 Which is kind of a recurring theme whenever we start talking about community as a solution to these sorts of problems. It’s never just for the one person.

Katja: 00:26:01 The website daughterhood.org has a lot of resources that can help you find help. Again, it helps all children helping aging parents, even if you’re not a daughter. Then the last thing that I’m thinking here is maybe some hawthorn or motherwort. They’re such big themes in my life right now, but such amazing plants for supporting change, transition, and the grieving process that’s natural, appropriate, and crappy when you’re going through these kinds of things. I will try to put a photo in the show notes of my beautiful new hawthorne and motherwort necklace that Hilary Kamien at QuintessentialArts on Etsy made for me. It is so beautiful and it’s really fun to wear my current favorite herbal formula as jewelry. If you want to wear your favorite herbal formula as jewelry, then check her out and tell her that I sent to you. She has all kinds of plants and she can make whatever you ask for, pretty much, so that can just be a little fun thing that can be a part of your experience.

Ryn: 00:27:28 Pretty great. It’s a really lovely necklace.

Katja: 00:27:32 Well hey, what are you going to talk about this week?

Ryn: 00:27:35 Well, I’ve been learning about botulism. [laughter] Basically what happened was one of our students in the online program sent us a message last week or a little while back just asking about botulism. This is a thing that I’ve been asked about maybe once a year and have usually given various versions of the same answer, and I just wanted to take a minute and kind of check my math and make sure I knew what I was talking about.

Katja: 00:28:09 We have never experienced botulism.

Ryn: 00:28:12 Right. I have not actually dealt with this, so I want to be clear that this is not based on 100 case files that I have stacked up for you.

Katja: 00:28:21 Actually I think that’s pretty good, though. Every so often people do worry about, “What if I make these tinctures, what if they go bad, and what if I make someone sick?” In 20 years that has never happened. So, I think that’s good.

Ryn: 00:28:36 And that jives with what I’m going to be saying about this. The place that people most often ask about botulism as a risk is that they’re making an herbal infused oil and they’re aware that this is the kind of thing where if it was going to happen, it would be in a situation like that, because of the environmental conditions that botulism needs (or the microbe needs) in order to thrive. We’ll come to those in just a moment, but the question to start out with is “What is botulism?” The word ‘botulism’ refers to the sickness. So, you’ve gotten sick and the kind of standard presentation, symptoms, and all that starts with a kind of paralysis. It generally begins in your face and then spreads out from there to your arms and your legs. When it gets really severe, what happens is you get paralysis of the muscles of breathing and so you stop breathing, and that’s a problem. Nowadays, what happens is it progresses slowly enough that people look at you, they notice something’s wrong, and they get you to the hospital. If it’s that severe, then by the time your breathing starts to slow down, they’ve got you on mechanical respiration.

Katja: 00:30:11 Okay, that’s good. I mean, let’s not do that, that sounds terrible. [laughter] That does not sound like an experience I want to have.

Ryn: 00:30:19 The word, by the way, comes from the Latin botulus, which apparently means sausage and this is in reference to what you look like when you have botulism. You can check out some photos. You swell up and all the muscles in your face get kind of slack, and people look like they’re asleep or like they’re super, super sleepy or intoxicated because the eyelids droop, but they’re actually totally awake in there. They can’t retain an adequate degree of tension in the face muscles.

Katja: 00:30:57 This sounds terrible.

Ryn: 00:30:58 Yeah, it’s not fun. The thing to think about first would be where does this actually come from, what causes that? With botulism, you have a couple of different elements going on. You have the bacterium itself; that’s a bacterium called Clostridium botulinum, and you might be thinking to yourself, “That sounds kind of familiar”. It’s in the same genus as Clostridium difficile (or C. difficile), which has gotten some attention in the last few years as a cause of really intractable antibiotic-resistant intestinal infections. These are the ones that people have been driven to do things like a fecal transplant from a healthy donor, and that’s one of the few treatments that actually works. So, that’s in the same family, it’s sort of a relative. Anyway. Clostridium botulinum is the microbe, is the organism, but that’s not what’s actually damaging you or causing the illness. I don’t advise this, but if you were to take some Clostridium botulinum critters, clean them real good, give them a scrub, and then eat them, you’d probably be fine–especially if you’ve killed them first. [laughter] That’s all ridiculous. What really causes the problem is a toxin that the bacterium creates. In this context, the word ‘toxin’ is used in a very specific sense. It’s a type of protein that the bacterium creates and it interacts with your nervous system in such a way that it shuts down some really important functions. I’ll come back to that in just a moment. About the bacterium: like many other bacteria, it’s not super hard to kill it if you get it really hot, you really dry it out, you attack it with acids, bleach, or other kinds of things like that. You can take what they call the vegetative form (like if you’re picturing a blobby little bacterium in a microscope slide), that thing is pretty easy to kill. You can destroy it by boiling and disinfectants.

Katja: 00:33:17 This is where home canning came from, the all the boiling and everything.

Ryn: 00:33:21 Yeah, and that will usually take care of it. There’re some asterisks that we can come back to on that. Alcohol content is also helpful to kill this bacterium, especially if you get it above 70 percent; at that point, you can feel pretty confident that you’ve got them all. That’s what they call the vegetative cell of the bacterium, but it has another form that it can take called a spore. That’s sort of like (I don’t know why this metaphor came to mind) if you take a video file and then you compress it down into a zip file, then you’ve saved a lot of space and you’ve taken some repeatable things and you’ve kind of squashed them down. So, you’ve taken the bacterium, it condenses down into a spore, it kind of has a hard shell around it, and is metabolically inert. Spores like this, they can survive in really extreme conditions. Not to my awareness of the botulism critter, but there are critters that live in the desert, for instance, and they’ll go into a mummified hibernation state when it’s really dry, but when it rains and the water’s flowing, then they’ll sort of burst open, wake up, and multiply really, really rapidly. The botulism spore here, the Clostridium botulinum, they do something kind of similar. They’re dormant a lot of the time. They’re dormant in the soil, dormant in lots of places in the world, but they’re not active until they get exposed to the right kind of conditions.

Katja: 00:34:57 It’s actually kind of amazing that it can do that.

Ryn: 00:35:04 Life is pretty cool, huh? So, the real thing you actually have to worry about is the botulinum toxin that these microbes produce. There are ways to defeat them, but it’s a little harder. If they were exposed to sunlight, then they would get broken down within a few hours, or if you heat them to relatively high temperatures (I’m seeing some numbers like if you heat it to 80 degrees Celsius/176 degrees Fahrenheit for 20 minutes or 185 degrees Fahrenheit for at least five minutes, things like that) then that will kill off the microbes. That’s below the boiling point. Generally, boiling for a few minutes, if the internal temperature of your food or whatever reached those temperatures then that would be fine.

Katja: 00:36:04 That’s why we have turkey thermometers.

Ryn: 00:36:07 Right, because you’ve got to get into the middle. As I’ve been saying, the bacteria wait until conditions are favorable for the spores to kind of enter the vegetative state, then to grow, multiply, and all of that, and that’s the time at which they’re going to be producing these botulinum toxins. Interestingly enough, in the course of digging into this, I found that because this is a protein, there’s going to be a gene in the bacteria’s genetic code that encodes for the protein. All of the proteins that build up your body, somewhere in your genetic code there’s instructions for how to build those, and it’s the same with this bacteria. So, they have those genetic instructions to do it, but we’ve discovered that the gene that encodes for that toxin protein is actually carried by a virus, or what they call a phage. It’s a virus that infects those microbes. Maybe if you gave your Clostridium botulinum microbe colony an antiviral, maybe that would solve this problem.

Katja: 00:37:16 Maybe some elderberry syrup? [laughter] Okay. So, a bacteria gets a virus? That’s amazing.

Ryn: 00:37:22 If you’re into genetic modifications and you’re listening to this podcast (Hi, what are you doing here?), please don’t get the idea to go mass produce non-botulinum-producing Clostridium microbes and trying to repopulate the soil of the earth with them, because that won’t work and it will have side effects.

Katja: 00:37:40 That would be terrible. Although, there is a whole branch of science doing work like that. It falls in that category of “Just because we can, I’m not certain – Maybe we should?” I don’t know, but I’m not certain that we automatically should.

Ryn: 00:37:58 The environment that this creature likes is one that doesn’t have oxygen in it, that’s low salt, low acid, low sugar (sounds like some diets I know [laughter] ), and is at ambient or warm temperatures–not too hot but not cold either, has an available protein source, and of course some moisture. Getting all of those things together in the same place is common in certain environments, like an inch below the soil, but it’s not super common necessarily in the aerial parts of your garden. Like on the surface of your tomato plants, there’s not really a whole lot of opportunity for botulism to be growing there. So, let’s talk a little bit about like what happens when people get sick with this, what that looks like. Again, the symptoms are that kind of paralysis, you would experience blurred vision, you would have a drooping of the eyelids that’s really obvious, there can be nausea, vomiting, diarrhea, cramps, and all of the sort of usual fun stuff. But then if there is that difficulty breathing, that’s when getting really serious. Interestingly, this pattern of effects–where it starts in the face and then spreads outward from there–that has to do with how frequently those nerves fire. Your face is a hotbed of electrical activity. I say nerves, but it’s specifically what they called the neuromuscular junction. These are the nerves that are going into muscles and giving them the signal to contract or slacken.

Katja: 00:39:43 So, if you got botulism while you were at the gym…

Ryn: 00:39:47 I don’t think it would help you to work out harder, no. [laughter] But I specify the neuromuscular thing to say that this isn’t attacking all of the nerves everywhere in your body. It doesn’t eat your brain, it’s specifically that particular type of nerve. If this actually happened and you went to the hospital, what they would give you is something called an antitoxin. It sounds kind of generic, but remember in this context that toxin is a particular kind of a protein and an antitoxin is also a kind of a protein. It’s one that kind of prevents that toxin from getting around in the bloodstream or prevents it from binding to your neuromuscular junction receptor sites. An antitoxin is actually an antibody; most of them are actually grown in a living animal, harvested from their blood, purified, and then injected into you. One of the problems that can come with this is a thing called serum sickness and so there’s a variety of methods they use to try to combat that. Previously, they would do little patch tests. With the botulism one, most of them are derived from horses and so they would test you out and try to see how you responded and then if it seemed okay, they would give you the bigger dose. These days there are varieties of the antitoxin that have had some of the protein cut off, the pieces of it that are more likely to cause this serum sickness, which is basically like an organ rejection situation.

Katja: 00:41:23 This is so complicated. It’s amazing that we can do this, because I don’t think there’s an herb for botulism.

Ryn: 00:41:33 No, I don’t think that there would be a whole lot of ways to solve this problem herbally. I was sort of starting to say maybe if we have something that stimulates the release of acetylcholine, because that’s what this is shutting down, but I don’t know, I don’t think so.

Katja: 00:41:51 I think it would be better to not get it.

Ryn: 00:41:53 It would be better to not get it. And don’t worry, that’s not too hard. The punchline here is going to be, “Don’t worry, this is actually not hard”, but I wanted to scare you a little first. [laughter]

Katja: 00:42:01 This is like a horror podcasts now suddenly.

Ryn: 00:42:07 Just in case you’re worried, they do have human-derived antitoxin now and a couple of other recent advancements, so that’s pretty cool if you end up in the hospital. But don’t worry, it’s pretty rare. How do we know how rare this is? There are some diseases where we’re not really sure or we have sort of vague estimates and we do our best, but with botulism, it’s actually pretty solid numbers here because the CDC, the Alaska Department of Health, and the Canada Department of Health are the only sources of that antitoxin, at least in the United States and Canada. Because of that, any case where somebody gets brought to medical people for help is going to be recorded. Some might not be recorded, but those would be maybe the misdiagnosed or if you were mildly affected, maybe you didn’t even seek medical care. I think that’s worth pointing out that sometimes this doesn’t kill you, with this and with a lot of things; it’s kind of similar to when plants are labeled toxic and people think that always means it kills you if you look at it the wrong way. You could get just a little botulism. “I’m just mildly sausage-like right now, you know, no big deal.” [laughter]

Katja: 00:43:22 I think I would like no botulism, thank you. [laughter] You said “a little like a sausage” and all I could think of was cocktail wieners. Do you remember those, for whatever that time in the past was?

Ryn: 00:43:43 I do. I have a story about that, but it’s not for the podcast.

Katja: 00:43:46 Okay. Sorry guys. You don’t get to hear it. [laughter]

Ryn: 00:43:48 Anyway. A thousand cases worldwide per year, more or less, and about 150 or 200 of those in the United States. 65 percent of the cases are what’s called infant botulism, about 20 percent in wounds, and about 15 percent foodborne. These are referring to like the mode of your exposure. Infant botulism is by far the most common, basically because infants don’t have the whole suite of defenses that we have; they’re more likely to get a colonization of the gut with the actual Clostridium botulinum microbe. That does occasionally happen in adults, but it’s extremely rare and it’s only in people who are already immunologically compromised or have a really severe dysbiosis situation going on. Infants are just susceptible to this because they don’t already have a whole compliment of healthy gut microbes in order to fight off the infection for them. That, by the way, is also where the warning to not give infants honey comes from a because it is possible for honey to have a few botulism spores in it. In adults, older children, whatever, it’s no problem. Your gut flora will suppress those from developing into full vegetative state microbes, producing toxin, or whatever else. You’re fine, you can handle a few spores here and there, but your infants, they run into problems. So, that’s the major reason for that warning not to give honey to infants under one year of age.

Ryn: 00:45:32 There are some cases of food exposure (about 15 percent of the cases are food-derived), and that’s the food you were producing, making, preparing, or whatever had some microbes in it, and because of the way you prepared it, the methods you used, or whatever, they were allowed to grow rapidly. Then they made a lot of toxins and you ate those later on and then you got sick. There are some cases of wounds getting infected with botulism. The majority of them are from intravenous drug use. This was a big problem, or has been and still remains a big problem, in places where black tar heroin use is really prevalent. But standard hygiene measures would take care of that, so it’s the kind of problem that needle sharing would spread, but clean needle exchange programs and things like that (yet another on the long list of things that those can help) can help to reduce the prevalence of. There’s also a few cases, very rare, of inhalation–like you actually inhaled microbes–but that pretty much only ever happens in a lab environment where somebody’s biosafety procedures break down. Then, of course, there have been a couple of cases of botox gone wrong. Those are referred to as injection exposures. Botox actually is botulinum toxin and they do use that to relax certain muscles in your face, and then I guess you look younger, but be aware sometimes that goes wrong. But don’t worry, not too often.

Katja: 00:47:25 Plus, you’re already beautiful.

Ryn: 00:47:26 That’s right. That’s kind of the breakdown on the epidemiology. You know, about once a decade or so there’s a breakout incident where a number of people get sick. There have been a few cases that were involving herbs in oil. I’ll talk about those in a moment. Actually, I’ll talk about those right now. I looked back through the CDC’s surveillance reports about botulism from 2001 to 2016, and I’ll link to those in the show notes here so you can check those out. Basically, when you look at the foodborne cases, there were a few that were people canning food at home and oops, you got into some trouble. That’s most likely to happen if you’re canning a low acid food and especially if you’re not using any additional citric acid or other kinds of acid in your canning process, because again, if you have a relatively acidic environment in your food, then you’re going to be fine. Or if you have a sufficiently salty environment, you’re going to be fine as well. For a lot of things, this isn’t a major issue, but there are a few cases where you have to be extra careful. There were a couple of cases I found in those documents about a big potluck or something and somebody made a whole bunch of baked potatoes. If you do that, do not leave them wrapped in foil at room temperature for a few days and then serve them to people, or mix them up, puree them, and add them to a soup, chip dip, or something like that, because there were a few cases of that happening. A couple with potatoes and one with beets. But think about it: you’ve got a vegetable that was growing in the dirt, and so it could have had spores on it, then you heated it up, then you let it come back down to room temperature, and then you had it wrapped in the foil, so that provides the darkness.

Katja: 00:49:43 And a little dampness.

Ryn: 00:49:45 There’s some condensation on the inside there. So, you’ve basically created the perfect environment and that can get you. There were a couple of other cases I found really interesting that we’re basically people in prison making hooch (homemade alcohol, pruno, whatever you want to call it). One incident, the people had been working with honey, apples, potatoes, and tomato paste, notably from a bulging can, so it may have already had an issue going on. They were combined, mixed together, fermented in a sealed plastic bag hidden under the bed at room temperature for three to five days. It did become alcoholic, everybody who drank it got sick, and some of the people ended up getting on ventilators for awhile. There were a few that were like that actually; I think in one of them, a couple of people died. But again, don’t provide the microbe with the ideal environment–with moisture, a protein source, not too salty, not too acidic, all that stuff. Tomatoes, by the way, are a case worth talking about here. Most people consider them to be acidic, but they’re sort of just barely on this side of the pH scale when they’re pureed that botulism still can grow in them, so be aware.

Katja: 00:51:08 I feel like saying, what about apples? What about blueberries? As if you’re going to have this all just memorized. But I’m now super curious.

Ryn: 00:51:21 There were also a lot of cases in Alaska, and those seem to primarily be coming from people doing home fermentation of oily fishy kind of stuff. That also seems to be a place where this is more likely to happen than with other types of fish.

Katja: 00:51:42 I was wondering what was special about Alaska.

Ryn: 00:51:47 Alaska and California; I think California is more with infant cases. I don’t really know exactly what it is about California in particular that makes it so much more prevalent there. But it’s Alaska and California, and then pretty much everybody else. There are also a couple of high profile cases, especially a few back in the eighties, of outbreaks of botulism that were traced back to–and this surprised me–preparations of garlic in oil. So, you had some garlic cloves and they were infusing into oil, then later on people use that as a condiment in a mixed dish or something, and then a bunch of people got sick. There were outbreaks in 1980, 1985, and a couple other years.

Katja: 00:52:44 That does surprise me. I would have thought that wouldn’t be possible. I would have thought that the garlic would be enough to take care of it.

Ryn: 00:52:51 In the cases that I saw, these were commercial products, they were garlic, they were in oil, and at least one confirmed that it was in soy oil (probably all of them). They didn’t have all the details, but worth noting that these were 1985 and 1989. In 1989, the FDA put out a ruling and they ordered that all commercial garlic in oil preparations that lacked an acidifying agent be removed from the shelves. I’m not old enough to remember that. Maybe I should ask my dad about it since he’s worked in grocery stores his whole life. Hey dad, if you’re listening… [laughter]

Ryn: 00:53:40 Now, anything like that is going to be mandated to include an acidifying agent, and that’s usually just like powdered citric acid or something like that. I have seen recipes for making oil infusions at home that recommend adding lemon juice or vinegar, one tablespoon per cup of oil. I feel like that would be a little odd and it wouldn’t integrate it together very well, but at the same time the lemon juice itself or the vinegar isn’t going to grow microbes either. There are recommendations like that that you’ll see here and there. Obviously if something looks bubbly, cloudy, has a terrible odor, or is turning a weird color that you don’t want it to, then that’s probably not good news.

Ryn: 00:54:34 The other element I want to point out here is that in all these cases, these food products where unrefrigerated for several months before they were opened, before they were used, so there were some of the conditions set, for instance, because it has to be warm to bloom. The thing I want to take away from this is that for us herbalists over here, none of those cases really sound very much like a standard oil infusion or tincturing method, in terms of the amount of time that your plant matter spends in a no-oxygen, warm, moist, dark environment. An oil infusion has some of those, but not all, and a tincture has some of those, but not all, so usually you’re going to be safe. My read on this is that a botulism contamination is potentially possible, but extremely unlikely in tinctures because the alcohol will kill the actual bacteria, provided it’s above 20 percent. It’s going to get more effective with increasing concentrations. If it’s above 70 percent, that would be definitely safe, at least in terms of the bacteria. Now, if there was a lot of bacteria on your plant matter to begin with, and they were in an environment that enabled their growth (anaerobic, warm, moist, dark, with some protein there), then they could have already produced a bunch of botulinum toxin and that would stick around until you heat or expose your tincture to light, which is exactly what we don’t do when we’re making a tincture. But you’re not going to start out with plant matter that’s been in a no-oxygen warm, moist, dark environment.

Katja: 00:56:20 I mean, unless you were trying to ferment something.

Ryn: 00:56:23 Some of your roots would have been in that environment, but when we tincture roots, if we’re going to do it fresh, you would dig it up and you would probably wash it a bit. It’s not like the botulinum spores are crawling their way inside of the root, they would be on the soil on the surface.

Katja: 00:56:43 I usually scrub them pretty good, because you want to get the dirt off, and I use a vegetable brush or whatever.

Ryn: 00:56:49 Right. Then you might chop them up, you might let them wilt for a little while, let some of that moisture evaporate. If it’s fresh plant matter you’re working with, you’re going to use really high alcohol anyway, so all told, this is fairly unlikely with tincturing. I’ve never heard of it in a tincture and I’ve never even heard of a rumor of one. I’ve heard rumors of people talking about oil preparations with botulism, but with tincture it’s just never come up. So, there’s little likelihood of a substantial infection in living plant matter or dried plant matter, it’s just extremely unlikely with that.

Ryn: 00:57:28 Now, with oils (infused oils we’re talking about here–so you take plants, put them into a jar, pour in some olive oil or something like it, infuse it, and then you work with that) it is a possibility, but it’s very rare. Like I said, I’ve heard rumors of this here and there, but I can’t speak to any first or second degree cases of that actually happening. The bacteria require that anoxic environment, which an oil does provide, but they also require water to bloom and ideally you don’t have water in your oil. This is one of the first things we’re concerned about for this reason and not just for botulism, but for other critters as well–mold, whatever else. We don’t want that to grow in there and so we try to prevent water from persisting in our oil infusions, whether we start with dried plant matter or whether we warm the oil while we’re infusing the plants so that their moisture can evaporate before we strain it and jar it, we’re going to be taking steps to prevent that very thing. Several conditions would probably need to be met for botulism to grow in your herb-infused oils. Like you were working with fresh plants and used a no-heat method in a sealed container – which, the reason I specify is that it allows the moisture to stay in – and you had herbs that were insufficiently antimicrobial to fight off the microbe. Although that may not matter that much given that there was the garlic thing. So, you could add some kind of acidifying agent to your oils if you were really worried.

Katja: 00:59:07 That doesn’t appeal to me at all, unless you were going to turn it into a salad dressing. I think I would prefer to put it in the refrigerator.

Ryn: 00:59:15 If you keep it in the fridge, that will definitely slow that down and reduce that.

Katja: 00:59:23 To be clear, we don’t keep our oils in the refrigerator and we’ve never had this happen.

Ryn: 00:59:28 Right. But if you were worried, you could do it. Again, contamination is usually pretty obvious, and I say that advisedly. There’re actually six or seven different varieties of the Clostridium botulinum microbe and they produce slightly different variants of this protein, this toxin, but some of them make obvious signs if they’re growing in a food. They’ll all cause gas release; if it’s a sealed container, there will be bubbling or be high pressure inside, so that’s one thing to always watch for. Some of the versions of Clostridium botulinum will also make it smell funny, turn weird colors, look slimy, or this or that. There are a few variants though–and these are the ones people worry about–that are undetectable, aside from the gas and the pressure thing, but otherwise undetectable. That scares people, but I would point out that if Clostridium botulinum is growing, there’re probably other things that are growing there as well. Usually there’s going to be some visible or sensory sign of badness for you to detect, some discoloration, bad smells, slime, whatever else going on.

Katja: 01:00:41 I would have to believe there would at least also be mold happening.

Ryn: 01:00:48 Again, the basic takeaway is as long as you stay away from creating an ideal environment, then you should be fine.

Katja: 01:00:56 Please make your environment sub-optimal. [laughter]

Ryn: 01:01:00 Yeah, that would be the way to go. For a variety of reasons, that sub-optimal environment for the microbe is better for your herbal extract, so you were probably doing that anyway. Now, if anybody out there has a documented case or an “it happened to me” case of an herb-infused oil product, like an infused oil, salve, or an herbal tincture causing botulism, I would love to hear about that. I would want to ask you a pile of questions: Was it foodborne? Was it a wound problem? Was it in an infant? Do you know how the herbal product was made, like step by step with all the details? How was it stored? How was it consumed? How was it applied? How much did they take? How severe was it?

Katja: 01:01:46 Inquiring minds want to know! [laughter]

Ryn: 01:01:51 I’m super curious. So, if you have a story like this or if you know somebody who you think hinted at having one at some point, chase them down for me; I would love to get a better sense of this kind of thing from the herbal community perspective. But you probably don’t, because it just doesn’t happen very much. I wanted to do this because people do ask and you may have been wondering or if you start teaching classes somebody might ask you later on. I feel like this one is pretty nailed down, but again I would be happy to hear your experiences and your information about it.

Katja: 01:02:29 It’s definitely something that I’m never concerned about, but now I feel very confident in my lack of concern.

Ryn: 01:02:37 Keep up those good manufacturing practices, people. You’ll be alright. Okay. Well that’s it for us this week. I don’t think we have any other announcements.

Katja: 01:02:50 Just check out the Instagram for the Herb Card giveaway.

Ryn: 01:02:54 Yeah, watch for that. Cool. We will be back next week.

Katja: 01:02:57 See you then!