Bile, the Vagus nerve, and how I learned to stop kvetching and love my bitters

I know in most parts of Canada there is still snow on the ground, but here on Vancouver Island, BC, spring is in the air. Spring can mean many things. Renewal. Change, Freshness. The light at the end of the dark, dark tunnel. Blossoms (in Victoria, falling cherry blossoms is sometimes the closest thing we get to snow). Its also a time of letting go, a time of sloughing off the weight of the fall and winter seasons, a time to start over.

Interestingly, many of the herbs that show up around this time of year are those which help us with the change the season already provides us; herbs with precious nutrients like nettles, lymphatics like cleavers, and, the protagonists of this post, bitters such as dandelion leaves or arugula.

Physiologically, bitter is an incredibly important taste, which has been vastly undervalued in our society’s pallet. Almost every other culture has a relationship with the bitter taste, either with certain vegetables, or with alcoholic beverages. Bitters have an essential role to play in our physiology, from the digestion, to blood sugar regulation, to resetting the nervous system. We have bitter receptors throughout our entire GI tract, so it is not crucial to actually taste the bitterness, as we once thought; however, I would argue that it helps, both on a physiological and emotional level. When we taste bitters, a number of physiological processes begin to take place, and it all begins at the increasingly famous Vagus nerve. Stimulation of the Vagus nerve in the brain initiates all digestive secretions in the body: saliva in the mouth, enzymes in the stomach and pancreas, bile in the liver and gallbladder. These secretions are released because the Vagus nerve is responsible for the initiation of the parasympathetic nervous system, or the "rest and digest" mode. When we are at rest, blood that lives in skeletal muscle during sympathetic or "fight, flight or freeze" mode, so we can properly run away from the grip of a tiger's jaws, is redirected to the digestive system in order to properly break down and absorb our food. In a culture where we live in a constant state of stress, and where more and more people suffer from anxiety, there is no wonder that there is an increase of digestive disorders. And of course, many digestive disorders such as IBS, Crohn's or Colitis, are made worse by stress. This is why bitters are important to the digestive system as well as the nervous system. Of course, the two are not disconnected, as we know, due to the enteric nervous system, otherwise known as the brain-gut connection - but that's another story.

As a culture, we have a rather confused relationship with bitterness. Not only has the taste been largely removed from the North American diet, resulting in many of today’s common health issues, but very often we have a non-existent relationship with our bitter feelings. We have a tendency to sweep our uncomfortable or unpleasant feelings under the rug, and pretend that everything is okay; our capitalist culture’s immense emphasis on productivity causes a lack of focus on simply being with our bitterness. It is not considered acceptable to slow down and feel our unpleasant experiences, or to take days off because of our physical or mental state, reflecting our culture’s attitudes toward disability.

Bitters have an important cultural association for me personally at this time of year. Later this month is the Jewish holiday of Pesach (Passover), in which bitters are a featured guest. One of the more important items on the Passover seder plate is Maror, meaning “bitter herbs.” The herb is usually horseradish, and represents the bitterness we experienced while enslaved in Egypt; they are there on the plate to remind us of those more challenging times, and how we may learn from them as we make our way out of exile towards the holy land. This story can be interpreted many ways, but I tend to read into the more symbolic meanings. Enslavement can have many interpretations beyond the literal, extending to personal, mental, or spiritual enslavement. The 40-year journey through the desert, from exile towards the holy land, can represent our personal journey from feeling trapped, stuck, traumatized or sick, to liberation, health, and happiness. There are many things, both literal and abstract, that enslave us: oppressive systems, trauma, depression, anxiety, illness. Maror helps us to remember, as we look back on our journey out of enslavement, the bitterness we once experienced, and allows to feel gratitude for the freedom we now have the joy of feeling in the ‘holy land.’

Bitters have a particular affinity for the liver, which, coming full circle, is an important organ during the spring time. In Chinese medicine, the spring is associated with the Wood element, connected to the liver and gallbladder. The liver and gallbladder can often be associated with anger - either holding too much in, or letting it spill out from the edges. In humoral medicine, the liver is also associated with anger, or choler. Bitters are indicated for an excess of choler, or for the choleric personality, to bring down heat and excess anger. I would add personally, that the emotion associated with the liver and spring is not always anger in the traditional sense - it can be any big emotions that have been stuck within you that make you want to yell and scream and throw things. It is the release of stagnancy, which is often anger, but can also be grief, sorrow, anxiety, depression.

Bitters can help with the smooth processing and regulation of big emotions, especially anger. I would almost like to invent a new action word here, and call bitters anger-modulators; they help to bring down anger when there is too much, but can also help with its release if the person has a hard time with expressing it. They do this, energetically and physiologically, by acting as choleretics and/or cholagogues. Hey, those words sound familiar!

Choleretics are herbs which increase the production of bile in the liver, whereas cholagogues increase the release of bile from the gallbladder. Most bitters are both choleretics and cholagogues, but the important thing is that they move activity in the liver and gallbladder, helping to digest our food - and our emotions and experiences!

Now for the fun part - which bitters to take?? There are a plethora of bitter herbs, from mild to OMG SO BITTER GET IT OFF ME, warming or cooling, and those with other important actions. Here are some important groups of bitters to get you started:

Bitter Nervines

These are perhaps my favourite class of bitters, because they both settle the nervous system and increase digestive power, and since bitters already stimulate the parasympathetic nervous system, bitter nervines are a double whammy of relaxed awesomeness. These bitters are perfect for people who have "nervous stomach", and for whom digestive issues are increased by stress and anxiety. A couple of bitter nervines:

Chamomile (Matricaria recutita)- of course! The mother of the gut! A great gentle bitter to start with. A really strong tea or tincture works best to get the bitter principles from the plant (probably a store bought Tetley tea bag won't do the trick).

Hops (Humulus lupus)- noooo, not beer, silly. Although a nice bitters is great every now and again. Hops are actually incredibly potent medicine, for a wide variety of situations. I could write a novel about hops, but I'll mention briefly that hops are particularly great bitters for the emotional and hormonal fluctuations of menopause, as in addition to a bitter nervines they are also estrogenic

Corydalis (Corydalis spp; Yan Hu Suo in Chinese medicine) - I looove this plant for so many reasons. Again, I could write a novel, but one of its lesser known actions is that it is in fact, a bitter. It contains berberine, which is also the bitter principle present in the famous Goldenseal and Oregon grape, but its very different from these other herbs. It also works marvellously for pain, as it works on opioid receptors and is a muscle relaxant.

Motherwort (Leonurus cardiaca)- There's a reason this plant is all over my website, she is one of my absolute faves. She is a bitter nervine that has another particular affinity for the heart - physiologically and energetically. Motherwort slows the heart rhythm and racing heart for people with palpitations, but also kind of makes you feel like you're getting a warm hug from a friend or - your mother! She is also a galactagogue (increases breast milk), so this can be helpful for mothers who are perhaps having issues lactating because of stress.

Ooooook, OOOONE MORE!

Wood Betony (Stachys officinalis)- Another favourite (you're probably beginning to think they're all my favourites). Stachys is just a wonderful herb for calming and slowing down the mind, and is also a digestive herb. Energetically, it can help with getting more in sync with your 'gut feelings' too.

Bitter Anti-Microbials

Bitter anti-M's can be particularly great for when you experience digestive issues in addition to, or because of, some unwanted creatures getting into your system - like a GI infection or food poisoning.

Goldenseal (Hydrastis canadensis)

Barberry (Berberis vulgaris)

Oregon grape (Mahonia spp)

Wormwood (Artemesia absinthium) -particularly for parasitic infections/worms!

Andrographis (Andrographis paniculata) - known as 'the king of the bitters', an excellent antimicrobial in several body systems, and an immunomodulator to boot. An amazing herb.

Warming Bitters

Bitters are usually (generally) energetically cold in nature, which means they can be difficult for people with colder constitutions. This is because they generally bring blood to the core and away from the extremities and skeletal muscle. However, there are a few bitters out there, which contain other warming constituents, that I immediately prescribe for a patient who tends to run more on the cold spectrum:

Angelica (Angelica archangelica): The first herb I go to if I want a warming bitter. It is a carminative, meaning it settles down gas and bloating, and is also a circulatory stimulant, bringing blood to the extremities as well as to the core. It is also anti-microbial, and a great herb for the lungs as well.

Calamus (Acorus calamus): This is an extremely unique and special herb. It is a warming bitter and carminative, with an additional gift of bringing clarity and presence to one's awareness, and was also traditionally used to bring expression and voice to those who required it.

Bitter Hypoglycemics

It turns out that bitters, in general, have an effect on blood sugar regulation, as it increases pancreatic secretions, including insulin. It appears that they also stimulate cholecystokinin (CCK), which seems to have a role in glucose regulation. There are certain herbs which potentially do this better than others, however, by having other hypoglycaemic actions, such as:

Andrographis (Andrographis paniculata)

Burdock (Arctium lappa)

Barberry (Berberis vulgaris)

Goldenseal (Hydrastis canadensis)

Oregon grape (Mahonia spp)

Dandelion root (Taraxacum off. RAD)

Bitters in the Diet

Perhaps the easiest and best way to get your bitters is by eating them in your meals! The first spring greens have bitterness to them - arugula, winter kale, endive, radicchio, even lettuce (not iceberg lettuce, no)! Adding them to a spring salad or just nibbling on them before your meal can be a quick and easy way to get your bitters and get those digestive juices to wake up after a long winter!

Also - you're going to love this.... believe it or not, CHOCOLATE and COFFEE are both bitters. Ok, hold your horses, now don't go ordering your double-double and eat a Mars bar and tell me you're eating your bitters. Nope, I mean DARK chocolate (70% or higher), and BLACK, UNSWEETENED coffee. Sorry. :) But truly. It turns out that coffee and chocolate are the #1 source of bitters in the North American diet (sad but true), and is it any wonder we like a cup of coffee in the morning before our breakfast? Despite the morning caffeine kick, it does help get the digestion going too and (as we probably know) our bowels moving!

But - eat some radicchio too!

So.....Bitters are gross....why would I take them again?

Well, if you're anybody with a digestive system or nervous system, bitters are basically indicated - especially if you live in a climate where the digestive system needs 'waking up' after a winter of any kind (even a Vancouver Island so-called "winter"). However, if we're talking pathology, bitters are indicated especially for:

- anyone with digestive disturbances such as IBS or just gas and bloating

- constipation (bile is a laxative!)

- poor appetite (especially valuable - take bitters and 15 minutes later, BAM, hunger!)

- anemia or malnutrition (as they help absorb nutrients more efficiently)

- excessive sweet cravings

- digestive disturbance due to stress

- convalescence and recovery after illness or surgery

HOW do I take them??

The great thing about bitters is, you only need a very small amount for it to work. A squirt (technical term) of a bitter tincture, a nibble of some bitter greens or bitter herbs could all work, roughly 15 minutes before meals. Or, as I said, just include them in your diet! As I said, there are many health benefits to bitter foods, so encourage the bitter taste in your pallet more and more and see how it grows on you - you might be surprised!

Contraindications and Cautions

There are, in fact, times to not take your bitters, and those include:

-Pregnancy (in general - a cup of chamomile tea is usually fine)

-Heartburn or GERD (Usually. But ask me more about this in a consultation)

-Peptic ulcers

-Acute gallbladder disease or gallstones

-Gastritis

-Kidney stones

So, go taste some bitter things, and see how they grow on you. And don't be afraid of the bitter things in life - they may have more benefits than you think. May you taste the bitterness and find your way to your own personal holy land!