Nature Deficit Disorder: A Green Rx

By John La Puma, M.D.
You know that unmistakable sigh of relief you experience when you’re standing on a hill covered in wildflowers, wading in a babbling brook or when the ocean comes into view? That’s you treating your nature deficit disorder (NDD)

Nature deficit disorder is defined as alienation from naturally green or blue places (e.g., orchard, farm or garden; ocean, lake or stream; park, meadow or hillside), resulting in behavioral issues, especially in school-age children, according to journalist Richard Louv, who coined the term in 2005. The causes of NDD are well-known: overreliance on screens and digital technology, excessive fear of stranger danger, and urbanization without adequate greening.

Since 2005, it’s become clear that NDD could be a real medical problem for both adults and kids. Without regular—even brief—immersion in nature, common medical problems such as attention disorders, anxiety, asthma, back pain, depression, and high blood pressure can result or worsen.

NDD can have even more medical repercussions. Vitamin D deficiency is prevalent in the U.S. (42% nationally) We are seldom outside and, when we are, we’re often sunblocked to protect against sun damage.

Overweight and obesity are more prevalent than ever in California, affecting 31% of kids ages 10-17, in part because kids have little free play, watch hours of TV, and are picked up and dropped off at school, at after-school activities, instead walking or biking.

Myopia (nearsightedness) is increasingly common, as we look at digital screens close to our eyes an average of 75 times a day.

Without the natural, soothing tonic that a quiet walk in nature, a peaceful moment in a meadow, or even weeding a garden, getting your hands dirty can provide, we are stuck. Stuck jumping at every text or snapchat. Stuck being stressed out in traffic. Stuck staring at cubicle walls and concrete. And that’s unhealthy.

But there’s good news: NDD is easily treated, no doctor’s Rx required. Here’s what the research shows:

  • Nine of ten depressed patients experience greater self-esteem after a walk through a park.
  • Just three house or office plants (e.g., ferns and palms) can filter common particulates from the air and improve attention.
  • Hospitalized patients with plants in the room require lower levels of painkillers, and have less reported anxiety and fatigue.
  • Forest therapy lowers blood pressure, cortisol level, pulse rate and stress; trees release phytoncides, which improve your own natural killer cell activity, an important part of the immune system that fights disease.
  • Spending time outdoors reduces risk for myopia in kids.
  • Scenes of swimming underwater, viewed through a virtual reality headset, can cut the pain and fear of a flu shot by half in kids under age 16, according to our own pilot study.
  • Having more plants and flowers around your house reduces the likelihood of environmental allergies, and increases the diversity of your natural skin microbiome (the bacteria that normally live on your skin and is involved in the immune system).
  • Walking in nature reduces blood flow to and the neural activity of areas of the prefrontal cortex, lessening stressful ruminations.
  • Exercise in nature and in view of nature improves both mood and diastolic blood pressure (the lower number in a blood pressure reading) versus exercise without nature.

Each of these interventions is a form of therapy. Like prescription medications, nature can have measurable, beneficial biologic effects.

The connection between your daily surroundings and how you feel, act and think is powerful. Although nature therapy is just starting to catch on in the U.S., Japan and Korea have used it for decades, and have funded forest therapy trails. Forest bathing (shinrin-yoku in Japan) is not a hike or a bath, but a way to use your senses to smell, touch, and hear what’s around you. You let go of beeping alerts; you embrace relaxation and reboot.

It’s deep mindfulness, outside, in nature.

Why does nature work so well to reduce stress, improve some conditions and reset your brain? Enhanced immune function might be the unifying factors, but there are at least 21 other theories. While we
don’t know why nature works, we do know that when it’s absent, it contributes to illness.

We are all part of nature— a tiny part. We can both observe and participate in it, and get a sense that we are part of something greater than ourselves. We can feel that our personal concerns are tiny, compared with the possibilities invoked by a smoldering sunset, a pouring rain, or the rapid flutter of a hummingbird’s wings nearby.

Corporations are beginning to catching on and turning to nature to improve both worker productivity. Amazon has opened “Spheres,” a 70-foot geodesic office dome containing several different microclimates and plants. Inside are dozens of meeting places so employees can relax, be inspired, and reconnect with one another.

To check if you have a nature deficit, ask yourself: Do I make at least five minutes for myself device-free in nature every day? No? You can easily fix that.

To find out more, take the Do You Have a Nature Deficit? Test And, when you can, go outside, and experience nature.

John La Puma, M.D. is founder of Chef Clinic, and runs an urban teaching and demonstration urban avocado farm in Santa Barbara.
Connect with him on twitter and Instagram @johnlapuma, and visit him at

Vitamin D deficiency


Forest Therapy

House Plants

Hospitalized Patients

Flu Shot Pain

Exercise Outside


Cognition and affect

Myopia and kids