Dhru Purohit Show - How Inflammation, Microplastics, and Poor Nutrition Sabotage Our Brains and Make Us Depressed with Dr. Drew Ramsey

Episode Date: March 19, 2025

This episode is brought to you by BiOptimizers, Our Place, and Manukora Honey. Mental health disorders are on the rise in our modern world, as our brains and bodies face constant disruption from environmental toxins in the air, water, and food. Meanwhile, connection and stress look vastly different than they once did. Today’s guest sheds light on what has changed, why these disorders are increasing, and—most importantly—how to protect ourselves. Today on The Dhru Purohit Show, Dhru sits down with Dr. Drew Ramsey to discuss the current state of mental health and treatment. Dr. Ramsey breaks down the top lies we've been told about brain health and healing. He also explores the challenges of modern life, how they disrupt our brains and mental well-being, and the lifestyle habits that make these disruptions worse. Plus, he shares the optimal diet for reducing the risk of depression and neurodegenerative diseases, along with the powerful impact of journaling, spending time in nature, and building community. Drew Ramsey, MD, is a board-certified integrative psychiatrist, best-selling author, and a leading proponent of Nutritional Psychiatry and Mental Fitness. He served as an Assistant Clinical Professor of Psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons for twenty years. Dr. Ramsey founded the Brain Food Clinic in New York City and Spruce Mental Health in Jackson, WY. A sought-after speaker, he conducts workshops nationwide, and his work has been widely featured in the media. In this episode, Dhru and Dr. Ramsey dive into: Top misconceptions about healing the brain (1:14) The biggest challenges impacting brain health today (4:12) How to protect your brain from microplastics (8:10) The top lifestyle habits damaging mental health (13:08) Which diets increase the risk of depression and neurodegenerative diseases (18:18) Is the chemical imbalance theory a myth, and the role of inflammation (26:42) How to improve access to better medications (35:12) The link between nutrition, depression, and finding the right practitioner (39:44) How journaling and nature impact mental health (43:09) Caring for elderly parents and the importance of community (47:57) The role of psychedelics in mental health treatment (51:44) How politics influence healthcare in America (1:17:40) How to connect with Dr. Ramsey (1:24:35) Also mentioned in this episode: Healing the Modern Brain How to prescribe physical activity for depression For more on Dr. Ramsey, follow him on Instagram, Facebook, X/Twitter, and his Website. This episode is brought to you by BiOptimizers, Our Place, and Manukora Honey. Go to bioptimizers.com/dhru now and enter promo code DHRU10 to get 10% off any order of Sleep Breakthrough and find out this month’s gift with purchase.  Reduce your toxic load by upgrading your cookware! Go to fromourplace.com today and use promo code DHRU at checkout to receive 10% off any order. Upgrade to the creamiest honey, packed with antioxidants and prebiotics. Just go to manukora.com/dhru to get $25 off the Starter Kit and boost your energy, immunity, and digestive health today! Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Drew Ramsey, welcome, brother. Pleasure to have you here in L.A. True. It's great to be back with you. It's such a treat for me to kind of have these touchstones of my life, get to come back and speak with you and talk to you about a new book. Well, we're going to be talking about that new book. It's called Healing the Modern Brain.

And we have a bunch of other things that I want to get a chance to ask you about that I've just been so curious. You've been on the podcast a few times. But now to have you back, there's been so much that's happened in that space. And one of those areas that I want to talk about is actually second. Because since the last time that we had a conversation, I've actually had my own experience with psychedelics. And I want to get your thoughts on the situation and where you see the moving going. But we'll come back to that.

Okay. A little bit later on. Let's start off with some of the basics and the key concepts that you talk about in this book. And I feel like some of those key concepts around the big lies that many of us have been taught when it comes to how to heal the brain and how to heal. heal the body. If you had to think about it, what are some of the top one or two big lies that are still out there that are governing how people are maybe misguidedly approaching healing the brain? I think the one that sticks out for me is differentiating between treatment and that we have a lot of treatments that work. I think people are really misinformed. I think the idea that when you have depression

or anxiety, you come to see someone like me an expert in treating those that, you know, it's going to be an arduous or difficult or complicated thing, you know, sometimes for sure. But I think a lot of people get better. I think another one of the pieces of misinformation that's out there and what's really changed, I think the motivation for this book is we've got to do a lot more, Drew. Like the modern world is coming for your mental health in a way that we're all seeing, you know, there's a lot of, in some ways, controversy, what's making all the numbers go up? Why are so many more people depressed?

Why do so many people, more people have conditions like autism and PTSD, etc. And certainly there are, you know, some concerning root causes of those in our environment. And I think what this book wanted to do is to ask people to think about what are the evidence-based tenants, what are things that we can agree on that are vital for our mental health, kind of like with nutrition. And it's just changed so much that there is low-hanging fruit for a lot of us in terms of improving our brain health and mental health. So I think that, you know, in some ways, that big lie out there is that we don't know that

that we can't figure this out and that you are in a state where you shouldn't have a lot of confidence about your own potency to heal your mental health. And I'm all for people getting lots of professional help. But I also think there's so much in the evidence about some of our lifestyle choices that we've got to get the message out there and then shift this model. I think probably the biggest lie, as you call it, is that you want to wait until you're symptomatic to see me. I hate this model. It's sort of the idea that like I'm only useful when you're really sick when you're in a crisis. And I'm very handy in a crisis. You know, that's what I'm trained to do.

But I don't know. You're probably not in the midst of a psychiatric crisis. Drew, if we got into it about your mental health right now, you had some ideas, some concerns, some questions, some things you wanted to put on an agenda of, hey, we're going to, you know, engage in these types of maybe behaviors. We're going to have a conversation about some aspects of yourself or your history. we'd have a great mental health conversation. And we'd be talking probably more about what I'm calling mental fitness. How do we kind of keep moving the ball down the field when it comes to our mental health? You know, you mentioned something really important.

I think a lot of people are at home scratching their heads and thinking, why are so many people having such difficulties with their brain? And why are so many of these mental health disorders on the rise? You mentioned there's a whole spectrum of them. autism, Alzheimer's, neurocognitive issues, and everything else in between. Depression, which takes a huge toll on our economy and the lives of people. When somebody comes to you and they ask you, why are people's brains so messed up in this modern day and age?

How do you answer the question? Our brains are changing. We just learn that there's a teaspoon of plastic in our brain. Not sensational science from the, you know, corners of the wellness world, like in nature, a teaspoon. So our brains have never had a teaspoon of plastic in them before. Just explain that for people that are not familiar. You're talking about microplastics and some recent studies. So sorry.

There was a big study came out in nature, really one of our most respected scientific journals, looking at microplastics, nanoplastics, these very small plastic molecules. And finding there is a lot of that stuff in our brain. They estimated about a teaspoon. It's throughout our body. We don't know exactly what that does. There's some basic bench science that it can trigger more inflammation. There's a concerning correlation between people who had dementia having more plastic in their brain. But I think it's an example of there's something new and there are clear steps.

In our household for the last 20 years, we've tried to heat nothing in plastic. We don't have a lot of plastic. There wasn't science that plastic was bad. It just seemed, I don't know, like something that was kind of. and that was a little concerning based on some of the data I was seeing. Even back my first book in 2011, the Happiness Diet, we went through a list of the chapter that got cut on toxins. And all of these plasticizers were known concerning chemicals back then.

It was like, what, 15 years ago at this point? So when we talk about what's changed, there's more weird stuff in our environment, not to fearmonger, but just to kind of be more clear. You can't kind of go around the world right now, just kind of live in your life, doing what everyone's doing. You're going to end up doom scrolling, eating mostly processed foods, getting lots of microplastics in your diet, getting lots of flavor retardants. I mean, there's all kinds of kind of icky stuff out there. So what's changed? Some of that relates to mental health risk.

Like, why are there more mental health disorders now? One is more awareness. The other are environmental changes. Now, the modern brain never had to deal with doom scrolling before. It's a very compelling, algorithm-driven, visually stimulating, intellectually stimulating device that we have. What do you think is worse? Doom scrolling or microplastics for the brain?

I think microplastics are probably worse for the brain because doom scrolling, you can over time curate your feed. You can get rid of apps. The difference between doom scrolling through a curated feed of like lots of mental health advice and good stuff that inspires you versus, you know, the stuff that you tend to get fed. I think both of them are concerning. And the idea right now is, hey, everybody amidst all of that, you know, that feeling like, oh, no. It's overwhelming. Like, what do we do about our mental health?

I think let's be realistic. Mental health rates are going up, right? When I finished training in 2004, 8% of teens had clinical depression. Today, 20% of teens have clinical depression. So something is radically shifted. There are some really clear suspects in this. In some ways, the nine tenets come from that. I go over these factors that have changed.

Look at the sleep of a teenager today versus 20 years ago. Look at the dietary and nutritional quality of food for a teen today compared to 20, 25 years ago. It's just radically shifted. And so has some of these foundational parts of our self-esteem. like how we relate to people, how we connect with people. I'm not trying to say everything in the modern world is bad. I just think with a modern brain in the modern world, there's a new set of rules.

There's a new set of science, and we've got to employ that if we're going to optimize our mental health. I want to come back to the microplastics conversation because it's a hot topic right now, right? So many people are becoming more aware of it. Any other couple things that you do to protect your body and brain from microplastic exposure? So you already talk about one that's a no-brainer.

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deglazing, deep frying, and so much more. I love it to personally pan fry sweet potatoes, sear steak, and make crispy fish for the perfect omelet. This pan can handle all meals making cooking at home easy and of course non-toxic. Stop, stop, stop, stop cooking with toxic cookware and upgrade to Our Place today, visit from our place.com slash Drew and use the code Drew for 10% off sitewide. That's from F-R-O-M-O-U-R-P-L-A-C-E dot com slash D-H-R-U, Drew. That's me. With a hundred-day risk-free trial, free shipping, and returns, you can experience this game-changing cookware with zero risk. For sure, I got rid of all my fancy teas and tea bags. I was really disappointed and upset. And I think, again, it's one of those things. Nobody meant to do this.

But when you get those fancy nylon tea bags, they're coated in microplastics. I saw an estimate I think it was two billion particles of microplastics. Compare that to a paper tea bag or compare that to loose leaf tea where you're not getting any microplastics. So again, same great idea. Have a cup of tea in the afternoon, you know, mellow out, have some chamomile, have some mint. Just wonderful kind of wellness tip, I think, for all of us. Take a breath. And the idea that In doing that simple act, you were poisoning yourself with microplastics. It's just, again, one of those lessons from the modern world that we don't want a fearmonger, but it's like, hey, you've got to shift your T-VACs, everybody listening.

Go, go see what you have. So I think that's one of certainly the lessons. There was a great article by my favorite psychiatrist, David Puder, who's the Psychiatry and Psychotherapy podcast host. They just published it in genomics, looking at how do you get rid of my And there's not a lot of data, but there was one study where more of this plasticizer BPA would come out in the sweat. And so some question of maybe more saunas is, again, a way to kind of get it out.

Because there's the idea of, okay, we want to limit exposure, right? So you're not getting as much. And then over time, your body naturally clears everything bad. And that's kind of generally true. But are the things we can do to promote it? And so maybe sauna is a way to do that. Yeah, I love that. I know Dr. Ronna Patrick has also talked about broccoli sprouts, which have a high concentration

of sulfurine inside of them, which helps sort of the natural detoxification process. Yeah, sulfurophane and all the sulfur-containing, you know, cruciferous vegetables. You know, people tend to feel that they, you know, can be very helpful. They have a little data, actually, that sulforaphane or christening kind of ramps up some liver detoxification enzymes. And so, you know, generally your body is very good at detoxifying stuff. and I'm a big fan of getting ahead of things. Let's limit exposure.

Other things, plastic cutting boards, I think being really mindful of the types of a lot of meats, fats, and dairy that you're eating in the sense that these compounds tend to concentrate in, at least in some of the studies and things like seafood, which is, again, one of my top brain food recommendations. So what do we do about that? In some ways, the same advice we've had

for a long time about seafood. We want to get younger, smaller fish. So more tinned fish like sardines, anchovies, smaller fish. Why? They have less environmental exposure, so they're accumulating less microplastic. You get less exposure.

Yeah, that's great. And I think we didn't cover the basics, but a good water filter at home, right? Good reverse osmosis water filter. If you can get it, there's a bunch of great brands that are out there. And then also something interestingly

that I've been seeing is that a lot of microplastics spread through the air. And so if you get new furniture, if you get nylon rugs or other things, you know, If you can splurge a little bit and get a good quality air filter, that's super helpful. Very helpful. Really good point.

All of my clinical rooms, because I spent a lot of time sitting in the same room in my bedroom, they all have HEPA air filters in them. I mean, a couple hundred bucks and important to change the filter, also something I find that people don't do. But again, one of these recommendations that, again, as a psychiatrist, wasn't the kind of thing that we used to talk about. Hey, you should filter your air. Hey, let's talk about your food.

Hey, let's think about microplastic exposure, not to overwhelm people, but to make sure that as we are engaging in treatment, as we're taking steps forward, that we're not missing kind of some of this new obvious stuff that's in the science. This is taking a huge toll when you add it all up on our overall mental health. You want to know, like, why are the rates going up? And so I think all of these things that I bring up in the book, all of these tenants, they seem to impact risk. You look at something like insomnia, not sleeping.

So one of the tenants is good sleep. of course. You have a 10 to 17 times increased risk of having depression or another mental health disorder when you have insomnia. I mean, just you can't ignore that data, especially, again, if like a lot of us, you're feeling a little toll on your mental health. You're wanting to do more. With our physical fitness, and we all have a lot to do, and I think we all have maybe some guilt. I was really proud I rode my bike to this recording session here. It's just a great way to start the day, but also just, you know, I don't know, helping me achieve one of my goals, get some oxygen, extra blood flow to my brain, you know, those types of things engaging in movement, engaging in

good sleep, they just, they really add up over time. And I think make a big impact as everyone knows on our mental health. If you had to rank some of these tenants that you talk about, and even the subtenants underneath them, if you had to rank food, environmental toxins, sleep and a sedentary lifestyle. Let's just start with those four. Okay. Right. So food, environmental toxins, environmental exposure, sleep, and sedentary lifestyle for the

patient set that kind of comes to you, even though every person is different, what do you see as being the top one and then take us from there? Generalizing to our population, what's the taking the number one toll on our population in our mental health today. I would say the top risks of the ones that you just described probably is sleep. When you don't sleep well, you're not cleaning out the waste in your brain. You're not really processing all the complex emotions that we're having. You're not consolidating memory.

So some of that brain fog, just not feeling your best, low mood. You know, I kind of put sleep there as fundamental. It's hard for me to decide between sleep and nutrition, Drew, because they're so biologically foundational, right? Nutrition is this is what your brain is. made of. You've got a diet with a lot of magnesium or not. You've got a diet with a lot of omega-3 fats and fiber or not. And so those two are really hard for me to differentiate between in terms of, again, like these foundational pieces. Part of what I'm hearing you say is also,

if your sleep is messed up, that might be number one for you. I just, you've got to, you've got to get sleep on. They teach us in psychiatry residences, you know, the most dangerous thing is when someone is not sleeping. If your patients are sleeping, you know, it's okay. you can sleep. But if your patients are sleeping, like, you've got to be very concerned. The risk, and I think everybody listening, Drew, you know, too, the risk is quite severe, especially, I don't know how other people experience this so much. But for me, at 2 a.m., when I have insomnia, my brain is in a very strange place chemically. I tend to be more catastrophic. I tend to have a lot more negative thinking. Not all the time, but frequently. It's not, it's not a time that I like

being awake with my brain, to be honest. And so I think for a lot of people, you know, when you begin to have mental health symptoms, when you begin to not sleep, it's also a time when we tend to ruminate, right? So that notion that now we're up, we're ruminating, we're having negative thoughts. So along with all the neurobiological part, we're not cleaning out waste, right? We're not engaging in all these, you know, very important kind of healing processes that are going on in the brain during sleep. you know, there's also just encountering the psychology of being with ourselves and not kind of the best state.

And so I think those things certainly contribute. You said, you know, nutrition, as I said, it's just, is it 70% of the calories most people eat come from ultra-processed foods. And so we say that word a lot. And I just think that that's food that isn't simply prepared. And if you're processing it with a chef's knife or, you know, your blender, okay, you know, that's great. but these foods that are made of food products, as so many of your guests have talked about, really at the center of the problem that we're having,

when you look at the statistics of these basic fundamental nutrients for mental health, like fiber, like folate, like vitamin E, and the majority of Americans aren't getting them every day. And then the point I often like to make, and it was very important for me as a physician, we don't know where to get them. Everybody likes to debate which type of magnesium to take. Is it glycinate or is it citrate?

But I find very few people know what their favorite magnesium food is or their top five. And I think it's really important that we translate this knowledge about nutrition into our everyday choices of nutrition. You mentioned environmental toxins. And so I think that probably depends on exposure. Certainly some people listening, if you've had a lot of environmental toxin exposure, that might really be the top thing going on. I'm probably of the camp that it is the minority of people struggling with their mental health problem, that it comes directly from a singular toxin. There's certainly certain examples of that in the literature and in the world.

But there are certainly a few classic examples. Someone gets mercury poisoning, you know, but it's not so clear that, hey, you get a bunch of microplastics in the next day you're depressed. Other than the number one environmental toxin, of course, out there. there Drew that is just lurking, totally destroying America's health, which is alcohol. And that certainly is the number one environmental toxin. That if they're for all of the talk of microplastics and mercury and mold and all this other stuff, it's like, no, the number one problem in America when it comes from toxins or it comes to toxins is certainly alcohol.

It's just a bane on our society. Yeah. You know, I want to talk about nutrition a little bit more. what would you say if if I told you let's design a diet that induces depression in somebody and also increases their risk of Alzheimer's other neurodegenerative diseases what would that diet look like there is one type of sweetener that have always felt great about using and never felt guilty about using and that is honey and the kind that I use is called monitoring Monucora honey. It isn't your average grocery store honey. Monucora is next level. It's rich,

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It would look a lot like the diet that some people are eating in an average day of American food. You wake up and you, first of all you're going to have caloric excess. You're going to have some breakfast cereal, maybe low-fat yogurt, you know, might still be in that kind of low-fat, trying for low calories, but not eating really satiating foods kind of mindset. There is going to be a lot of processed food, right? So you're going to experience a lot of intense flavors, a lot of sweetness, a lot of saltiness, a lot of saltiness. you know, this nice palatibility of fats and sugars. You know, the rest of the day could be some snacking, some ultra-processed food, some fast food, you know,

a nice burger and fries. It's a great study that came out, drew a couple of years ago now, about fried foods. And the people who eat the most fried foods had an increased correlational risk of anxiety. This is a large UK Biobank study. And it was kind of showing, what some of the new nutritional psychiatry studies are looking like where they find this correlation

and the researchers like, huh, what is it about Western food that makes people have more anxiety? And they say, oh, they're the signal in fried foods. And so they created an animal model. It was a zebrafish model where they found they took acrylamide, which is this byproduct when you make French fries. Especially when things get like really charred. Yeah, yeah, exactly. Acrylamide is a byproduct, this mallard reaction anytime sort of heating up. fats and proteins. And so acrylamide to the zebrafish ended up really disrupting their behavior. Zebrafish tend to pull together. They'd be curious and they kind of go explore stuff. When they'd put new things in the tank, the zebra fish would just kind of move around

chaotically. They wouldn't pull together. And the researchers kind of took this as an indication that, huh, it seems like these are more anxious, more depressed zebrafish. They don't want to partner together. They don't want to explore. They're not as confident. They don't want to work together and connect. So who knows, but a lot of fried foods. And when you compare that, like, what, what is a French fry compared to an oven roasted potato or, you know, even a potato in an air friar? When you oven roasted potato with some olive oil, you reduce acryllabide by 90, 95 percent in the data I've seen. So that's an example. Lots of fried food. You're going to probably start to get a little slumpy. So let's hit you with a few energy drinks in the afternoon. Not that it's horrible to have a little

energy type of drink maybe early in the afternoon, but I really think people should go coffee tea, you know, simple, lots of antioxidants, lots of data that it helps. And so as you're seeing, you know, you're also, I want people to think about the colors I'm describing. It's beige. It's not full of all these vibrant colors

that we want to see on your diet. It's not these basics of nutritional psychiatry of my little rhyme, seafood greens, nuts and beans, and a little dark chocolate, which I think people remember from the last time I was on, of just thinking about what are these food categories that are really nutrient dense that have the most calories that we need for our mental health. Yeah.

And I think that, you know, when a lot of people listen to that, they probably know a couple people in their world who are eating a diet that looks not too dissimilar from what you've described. And, you know, people today are feeling, regardless of what side of, you know, if you're an informed person in wellness and you care about wellness, you know, you know, if you're an informed person in wellness, and you care about wellness, it kind of feels like a national emergency. It's like, whoa, our society is being set up in a way that we're kind of poisoning ourselves. And nobody's really talking about except for a few people.

Nobody's really talking about like just how bad this is. Do you feel that way at all? I feel, yes, I feel that we're not maybe talking of how bad it is. I guess I feel more that on an individual level we're having a hard time taking. individual actions today. I think that in healing the modern brain, I get into the first tenet is self-awareness, and I get into the notion of externalization.

And what you're talking about is, I think, true, that we are set up that the cheapest calories, right, are the worst for us, that just to get by and feed your family, boy, when you do something that, you know, in my mind, as a parent and as a physician, is a nice move in the beginning of the day, which is to have some eggs. you know and until recently that's been a pretty economical move you know doesn't eggs used to be five bucks that's filled with controversy for a lot of people right the idea that you're going to go and

again have a simple 70 calorie egg perfect protein nice way to start the day what's controversial about that well i think controversial is that this is traditionally a food that's been thought to be high cholesterol or high saturated fat that tend to be avoided i think that eggs were one of those foods that's always been kind of lambasted, right, in a certain way in the science. Eggs are also one of those foods. I think everyone should always be suspicious if all of us are only citing one study. What study besides the hard-of-verd egg study does anyone talk about when it comes to eggs and risk?

Until recently, there weren't really any. And then as we get a little bit more mature data about including eggs in the diet, I think the most recent data, they look pretty good. And so I'll say, you know, are we being set up? I think so in a certain way. That's where some of the motivation for this book comes from is to get out of that stance a bit and think about, you know, how are you contributing to that? Are you walking into Walmart and buying garbage?

Are you walking into Walmart and buying wild salmon, pesto, anchovies, kaffir? All the best brain foods are right there. I don't need to mention Walmart could be Costco, it could be any big box store. But the idea that, you know, the setup, I think the setup in part is misinformation and lack of knowledge. And then I think the setup in part, and we see this so often. I love these inspirational stories. I see this all time in my practice where people can take control of their health. They do. It radically shifts. You aren't eating plants. You start eating more plants, more fermented foods. Your health starts to shift. Almost always when people do one of these

tenants, you start moving your body a little bit more. It's almost you can't do that without starting to care more about your nutrition. Boy, once you care about your nutrition and you're moving your body more, you're going to probably sleep better tonight, as my guess. You know, that's what all the data seems to suggest. Now you're moving your body, boy, your risk of depression just plummeted. And if you have depression, you've just engaged in an activity that's equal to the antidepressant Zoloft at 18 months in high-quality trials. You know, so there's a way these tendons kind of begin to inform one another.

And are we being set up? Is it a pathogenic culture by which you can end up with severe mental health problems if you don't take certain steps. Yeah, I think so. I think everybody probably agrees. You know, we're just, we end up eating, again, lots of processed foods, having all of our relationships on the screen or digitally. If we don't think about our connections in the modern world, if you don't think about your connections really in your lifespan as you're aging, how I think about my relationships now in my 50s is very different than I thought about things in my 20s. So continuing to engage in these tenants, I hope gives people this framework like we have for physical fitness. Because

you ask people, you know, we all know what we should be doing. Everybody knows like exercises for their core, we want to make our biceps big, right? Where we want to work on our endurance or our flexibility. All these kind of categories when it comes to physical health. When it comes to our mental health, I find we don't have as much. There's not there's not really the same kind of robust notion of, hey, a couple times a week, like three or four, or I argue every day, just like your physical health in some way you want to pay attention to it, check in with your body and work on it. You want to do the same thing with your mental health. You want to create a framework for yourself of mental fitness.

I think that allows us to be more insulated around the mental health challenges that may come our way. You look at statistics, all of us are going to deal with mental health challenges at some point in their life. And then also, if you're in a mental health challenge of some type, these give you things to focus on that are under your control. Everything in the book, all of these tenants, the most of the most of you. most part, they're free. They're things that we can do. Let's talk about this idea that you address

in the book. And it's that idea, some people might be familiar with it, that this whole idea of a chemical imbalance is a complete myth. Well, I wouldn't say I put it exactly like that. I think it's all chemicals up there, Drew. It's all molecules. But that a chemical imbalance is the root of all depression. And once that chemical balance of a single chemical or a couple little chemicals, for sure, is addressed, then the depression goes away. We need to understand the chemical imbalance theory came from an idea that depression and mental health disorders really primarily exist in the brain. And that when we change chemicals in the brain, when you give someone MDMA or when you give them Prozac, you're shifting chemicals in the brain. I think that's very true. I think what isn't helpful

in what a lot of patients experience is that, simply getting on a medication doesn't get them all the way better. We know antidepressants work for maybe 60% of people. 40% of people aren't getting a benefit then. That's a lot of people. What we want to move away from, I think, is a simple theory, that depression is just one thing. Because I think we then approach it that first of all, you wait until you're really depressed.

And that one thing being serotonin. Yeah, serotonin is great. Serotonin's like Madonna in the 90s. I've listened to a lot of other music. I like Madonna. Classic. great, really important, just like serotonin, really important neurotransmitter. Anybody is saying that serotonin isn't involved in depression or mental health,

I don't think has been in the mental health world. I mean, I give antidepressants that modulate serotonin every day. And you see things happen very quickly with people in terms of their symptoms, in terms of their experience of the world. And so a lot of what we're seeing right now, I think in the controversy around serotonin one, there are a lot of people talking who probably shouldn't be. because they don't prescribe these medications, they haven't taken these medications, or they've had limited experiences. Now, if you take a medicine and you have a horrible experience of it, of course,

your generalized notion is like, ah, there's a bad thing. When you're in my position, as a lot of clinicians are, where you see a lot of different people take these medicines, you get very humble, very quickly, because you see they work profoundly well for some people, like life-saving. And you see for other people, they don't help at all. And it's really confusing. And it, again, gets right to this idea of it's not one thing. If you come to me and you have profound inflammation, you had a horrible development, all kinds of development and neglect, you just went through divorce and you're drinking too much. Is that a serotonin problem? Serotonin's involved in your mood, but when we think about how to address that clinically, it's not like the only thing I say is like,

you've got to get that serotonin up. It's a much more complex clinical process of what we engage in with patients. And so I think what I wanted to address, because it has bothered me is there's this kind of gotcha notion that like, you know, psychiatry has been totally off base and that antidepressants and SSRIs have no efficacy and they shouldn't be involved in the story. And that's just not true in the data. What is also clear, though, is we've got to do more than have a mental health system where all we think about when it comes to a psychiatrist is that like all I've got for you is a med. Because that's not true. I'm a psychotherapist. I sit and talk with patients. I mean, mental health professionals sit and talk with patients more than any other field in medicine.

And I think we need to honor more around it's not just serotonin and medications aren't the only intervention we have, but we do need to be aware that there's so much stigma around those that most people aren't probably getting the right care or an understanding. ability to approach and kind of appreciate how those medicines can or can't help them. That's, I think, the main problem we're having. Was there this idea that one of the ways these medications work in addition to serotonin is that they lower brain inflammation? Well, there's a couple.

So for sure, Prozac, I talk about this in the book. Prozac, you know, our prototypical SSRI selective serotonin reuptake inhibitor antidepressant is a powerful central anti-inflammatory. So again, the same crowd often that's talking about. how awful Prozac is, is awful talking about how we want to get rid of inflammation. One of the ways we get rid of inflammation in the brain, some of the antidepressants are great anti-inflammatories. The other thing that some of these medications do, and probably a bit of a final common pathway for a lot of our interventions, is how they affect neuroplasticity.

And so the idea that, you know, you see these sound bites that just sort of frustmate me, like there's not a serotonin deficiency in the brain. It's like that. Or it's not a prozac deficiency in the brain. And it's just, it just kind of speaks to not having a very nuanced kind of sense of some of these medications are triggering receptors, right, that then lead to an increase in neuroplastic processes. You get more BDNF, brain-derived neurotrophic factor. And so, again, they don't work for everybody, but when they work, it's really impressive. And I'd probably argue in the history of medicine, find a medication class, one that's been

as scrutinized as SSRIs, two, that's been as effective in treating, you know, something that never historically has been treated. In the history of the human race, we've never really done a good job taking care of our mental health, ever. Everyone's had depression throughout, there's been depression throughout history, but this is really the first time we have something that, you know, one, we have all these lifestyle factors we're talking about in the book. They have a lot of evidence behind them that help our mental health. And then two, you know, when you need more treatment, there's just, we know more about these medicines. We know more about what are effective evidence-based interventions than ever before.

So it's like a better time than ever before to have mental health problem. I think where I get frustrated is there's a notion of like, oh, we've been wrong for 35 years. And I was like, I don't think any psychiatrist out there that I know who's trained in the modern world thought it was all about serotonin. Like that idea of a chemical imbalance is to help people think it's not because you're an awful person. It's because there are some things going on, a mix of your environment,

a mix of your genetics, and then probably an expression of your epigenetics, how your genes get played that's really underlying your mood state. And let's try and address that given all the tools we have. I think that one of the feelings that is there is that I came across this, we're writing about it on Friday, I believe there was this review paper by Nicholas Fabiano. Do you know him? He's like with a metabolic psychiatry sort of work that's there, Canadian physician. And it was basically like, here, the prescription for working out, right? Like if you were going to hand a prescription to working out to a patient, and in the opening in that review paper,

we'll link to it in the show notes on the podcast, it was basically talking about, and you talked about this too, is that physical activity in getting somebody out of a sedentary lifestyle is as effective as talk therapy, not that it's about, hey, either or, it's as effective as talk therapy, based on all the review of the data that's out there.

And it can be as effective as, you know, an SSRI for depression. It was all about what is the relationship between physical activity and depression. And I think, again, this goes back to a larger idea, what you're saying about foods, is that nobody ever told you which foods have magnesium in them. You might have learned that magnesium is important, but nobody ever told you how important it was. And nobody told you definitely what foods to be getting them from. So I think when people feel and have their criticisms on SSRIs and there's no serotonin deficiency

in the brain, partly what I'm seeing that's there and anything can be taken to the extreme is that nobody really sat down and told the patient like, hey, physical activity actually could be a first line response. And that obviously plays into this whole idea, well, doctors don't have that much time, how much are they genuinely educated in that? And, you know, and also patients genuinely, a lot of times want a quick fix. You know, most of them are not going to be in a position where they're even being shown that this is a particular option that they should put a lot of, you know, weight into.

Yeah, I think it's a good point also that people sometimes don't have the time or resources. It all sounds great. Start eating leafy greens and seafood. Start working out, 150 minutes of exercise. once a week. When you're a busy parent with a job and you're depressed, that sounds great. It's really hard to do. And I think, you know, when we talk about kind of like a quick fix, I think that when we think about nuanced stigma-free mental health care, which is the system that we need to move towards, where we do more preventatively to care for our mental health,

we have more options available. It would be really great right now of all generic psychotropic medications were free to all Americans. That would really help with the major, major problem we're having in terms of the efficiency of our economy, right? The top drag on our economy is clinical depression by far, which is very clear. Mental health disorders are really what is the top cause of disability in America. And so we think about, okay, well, what can we do? Boy, there's some low-hanging fruit. You know what a lot of us did over the last two years, Drew? After all of this training, I spent a significant amount of my week feeling like a drug dealer is my patients and I'd have to call around to the pharmacies to try and find who had a formulation of a stimulant because they'd been well treated

for years and now their meds are gone. No one really explained like why did the stimulant supply to America get cut off for about a year and a half. I'm not familiar with this. Why? What happened? I'm not sure. I was busy trying to find it for my patients. So you're saying that somebody who was taking maybe an SSRI all of a sudden couldn't get that drug? Yeah, not SSSI. Not SSSI. I'm not a So I'm not so much. That happens sometimes. It happened more with that well butchutrin in the past, but more with the Adderall, the psychostimulants. And so we've seen this kind of huge surge in an interest in people pursuing or thinking about that some of what they're struggling with is maybe not depression, but is ADHD. So it's been an increase in diagnosis of ADHD. Treatments for ADHD, organizational therapy really helps quite a bit, but oftentimes people end up taking stimulants. And yeah, the stimulants supply in America just got kind of totally disrupted. Totally. Because it's like whole time. telehealth revolution where people, there's all these new startups that are basically, you don't even have to see a doctor. They just feel out an intake form and then Alveson, this person's getting it.

Not at all. I think it's because that our medication supply hasn't been protected. I mean, if you have millions of people who are taking a medicine, they're engaged in treatment, it's working, and then those medicines aren't available. And it's so stigmatizing, too, Drew. I mean, if you're an executive and suddenly you're calling around to pharmaceuticals, to pharmacy. Hey, do you guys have Adderall? Hey, do you have riddalen? And so that's improved. But I don't mean to get onto attention. It's just like it's one of those things when it comes to

really taking mental health seriously. There are just some things that we could do that would be very helpful, giving people better access to medications when they need them, giving people better access to some of what we're talking about. There's no way for me to prescribe exercise. There are some states where I can prescribe food. And so a lot of where we have the mental health system that we do is that there really aren't some of the capacities that we would hope for to really help people engage. Again, if you're really depressed, you know, if you have a men's group that shows up and's like, hey, man, like, let's go for a walk.

Let's go for a run. We know you're feeling down. For sure, you're going to go on a walk or a run with those guys. You know, it's like easy, peasy. Without that, some people, but it's very hard, again, to get motivated. It's very hard to get motivated. I know that there's, you know, so many of my family. being Indian like is in the medical field.

Many doctors and even people who are doctors, executives in the space, other stuff. These are people who genuinely care. And it's okay to criticize a system and say that through lack of awareness, things just don't get priority. Right. So there's a lot of people that listen to this podcast who have shared with me that, you know, they've gone to their doctor. Like you're in a completely different space, but they've gone to their psychiatrist. And things have definitely changed.

changed in the last like couple years, but most people are going to the doctor and they've heard that food has nothing to do with their depression, right? That's a common thing that is regularly shared with people that's out there, right? So I don't want to let people off the hook who are even still good intentioned is that, yes, you can still be a caring human being good intention, but you actually have no clue, you know, you have no training, you have no clue, you have no awareness of the fact that actually, you know, people can eat, you know, French fries a few times a week and literally feel more depressed, you know, and that there is a connection that's there. Yeah, I mean, I think you're also talking about how sometimes

the field doesn't update itself quickly enough. You know, now nutrition is in the WHO depression treatment guidelines, really all of the major depression treatment guidelines, really through the work of Felice Jacka and her crew, the Mood and Food Academy at Deakin University in Australia. Felice is probably our top nutritional, not probably. Felice is the top nutrition. Psychiatry researcher in the world. And she has worked so hard to make sure that our standards for treatment include nutrition and exercise. So I would say any clinician who's not saying, hey, one, at least informing alliance, tell

me your thoughts about how food relates to your mental health. Because what I hate is when patients are interested in something, hey, I really think my food is contributing to my anxiety. And you hear stories where clinicians shut that down. It happens all the time. I think it does. It happens in cancer. happens in, you know, depression, so many different categories.

I think part of that is we have a health care system that isn't based around food. You know, most doctors get some training on food. I still argue we can see this criticism, 26 hours of nutrition education for the average physician in America. I do like to point out that's 26 hours of medical school education, which is pretty complex. That's on top of like a year of biochemistry. And that's a lot of training.

It often gets criticized, like doctors have no training in nutrition, but that 26 hours is a lot of lectures, especially again, in a graduate medical level. So, and again, I think things are shifting. I finished my medical degree 25 years ago. So things have shifted. You know, there are more and more medical schools now with culinary medicine curriculums. You know, I think there are more doctors than ever who are curious about this. I think there's more excitement and engagement, for example, in the lifestyle medicine. which really focuses on things like nutrition and sleep.

So, and then I think what you're talking about sometimes is where people have a mismatch with their clinician and they don't do anything about it. And not everybody has the privilege and the freedom to choose their doctor. But if you do and you're in a situation like Drew describes or you're not feeling listened to, kind of, again, to get away from the externalization of like, you've got to change your doctor. You've got to find somebody who's going to engage with you in the way where you feel supported in your journey to health. I treat, it's one of my favorite things about being a psychiatrist. I get to treat people of all kinds of different values and backgrounds. And my job is to take good care

of them, not to judge their values. And so, you know, you want to have a good fit with your clinical team when you have, especially when you have mental health concerns, because that really, when we look at all the data, like what, like trying to understand, for example, like what psychotherapy works the best, the data tends to tell us like it's when there's a good fit. You know, someone has good training and a good sense of psychotherapy in terms of on the clinical side, but also that you feel a good fit. You feel safety and that you're in a place where you can express yourself and not be judged.

Coming back to these core tenants, you've been in this space for a long time. You have talked about the power of food throughout many of your books on your podcasts, on social media. Was there anything new in the category of food that you incorporate in this book that you thought, man, this is something that people, it may not be completely new, but it's not something that people are putting as much attention on. Food, supplementation, any other kind of novel component that was even for a little bit for you, as you're researching the book and putting together saying, man, people might know this,

but they're not giving as much attention to it? There were a couple things in food, Drew. What really blew me away was in some of the other tenants, to be very honest. When I, in fact, I brought this journal for you. This is for you, a little moose journal. Nice. And I'd love you to fill that up with all of your deep middle-aged male thoughts. The data, for example, on journaling, the research on what's called affective labeling is striking.

When we engage in journaling, we increase the activity of our frontal lobes, a part of our brain. that's involved in executive functioning, getting stuff done, making decisions. Again, part of our brain that for a lot of people we're struggling with, with all of this kind of overwhelm. And so, again, a simple idea of carving out some time to write to yourself. I particularly encourage people to write about powerful feelings,

struggles, try to kind of get to a point, get to what you're trying to tell yourself, kind of like we do in a good psychotherapy session. It all adds up to something in a good session. session. Is there a framework or you just want people free journaling? I put some different prompts in the book. I'm an old school psychiatrist and I just want to hear what's on your mind, raw, just like one thought to the next. And so I'm a big fan of just get it out on the page, really, as raw as you can. That doesn't work for everybody. I think I've had a lot of therapy and I've spent a lot of time

journaling. So if you're new to it, we have some prompts in the book, you know, things, thinking about some of your goals, thinking about fears, thinking about aspects of yourself that you're struggling with or aspects of yourself you want to be kinder about. And so, you know, certainly there are all kinds of also directed journals. There are journals that have a lot more prompts or that are set up in a way. I really encourage people in the book to experiment and as opposed to there being kind of one way or one prompt to try and figure out how you can get in the habit of self-reflection and get in the habit of more self-awareness around your emotional states, where they come from, and what they mean.

And so in terms of what was new for me in the book was seeing all of the science behind some of these mental fitness activities that over the years I've seen really worked for my patients, things like going out in nature. The idea that just going out in nature and walking is what I did last night. I flew in and I got right out to the beach. Just had to get out there and just kind of feel the universe a little bit, settle down for a little bit, really,

does a lot for me in my mental health. When you look at the data on, you know, just getting out the nature one time does profound things. It really shifts your brain. Or when you look at even just people seeing more green space, right, it settles things down in a nervous system. Really kind of cool. So I would say those types of things or in forests. I always love going into forests. I always feel like something settles down.

There are actually these molecules we inhale phytocides, which kind of activate and improve. our immune system. So again, I think probably Drew and he asked like what surprised me. There's a little bit in the nutrition chapter. I get into ketogenic diets a little bit. There's some data there that's new. Talk a little bit about some of the new research in the microbiome. And that's one of the central themes in the book. So I try to say, hey, step one for everyone. I want you to up level how you're thinking about mental health. If you're still thinking just serotonin or you're spending all your time arguing about whether meds work or not, like, this is not where you should spend your time in your energy. You should spend

your time in energy thinking about these new kind of three arenas, right? We think about neuroplasticity now. We think about inflammation. And we think about the microbiome when we think about mental health. So it's really striking to see a lot of these tenants. Like we talk about social isolation. Social isolation decreases the diversity of your microbiome, which tends to correlate with worse health outcomes. It's like not the kind of thing we used to think about, right, in terms of of how some of these aspects of our life, like how social we are, have direct biological effects on things like

our inflammatory factors and our microbiome. That's great. I love it. The social isolation piece, I think a lot of people are in this category where as you are getting older, you're also taking care of your parents. And whether or not you're directly taking care of your parents or whether you are just sort of ushering them

into the right sort of direction to prioritize their health, one of the biggest things that I see, and I tell all my friends, especially in like my men's group that I have that's been really close and we've been meeting for about 10 years now, I say, you know, anything that you can do, especially if your parents are living on their own, maybe they've lost a partner, maybe they've been divorced, like try to get them out of being isolated is one of the most important things. And it's tough because as you get older in a lot of ways, you get kind of used to things. Even if you don't want to, you don't want to be isolated. A lot of parents end up just being used to it and they don't necessarily always

want to try something new that's there. But when you can regularly get a parent in something that, or anybody, doesn't even have to just be a parent, when you can regularly get them into some sort of social aspect of life, it's a complete shift in how they operate and see the world. Oh, it's really true. My dad took up a Zoom yoga class and went from not doing yoga at all. He'd 86 now. And he's got this class. He loves these guys and they do yoga together by Zoom. He has a little like place set up in the house where he does it. And it, I found it very relieving because of what you're talking about. This idea that, you know, as we age, you certainly can kind of end up in your study going through stuff, you know, not really connecting with other people. And so sometimes it's something digital like that, you know, something new that we can engage in a group or we can engage in a yoga class. I think the most powerful or a more. we get out and about in some way and have commitments in our schedule. I think particularly as we age, that's really important. See my wife do a really good job of that. We move to a new community. And it's been for me like a masterclass in connection building. I mean, it's really been impressive

to see her make sure that she's volunteering and having lunches and going on walks with people and really just making those connections and building community in a way that I've just found very inspiring as I've been doing some of that myself, but not, not. not as impressively. But I think about that in some ways trying to set up the next 30 years of making sure that within my community and a new community, I've got a lot of connections and I've got some commitments, you know, things on my calendar that I'm engaging in. I just, as you're saying, as we age, it's one of those really, really important facts that I think we miss. You know, there's so much focus right now on like living longer. And like I guess I appreciate that. Okay.

I don't know who kind of decided that we need more time, or that we're not doing enough with the time we have. I think one argument could be made that a lot of people maybe needing to live longer aren't maybe doing enough with the time that they have. But maybe that sounds a little judgmental. I'm sure I want to live longer as I'm getting older. But the notion, though, of really trying to fill the years you have

with a depth, with an engagement, with a sense of connection, and with a sense of reality. Like in that first tenant being self-awareness, if you're 65 and isolated, today is a day where there is possibility for you of just doing the very first little threads of more connection. Maybe it's that you have not been leaving the house, and so you're going to go leave the house. I was working with a patient recently that that was our goal. Again, it's hard for some people to kind of conceptualize that being so depressed.

You can't leave the house. but that's where some people are. And, but you see those first threads of connection when people, you know, it can be the littlest thing saying hi, someone saying hi, someone being nice. Just it kind of lights up the human spirit in a way. What do you feel is the role of psychedelics in this process of us figuring out our mental health and up leveling our mental health and going for mental health to mental fitness? Okay, well, everybody, let me tell you where I am with the psychedelics because I just want to give

people my context. I think I sound a little contrarian sometimes. Like sometimes I get, yeah, I think I sound contrarian. When I moved to Wyoming, I did some training in ketamine-assisted psychotherapy. Ketamine is a dissociative anesthetic and if dose correctly gives you a brief psychedelic experience. Unlike psilocybin, where you can have journeys or trips that last four, six, eight hours, ketamine tends to be a much shorter acting. You have more of a maybe 20 minutes to 45 minutes of a kind of deeper

psychedelic experience. I was very excited with all of the data coming out and this idea that MDMA was going to get scheduled. Then I wanted to prepare a clinic where we could safely give these compounds and built a team. We had a protocol. And I don't know what I think. I think one, the data is shifting a little bit. I think two people haven't really paid attention to some of the costs and side effects.

One of the things that happens during psychedelic journeys is people recover memories and people recover experiences. People enter into very effusive and sometimes grandiose, affective states. And so there's certainly, you know, some powerful healing that's happening. I think there's also a lot of avoidance that's happening. And there's a flooding of the mental health field with people who don't have training in mental health that are approaching it from a kind of psychedelic perspective. I think it's also very concerning. There's a very large kind of anti-psychiatry movement

within the psychedelic movement that somehow they're tickling of the 5HT to a serotonin receptor is okay, but the ways that we get involved with serotonin and psychiatry aren't. And I think this is where I sound, again, a little contrarian that I don't think people are paying attention to how complex it is to deliver psychedelic medicine effectively.

To deliver a ketamine-assisted psychotherapy session is three to four hours. Two clinicians in the space, again, because you're going to have somebody who's significantly impaired. It's just a very complex and then kind of expensive. You extend that with psilocybin to an eight-hour journey. There's just a lot of time. And then that's just the beginning, right? There's really good integration if you're doing a good protocol where you're coming and

talking about what happened. I find that oftentimes there's a little less engagement in that integration. And I get concerned that there's a big difference between psychonauts, people who want to explore their consciousness and do a lot of different substances, and mental health clinicians, those of us who are in the space to help people heal. And I think sometimes those two things get kind of confused. And then I think the last part of a critique is there isn't, really much accountability. I have a lot of patients who engage in these things. And, you know,

some of the guides are great. They'll check in. But because it's kind of so illegal and underground, a lot of people are hesitant to. So then you have folks who are combining, you know, a mix of psychotropic medications that I prescribe with a mix of psychedelic medications. And, you know, ideally we have a system where there can be better coordination that when there are protocols that are really effective, they can be cost effective too. That's not really what's happening right now. People are generally going abroad. There's kind of this, I was a quick fix mentality, but there's a notion of like a transformational weekend. It's going to like shift things forever. And I think, you know, certainly that happens for some people. And then I think everyone's doing

these things, Drew. So like, you know, everybody has a kind of experience and opinion. I've certainly had experiences and informed some opinions. And so I think we need a lot more research. I think there's a concerning downside people aren't talking about. And I don't mean to fearmonger. I'm not trying to say that these things should all be illegal. I mean, I like the idea of us exploring them more and having more tools.

But they're very powerful compounds. The idea that you're going to disrupt your default mode network and like trash, you know, get rid of your ego, I don't know who decided that was a good idea, Drew. I like your default mode network. It's really interesting. You're Drew. I'm glad that there's consistency between us over the years.

I don't mind if you want to disrupt it for a little while to go experience something different or if you're suffering in some way and you get away from that. Okay. But the idea that, you know, for two months, your default mode network is really going to be off. I'm not, you know, I don't know why we decided that's like, that's great. Or the ego death. I don't know. In psychiatry, we did a lot of training around what's called ego-supportive psychotherapy. That your ego, in the 40 model, the part of your mind that's kind of negotiating between these primal drives and our kind of moral and cultural and societal values.

That ego strength, right, was your ability to live according to a set of values, not just to give in to our impulses, you know, violent and sexual and aggressive and all that. I always like that model, you know, this idea that my ego, like what part of the world. of what I'm working on in mental fitness is a self-awareness of my sense, my defenses, my communication style. And so I'm all four people having access to medicines that work. And I think when we're going to include psychedelics into the space, we need to be more thoughtful than we've been. And we need to keep paying attention to some of, I would say, the negative singles that we see in the space that, again, don't get talked about. very much. I think as anything is emerging, especially something that has been suppressed for such a long

time. The research has been, you know, you couldn't do research on it for a long time. Stigma around psychedelics. You can even have a conversation about, you know, exploring it. Even some of other people, early people in the last few years, right? There's been different stages of it. You know, them even talking about it, wanting to be able to talk about it, discuss it. You know, even Michael Holland talks about this and in his book is that people would look at him like, dude, why are you going there? We already know what we need to know about this stuff. Right. It's not a good idea. So anytime that happens, you get, you get the Wild Wild Wild West. And the Wild Wild West sometimes, though, is needed. It's not, whether it's needed or not, it just ends up happening because you end up

getting people that have to push the boundaries in some aspects. And then you get researchers, that are fighting for, you know, like I've had, I'm blanking on his name, the founder of Maps on the podcast. Rick Doblin. Rick Doblin, right? He's seen as a very controversial figure to a lot of people because he has a lot of unique and interesting thoughts that are there. And nonetheless, he's created this organization.

And sometimes I see it as like, you kind of have, mad scientist explorers in every field. It's not unique to mental health. It's not unique to psychiatry. That kind of gets something going. And then the community ends up deciding how they want it to be handled. Right. Like, hey, we need more research.

We need more standardization. We more that. But sometimes these sort of fringe characters that have crazy ideas, sometimes it takes somebody a little bit out there. When I say crazy ideas, I know that's a very sort of, you know, loaded word. I mean, different than what people who are more established in the space. Because I think sometimes people who are more established would say they wouldn't,

they wouldn't even have even thought to go down that route of looking into MDMA or a ketamine or other things. Sometimes you need a little bit of a pioneer, even if that pioneer is not everybody's cup of tea. And then, you know, it's up to the community to decide like, how do we want to handle this, right? How do we want to create better ways of not stigmatizing anything or, actually what's the most safest way to do this or how do we get the, you know, government to support research. So that's just my defense of the person who's a little bit of the Wild Wild West cowboy character. Yeah. I mean, it's just you look through history. We've always had people like that to kind of get something going when something has been, you know, a field that people don't want to

touch for a long time. Yeah. I mean, I think there are a few folks in the space who do really deserve some accolades around the notion of being disruptors, right? When I think about Paul Stamitts and his dedication to just mushrooms and mushroom cultivation and the celebration of that and just what a cool, nerdy, interesting guy he is around this or Rick Doblin who, you know, it's interesting, Rick, to my knowledge, isn't a mental health clinician in any way. And, you know, has been really toiling for decades, you know, again, trying to get more research, trying to get more access. And so, you know, I think certainly will go down in history as somebody who has helped shake the space up. There are hundreds of psychedelic compounds in development now. I mean, every major medical center is

thinking about this. I think Utah, oddly enough, but Utah is this wonderful mental health center, the Huntsman Mental Health Center. And Utah, the governor, has allowed them to research MDMA and psilocybin, I think about a year and a half ago. And so, you know, I think also part of what you're speaking about is how those of us who've been in the field in a certain way get a little bit defensive. And I think that's in part because we've been through many different iterations of this. There's a new medicine. There's a new therapy. There's something new for our patients. And sometimes that's great. That works. I saw that happen. There was a whole new medication class for the psychotic disorders that came out when I was in residency. And, you know, you get very hopeful.

And then you see the reality. Maybe help some people as a promise. Maybe you'll maybe help some people as a promise. not so much others. And so I think that where I sound a little contrarian with the psychedelics is where they get treated in an anti-psychiatry way, you know, that like, duh, you just need some MDMA. And I just find that to be a little offensive in the face of the complexity of how mental health problems get handled. And then I also think sometimes disrupting people's minds in the way that these compounds tend to do might not help with some types of human. as much as we think. Oh, man.

I had a friend from England who was like really wanting to do, you know, she was coming to a trip to Los Angeles. And this friend, she had had a lot of, you know, trauma in her life. She lost her mom through a battle of cancer. And it in particular really weighed on her because she was an alternative health care licensed but alternative healthcare practitioner in England, and felt like, how could this happen to my mom? And, you know, she really tried very hard to bring her to a lot of these more experimental

treatments in Germany, you know, these medical centers that were there, and just really felt bummed about the whole situation that not just her mom passing, but just the fact that on top of that, the idea that like she was really the daughter, but also kind of like trying to be the mom's advocate for her. health, right? And anybody can imagine that that's like devastating enough to lose your mom, but then partly you feeling like, hey, I was responsible. If I knew better, I would have figured something out, right? That's just her thought, whether that's true or not is a different situation. And she said, you know, I'm coming out to LA. You know, I really want to. This is, and it had

been years since her mom passed away and there was a few other things that were there. I really want to have like a psychedelic experience. And this was in like 20, 12. And me, I've never, I didn't even grow up really drinking, right? I didn't like the taste of alcohol, all this stuff. I never smoked weed. I just, I didn't have anything against it, but it was like, hey, this isn't for me and I don't feel like drawn to these things. Just it like seemed like unhealthy behaviors to you? I don't even know if I thought alcohol was unhealthy. I just thought like, I don't get it. Right? And maybe you, yeah, I didn't feel like I really, I really got it. So anyways, long story short, you know, I message a friend and said, hey, listen, you know, she's, she's interested. Like, I don't know, like maybe let's try to create a little bit of like an intentional setting at our place. And, you know, if some people want to have some, you know, magic mushrooms and, you know, have that. And again, this is just, you know, no understanding.

like I've had some really incredible people on this podcast that are like researchers in the space, but this is just like, oh, we're just all friends, you know, doing some mushrooms, right? And man, she had such a bad trip. And since that time period, you know, she's never been the same. And this is an extreme situation. I think there's some other factors that play into it. This is an individual that probably was abusing marijuana. and I'm like very nervous about especially the abuse of marijuana these days.

I've had multiple people in my life who seem to have, you know, weed-induced schizophrenia. I wouldn't say seem to. I mean, that's the major risk with cannabis, especially in adolescents and late adolescence. Totally. So let's say 16 to 25 is psychosis.

I mean, the risk for psychosis and psychotic disorders just skyrockets if you're using cannabis. And they're generally thought to be like, you know, very safe. And if you look at the long-term data besides psychosis, you know, reasonably, although there's just a big signal for increased risk of heart disease for cannabis users. But yeah, the, yeah, happy cannabis users. Yeah. And I think, you know, you're here in California where there's just been, there's a proliferation of, you know, both access but then concentrations.

And so anyway. Yeah. So, so kind of a few. different layers that were there. Obviously, she had a multitude of things going on. I've had plenty of people, you know, that have had psychedelic experiences, myself included. I've shared on the podcast, but two years ago, I took my parents to a guided psilocybin journey that was in Maui with a group that had, you know, regularly does this where everybody had support. There's a protocol, heavy focus on integration. The whole thing's like really done well recommended by multitude of people. And it wasn't for anything that was wrong. It was to have that journey and experience together. And what was it like? How old were your folks when they did this? My dad just had

turned 70. And they're both like, my dad had just turned 74 and my mom was just about to turn 70. Okay. And they had never done anything like this before. I mean, you've never done. They don't even drink alcohol. Yeah. I'd taken psilocybin one time previously prior to that, but nothing like, it was more like a very small dose. What was their intrigue with it? Their intrigue is they've heard, man, I didn't take my neutrophics this morning, so I'm blanking on a bunch. The gentleman from Johns Hopkins, who passed away. Right, Roland Griffiths. I've had him on the podcast, and I've had a few other people on the podcast.

I had him on the podcast before he passed away. He was at the functional medicine conference a few years ago, got a chance to sit with him and interview him. And my parents listened to this podcast, and they thought, wow, this is. something, you know, interesting. And at that time, too, I believe it was Michael Pollan's Netflix documentary had just come out. And I was sharing that I was interested in having the experience and for a multitude of reasons. And they said, you know what? If you do it and you find a place that, you know, is recommended, we would love to do that as well. So there was a curiosity that was there. And I would say that the real driver is one of the main things that Roland Griffith's

research showed. I mean, he's done a bunch of it was in their national survey. on psychedelic people who've had a psychedelic experience. He showed that, you know, I think it was like five to seven percent of them had had a bad trip and most of those was in a setting that was not a safe setting, was a party setting. It was combined with alcohol, all the things like that. But for the people that had a good trip, one of the biggest takeaways was people said it was the most mystical experience of their life. And my parents are very into their hindering.

tradition, which is a tradition of not just religion, but mysticism. And I think that idea drew them in of like, wow, if people are saying that this is the most mystical experience of the life, what would that experience look like for them? What would come to them? So we all went to Hawaii. A couple of my friends. My wife came as well. My parents.

And first of all, everybody's saying, oh, my God, the fact that your parents are doing this, like, that's like wild. Like our parents would never do it. I think this is why I sound like such a jerk about the psychedelics is because I think there's, I won't call it jealousy, but there's a way that like, it's just more fun. You know, the idea that like you and your parents would like come to like maybe an intensive to like, you know, connect or, you know, talk about mysticism or explain something that's more traditional mental health. You know, it just has this like grin or excitement that going, there's something about the psychedelics that gets people jazzed up about engaging with their mental health in a way. Yeah. To go in it.

It's like a, and I think it's because it's an active. experience. I felt this as a clinician where I'm used to an experience, you come and you sit down, and you know, you're running the ship. Like you want to talk about, you know, your background, your development, what happened yesterday, you're, I mean, you know, it's like, I want to hear what's on your mind. With psychedelics, it's different because you're inducing something. And you don't know if it's going to be good or bad. You don't know in an hour if the patient's going to be throwing up or whether they're going to be having a deep mystical experience. And there's something about that, I think, as a clinician,

going from this kind of maybe more passive receptive stance, right, where the only thing I'm really giving are interpretations, maybe some food prescription, a little mental fitness prescription, maybe some meds, to you're going to have this experience. And it could be a profound experience that is with you for the rest of your life, a transcendor. Or it might be kind of a bad, dark experience, ranging from like, I don't quite get the dosing right

to just this isn't a good. good medicine for you. And it was just, it's a very different stance as a clinician. But I think what you're demonstrating is, boy, it's just, you know, it's more, it's more fun. And it's a more active way of engaging with our mental health. And I think that's- I don't even know if that's what I'm saying. I think that there's different tools for different toolboxes. So one thing is shout out to the group that was there that was doing it. They screen everybody for, look, if you got something made. major going on in your life or you're dealing with depression.

There's other people that are there that might be there for you, right? This is not the experience that's there for you. You know, it was people that had a lot of clinical experience, but they're not in your boat where they're like their main thing is to be working with somebody who's depressed or dealing with some severe PTSD, although they did have a lot of experience working with veterans that were there with a different, you know, combining with a different, you know, combining with a different group that they had support with. And so our thing was like it was more the thing that with my parents, my brother-in-law was there, my wife was there, it was more of, hey, we're all good,

like we have good mental, nobody's working through something right now. And it's more that this is a mystical experience we want to have together. Right. But I don't think that that's the right fit for a lot of people. And I think that there's a lot. And the crazy thing was, is that here, especially in Los Angeles, I'm always amazed when I go to like events or a dinner party and somebody's like, oh yeah, you know, we're going to do, you know, just some like major dose of ayahuasca or psilocybin or something just like off the cuff this weekend. And they did it a few weekends before. And I'm just like, man, after I had that experience, I didn't have the draw to even want to,

I felt like good for a while. It's a great point also about some. I felt great. And I think that that goes back to this. There's a lot of maybe escapism or other stuff or reliance. I'm not going to have any judgments on anything, but I am excited about the fact that one thing that seems, even as controversial as an individual as you might be to some people,

and a lot of people on my podcast, you know, they listen from all walks of the political aisle. So people don't even like me mentioning this sometimes, but I'm still going to mention it. I think one of the things about having Secretary Bobby Kennedy in is it does seem on the roadmap. there is some hint to opening up more traditional research dollars to this whole area of therapeutic usage of the spectrum of psychedelics that might be there.

And I think that that's one thing that I am actually really excited about because I think we need more places like where I can tell a friend who's dealing with depression, hey, not just go see, you know, Dr. Ramsey, but also if you do, decide that it's a good fit, maybe one of these tools in the toolbox, that you don't have to be doing it underground, and they're going to get a much better treatment and experience through you than, you know, trying to go to some sort of weekend retreat that's out there. You know, how we figure out the right research to really understand how these compounds work, and do they work better? I think that's the other part that, that, you know, right now I think

the efficacy looks about equal. And so. For some things, right, MDMA, the efficacy for that for people that have been dealing with post-traumatic stress, right? It's like, is much higher than a lot of the options out there. The PTSD is a data that I think, you know, as a space where the data stands out, right, that MDMA is showing some, you know, more robust results than anything else has. I think psilocybin for alcohol use disorder was very exciting. I think, you know, part of what you're talking about is how do we kind of keep this cutting edge moving forward with research but also give people access.

It's very frustrating to be a veteran right now, a severe PTSD, who's done a great job. So many of my patients do such a great job. They try so many things. They're really like working hard to get their mental health better and we are letting them down. So the idea that someone in the situation, one of our veterans, you know, who's struggling with PTSD, maybe suicidal has to then like fly to Jamaica and go to some retreat, spending thousands of dollars as opposed to being able to access something that the thing about psychedelics, they work quickly. That's a, I remember I had a patient in Wyoming that was just really, really, you know, struggling down.

And I'm sitting there with her and I was like, you should come back tomorrow and let's give you a ketamine journey because, you know, the next day she was feeling better. Like when it works, it works quickly. And there's a lot of tolerance of suffering that we have. There's a lot of people not getting all the way better. And so I like the idea that we have better access. I like the idea of it coming above ground. You know, what's horrible right now is all of the underground guides are terrified because they're breaking the law.

Because of that, you also then have real questions about supply and supply safety and quality, right? What are people actually taking? And then on top of all that, you kind of have the question of like, who's the right person to give these compounds? You know, like I said, I think I sound a little bit like a jerk about this, so I'm not sure it's me. although I certainly want if they work for my patients to be involved with their care in that way.

And so we'll see. In terms of the new administration, we'll see. I hold those in charge to a very high standard when it comes to our health. And I've always been concerned whenever our health care is directed by anyone who's not a physician. Because I think physicians think differently. We just think differently about health. and have been in it in a way that it just shifts how you think about these things. Yeah.

Well, we do have a long history. Previous, you know, heads of HSS been lawyers and other stuff and things like that. But, you know, we'll leave that. I always think it's a bad idea. I think anybody who's running health care in America, NIMH, HSS, I just think we want a physician in charge. And I know there's a long history of other. I just think that, again, it's a perspective that's different because all other fields think about health, think about the kind of humanity and ethics of health care just differently than physicians.

So here's where I would push back just a little bit on that, right? Just because it's a podcast, we can do that. We can have this great conversation. I want all the perspectives. Let's do it. Let's do it. I think where you have the other side of it is that you have people that are like the head of the FDA, and then it's like they're regulating things that are direct.

directly related to pharmaceuticals. And you have this revolving door where you have somebody then is a physician and sometimes not a physician and then goes and leaves and then goes and works for Pfizer, right? Or goes and works for Merck. We've seen that many times over. So I see it as like, let's judge each individual person as a person. I don't see any history that physicians themselves, physicians are human beings, right? I don't see any history of there's something that would make a physician more so wanting to keep that perspective. I think when you have any kind of influence that can kind of cloud the waters and corruption can kind of come in regardless of where people are coming from, you know, you'll see that corruption come in.

And I don't think physicians are immune. And I don't think physicians can be, you know, are you. are uniquely immune from that, I think they're just human beings, just like everybody else. It's not that physicians are less prone to bias. I think it's that physicians in general tend to be a little bit more tuned into it.

And the revolving door thing, I don't think, is exclusive physicians. I think it's where you're speaking about a system we have where there's an interplay between regulation and commercial industry. And that's true in all aspects of the government, whether it's the Pentagon or whether it's the FDA. I, you know, I'm a simple clinician, Drew.

I take care of patients on all sides of the political spectrum. It's really been important to me throughout my career that no matter where you are and your political beliefs that I can care for you. Yeah. That my job is that if you have depression, anxiety, a substance use concern that you can come to me and you will feel you're taking a step towards healing. So that's a, I think important. part of, again, improving health care in our country.

I think what probably everyone agrees with is that things have not been going well. We have a very expensive system that doesn't work very well for a lot of people. I don't know anyone who feels satisfied with the health care system or with the mental health care system. I know, like you know, people from all types of echelons of power who need help and don't know where to find a couple's therapist, a therapist, a psychiatrist, don't know even the next step to take care of their mental health. And so I do hope we end up with something much better than what we have. Yeah. Well, I'm team human, and I've seen, you know, anytime humanity deals with these various versions of crises,

especially here in America, like, you know, I feel like we'll figure it out. We'll figure it out together. And it's, we can't, you know, going back to something you mentioned earlier, you mentioned that you're really focused on what the individual can do, right? Like the food system might be corrupt. There might be big companies that are pursuing profits. Politics can swing this way or that way. But at the end of the day, what are the things, the core tenants that people who are listening can do?

And I think that 100% that is first and fundamental because if we're not an example in our own life, if we're not sleeping better, if we're not eating better, if we're not then, you know, trying to help the people that are around us. It's like all change really starts from there. So let's bring it back to the book. Okay. I love that tangent that we went on and thank you for talking about. You know, I appreciate you asking me about it and I'm always working to, you know, it's a lot.

It's just a lot, you know, between the nutritional psychiatry data, the traditional psychiatry data, the psychedelic data, running a practice of just the reality of keeping up on all the meds that you prescribe and, you know, all the psychotherapy research, it just, you know, and it ends up being a lot, and it's a great challenge to keep up with it. But, you know, I hope what everybody listening hears is my encouragement to explore. And I think a little bit of my caution, I think there's hyperbole. You know, it's the same way that I just think having given a lot of psychotropic substances throughout my career, it's like we need to approach all this with much more humility.

Yeah, well said. Let's come back to the book. Especially right now, who should be reading this book? This book is for anyone who feels they need to do more for their mental health. If you have concerns, this isn't a book really for, necessarily for anyone who is currently struggling. I think it is helpful. Certainly these tenants are supportive of any type of mental health treatment because they're the foundations of kind of the self-care that we need to do to engage with our mental

health and improve our mental fitness. I think who I hope is for and ideally people who will find it again are people who want to engage with the self to improve it and maybe that's too general and not focused enough this book is for women between 35 and 65 but

it's the truth and I think we're also in an era where you know more than ever men are engaging with their mental health you've mentioned your men's group a couple times which is just awesome I'm super jealous of that we actually have a retreat this weekend we leave tomorrow oh my gosh I want to like hide in your

trunk and come along. It sounds incredible. But, you know, the kind of thing that people didn't really do in the past that much. Occasionally, you know, you'd see maybe a men's group at a church function or as part of work. But, you know, we're seeing more and more people get engaged with their mental health, think about their mental fitness. And so, you know, this book is really for men and women who are thinking about needing to make some changes. And I guess wanting some framework. And it's easy to say, like, I'm going to work on my mental health or every May we have mental health awareness month, which I love. It was one of my patients said to me years ago, you know, awareness without action doesn't do much for us. It really struck me.

I was like, you know, it's easy for us to feel we're fighting stigma. But like with the example you gave around food, you know, you buy lentils or you don't. You cook lentils at home or you don't. And I don't mean that in like a judgmental or accusatory way. It's just like, you know, we can complain about the food system and how whole. horrible it is, but there are lentils in your grocery store. There's kale in your grocery store. There are a bevy of the foods that you need that are good for your health in your grocery store. And so I kind of get to this question is like, what's getting in your way? Like, what are the

barriers that you're facing to incorporating these foods into your life? Because that that's where the change happens. Yeah, absolutely. Talk a little bit about your world. You have a podcast that you launched since the last time that we talked. Yeah, we've got the Dr. Drew Ramsey podcast. I just wanted a space to talk about all things mental health and mental fitness, whether it are episodes on the gut microbiome and, you know, or whether thinking about inflammation or they're talking to inspirational figures. I wanted a space to ask people what they're doing for the mental health and to have some inspiring examples.

You know, Drew, my world is really like involved in clinical care. I spend maybe like 30 to 40 hours a week taking care of patients. And I just, I don't know, I just really love that work. I'm very happy in a psychotherapy session with all of the associations flowing around trying to understand what's going on, understand how it can be helpful. We've got an e-course that goes with the book, Healing the Modern Brain. It's up on my website and really just try to give people a lot of tools, whether it's some downloads on some of my favorite antidepressant foods that are surprising or the ultimate

mental fitness morning of kind of how to get your day started to really live by the tenets of mental fitness. But yeah, I think, you know, that. I'm adapting to living a mile up. We're at 6,250 feet in Jackson and living in a place where it snows like pretty much every month. Maybe not July or August. And also being in just a wonderful new community, a lot of these mountain towns like Jackson and Vail and Aspen have massive mental health crises.

Part of what actually drew me to the place as we were looking for kind of the next spot for our family was thinking about a place that really valued mental health. And Jackson was fascinating. They'd already done a community survey of thousands of people in the community, kind of better defining the mental health problem there, significant problem with alcohol use, significant problem with social isolation. But it's just very, you know, my world in some ways is trying to understand more about being in a community, being of service to that community He is a psychiatrist, trying to continue to settle in and build connections. And then a lot of my life is about being a dad and a husband, just the day in day out of that

and trying to with all these other things we've mentioned, I find that's in some ways the most important and at times, I wouldn't say elusive, but it's just, it's really easy for the rest of the stuff to eat your day. And well, you know, and it's easy for all of us to get. too busy and say that. But boy, when I get focused and get to spend some times with my wife and kids, that's, that's what else is going on. That's certainly a big part of it for me. I love it. Well, the book is, depending on the day that we air, it'll either be pre-order or order. Okay. I hope you'll do both. I hope we'll do both. Well, depending on the day that the podcast comes out,

you know, so you can either get it right now or you can pre-order it. Healing the modern brain. We have the link in the show notes below. Dr. Ramsey, thanks for coming. coming back on the podcast. It's so much more fun to do in person. Drew, it's awesome to see. I was a little nervous for it. I haven't done an in-person podcast in a while, but it's a treat to be with you, man. I really appreciate all of your support. People don't know this. But years and years ago, years ago was at this conference called Wanderlust. And I think Palm Desert, Palm Springs. And I sat down with Drew. And I was, it didn't really have just done maybe my second book. And Drew sat down with me as this like beautiful, leafy outdoor patio. My wife actually still

remembers it. And we sat down for a part an hour and you were so kind and so generous and so encouraging. And it really, it sticks with me, man. I don't think this book would be here without folks like yourself encouraging me and giving me a platform to come and speak and value my opinion. So it's just a real treat to come back and a real touchstone for me. So thank you, my friend. Thank you, brother. Appreciate it. Anytime.