Feel Better, Live More with Dr Rangan Chatterjee - #212 How To Eat To Beat Depression And Anxiety with Dr Drew Ramsey

Episode Date: October 26, 2021

We know how vital what we eat is for our physical health. What’s less widely appreciated, despite a wealth of evidence, is just how important the right foods are for our brain and mental health. But my guest today is here to turn the science into easy steps we can all put into action. Dr Drew Ramsay is a psychiatrist and a leader in the emerging field of nutritional psychiatry. He’s assistant clinical professor of psychiatry at Colombia University and founded The Brain Food Clinic in New York. Drew’s book, Eat To Beat Depression And Anxiety: Nourish Your Way To Better Mental Health In Six Weeks is a powerful prescription for optimising your mental health through diet. His clinic incorporates evidence-based nutrition and integrative psychiatry treatments with psychotherapy, coaching, and responsible medication management. He believes everyone working in the field of mental health should be talking about nutrition – and I couldn’t agree more. Over his 20 years as a practising doctor, Drew became frustrated that the robust data confirming a relationship between food and mental health wasn’t making it through to doctors, let alone patients. With depression being the most disabling illness in the world, he’s made it his mission to bring the evidence on nutritional prevention and cure to the masses. The trick, he says, is to find foods that do one of two things. They either feed your gut microbes and fight inflammation (linked to both depression and dementia) or they put your brain in ‘grow mode’. And which foods do these things? Drew reveals his ‘power players’ in our conversation, giving specifics on different nutrients and how they work in the body. He simplifies the research on foods that can treat depression – such as the famous SMILEs trial. And he provides a super-helpful, realistic guide to changes you can make right now (that don’t have to be expensive). Mental well-being is such an important topic and Drew’s work is so valuable. This episode is a must-listen for anyone who wants to do the best by their brain. Thanks to our sponsors:   https://www.vivobarefoot.com/uk/livemore https://www.blublox.com/livemore http://www.athleticgreens.com/livemore   Show notes available at https://drchatterjee.com/212 Follow me on https://www.instagram.com/drchatterjee Follow me on https://www.facebook.com/DrChatterjee DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Nothing will give you better dividends and more rewards than taking care of and investing in mental health. When we feel in the upper echelon of our mental health, the world and life is amazing. We are filled with love and creativity and spontaneity and connection, and we live more. Hi, my name is Rangan Chatterjee. Welcome to Feel Better, Live More. Hello, how are you doing? I hope you're having a good week. Thank you so much for joining me and tuning into this week's podcast. Today's episode is all about food and how we can eat to enhance our mental well-being. Now, I sort of feel that most of society understands that what we eat is vital for our physical health,

but I think what is less widely appreciated by the public, but also with healthcare professionals, is just how important the right foods are for our brain and our mental well-being. And my guest today is one of the world's leading voices in this brand new field that's called nutritional psychiatry. Dr. Drew Ramsey is a psychiatrist. He is Assistant Clinical Professor of Psychiatry at Columbia University, and he's also founder of the Brain Food Clinic in New York. Now, Drew's book,

Eat to Beat Depression and Anxiety, Nourish Your Way to Better Mental Health in Six Weeks, is a powerful prescription for anyone who wants to optimize their mental well-being through their diet. Now, the bedrock of Drew's approach is evidence-based nutrition, and he believes, as do I, that everyone working in the field of mental health should be talking about nutrition. Over his 20 years as a practicing medical doctor, Drew became frustrated that the robust data confirming a relationship between food and mental health simply wasn't making it through to doctors, let alone patients. Now, depression is one of the most disabling mental health conditions

in the world. Other mental health complaints are coming up all of the time. And because of this, Drew has made it his mission to bring the evidence on nutritional prevention and cure to the masses. The trick, he says, is to find foods that do one of two things. They either feed your gut microbes and fight inflammation, or they put your brain into grow modes. And which foods do these things? Well, in our conversation, Drew reveals his power players. He gives specifics on different nutrients and how they work in the body. And he also details which kinds of foods can actually treat depression and help all of us with our mental well-being. He also provides a helpful, realistic guide to changes that you can make right now that don't have to be expensive. Mental well-being is such an important

topic, especially these days, and I was really honoured that Drew took some time out of his busy schedule to join me on the show. I love his passion. I think his work is invaluable, and I really hope you enjoy listening. And now, my conversation with Dr. Drew Ramsey. You have been a practising medical doctor for over 20 years. You're a psychiatrist, a very well-respected psychiatrist. When did you first become aware that food could help improve our mood? Well, I think it began for me pretty early. I was really interested in my physical health. I was an athlete in college. Back then, I was a low-fat vegetarian. And that was sort of before it was cool. It was really interested in my physical health. I was an athlete in college. Back then,

I was a low-fat vegetarian. And that was sort of before it was cool. It was very strange. I was a medical student in Indiana, which in the United States, or everybody listening in the UK, is right in the middle of the Midwest. It's known for meat, potatoes, corn. And so I was very interested in food and health and the connection between that and really had kind of bought into a heart first model, really thinking about how to adjust my diet, getting rid of cholesterol, saturated fat, those kind of things. On a personal level, it really wasn't very good for my mood in a certain way. I was having a lot of problem with really significant fatigues, mood lability, lower moods, a lot of angst. And maybe some of that's just, you know, being a young doctor in development. But for me during residency, so this is our specialty

training in psychiatry, I had this really stark contrast in my personal life. I'm thinking a lot about what I'm eating and how to optimize that. And in my professional life, as we're learning all about the brain and brain health and therapy, there's no talk at all about this. And it really just struck me. But I think when I really became aware is the data started coming out. Evidence drives everything in medicine. And in psychiatry, this is back, there was not nutritional psychiatry. I remember there was a, at Columbia University, there's a psychopharmacological listserv. So it's all like the big psychopharmacologists, really like some of the smartest guys in psychiatry and women are on this list. I should say men, women, and non-binary folks as well. And I remember writing about omega-3 fats and saying, hey, there's this data and it looks

like these things have an antidepressant effect. And I remember there was omega-3 fats and saying, hey, there's this data. And it looks like these things have an antidepressant effect. And I remember there was this moment where I was like, wow, where do these things come from, omega-3 fats? And it was like, well, they come from fish. Why aren't we talking about fish and evaluating that in patients and thinking about how to get people to, if there's good data about it, why aren't we assessing it and thinking about it? If there's good data about it, why aren't we assessing it and thinking about it? And I think that probably is like 2002, 2003, it really becomes just on my mind a lot. How do I incorporate food into my clinical work as a mental health practitioner? And eventually this develops into, with a few other colleagues, the beginnings of nutritional psychiatry.

That's early, 2002, 2003. If I think about the research I've read in this area, particularly in the last few years, it strikes me that you're talking maybe 17, 18 years ago about seeing that relationship in the data between food and our brains, food and our mental health. It sounds very much as though it did come from the data. Do you recall an early patient at all or any experience where you suddenly thought, hey man, in my own life, I'm really trying to focus on my lifestyle and what

I'm eating. Yet with my patients, I'm kind of, I don't know, looking at their symptoms, looking at lab values and trying to treat those symptoms. When you say it like that, it don't know, looking at their symptoms, looking at lab values and trying to treat those symptoms. When you say it like that, it's pretty obvious. But for so many of us, when we're in that system, we kind of don't see the relationship, at least not early on in our careers. And you're scared to do anything different. It's weird. I mean, I've taken it on the chin and enjoyed it. But I've been teased as Dr. Kale at national American psychiatric meetings. I think what you're pointing out is there is this relationship. We have been incorporated into our model.

And particularly what I noted is we haven't done that with mental health. Where there's maybe a gap in physical health, people know, hey, what do you do to take good care of your heart or avoid cancer? Or are there some foods that are good for that? Almost everyone has a few. When you say, hey, if you have a history of depression or anxiety in your family or any mental health problem, or you're a parent and you've got kids, you're raising them, you have some conditions in your family, you want to just try and minimize your risk. Are there things you should be doing every day, foods that you should be eating that at least the data suggests, and now I would say suggest strongly, are going to help with that? And it really turns out, since when we're talking about, you know, 17, 18 years ago,

the data that has come out has really been very robust, supporting a relationship between what we eat and not just our brain health, which is very important, of course. That's where our mental health comes from. But our mental health, and specifically depression, has been most of the data. That's so important, as you know, because depression is the most disabling illness in the world. And that just means it prevents us as a population from really achieving our kind of highest possibilities. And the potential with nutrition and nutritional interventions in terms of prevention, I think in mental health is unparalleled. I don't know of any other set of data or set of employable, economical, possible

interventions for our mental health than food. That is the real promise and excitement around nutritional psychiatry. Yeah, I mean, we're going to get into this. We're going to go into a lot of different areas, I hope, in this conversation. But before we do, I thought it would be worth asking you about inflammation. Inflammation is a term that many people, many of the lay public now have heard about. They sort of know there's a disease and symptoms might have something to do with inflammation, but I think a lot of people still don't really understand what it is. So I wonder if you would explain how you view inflammation in the context of our physical

and mental health, but then also really split it up into body inflammation and brain inflammation and how those two things sort of link together. For sure. So inflammation is a very important system. It's what protects us. It's what keeps us safe. Inflammation is really at the root of our immune system and how our body recognizes threats and injuries and then eliminates

them. However, because there are a lot of things stimulating us, whether that's noise of the city or air pollution, by the way, very, very strongly linked to your risk of depression, or whether it is a stressful or toxic work environment where you're always wired and revved up, there's a lot that is stressing us. And because of that, it's a little bit like, I make the analogy sometimes, it's like if you went in to take a test in school and the fire alarm went off. And instead of leaving, they said, this test is important. You sit there, take your test. And you're taking the test. And then the sprinklers come on, you know, and it's messing up your work and the the proctor of the exam says sorry you know it's a tough exam having too much inflammation

is a little like that you can probably still finish the exam but you're just your alarms are preventing you from uh really living your best because they're going off inappropriately inflammation is uh very tightly linked to our food because the largest part of our inflammatory or immune system is our gut and so you think about food as really a set of signals and and as a way to really fuel and nourish your immune and inflammatory system and also to regulate it there's also this concept that a lot of people have heard about called the microbiome or the idea of the microbiome. The reason we're hearing about these two ideas is they're very linked. The microbiome is the set of organisms, primarily bacteria,

that live in your gut and mostly in your colon. They're at the center of really helping regulate a lot about our body, including our inflammatory response. Yeah. It's super helpful to, I think, explain that to people. I'm curious what you feel is really one of the best ways to explain inflammation, because you've heard so many people talk about it. And I really agree. It's one of those words, it's easy to pass around. And I'm wondering how it sits with you in a way that makes sense and resonates with patients and people. Yeah, you know, as I'm sure how it sits with you in a way that makes sense and resonates with patients and people.

Yeah, you know, as I'm sure you would agree, you know, the way we explain things often depends on who we're communicating with. As I'm sure you do, I change my communication style in clinic depending on who that patient is in front of me, their level of understanding, the sort of energy I get from them, the sort of, you know, the prior interaction, it all plays into it. But I guess in a sort of public setting like this, how would I explain inflammation? Yeah, not dissimilar to you. I'd say inflammation is a way that the body tries to protect itself. So, you know, we all understand, everyone knows the feeling of when they've cut themselves and they cut their ankle and it's bleeding. And then the body needs inflammation to try and repair that ankle, right? Yeah, it reminds me, I remember once talking about anxiety and writing about it and really talking about how it's a superpower. And it's funny, as you're talking about, inflammation is a superpower.

I mean, when you think that you can get cut or trip and sprain your ankle and the body protects itself, then repairs itself. Well, you're just sitting on the couch, snacking. Exactly. We don't have to do anything. Our bodies are built to thrive, right? They will take care of that cut without us doing anything, which really is the miracle of the human body. I think we sometimes forget that in medicine, just how intrinsically powerful our bodies are. But that inflammation, I think, in the short term, to fix that cut, fantastic for your

skin to repair and heal. I guess what we're talking about when inflammation is linked to lots of these chronic diseases, including depression and anxiety, we're talking about that chronic inflammation, that sort of low-grade, unresolved inflammation. And I often describe it to patients as saying, look, it's almost as if your body is trying to protect itself from attack every day, but it's protecting itself from the attack of your daily lives, whether it's your diet, your lack of physical activity, the chronic stress, the air pollution, whatever it is, lack of vitamin D, all these things

are the body's interpreting that as an insult in some way and it's mounting its immune response through inflammation. Well, inflammation is one of those mechanisms to try and calm it down. But actually, if it's happening day in, day out, that's when it can start to become problematic. Yeah. And that's where, as you asked, we should point out talking about mental health, there is a real strong link and set of evidence now linking inflammation and chronic inflammation to depression and anxiety, as well as brain fog. We really think those are symptoms increasingly people have identified and complained. And also, those are symptoms that often get explained in all kinds of incorrect ways and treated in all kinds of incorrect ways,

both by conventional medicine and also by the wellness industry and supplement industry so it's really important to talk about the reality of it so the the the simple truth is when you have inflammation a lot of us you've experienced this when you have the flu or when you've been sick in a sense a feeling of anhedonia loss of of pleasure, loss of engagement, kind of retreat and isolate. And oftentimes our mood goes down, just feel really sad. We want to kind of curl up and rest. And that makes a lot of sense from your body standpoint. They're kind of shutting things down, saying, you know, hey, we need to heal and fight this bug.

Anxiety comes on board where when we get ill, we get a little hypervigilant, meaning that we're looking around. We don't want to be messed with. We want to heal. And then there's a little brain fog where as you think about it, as you're sick, you don't want to be having all your best ideas, super creative. You should run to do this or take care of those errands. You should run to do this or, you know, take care of those errands or, right? Because there's kind of almost intention of your body's alarm system shutting down some of that process and having a little bit of brain fog. So in real life, though, when we're having those symptoms, it's horrible.

So there's some data, large meta-analyses looking at anyone who's been taking an antidepressantant if they're also on any anti-inflammatory agent. And I do want to note something a lot of people don't know, I didn't really know, is that SSRI antidepressants, which are the most common prescribed medication, they're often thought of as serotonin medications. They are, but they also help fight inflammation in a way that's really kind of interesting when you think about how they work. But back to this meta-analysis, individuals on antidepressants who were given any type of anti-inflammatory medication gotten twice as better if you are on anti-inflammatory medication with your antidepressant. And so just to me as a clinician treating depression and anxiety every day just brings that right into the clinical room. All right right how do you do that in a patient's life where is the inflammation coming from how do you eliminate it can you um how do you measure that so that's i think how

how it relates what i think is really interesting for many of us is this idea that what we do to our bodies can affect our brains. So this idea that if we can reduce inflammation in our body, that can also reduce inflammation in our brain or certainly help symptoms in our brain. And you have mentioned the gut-brain axis before, but I guess I'd like to tease out how exactly food is impacting what's going on in here because there is, yeah, I guess structural components. Let's say you're having an omega-3 fat and that's involved in the structure and many other things in the brain, but there's also this communication pathway where this is kind of sending signals as well. And I'd love to just unpick that a little bit. And also really understand, Drew, when you have got patients in front of you,

who presumably by the time they're referred to you as a specialist psychiatrist, you know, they're presumably struggling in some way, in quite a significant way with their health. Isn't that, by the way, totally, totally effed up about the mental health care system all over the developed world? Like, you talk to me when it's like, well, got serious, so you had to go see a psychiatrist. That is such BS that needs to change. Because, you know, everyone has to see you once a year and be like, hey, and like, if they're not paying attention to their health, you say, hey, you know, in some way see you once a year and be like, hey. And, like, if they're not paying attention to their health, you say, hey. You know, in some way, you should pay attention to your health.

I'm going to take your blood. Hey, look, here's some stuff that's doing well. Here's some things you need to work on. We don't do that in mental health. The only time you get to see a mental health psychiatrist is if you have significant symptoms. And I just wanted to point that out to everyone. I think it's a really shift we all need to make to think about mental health and mental fitness and our own mental fitness and how do we prevent these conditions. And then if we have them, really use everything that we have to treat them.

So sorry to just jump in there about that. And I also want to say, because I'm a psychiatrist, that thing you're saying, like the brain and the body being different, I don't think like that. I don't in any way separate my body from my brain. When we're talking about inflammation in the body, that's dead synonymous with me. There is no inflammation in the body without inflammation in the brain. I get it. Me too. I don't really think like that. It's more about, I think a lot of people I've spoken to really do see the body like that, or they've been conditioned to see the body like that. And therefore, it's about trying to help people understand that actually, if your body's inflamed,

your brain's inflamed. But what do you need to get certain buy in with your patients? Like, do certain patients come in, and you're trying to help them change their diet to help their mood, their happiness, their depression, their anxiety, whatever it is. Are some people skeptical? And if so, how do you overcome that? Well, I think everyone should be skeptical because it's mental health. And I think so many, because it's a subjective field, so many people have ideas and opinions and experiences of it. And so the first thing that I do is I'm a general psychiatrist. I take a good psychiatric history and I treat the patients in front of me. I don't think about medications as really different than psychotherapy, as different than lifestyle.

These are all really important tools to battle depression and anxiety. And I want to try and understand for each individual, how do those fit in? Some people come in and they're like, Zola, for my brother, I need it. I want it now. Other people come in and that's an antidepressant, you know, come in and they're really, you know, they're against medications for whatever reasons. When it comes to food, I want to be curious what people think, what they've heard. I want to be clear about my intention that, you know, I have my own set of values and biases about how food can work and can't work when it comes to mental health. And so the first thing I do is try and check in and

assess where is someone around those ideas and where are they as an eater? And then in terms of buy-in, I try and have it be part of the ongoing conversation where I'm both showing some enthusiasm where I'm both showing some enthusiasm about how nutrition impacts mental health. I'm trying not to be annoying. I find that doctors in general are really awful about food. We're really fear-based. Oh, don't eat that because you're going to get a heart attack. Don't do this.

Whoa. No salt. It's not loving or kind. And I've really done away with that. I think people who talk like that from a medical perspective really aren't doing any good for public health. I think fear mongering is just silliness. You can eat all kinds of different foods and have a reasonably healthy life. focus on the hopefulness of it. If we think about depression and anxiety in modern terms, in Eat to Beat Depression and Anxiety, it would be a graphic here, the new science of depression and anxiety. Let's just stop thinking about this as mental health is basically suicide and SSRIs. Let's really start thinking about mental health robustly. We incorporate these different factors in how we approach patients so with food

um what what you see oftentimes is first of all mental health affects it and we should be talking about it because and we do talk a little bit about symptoms right has has depression affected your appetite a lot of patients say yeah and we say oh that means you have depression it's like right but what does that mean for us as clinicians it means that your patient isn't nourishing themselves in the most important period of recovery. They're trying to get better from depression and anxiety. So what do you do in that situation? Well, in nutritional psychiatry, as we talk to and train clinicians,

and we now have a really nice clinician community of nutritional psychiatrists, we think about all of the ways that you get more nutrients into a brain in different ways. If you don't have an appetite, soups and smoothies are really great for you. A handful of nuts is a great handful of nutrition. There's all kinds of ways to help accommodate where someone is in terms of their illness with nutrition and to incorporate that into treatment. their illness with nutrition and to incorporate that into treatment. I think one of the things I've always loved when I've heard you speak or seen you on Instagram is there's a real open-mindedness, there's a real humbleness. I imagine your patients really,

really enjoy their interactions with you. I would imagine from the sort of the tone with which you speak, and I've seen you speak, what I'm really curious about is you obviously have a very personalized approach to each of your patients. You know, everyone has a different set of life experiences, family background, genetics, desires, needs. Yet you've also written this quite fantastic book, Eat to Beat Depression and Anxiety. And I'm asking this because this is something I've struggled with in my publishing career is, I believe in personalized medicine, but then you're trying to write a book that's going to help masses of people. I know how I've tried to do it and I'm'm interested to, you know, how was that for you? Was that a struggle? Did you, was that something you had to think a lot about? Because it's a

great book, it's helping a lot of people. But how do you deliver that personalized approach in a book that's written for everyone? I hope in this book, Eat to Beat Depression and Anxiety, Chapter Six, Eat or Heal Thyself, does a good job of helping people see how I approach food. This isn't a diet book. This isn't a, this isn't a gimmick. This is really trying to ask you as a reader, as an eater to take a step back. There's been so much chatter, misinformation, so much removal that people have had from their culture of origin,

when it comes to their nutrition, our sense of taste and sense of what's healthy for us has really been abdicated by a mix of big food and big science. In terms of food, I have to say, because I'm a psychiatrist, I would say I haven't figured that out in terms of mental health and psychotherapy. I, the stories I hear, the ways I see people cope and have resilience and triumph, that is a really hard thing to explain. What is psychotherapy? What is mental health improvement? How do I as a psychiatrist kind of get in there and help individuals do that work. In terms of food, nutritional psychiatry and the evolution of those ideas, as I worked specifically with Laura Lachance, who's a colleague who came up to me at a conference and said,

I want to do some work together. And we started trying to create a manual of nutritional psychiatry of sort of how do clinicians do this who created the antidepressant food scale and we just really asked a simple question all right with all this nutritional information what nutrients matter for depression and we found there were 12 that had significant levels of scientific evidence so they could help prevent depression and help treat depression things like zinc and magnesium and b12 and omega-3 fats and folate and iron and and then we said you know what foods on planet earth just natural whole foods have the most of

these 12 nutrients per calorie really simple question and that led to a list of the top plant foods and the top animal foods and and i well i don't love listing foods like that it led because everyone says you know what's number one, watercress? I was like, oh, I should eat more watercress to fight my depression. And what really led me to understand is these are called nutrient profiling systems. And the antidepressant food scale was the first nutrient profiling system that was ever created specifically for mental health. And what Dr. Lachance and I understood is that if you looked at food in terms of food categories, and this is what nutrient profiling systems really encourage you to do,

what you see is what's in the top five animal foods. Three of them are bivalves, mussels, clams, and oysters. Why is that? Well, if you look at one of the most important nutrients for mental health, it's vitamin B12, the largest largest vitamin we eat you'd think we'd all know what is the top source of vitamin b12 in the natural world and i certainly did didn't it's clams i mean who's called clam a superfood right it's like who said like oh you know i'm going out tonight i want to make sure i recover from my hangover i I'm getting a B12 injection. It's like, hell no, I'm having pasta vongole. My B12 levels up. I mean, it's so looking at, to get to your questions, how as an author do I personalize recommendations? I think one in trying to let people know that my approach and goal of the book and the limitations of that. And then two, to try and replicate as much as I can

the way that I think about this information with what I feel I hope you and I can bring to authorship, which is the experience of a clinician. Because of clinical experience, you and I have the privilege of hearing and sharing thousands of individuals and their families and their stories. And oftentimes, especially when it comes to mental health, and especially on social media, what's getting talked about and shared is an individual story. And there's real importance

in that in terms of, you know, today, if you have bipolar disorder, or borderline character disorder, or addiction, any substance use disorder, rather, you can put in a hashtag and see an advocate see a you know someone who's recovered you can reach out to resources i mean it's really you can direct message someone and be you know chatting with a mental health advocate or even a clinician pretty quickly so i think that's wonderful and at the same time though what you're talking about is that when you see um the aggregate of many many many stories, it does create, I think, the humility of understanding the importance of our commitment to patient autonomy, our commitment to health, and I really shifted one as I was employing a number of vegans. But also, as I began to really think about freedom and choice, and again, where I wanted to be in the conversation, which is helping people, no matter what they're deciding to eat, feed their mental health and take care of their mental health and prioritize that.

And that should really be the top tier of our goal because that's the best. I mean, that's why we separate the brain and the body or people traditionally do. It's just the brain's the best part. That's all of it. That's like, that's the whole game, right? There's a lot of other organs you can replace. I always kind of joke sometimes. I say, you know, when you go to like the home improvement store, there's a lot of body parts

you could buy, right? You can buy like your kidneys, like filters. buy like pumps like your heart it's like consciousness hopes dreams generator you know art like i don't there's none of that anywhere except the human brain so yeah i think you've done a great job in the book actually i think uh one of the things i really liked actually is this focus on dietary patterns. I think you're a fan of the traditional dietary pattern rather than labeling it around a particular country necessarily. I mean, we can maybe expand on that, but also you do focus in on these 12 nutrients, these 12 nutrients that can help us all build healthier, more vibrant brains. So, you know, that I really like the interplay between the

specific nutrients, but also the dietary pattern. So I wonder whether we could spend a bit of time on what some of those nutrients are. You can talk about how they fit into certain patterns. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science-driven daily health drink with over 70 essential nutrients to support your overall health. It contains vitamin C and zinc which helps support a healthy immune system, something that is really important especially at this time of year. It also contains prebiotics and digestive enzymes that help support your gut health. All of this goodness comes in one convenient daily serving

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or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. That's drinkag1.com forward slash live more. livemore21.com forward slash live more yeah remember the dietary pattern i think is a really brilliant shift that researchers made and you've had felice jack on she's really uh you know one of the founders of this field i mean she's done some of the best research and led i think really, really our movement. Felice, Dr. Jacka, had actually the first real nutritional psychiatry paper ever published in the American Journal of Psychiatry, what we call the Green Journal, really kind of one of the top journals in mental health. And it was actually her PhD dissertation, I think a real inspiration for anybody out there who's in graduate school or thinking about a career. Dr. Jack has shifted careers, became an epidemiologist, got her PhD.

Her dissertation gets published in the American Journal of Psychiatry, a paper based on it, which was a correlational study showing that dietary pattern. So it's not about just B12 or this or that, but a dietary pattern. So the pattern of all the foods you eat a traditional dietary pattern so those are you know foods everybody's going to recognize where everyone's heard that phrase you know foods like grandma ate right so potatoes tomatoes you know okra salmon beef right stuff that is real food compared to a modern or western dietary pattern and in a traditional dietary pattern was correlated with a significant decrease in depression and anxiety so it's just a correlational study but really fascinating and i like this shift

because it allows us to eat pizza and chocolate cake and have the occasional beer and and not freak out because we have a dietary pattern that's consisting found as a foundation on really we're called nutrient-dense foods. Again, those foods on the antidepressant food scale, like leafy greens, you're always going to have a lot of nutrition, not a lot of calories. And that's what we look for in nutritional psychiatry. And then in terms of individual nutrients in the book, I really try and break it down with these illustrations because one, I thought it was a lot to keep in my own head. Like, Oh, like what's the top source of vitamin B9? Like, and I just liked having a set of foods.

And from that, you know, your question earlier, how do you sum it up? I found that, that iterative process of writing with it and working with my editorial team really helpful of like, look, you do, you know, we talk about the thinking and the power players, but if somebody is just getting started, what's the food they can pick up in the grocery store today? And that really inspired me to get very specific. And so in this book, we have a list of the power players and the power players really represent each food category. So red peppers are on there because they're one of my son's favorites, but they're also really, really high in vitamin C. They're easy to add into any dish. I find they're easy to snack on.

They're easy to dip in hummus. They're easy to throw in your frittata. They're easy to throw in right there. And they last serve in the fridge. So that's one of those foods that for me is power player. And in nutritional psychiatry and eating for mental health, there's some other usual suspects, wild salmon, but really as a clinician i find all right the real challenge is anchovies and sardines those were a challenge for me i'm like an indiana farm boy as a clinician or as a parent or both well i think first they were challenges in eater where all that omega-3 data came out and i'm like a low-fat vegetarian who like turns up my nose at fish and i was a little bit of a picky eater and i've had some weird you know i didn't like pie until i was like 12 i thought it was very strange

so but fish was really hard for me i didn't eat any fish until i i don't know i ate a little piece of sushi every now and then but no like any cooked fish no any bivalves oysters i had no idea and then i just i don't know the data compelled me to get a little more curious. My wife and I were living in New York and kind of like had this realization, I don't realize, you know, New York's great in all kinds of ways. It's also an island in the sea. There's all kinds of amazing seafood. And started meeting a lot of people in the restaurant industry

and having a lot of friends who were young chefs. And this sort of introduced me to simple ways to prepare fish, and I started developing my palate. One of the things I really encourage people to think about in the book, just like the way to think about your mental health and evolution, to think about your palate and evolution. And there are a lot of foods that I think we've lost. A lot of us have lost the tradition of seafoods or nutrient-dense foods

or how leafy greens are used. A lot of us don't have that knowledge of how to prepare and cook foods at home in very simple ways that are very easy and economical but that support our health. And so the hope is to translate those nutrients, get people excited about these nutrients and what they do in our brain, but really translate them into foods and then help people get those into our lives. That's why our newest program in our clinic, we have a virtual cooking school,

the mental fitness kitchen. And it's been so much fun. Anybody can, it was welcome to join our classes where we're really trying as a clinic to help people actualize this, that if you need coaching around how to take care of your brain with nutrition and integrate these foods if you need to learn some new recipes if you need um some community support then we really want to as a clinic try and replicate some of the data there's a great

study the healthy med trial um and i don't know i just feel like geeking out on science with you for a minute so let's just talk about the randomized trials so i'm just like all right so there's all this correlational data but like like you and I know, like correlational data is great, but it's not going to convince anybody. You know, I'm a Columbia psychiatrist. It's a very, it's a great department, but I wouldn't say it's conservative, but it is historical in the sense that it's seen a lot of things come and go. And it's not going to be impressed by correlational studies. And while, you know, the serious clinicians, policymakers, they need to see randomized trials.

So now there have been five trials of food specifically used to treat people with clinical depression. The first was by Felice Jacka. It was a SMILES trial. Felice has been on the show. She talked about the SMILES trial. The SMILES trial is incredible. What it does is it goes into a mental health setting.

About 67 patients, The majority of them are already taking an antidepressant or intone type of psychotherapy. So kind of like a clinic like our clinic. And they give people seven individual therapy sessions around dietary change by a nutritionist. Over 12 weeks, what they see is a third of individuals going to full remission from their depression if this were a medication it would be a multi-billion dollar blockbuster drug it's all we would be hearing about so food does this that's one trial that's then just let's just let's just that was i mean i love the smiles trial i think it was a landmark trial when it got published and let's just just repeat what you just said at the

end there a third of the patients like a third of the patients 32.3 percent go into full clinical remission and that is incredible this is in trials remission is very important idea and i think that let's sort of tease that out because there's response like oh like how are you feeling like oh you know those avocados that weird stuff Ramsey gave me those brain food smoothies like I'm feeling a little more energy like I'm not crying and I can feel a little better but that's just response remission is actually you don't have depression anymore and so it it does feel like um an important thing to note that people go into full remission let's talk how do they do that it wasn't a lot of people start eating like one more seafood meal a week and like a half serving of vegetables a day

more or and like a actually like a serving of vegetables one more serving of vegetables half serving of fruit a couple servings of beans and legumes a week a serving of fish a week and then the big thing they did is 21 fewer meals of highly processed or quote-unquote unhealthy food and 20 21 oh so 21 fewer meals per week or fewer you know so that's snacks that's you know that that's the difference between you know going out and getting a burger and fries and i don't know making yourself a vegetable stir fry um so that's the smiles trial great trial in america to get a medication approved you need two good quality randomized clinical trials so this is number one uh it's what 2017 i think is this comes out so four years ago also interesting like translation to clinical practice we're jumping up

and down about this we've trained um over 200 clinicians around nutritional psychiatry and in our um we have an e-course and a live training that we do but it's interesting how it takes a long time to translate a lot of questions you get from clinicians like am i allowed to talk about food it's like wow it's like one of the most foundational pieces of mental health and brain health. And we're not even sure that we're allowed to talk about it sometimes in mental health. Yeah, I mean, this is something, you know, I want to hear about more of these trials that you're about to share. But just on that translation to clinical practice, I remember so clearly, I think it was three or four months after the Smiles trial came out, or maybe it was a year and four months. I can't quite remember. It was a winter conference. And I think that paper came out in November 2017, if my memory serves me correctly.

And I was speaking at this Royal College of GP event. It was where we were teaching doctors. There must have been, I don't know, a couple of hundred people, a couple of hundred doctors in the room. And at the start, I asked them, how many of you talk about food or ask your patients who are coming in with depression about food? And this wasn't sort of measured in any way, but just from the show of hands, it was about 5% of the room. Then I presented the SMILES trial, a few other papers, including your 2015 editorial in The Lancet Psychiatry, which I think you co-edited about how you want to see nutrition becoming as important to psychiatry as it is in cardiology, gastroenterology, endocrinology. I presented that paper, that editorial many,

many times actually. And it was interesting, maybe 25 minutes I spent on this. And then I asked them, how many of you are now going to start having a conversation about food with your patients who are struggling with depression? And pretty much everyone's hand went up. So it's really interesting, isn't it, how there is this good data out there, yet it really isn't, I don't think, translating, or certainly it hasn't converted to mainstream medical practice yet. It's really hard. Because we frame mainstream medicine as we take care of disease,

and we have a community standard of how to do that. And if you're going to deviate from that community standard you're putting yourself in some medical legal risk if i have bad outcomes someone comes to me and there's a bad outcome they say well you know how how is he treating you oh he prescribed the mediterranean diet and we were like talking a lot you know that doesn't that's not complete robust treatment maybe in some people's eyes or evidence based enough. So, and then there's a question of how, that's why we developed our clinical training because I sat for years where, you know, I'd write little three by five cards,

like little papers of like I'd hand them to patients like lentils, Oprah, you know, it's like, you know, these are some foods to try this week based on a conversation or, you know, and that we've had about their preferences but you know how do you do it and how do you incorporate it where look people have a lot to talk about in terms of mental health and one of my concerns is you know people maybe forgotten i'm a psychiatrist and i think all i do is like talk about food like hey i don't want to talk about your mom or your dad or your development or your trauma and you know that's

all i want to talk about i mean and so how do you responsibly though drop a little intervention or a little evaluation first that's efficient how do you walk through the day of an eater how do you frame this and so we really worked hard in our practice with um samantha el-krief who's uh really been such a my co-conspirator collaborator in terms of developing our clinical team and she's essentially a early early fan of yours and besides seeing you earlier in that video really kind of shared with me some some of your progress and got us really tuned in to everything you're doing a couple years ago and so so she and I really put together all of the data to help support that because clinicians need to make evidence-based interventions only, in my opinion, when it comes to food. There's

best that we can, some things we don't have evidence for. But where is the evidence on some of these conditions? It's quite robust for depression, not as robust for anxiety, but there's certainly some data. And then what do you do? How do you assess somebody? And then how do you activate changes? You said you're a great example. In a talk, you don't just say, hey, here's all this data. Hope you guys are compelled. You put people on the line, come on, put the hands up in the air, everybody. Do you ask about this or not? No. Huh. Here's all the data that's come out. Then you say, are you going to ask about this? And you're making people, and the next time someone's with a new patient, they're feeling a little pressure from you to be evidence-based. And I think that's

exciting. Patients aren't interested in being evidence-based. Patients are interested, I think, in getting better and also doing things that matter. And I think what's exciting is for me, you know, a lot of times mental health, we're trying to take something away from a patient in a certain way, right? A bad habit or defense or a toxic relationship or a substance. What I liked about food is, one, patients were already doing it. You're already eating three, four times a day. And so it was like it's a much easier pivot. You're already in the grocery store.

If I can help you look right instead of look left, wow, I can make a massive outcome in your health in your mental health particularly yeah let's talk about the evidence-based for a minute because i think there's an interesting follow-up for me in my head which is you know i've heard you talk about before how we can learn a lot about brain cells and brain function from its structure right so um we we can you know you can expand upon that for sure but then if we if we take it further right and go okay there are certain nutrients there are certain foods that help to build a healthy more robust brain okay if that's the starting point which kind of makes intuitive sense i think to a lot of people as well that yeah well kind of what we fuel that brain with will determine how it grows what its

material is how it functions so let's take that one step further so we have some good studies on foods role in depression okay great so now we can make an evidence-based recommendation to our patients with depression. But what about those patients who don't yet have depression? They want to stave off depression. It seems pretty reasonable that, hey, well, actually, if you adopt these kind of changes, you may reduce the likelihood of going down that slippery slope, but we may not have a trial on that. We have a trial on that. No, no, no. Oh, we have a trial on that? We have a trial. Okay, well, you can tell me about the trial, but just to finish off that thought, it's basically, well, what about other brain conditions then? So you must see patients with bipolar and

all kinds of different psychiatric conditions and i don't know if we have trials on those specific conditions yet but would it not stand to reason that well look there's no harm really improving your diet and improving our diet is going to help our brain function better you see what i'm getting at it's kind of like evidence is important but we also need a bit of common sense as well how we expand that to other things yeah and i think exactly and also it's how do we you know in medicine we get specific for conditions and so there's that kind of universality about some nutrients foods concepts around eating that are good for brain health and that's always going to be good for mental health

so i mean let's go back to some of those studies. You started off with the SMILES trial. SMILES trial. HealthyMed then comes out. HealthyMed, I love it. It really is what we try to replicate with our mental fitness kitchen cooking class. So the HealthyMed trial took individuals to depression.

As you look in detail at this study, there's a couple of things that are important. The first, oftentimes, people are like, oh, like food is for like to depression. As you look in detail at this study, there's a couple of things that are important. The first, oftentimes people are like, oh, like food is for like mild depression. So this study, 86.3% of the people in the trial have severe or extremely severe clinical depression. So this isn't mild depression. They get a little tiny dose of fish oil,

not really enough in any way to make a difference with depression. The data on little tiny dose of fish oil, not really enough in any way to make a difference with depression. The data on fish oil and depression is mixed, but it's a much higher dose. They get a couple hundred milligrams of fish oil and they get a Mediterranean style cooking class. What they see over three months and then at six months is a significant reduction in depression and anxiety scores that stay low. They drop quickly and they stay low. And individuals are no longer severely depressed. And so, again, in terms of risk mitigation,

what was striking about this trial is antidepressants take a month to work. A lot of these individuals were already on medicine, so they, again, had a resistant depression that wasn't working. They get given a nutritional intervention and encouragement to eat better and it's a 45 percent reduction in their formal anxiety rating scales and about the same for their depression rating scales so that's the healthy bed trial and that's in some ways what we're trying to do with our cooking class is really you know once, once a month, give people a feeling of cooking together, of, you know, kind of sharing the spirit of really trying to care

for our mental health in an active way with our nutrition. And then the joyfulness, you know, big part that Samantha brought to our practice and brings to our clinical work and our clinic, and you see her influence in the book is really around an idea of joyfulness. As we, as we sat in the food space, maybe five years ago we started working together and saw all the, I don't know, we're both very peaceful. I think kind of people, we just saw this, there's a tone in the debate around food that we really wanted to try and

transcend with a sense of joyfulness that we felt around eating and nutrition and being really in a sense of engagement and in a sense of conscientiousness about our nutrition and the impact it has on our health and our mental health. You mentioned there was another trial which is showing that changing the food that we eat or certain dietary patterns can help reduce the likelihood of developing depression in the future that's yeah yeah you're not that's so the the i think the best trial in that is is back to a prospective correlational trial which was an epidemiological study of 10 000 i think it's like 930 some odd uh university students in Spain. And what that study

showed is that if you look at them at the beginning of college, and you look at how Mediterranean their diet is, so it's a nine-point Mediterranean dietary pattern scale. If you look at people in the top half of that, so they're eating a fairly Mediterranean diet in their freshman year, and follow them over four and a half years, kind of checking in about who gets depressed and what they're eating, they found that there was between a 30 to 52 percent reduction in the risk of getting clinical depression. And they ran this as a really interesting study. They did a number of different models. For example, they looked at anybody who got an antidepressant in the first two years of and and they ran this is a really interesting study they they did a number of different models for example they looked at anybody who got an antidepressant in the first two years of the

trial and just you know take took them out of the data set to really try and see we're really looking for people over the span of their college career eating a poor dietary pattern versus a Mediterranean dietary pattern the trial that I was thinking about in terms of prevention, it's because I think a lot about college depression, and I treat a lot of college students who really love working with young adults. It's such a challenging time. I think for me it was a challenging time with my mood. It's such an exciting time of life for people too.

And depression is so crippling for individuals during the late teens and early 20s. There's a trial in Australia, really fascinating. Heather Francis led the team. They looked at college freshmen that had poor eating habits and had depression. And they did a very simple intervention. This is, I sort of joke with clinicians, like if this can work, boy, we've got to be able to be effective. This was just a 13-minute video and then a five-minute phone call a week later. And then a second week, one week later, so two weeks after the video, another five-minute phone call. And the five-minute phone was like, hey, Ron, how are you? Like, you eating some veggies, man?

How's dorm life? Like, you using the turmeric? How about the nuts? And so they gave people a little box of nuts, nut butter, olive oil, and then cinnamon and turmeric. So they send these into the college dorm and, and, and with like a lot of encouragement in the video, like you, you can improve your mental health with food, eat more vegetables, eat more plants, the cinnamon and turmeric. There's a little bit of data about those being good for brain health and brain growth. What they found is that just with that minimal intervention, individuals significantly shifted their diets. There was a significant

reduction in anxiety, depression, and stress rating scales at three months and at six months. And it was like, there's like 21 minutes and there's like, there are 23 minutes and there's no actual face-to-face human intervention. So very, very, you know, cost-effective intervention

in terms of potentially preventing college depression. So that's the trial, I think, that probably relates most to depression. Those two, the Sun Navarro and then Heather Francis's trial in Australia. Yeah, I mean, we'll get hold of those and put them in the show notes for anyone who wants to sort of read those further. There's a concept in the book I really liked, which was

you'd like to help your patients put their brains in grow mode. And I thought that was really interesting way of thinking about it. So what is grow mode? And how do you help your patients get into that state? I encourage my patients and really everybody with the brain to think beyond serotonin, our beloved serotonin, a wonderful, wonderful neurotransmitter. But it feels like the conversation about depression gets reduced, like that's the brain molecule that's involved with mental health. That one and maybe dopamine. And I think that really above all of these players is BDNF. And BDNF is a neurohormone.

Ranga, you brought up connection earlier. And it's really, for me, a driving core principle of my own personal life, of how I think about my mental health and my happiness and my family's happiness. But also I think about my patients when I value them as a kind of tentacles of your life, reach out, like, where do they go? And what are the qualities of those connections? And, and, and as a psychiatrist, I love this notion also that that's exactly what our brain cells do.

You know, when you're learning, your brain cells are reaching out and, you know, like making, making new connections. And that's what memory is. That's where our memories live in these connections between our neurons. It's really just fascinating to think about the brain is this. Not what even I learned in medical school 20 years ago. I'm sure you learned the same thing, right? Hey, you get like 90 billion brain cells.

Don't mess with them, bro. Like, don't mess up. Don't do bad things because you don't get any more. And then we know that's wrong, that your brain is always not a lot, but making some new brain cells. And another Felice Jack study, a great study showing that between 60 and 65 individuals with a healthy diet, you could see a significantly bigger brain, like a couple of cubic millimeters, more brain in the left hippocampus compared to individuals who were eating a very unhealthy dietary Western dietary pattern, right?

That's a lot of brain cells, like two cubic millimeters. I mean, so that's exciting to me as a clinician. And I try and bring that hopefulness and enthusiasm because often when we are struggling with our mental health, we really feel badly about ourselves. We feel very down. We feel very stuck. So the idea that, you know, this brain that I'm lugging around, that's not really serving me so well right now in this moment, I have the power to change that. And those things that I know help me feel better, exercising, sleeping well, eating well, connecting with loved ones, and playing. I've got my hands up.

I was feeling nervous for that. Playing a little instrument, playing a little music. All those things support my brain making more connections in a very intentional way. And so I love the idea of neuroplasticity. It's really the most powerful way that food and lifestyle medicine can work for us, literally giving us more brain resilience, more brain repair, and more brain power. That's what BDNF does. Yeah, it reminds me of just a few hours ago, I was having my morning coffee in the living room and I was reading your book. I was trying to, you know, prepare for the conversation today. And my daughter came down and I was on the page

with BDNF on it. And so these illustrations in the book are fantastic. So let's see if I've got this right. But she came in, said, Daddy,. So let's see if I've got this right. But she came in, said, Daddy, what are you doing? I said, I'm reading this book. I'm talking to a guy called Drew later. She goes, oh, yeah, what's Drew about? I said, oh, well, you know, he helps people improve how they feel through many ways. But one of the things he does is help people choose better foods. He goes, oh, cool. And so she came and had a look. She's only eight. And so she read out brain derived, she couldn't quite make out neurotrophic. So I helped her out with that brain derived neurotrophic factor. But these illustrations are great because there were four foods that you'd

listed in this gorgeous graphic. And we went through, you know, so, hey, darling, how many of these are you having? So there was, I think, nuts, there was wild type seafood, there was berries, and there was dark chocolate. I think I remember that right because of these graphics and she did as well. So then when my son came down later, we ticked off how many he does as well. So I want to say thank you because I love chatting to my kids about all this stuff because, you know, I hope that by sort of feeding them this information at a young age, hopefully this will just sort of seep into their, you know, their subconscious minds as they get older. So we all of us now in the family know the four foods that according to Dr. Drew Ramsey and the research, of course, help us increase levels of BDNF.

So thank you for that. I put in the best data behind that is the nut data. It's a really interesting part of that. I think it's a Sun Navarro data set. You know, I'm not getting that right. But it was a study looking at, they gave people olive oil, who are already in the Mediterranean diet, supplemental olive oil versus supplemental nuts.

And they like delivered it to the door. They're like, drink as much olive oil as you can, eat all these nuts every day. And in terms of BDNF levels, what they found, and BDNF's not a perfect biomarker for mental health. I don't want everyone to think you should run out and get your BDNF levels measured, just as a disclaimer. But what they found is there was a protection,

something like 78% fewer people had who ate the nuts had severely low levels of bdnf and so there's something there and that's really the only one of the only studies that show a real specific correlation it's one of the reasons again when i hear patients are snacking and they're hungry in the afternoon or they're a little nasty and they need something you know a quick handful of nuts or I'll mix some nuts and dark chocolate chips. And you've got a nice mix to keep you going that probably is good for your brain health. What is your view on things like supplements and probiotics? before we get back to this week's episode i just wanted to let you know that i am doing my very first national uk theater tour i am planning a really special evening where i share how you can

break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour, and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've

been recommending to my patients for years. It can help improve sleep, lead to better decision making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits and improve our relationships. There are of course many different ways to journal and as with most things it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three question journal. In it, you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes,

but the practice of answering them regularly will be transformative. than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal or click on the link in your podcast app. Certainly there are some supplements I think are important like vitamin D.

Is the data great around vitamin D and depression? No, it's horrible. There's no good data that vitamin D prevents winter depression. Do I still think giving a little vitamin D in winter is helpful for my patients? I do. So omega-3 fats, if you don't eat fish at all and you're willing to take an omega-3 fat supplement or liquid and you want a more naturalistic approach to try treating depression or anxiety, I certainly will use fish oil supplements in that scenario. There are a few other couple natural antidepressants like St. John work, that have some good data on them. So at the same time, what I often see is that people

are using supplements to avoid mental health treatment or to kind of supplement or augment mental health treatment or replace it. And that always concerns me because it means you're working on your mental health alone. And I think it's always best to work on your mental health in partnership, whether that's with somebody you love or a friend or a counselor or a therapist or a psychiatrist. But because a lot of times I find people are taking things without a fact. And that's medications, right? They've been on this or that medication forever and they've still been chronically depressed or they've been taking the supplement forever and they're still not feeling well. In terms of the gut, I think probiotics are a good example there's there's very little data

that there's a you know specific intervention in terms of probiotics that that help with mental health there's some data certainly that some strands of bacteria in our gut help us improve our cognition and help decrease anxiety and that people who get depressed have different organisms living in their gut than people who don't. We know that right now. So how do you get a kind of better mix of bacteria in the gut? I think you do it the way that humans always have done it. And that's we ferment stuff and then we eat it and then we eat a lot of plants. And that's really, if you look at how did traditional diets kind of line up and how are they different from the Western diet, they include more plants.

They include more olive oil or some type of natural oil. They don't have processed foods, and they often have a lot more seafood, but they almost always have fermented foods. That's a traditional Japanese diet or an Indian diet. There's all these ferments that happen, and that's what we seed the gut with in terms of these healthy bacteria. all these ferments that happen and that's what we seed the gut with in terms of these healthy bacteria i just think uh and i like prescribing food better than supplements i just trust it yeah it's it's a tricky one i think because you know i i also adopt a food first approach uh i do think supplements have a role for certain people at certain times for sure um and then you know again just sharing what I

found with certain patients, I've got some patients with anxiety that come to mind, who will tell me that there's a particular liquid probiotic that they take, that when they're taking it, they really feel that their symptoms completely change, that they don't feel anxious anymore. And then when they stop, they come back. And that is not a clinical trial. But on that one-on-one individual basis, it makes you think, so well, we know there's a gut-brain axis. We know certain trials are shown that different compositions of gut bacteria impact what is going on in the brain. So I just think, well, could it be that in some of these trials, we've got people with vastly different microbiomes? I mean, I think you just say it accurately. In our clinical trials, we've never paid attention

to the microbiome or inflammatory markers. So we're hoping that randomization works to really just separate out and make the populations equal. But it is kind of a curious thing. And increasingly we're seeing in the data. Here's a trial, and one of the other things we looked at, there's a great trial in bipolar disorder. It's a probiotic trial. So it was a trial at Johns Hopkins. They looked at 80 individuals who were admitted for mania. So they bipolar one disorder that been hospitalized, they get treatment as usual, usually lithium,

Depakote or an atypical antipsychotic. So their medication, and then half of them got a placebo, half of them got a probiotic. And they measured something called an inflammatory index. something called an inflammatory index. This is not used a lot, but it's looking at how sort of the amount of antibodies to certain things, certain viruses that kind of give a sense of how much inflammation somebody has. What they found is individuals who had a high inflammatory index who got the probiotic, there's a 90 percent reduction in the re-hospitalization rate over six months compared to the placebo we don't see effects that big usually in medicine so you know the idea there is that part of a manic episode potentially is related to a kind of inflammatory dysregulation or or storm somehow that

is some somewhat regulated or influenced by the microbiome yeah is eating for better mental health expensive or does everyone have access to it no i think if you start eating from mental health you can save money and and according to the research that's that that's true the smile study individuals say i think it was 140 a month it's around a thousand dollars a year if i remember correctly um was estimated in terms of their savings as they begin to eat more mediterranean style diet the key to eating for broader brain again, is to really take a step back and think about the myths that exist around food, that it's complicated, that it takes a lot of time, that it's way too expensive.

One of the power players in the book is red beans. Now, you can buy those dried, soak them, two, three bucks a pound in the uk you know a couple pounds i would guess um uh for a kilogram um so you know there's a uh certainly cost is a factor and we we have a resource coming on our website brain food on a budget where we uh break down all of some of the the best foods and then i think it's, again, it's that challenge. Like I really like wild salmon. Wild salmon can be like between 10 and $20 a pound unless you buy it canned. And if you buy it canned, boy, it's cooked right after it's pulled out of the ocean. It's in there. It's super fresh. You make it into salmon salad. You make it

into salmon burgers. Great value. That wasn't something that i ever really did until i got into this work or a can of sardines or anchovies so um and then i always think look of the things we have to spend money on i want to invest in my brain health and i want to invest in my family's brain health to the best of my ability and i think working working on that, not with extreme and harsh constraints and lots of guilt and shame, not any of that, but working on that with a sense of, again, joyfulness. How can I engage my family in a loving way with food? How can we cook together?

How can I, based on maybe a limited palate of one of my family members, still get a lot of brain nutrition in there? And family members, you know, still get a lot of brain nutrition in there. And to really, you know, I'm a parent, I know sometimes food is a burden. And you're like, Oh, my gosh, I can't cook another meal and do another dish. But I try to get back to that reset as much as possible. Yeah. We should cover the environment at some point in this conversation, because I know that all this talk of fish, for a lot of people, they get very upset because they're very keen to try and help the environment, the climate, and they don't like people promoting fish. I feel we should at least have that conversation.

For sure. There should be environmental concerns about what we eat. Sure. There should be environmental concerns about what we eat. I think the environmental debate has really been framed in a way that revolves around some misinformation. And I think it's really concerning. For example, the misinformation regarding things like fake meat and impossible burger. Maybe misinformation is a strong word, but the way that that kind of way of creating food is being framed as somehow healthy. Essentially, it's food processing of the same ingredients that are being used for the last 50 years that have ruined our health compared to, you know, something like grass fed beef, a local beef. And that the environmental, you know, kind of debate is like these plant foods are good and meat food and seafood is bad.

And I think that's really overly reductionistic. I think it leaves out, for example, some of my clear experiences, like where's your organic kale come from, folks? So it's all grown in manure from dairy cows, or most of it is. in manure from dairy cows or most of it is just they scoop it up in the conventional dairies and they they ferment or they get it you know really hot to kill all the chemicals and reduce everything down and they spread it on the field and and and that's where organic kale comes from and there's somehow that like better organic kale is like revered and pulled out separate from the system that supports its growth,

which largely revolves around manure. Because if you're not using manure on your fields, then you're just using chemical fertilizers, which usually the same people who are the same kind of, let's say, groups or movements that are really supporting plant foods and not eating animal foods, I don't think have spent a lot of time growing food. And if you spend time growing food you spend especially on farm small farms you spend a lot of time with poo and manure and animals small farms have always worked that way i think that the concerns about the way the meat system exists are a hundred percent valid right we have a system that wastes meat we have a system that

repurposes and process meats into foods that are horrible for us, from horrible for us, all kinds of meat pockets and meats with fried breading around them and sweet meats. In terms of seafood, the seafood is a really, to me, important place to be an eater because it gets me at least minimally involved in the system by using my food dollars to support people who are, for example, taking care of oyster beds or to support farmers who are growing mussels, a very environmentally friendly way of producing food. I certainly appreciate, if I'm being conscientious of the fish that I'm buying. I'm not buying things like, I don't know, farm tilapia or farm shrimp. I'm trying to buy

mostly wild type seafoods. I'm trying to buy small fish and encouraging people to buy small fish, more anchovies and sardines, you know, less tuna, less wild salmon. So those are all ways I think that we can work to improve our impact. I also think there's lots of other new concerns that we don't have many answers to, but I'm going to go down with the fish is kind of what I've decided. If we're going to like destroy their environment and fill their room up with plastic, I'm, I don't know, I'm just going to suffer the same fate as they do. Maybe that's, maybe that's strange. But I certainly think there's also things like, you know, I don't eat fish from lakes or fish from rivers, because those are all polluted. But again, we know about that, because people are eating those foods. And then because of that, and because of our interest in nutrition, there's a lot of cleanup efforts that have come in terms of how do we reduce the environmental impact on our water supply.

I think overfishing is a huge concern. I think slavery in the fish industry is a huge concern. I don't want to minimize these concerns. fish industry is a huge concern. I don't want to minimize these concerns. But for me, personally, as an eater, and then I guess for me as a nutritional psychiatrist looking at the data, and then also somebody interested in brain health and brain development, there's a great book on human brain evolution by Brett Stetka. And he talks about and writes about the science of how our human brains evolve and the importance of small fish and shellfish.

So I think I also get those foods in some ways out of respect of our history and genetic history and evolutionary history as I've understood it through experts like Brett. And to really do my best to be responsible in those seafood choices. I don't think that's in any way a complete answer, but it's where I am now, which is trying to eat three to four seafood meals a week. For me, that consists of a mix of anchovies and sardines, usually on gnocchi or over a pasta or on a Caesar salad, usually like an oven-roasted wild salmon filet, probably trying to get maybe six ounces or so into every family

member at least once a week, and then trying to eat mussels or other bivalves, particularly ones that are farmed in the U.S. There's some concern about increased microplastics in the stomachs of bivalves, particularly in the report I saw coming out of China. What is bivalve? Could you just explain that for people? I didn't know that term until I read your book. Bivalves are mussels, clams, and oysters. And so they're grouping in the seafood family, mollusks, and they're filter feeders. And so, you know if uh understandably people have

concerns are they filtering out all the plastics and the toxins and and you know it depends the water that they're grown in the uh truth is that when you that these foods that are very good for us bio concentrate nutrients and so by by doing that if you grow food in a toxic environment it's going to bio and concentrate some of those toxins and that that data is really getting misused to then vilify these foods as opposed to focusing on all right how can we all stay clear on this is a really important food supply 70 of the planets an ocean right you don't have to do anything i mean think about especially when people are like oh no, no fish, eat more plants. It's like, have you grown some plants?

Because I have. You know how freaking hard that is? You know how much diesel fuel it takes? First, you've got to level that field, right? Then you disk. Then it depends on what you're planting. You're either seed drilling or you're planting seedlings by hand, right? Then you're weeding.

Weed, weed, or you're spraying. Then you're fertilizing either with manure or top dressing, right? Then you're tending to the plants. Then you're harvesting. Then you're processing that food. Then you're driving to market, right? This is so energy intensive. And just compare that with, you know, it certainly takes a lot of energy, but catching anchovies.

Right. You don't have to plan it. You don't have to tend to it. You just catch it. So, you know, I think that the sea makes a lot of sense to me. And there's also more than fish that comes out of here. Out of there, there's seaweed. makes a lot of sense to me and there's also more than fish that comes out of here out of there there's seaweed um you know which i think is a really interesting and important uh human food yeah what you're speaking to is that lack of connection you know that lack of connection to the food supply and you're someone who has literally spent a lot of time growing food so you

you understand what it takes to grow different types of food whereas i think many of us are trying to enter the environmental debate from a theoretical position from sitting on the fence looking down going oh this is what we need to do whereas i guess it's probably the farmers who know best how we can actually you know improve the food supply in a much more environmentally friendly way. Well, I mean, the reason I don't like to trash talk about food in that way is that farmers are the number one group after physicians in terms of suicide risk. And in India and America, there has been thousands of farmers who've died by suicide in the last two to three years. And so

there's a way that as we trash talk, and I would agree in a kind of, you know, polite and educated, but often, you know, minimally informed way, it's easy because it's confusing and there aren't clear answers to take strong positions. And that's where I've really, really worked hard to get into more of a stance with a show on male mental health with my friend, psychiatrist Greg Scott Brown. And Greg and I talk a lot about this idea of curiosity before judgment. I really want to be curious and not make a judgment of things. And realize that some of this stuff is too big for me to have a full comprehensive understanding of and i'm going to just i'm going to do the best that i can given my limitations and and the possibilities in front of me

curiosity before judgment i really really like that i was going to ask you what is the um what is the most important lesson that you have learned in over 20 years of seeing patients? I'm not sure if you've just answered that or not without realizing it, but if I were to ask you that, what would you say? Spending important time with your partner and your kids. I think that's the least valued, most important thing that I've learned. Nobody is going to give you a spot on your resume because you're a good dad or a good partner. Nobody's going to give you a spot on your resume because you're a good dad or a good partner nobody's going to give you a promotion or give you more money for that but i think that that's the most deeply gratifying human experience at least for me in terms of what i've been doing with my life

around kind of family um for other people um if that isn't your your structure i think really being intentional about the quality of interaction. I'm just struck that I talk to many people for 45 minutes once a week. And over time, I realize I know them better than many people in my own life, simply by just really listening to all of the nuance and intricacy going on in their inner world and how hard it is for us to get into that space with people these days i mean i find that through this podcast a lot i find sometimes wow i've had a two-hour conversation with someone where i've been listening attentive not look to my phone not look to my emails i think wow i i know some of my guests pretty well i probably when was the last time i had a two-hour conversation with some of my friends like that where we weren't distracted

at all do you know what i mean it's really been very humbling for me to go wow maybe that is something i can take away from the podcast into the rest of my life one of the things that struck me about you over the years is the amount of vulnerability that you've been sharing about really your own mental health. I think that's quite rare in this space, especially for men. And I was really curious in a broad way to ask you before we end about some of your take on the struggles that men have in terms of their mental health and

talking about mental health, particularly with this paradox, I think, in masculinity where, you know, it feels like modern masculinity really is revolving more around a notion of strength through vulnerability, that I can be very open, humble, non-defensive, and that makes me stronger and more settled. But that's not in any way how masculinity has been built in the past, right? Tough, strong, silent, stoic, grit my teeth, get through it. I don't have pain. I don't have depression. And that's led to men mainly treating mental health through substance abuse. So 50% of men in America, one in two will have a substance use disorder in their lifetime. It's led to men being, particularly white males are 75 to 80% of all suicides in the U.S.

And it's something I've been trying to wrap my head around, both honoring the importance that we're at a certain moment and kind of the patriarchy and reckoning with masculinity, but also for those of us who are men right now, how do we think about mental health and improving our own mental health and ideas around male mental health? Yeah, I think it's a big challenge. Obviously, the statistics on male mental health are pretty alarming and worrying. And I have thought a lot about this as to why has this really become such a problem. And I think, just expanding out for a second, I think as modern life has changed so rapidly over the last 40,

50 years, I think women and men have both had their struggles in very different ways. I think a lot of women, a lot of my peer group, my age group, who I talk to, a lot of my male friends as girlfriends or wives I speak to really struggle with anxiety, with depression, with a lack of purpose. There seems to be something, and I appreciate I'm a man speaking about this, so this is just my perception from what I've picked up, that there's a real trickiness of actually, some of my peers have been to university, had decent jobs, and they decide to start a family. They get pregnant, they have the baby, they're, let's say,

staying at home for a period of time and really feel this kind of lack of, oh man, I used to have a really important role in society. I used to really contribute with other adults at this job, whereas now I'm just at home with the baby and I may be isolated as family. Maybe we've moved for work. So there's no one around me, there's no friends, there's no family. And then they see these female celebrities on TV who seem to have the perfect boyfriend and kids and the perfect body, straight six weeks after pregnancy, which is then blown up in the press. And so there's this kind of feeling of discontentment that I just can't compete with this kind of manicured and probably unrealistic image that's there in front of me. So I think the changing

gender roles are certainly playing a role here. And then for men, I think, you know, again, I'm not sort of fantasizing about the past where women maybe knew they weren't going to get a job. Their role was to sort of bring up the family. I'm not at all saying we should go back to that just to be really clear. But I think a lot of men struggle with this idea that they kind of were brought up with this idea that the man should be the breadwinner i think it's just trying to fit trying to understand where we fit into this new way of living and i think depending on how we were brought up depending on what we saw in our parents that often conditions us to what we think the world should be like or what our expectation is i think that plays a role it's so hard because I think even in well-meaning parents

of the last generation, there is a profound amount of subtle and not so subtle misogyny. There's profound support for sort of patriarchy and gender roles. I mean, it's really challenging to unwind. I think what you're speaking about is how, you know, as you start a family

and you see some of these traditional gender roles are like, I don't know, like I remember when we had our first baby and I thought I'd be a really, you know, like right dialed into parenthood. And there was this way that I didn't quite know what my role was, you know, like I wasn't abreast. And when like really there was a lot of crying, like I do so much, but I wasn't going to really, you know, I'm not mom. And I kind of came up with this phrase really, I joked with friends, I'd say, you know, daddies aren't mommies. And as much as I'm a firm believer in full equality and a full feminist, there is a way that, for me me fatherhood put me into kind of

i would say worship and adoration of my wife but of women in general and of the really just profound ways that motherhood is not celebrated that lactation and breastfeeding is not supported and that that we really have our priorities wrong. Yeah, I couldn't agree more. I had that same realization. You know, I'd grown up, you know, thinking about equality and, you know, I completely support that. But I remember, yeah, like you, this moment when my son was crying

or would he fallen over and, you know, I thought I'm a pretty hands-on parent. I'm always around. I'm doing this and doing that. He didn't want me. He wanted his mom, right? And for me, I think it was an affront to my ego at the time all those years back. But actually, it is really, and I see this certainly with my wife and other women, I have a newfound

appreciation of how incredible they are going through childbirth, growing another organism, animal inside them, growing another person. That is something we will never do. We will never experience what that is like or the pain of, let's say, childbirth and how one gets through that. I really see a resilience in women, or I've got a newfound appreciation of that resilience in a way that I possibly didn't have 10 or 15 years ago. When it comes to men, in terms of your original question, something I observed in the lockdowns here in the UK was that when people were out for their, let's say their daily walk here, you'd often see women walking with other women. Almost certainly there'd be two or three women or two walking together chatting. I rarely saw men doing the same thing. For me, if I go out, it's by myself. My wife goes out,

she meets a friend and they go and catch her whilst they're walking. And I'm not saying that's the whole picture, but it just made me think, wow, there's something about that. No, that's fine. You go out with a group of guys, right? You go out with a group of women first and start talking about the kids, right? You go out with a group of dads. Sometimes I'll leave and like I realized, dang, like we're awful. Nobody said like, hey, how are the kids? You know, like sometimes, but oftentimes, you know, it just kind of has woken me up to, you know, again, just kind of biases and values that I wanted to check and make me when I noticed that after dinner, I made sure the next time I made sure I asked everybody about the kids, you know, and got that conversation going.

But I think men and women, there's also, we can support equality, but also recognize that we can be different in some ways as well. And we don't have to nullify that part of ourselves. I think that is, again, it's like everything we've been talking about. There's nuance to everything. I think that is, again, it's like everything we've been talking about. There's nuance to everything. Well, I think the uncomfortable part for a lot of men is also really being very, very clear and committed to the notion that there's lots that women are better at. Because I think part of really being seen and perceived as the dominant gender for so long is that that's really threatening.

The idea that women are actually much better at a variety of things than men. And I don't mean to be so sort of gendered in this um uh because that conversation has really opened up over the past four or five years but um i do i do think that part of what we're speaking about is where mental health for men is challenging and i think because our role is really in transition and one of in the sense of you know just simple things for for younger men, what makes a good man today? You know, like, how do you date today? How do you show respect? What is masculinity? And especially if you're from a more, let's say, traditional culture, where it's not as easy as maybe it is, I don't know, for me, to kind of like, I don't know, define modern masculinity here in America, because like, we're constantly evolving and renew as opposed to like, no, what a man is in your culture is really defined very differently in a much more probably

nuanced and historical way. Yeah. Well, Drew, I'd love to go deep on that. And maybe next time we get together for a conversation, either at your farm, or next time you're in the UK, we'll definitely follow up there. Just to sort of close off this conversation, you are a pioneer in this area about food and mental health. You've been practicing this way, you've been researching this for many, many years. I think you've done a great job at putting it all together in your latest book, Eat to Breed Depression and Anxiety, which is going to be super helpful for people. Just to close off this conversation, the podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of life.

And I wonder if you have any closing words, any closing thoughts about things that people can think about introducing into their lives right now no matter where they fall on that mental health spectrum that's going to help them get more out of life well i would think first is validating the importance of self-care and that self-care isn't selfish self-care is foundational and be clear and rigorous and kind and loving in your care of yourself, starting with the words that you use and the time that you give yourself to the types of nourishment and the foods that we've talked about in this episode that fuel the brain and can fuel and improve mental health

based on the most recent research. I also hope people feel inspired to do something. Mental health is an active process. Increasingly in our clinic, we talk about the concept of mental fitness, that we're really working on improving our capacity for emotional connection, our capacity for love, our capacity for creativity, that we're really in our daily lives and rituals and habits, we're trying to promote a set of lifestyle choices that, to the best of science's ability to tell us what's good for our brain, is really supporting us and supporting our mental health. And there are lots of ways to do that, I hope, is the other good news you hear, and lots of science supporting

the notion that your brain and your mental health evolve over time and that the more that you learn about the self the more that you experiment a bit with things like food and improving sleep and improving your movement feel better live more of the mental health concept feel better is really saying when we feel in the upper echelon of our mental health, the world and life is amazing. We are filled with love and creativity and spontaneity and connection, and we live more. And when we're missing those elements, and we've all been in states probably where we've had more of that and states where we've had less of that, the world can look like a very, very dark and isolated and unfriendly and environmentally increasingly distressed place. So I hope everyone hears encouragement to feed

their mental health, that nutrition is a neglected piece of the puzzle, but also that nutrition isn't the only piece of this puzzle. And that putting together your mental health is just a really important place, really rewarding place for you to spend time and energy and to invest in. Nothing will give you better dividends and more rewards than taking care of and investing in mental health. I love it, Drew. Thanks so much for making time. Really, really enjoyed our conversation together. Appreciate it. Take care. Really hope you enjoyed that conversation. As always, do have a think about one thing that you can take away and start applying into your own life. And as always, let Drew and I know what you thought on social media.

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