Feel Better, Live More with Dr Rangan Chatterjee - #74 How Diet Can Save Your Mental Health with Professor Felice Jacka

Episode Date: September 18, 2019

We all know that a poor diet negatively impacts our physical health. In fact, it is now the leading cause of early death in men and number two in women. But it’s not only our physical health that is affected – the effects on our mental health can also be devastating. This week, I am joined by world leading expert in the field of nutritional psychiatry, Professor Felice Jacka, to discuss her ground-breaking research into the link between food and our mental health. We discuss why lifestyle medicine should be the starting point for many mental health conditions and why there is an urgent need to train medical practitioners to give such lifestyle advice. We delve into the important role the gut microbiome plays in this area and how a diet rich in diversity is key. We also talk about the link between a mother’s diet in pregnancy and their child’s emotional health. At a time where the modern food environment is so broken and depression and anxiety are on the rise, this conversation is more important than ever. It really is a fascinating listen – I hope you enjoy it! Show notes available at https://drchatterjee.com/brainchanger Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk 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. Hosted on Acast. See acast.com/privacy for more information.

What I think is fascinating is that healthy dietary patterns and unhealthy dietary patterns are not related to each other. They're not just the opposite of each other. There'll be lots of people who have really, particularly like kids, have lots of healthy food at home, but then they have lots of junk and processed foods when they're out and about. That is still problematic for mental health. Hi, my name is Rangan Chastji, GP, television presenter and author of the best-selling books, The Stress Solution and The Four Pillar Plan. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated.

With this podcast, I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people both within as well as outside the health space to hopefully inspire you as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier we are happier because when we feel better we live more. Live More. Hello and welcome back to episode 74 of my Feel Better Live More podcast. It was so good to be back last week with a new season and I am absolutely delighted with the response. Last week's guest, Ross Edgley, is certainly an inspirational figure and I'm so pleased that many of you have used our conversation together as inspiration to get going on your own health journey or to take on some new challenges in your own life. Thank you for all the feedback

on social media. Now today's show is all about how our food choices affect our mental health. We all know that a poor diet negatively impacts our physical health. In fact, it is now the leading cause of early death in men and the number two cause in women. But it's not only our physical health. In fact, it is now the leading cause of early death in men and the number two cause in women. But it's not only our physical health that is affected. The effects on our mental health can also be devastating. This week, I am joined by world experts in the field of nutritional psychiatry, Professor Felice Jacquet, to discuss her groundbreaking research into the link between food and our mental health. We discuss why lifestyle medicine should be the starting point for many mental health conditions and why there is an urgent need to train medical practitioners to give such lifestyle advice. We delve into the important role the gut plays in

this area and how a diet rich in diversity is key. We also talk about the link between a mother's diet in pregnancy and their child's emotional health. At a time where the modern food environment is so broken and depression and anxiety are on the rise, this conversation is more important than ever. It really is a fascinating listen. I hope you enjoy it. Now, before we get started, as always, I do need to give a quick shout out to some of the sponsors of today's show who are absolutely essential in order for me to continue putting out weekly episodes like this one. I'm absolutely delighted that Vivo Barefoot are supporting this episode. As you will know, if you are a long-time listener, I am a huge fan of minimalist shoes and have been exclusively wearing Vivo Barefoot shoes

now for many, many years, as have my wife and my children. I strongly believe that our feet are one of the most important parts of our body for our movements and our musculoskeletal health. parts of our body for our movements and our musculoskeletal health. Their function influences how we walk, run and so much more. Not only have I used them myself for years and found them extremely beneficial for back pain, I've also recommended minimalist shoes to many of my patients who have reported back to me improvements in a variety of different complaints such as hip pain, knee pain and back pain. I think there is also going to be a really strong case for minimalist shoes in the elderly in terms of their fall risk. I moved my own mother over to Vivo Barefoot Shoes a few years ago and she has commented on how they have helped her

improve her balance and her stability. Minimalist shoes are thin, wide and flexible and vivo barefoot makes shoes for every occasion for both adults and for kids for listeners of my show they have come up with a great deal they are offering 20 off to all new customers in the uk usa australia and selected eu countries if you have thought about giving them a go this is a great incentive to get going. It's important for me to say that they offer a 100-day free trial for new customers. Last week, I incorrectly said a 30-day free trial. It is a 100-day free trial for new customers. So if you are not happy, you can send them back for a full refund.

I think this is an amazing offer. If you have been sitting on the fence about trying minimalist shoes, do consider taking advantage. You can get your 20% off for new customers by going to vivobarefoot.com forward slash live more. That's vivobarefoot.com forward slash live more. Now, on to today's conversation with Professor Felice Jacker. So, Felice, welcome to the Feel Better Live More podcast. Thank you. It's great to be here. Yeah, look, I don't know how you're feeling at the moment. I know you have just flown over from Australia. Really jet lagged.

Tell me, what time did you get up today? Oh, 2.30 in the morning. Wow. I know that was pretty bad, but I went for a run at six and that made me feel a little bit fresher. But by three o'clock this afternoon, I'll kind of be toast. Yeah, well, we're close to that time now. I'm very impressed that you declined an offer for coffee. So, let's see how this goes. But Felice, I've got to tell you from my perspective, I'm so excited to be talking to you. I have been reading your research for years.

Your SMILES trial, I think I've lectured to hundreds, if not over a thousand doctors now, talking about that data, talks about it in both of my books. So you are someone who I have been following for a while and thank you for making the journey up to my house today to talk. Such a pleasure.

Thanks for having me. So you have finally got around to writing a book with all this amazing research you've done and you're here to promote that book. And I've got to say, it's absolutely incredible. It's full of research, full of evidence. I think you've taken a very balanced approach, you know, really paid homage to a lot of the views out there, but then really try to be clear about where the research lies. But let's just dive in. Diet and mental health. Until recently, as a conventional medical doctor, the widespread view was that our diets don't really play that much impact in terms of the

way that we feel. What is going on there? Yeah, I think, you know, there's been this longstanding, I guess, dichotomy between mind and body, this idea that somehow the brain was up here and the body was down here and they really didn't have a lot to do with each other. But what really got me interested in the link between nutrition and mental and brain health was the understanding, probably, you know, late 1990s, early 2000s, that the immune system seemed to be really central, particularly with depression. It seemed to be both cause and consequence of depressive illnesses. And of course, nutrition is a really strong driver of immune function. And also in the early 2000s, a lot of neuroscience work coming out of America that looked at the impact of nutrition as well as

exercise on brain plasticity, in particular, this region of the brain called the hippocampus, which is really important for learning and memory as well as for mental health, and showing that you could manipulate that in animal studies very rapidly by altering diet and also exercise. So there was this emerging evidence that, of course, the mind and the body were one highly complex integrated system. And our new knowledge around the gut and the gut microbiota is really solidifying that knowledge and giving us some more insights and targets for our research and potentially our prevention and treatment strategies. Yeah, absolutely. Well, the research is emerging all the time and continuing to evolve.

But what led you to this? You know, what were you doing? What was happening? Were you having problems with your own health? What took you on this journey? Yeah, so my first degree was in fine art back in the 1980s. You know, I was going to be an artist. If someone had told me that I might end up being a scientist,

I would have just laughed my head off. But I had a lot of common mental disorders, so depression and anxiety during my adolescence and probably even before that. And I was drawn towards psychology and the study of psychology because of that personal experience. And as I studied psychology, I became pretty clear that I didn't really want to be a clinician, but I really liked statistics. Sorry, that's so nerdy. So I ended up volunteering while I was doing my undergraduate degree to do some research with a very well-known professor of psychiatry and really loved it. And so I went on and I finished my undergrad degree, did my honours degree looking at the link between depression and bone health using epidemiology and learned a lot of the basics

there. But while I was doing that, I started to realise that there were really very little data, very few data on the role of nutrition and mental and brain health. You know, there'd been a few randomized control trials of supplements. Some of them were pretty terrible. Some of them were okay in terms of the rigor. And there had been a few epidemiological studies looking at individual aspects of diets such as fish consumption and depression. But really, compared to the wider field of medicine and chronic disease, there were very few data on the role of nutrition in mental

health. So for my PhD, I decided that that's what I wanted to actually tackle. And I met with a lot of skepticism and I guess some almost sniggers, you know, because as you say, there just wasn't this idea that nutrition or what you put in your mouth might have an influence on your mental and brain health. But I undertook that study for my PhD. I looked at data from more than a thousand women, highly representative sample of the population and looked in detail at their diet and their mental health using proper clinical assessments.

And of course, all of the other factors that you need to consider like income and education and those sorts of things and found the links that I expected to see. And this ended up being quite influential. It was published on the front cover of the American Journal of Psychiatry in 2010. And it, along with two other prospective studies that were published around the same time, one from Spain and one from the UK, really kick-started a whole lot of interest in this field. And for me, it made perfect sense. But for others in the scientific community or clinical community, it really was quite revolutionary and there was a lot of scepticism. And

that's only really started to abate in the last three years or so. But before we delve into the research, and I really want to go deep into the research, we have a lot of healthcare professionals listen to this podcast, but also, you know, thousands of members of the public who listen to these to actually just get information to help improve the way that they feel and get more out of life. I just want to really try and understand the scale of the problem. So we know that mental health problems in general are on the rise. There's many reasons for that. And many things in the modern environments have improved, haven't they? Whether it's, you know, things like sanitation, hygiene, these things have all got better. But it's pretty hard

to make a case that our diets have got better. So how much of a problem is the modern food environment, do you think, in terms of these increasing rates of mental illness? Well, you know, the scope of the problem is actually mind boggling. So we now know from the very large studies that have been done, the Global Burden of Disease studies, that poor diet, unhealthy diet, largely as a result of the changes to the food system that are prompted by big food industry making a lot of profits from these ultra-processed food products. But poor diet is now the leading cause of early death in men

and number two in women across the globe. And obesity now kills more people than undernutrition. The WHO have said, you know, by 2030 it's going to cost the global community upwards of $30 trillion and made the point that there's no economy in the world that can actually cope with the costs, the poor health outcomes of unhealthy diet. And yet there's been very little action to kind of change the food environment at the policy and legislative level.

At the same time, we know that mental disorders, mental and substance use disorders account for the leading global burden of disability. So even though they may not directly always lead to early death, although they do have an impact on that, they cause a massive amount of disability across the globe. And unipolar depression in particular is in the top five causes of disability across the globe continually. So the fact that the two things are linked is incredibly important for prevention and for treatment. The fact that poor diet is such a major issue globally for health really highlights the craziness of medical practitioners getting so little training on nutrition during their

residencies, et cetera. So it's a major issue. How much poor diet feeds into mental health problems is yet to be established. And that's a really important question, but I suspect it varies enormously from individual to individual. And it should be always said that, you know, something like depression is a very multifactorial disorder.

There are so many things that drive into it. But if you think about the risk factors for mental illness, they're very often things that you can't readily change. They're things like family history and early life trauma and life events and poverty and disadvantage and interpersonal violence. These are things that are often very challenging for societies to address. So we need to be looking for the things that we can modify particularly if we want to think about prevention because half of all mental disorders start before the age of 14 so we want to be able to prevent as many cases as we can so if we know that diet and physical activity are both

modifiable risk factors for depression in particular which we absolutely know from very extensive data from around the world, then this is where we should be targeting our interventions as the low-hanging fruit. Yeah, so many thoughts going through my head at the moment. You mentioned diets and physical activity are modifiable risk factors for depression, but they're also modifiable risk factors for obesity. They're also mod modify risk factors for other conditions, which therefore, in my head, you extend that thinking further. You say, well, how could these two things modify your risk of a whole variety of different conditions? Maybe all the different conditions aren't quite as separate as maybe we think they are. Maybe there is a common underlying driver,

maybe we think they are, maybe there is a common underlying driver, such as inflammation. I really think about this a lot. The more science that emerges in various fields of health and medicine, the more we often find that the lifestyle factors that we are promoting to help reduce the likelihood or even help treat those conditions are quite similar. Absolutely. And I think this recognition of certainly the common mental disorders such as depression as another of the chronic non-communicable diseases is a really important one because we certainly think on the basis of the research that they all have common drivers. But apart from anything else, it just makes so much sense to be tackling this. And I mean, we're really pushing for this lifestyle psychiatry or lifestyle medicine as a

fundamental principle in psychiatry. Because if you think about depression, you think about how common it is and recognize that if you are depressed, your risk for heart disease and obesity and a whole lot of metabolic problems goes right up if you have those conditions in turn your risk for depression goes right up and then if you look at the the serious mental illnesses such as psychosis and schizophrenia we know that that that patient group has a massively reduced lifespan compared to the general population because of their lifestyle behaviours and the impact of the drugs that they are given. And we also know that if you tackle their lifestyle behaviours and support them to have a healthy diet and do exercise, it actually

can mitigate nearly all of that noxious impact on their metabolic health. And then finally, if you go and look at the two intervention studies, the SMILES trial that we led and the one that came after us in South Australia, where they did a detailed economic evaluation of both of them, and we showed that there was a massive cost saving because the people who, certainly in the SMILES trial, who got the dietary support compared to the social support, there was an average cost saving of about $3,000 Australian dollars. And that's because the participants lost less time out of role and they saw health professionals less often. And the HealthyMed study in South Australia found

very similar. So what it's saying is if you take this lifestyle medicine approach to supporting people with mental health problems, in this case depression, but it will also be the same in schizophrenia based on what we know so far, you're going to get huge benefits across the board. It's not just targeting a particular molecule or particular brain pathway. It's targeting the whole person. And so it makes all sorts of sense.

Now, in 2015, the updated clinical guidelines for the treatment of mood disorders were published in Australia by the Royal Australian New Zealand College of Psychiatry. I had quite a bit of input into that. And they said step zero, if you have a patient with depression, step zero should be basically lifestyle medicine it should be diet exercise sleep hygiene smoking cessation substance 2015 that was in 2015 and see that is not being translated to clinical practice that's right that's right and we really need to change the way we we train practitioners and i think you know obviously the pharmaceutical industry has had a big part to play in pushing a sort of a you know a pharmaceutical approach to treatment and certainly this is not an either-or question you know we absolutely everyone in the smiles trial was on well most people were on other forms of treatment

but it's saying that this should be the starting point the the fundamental and if clinicians take it seriously and they give diet and exercise advice as a prescription and they say this is actually really important we think that that will help people to change their behaviors yeah felice i think that last point is something i keep trying to hammer home um when i'm talking to health care professionals and which is this whole point that first of all some some people are very uh close to the idea that food can make a difference in mental health. So I think it was two years, maybe a year and a half ago, it was just after my first book came out, actually. I remember it was a month after that. I was giving a talk in Bristol for the Royal College of GPs to, I think, 100, 150 doctors there. And at the start, I asked them,

how many of you will discuss your nutrition, you know, a patient's nutrition or their food in someone who comes up with a mental health problem? And roughly 5% of the room put their hand up. This is only, this is after the smile, this was 2018, I think, actually, I think January, February 2018. And then I literally gave a 20 minute talk, just an overview of some of the research. Some of it I knew was yours, some of it I've quoted of yours, but I didn't realize it was yours. And at the end of it, I said, how many of you are going to do it now? And they almost all put their hand up. And so

it's really that slightly frustrating thing, whereas there is research out there, guidelines are being written, but they're not being translated to clinical practice. And this led me a few years ago, well, a couple of years ago now to, with a colleague, create something called a prescribing lifestyle medicine course that, you know, we're delighted that Royal College of GPs is accredited for the second year running. And we've trained, I think, about a thousand clinicians now, doctors, pharmacists. We've had a few psychiatrists, cardiologists, because this is not universal. This is not just a general practice problem. This is a problem across medicine. And again, we're not training them in nutrition. We're training them

in a lifestyle medicine approach, how you evaluate a patient, how you can start to input various things from their symptoms and start to deliver a personalized lifestyle prescription. And you know, 95% of attendees love it and say it significantly influenced the way that they practice because we're not being given this information. And I like you share that passion that lifestyle medicine, lifestyle psychiatry, these things, you know, if you think about it, the worst case scenario here, worst case scenario is that someone changes their diet. They don't feel any better. There's no downside, right? that's exactly right well let's dive into that research because i think the smiles trial which is you know i remember seeing that

when it came out thinking oh my god this is the first time that i had seen a randomized control trial showing how diet can improve symptoms of depression you know using the same level of evidence that we would expect from a pharmaceutical drug and that was the really exciting thing so let's dive into what happened in that trial why you thought of it what the results were but also for the members of the general public who are listening um nutritional research is quite complicated to do isn't it and you've mentioned terms like observational studies, epidemiological studies, intervention studies. Could you just briefly explain what those are so people understand the difference? Yeah. And this is, I have a chapter in the book that talks

about this because it is so important that people understand this concept of the fact that correlation doesn't equal causation. And doing research in general is really difficult, but doing nutrition research is just horrendous. But so observational studies or also called epidemiological studies are where you collect lots and lots of information from people that you believe are representative of the population or representative of a particular group of the population and you use statistics to put those data together and to test hypotheses. Now, we led many, many studies in adults,

including that first one, which was my PhD. Then we went on and we looked in adolescents, the primary age of onset, really important to look at this in young people. Then in pregnant women and in children early in life and then older adults. And we were joined by many other people from around the world. And from all of those observational studies, we can say that adherence to a healthy diet seems to reduce the risk of depression by about 30%. But to know whether that is actually a causal relationship whether diet is causing the mental health you need to do experiments where you actually change diet to see if you can change mental health and that's an intervention study now the obvious problem with doing something like

that in nutrition is that you can't blind people to the to what they're getting they know what they're eating you can't have a placebo diet you know and there's no information to say that one particular form of healthy diet is better than another particular form you can't ethically put one group of people on a junk food diet and see what happens so you've always expected that to his son yeah you know which is which is actually episode one of this podcast it was the very first conversation i was with tim and he explained that he that's exactly what he did to his son like any good research clinician would scientists would do but you're right you can't ethically do that but so you you have to do the best that you can and you also have to to triangulate the data so you have to look at the human data you look at the animal studies and the animal

studies are really useful because of course you can tightly control diet and then you can chop their heads off at the end and see what's going on in the brain and that sort of thing. But with the human data, I designed it when I was a very early postdoc, the SMILES trial, and it took me a couple of years to get funding for it, but we got the funding, but they slashed the budget by 35%. So we really did it on the smell of an oily rag. It was a really, really difficult and challenging study to do. We really struggled to recruit people. And I think, yeah, this is really interesting because we had hoped to recruit about 180 patients with major depressive disorder. After three and a half very long, hard years, we'd recruited 67. Now, I think that's for two reasons

one is that people in general were sceptical that diet was going to have an impact on something as serious as major depressive disorder but really importantly clinicians they were just completely sceptical so none of them sent their patients to us to enrol in the trial. So that was really challenging but what we did in that study was we recruited people with major clinical depression and we randomly assigned them to get either social support or dietary support for a period of three months. Now, the social support, we already know that that's helpful for people with depression. That's just going and talking to someone. You could be talking about the football or your grandchildren or whatever, but we know that it's helpful and it's called a befriending protocol. They often use it in

psychotherapy trials as a control condition. And then the other groups are a clinical dietitian for three months. And that dietitian just worked with those people to help them to gradually make positive changes to their diet, to set some goals, to do it in a way that was feasible and achievable for them. And that was things like swapping out their refined carbs, their white flour, white bread, et cetera, for whole grain versions, increasing the amount of vegetables and fruit in their diet, starting to eat more legumes, so your lentils and chickpeas, et cetera, having some nuts and seeds, eating fish, getting some olive oil into their diet, but also really importantly, reducing the intake of the

junk and processed foods, the sweets and cakes and chocolate and fried foods over a three-month period. And at the end of the study, because we only had 67 people, we had no expectation whatsoever that we would see a significant difference between the groups on the depression outcomes. We just thought it was incredibly unlikely. And I sat with the statistician and we did the stats and she did the stats. And it was, you know, you don't unblind the groups until the end. We just knew it was group A and group B. And there was just this massive difference in the depression scores after three months. And we were just completely blown away. How big a difference? Well, to put it into, I guess, a meaningful

context, more than 30% of the people in the dietary group achieved what we would call full remission, where they just weren't depressed at all anymore. And that was compared to about 8% in the social support group. So, hold on, we just got to pause there because, you know, I'm asking you the question for the listener. I'm very familiar with the trial. That is absolutely remarkable. You were talking about people who have got moderate or severe depression, who literally were doing exactly what they were doing. If they were on treatment, I believe they stayed on everything that we're doing doing but they were just split into two groups and if you change your diet within 12 weeks you got above a 30 remission rate in symptoms of depression that is absolutely staggering no wonder you got so much attention after that trial because

not only the results amazing the fact that you everything you had to overcome the skepticism recruiting patients all this kind of stuff you know and you didn't know until the end i mean do you remember where you were when do you remember absolutely when you got the results what tell me about it well hilariously the the statistician was sitting there and she you know did whatever the statistician does with the magic computer and And she went, oh, no, there's no difference. And we sort of went, oh, well, that's what we expected. And then she said, oh, hang on, I haven't done, you know, X, Y, Z, whatever it was. And she went, hang on, hang on. And then she went back and she went, oh my God, we really just could not believe it. And then of course, we unblinded it and we went,

that's the diet group. That's extraordinary. So initially you knew there was a big improvement, but you didn't know yet. Was it the social support group or the diet group? Yeah, that's exactly right. Oh, wow. And then, of course, there's a few really important things that came out of that study. The first thing is that most people were able to make positive changes to their diet. That's really important because so many clinicians, I think, are very skeptical about patients' ability to take dietary advice and act upon it. And we found that people loved this. It was something that was under their own control, unlike so many other things in their

life. Secondly, the degree of dietary change correlated very closely with the degree of improvement in their depression. So the more you change your diet, the more you would improve. Exactly, exactly. Third, we did a very detailed cost analysis of the diet that we were recommending compared to the cost of the diet that they were eating when they came into the study. Our diet was a whole lot cheaper. So it put to bed this idea that it has to be expensive to eat a healthy diet. And then lastly, and I think this is possibly the most important finding in the trial, was the economic evaluation showing that massive cost saving because it benefited people across the board. Now, the really cool thing is a few months later, that study was more or less

replicated, but in a group-based setting by the group in South Australia, they found very similar. People were able to change their diet. The degree of dietary change correlated with the degree of improvement. They saw a big difference between the groups and it was highly, highly cost-effective. So, that's two clinical trials that have shown this. So, I think it's really exciting and we just need to now get this translated into clinical practice. Yeah, just a couple of things I want to pick up on there. First one was when you mentioned that a lot of healthcare professionals think, you know, our patients aren't going to be able to make that change. And it goes back to what you

said right at the start, which is one of the reasons why I went to all the hard work of putting on a course from scratch is because if we as the clinician prioritize the nutrition or the lifestyle change, I think the patient is going to prioritize that. If we spend nine out of the 10 minutes of our lengthy consultation talking about a pharmaceutical approach, and as the patient is walking out saying, hey, if you can improve your diet and go to the gym, that'll be helpful as well. A patient's going to go out thinking, oh, it's all about the drug. Yeah, he told me about the lifestyle thing as I was walking out, but you know what? I can take this drug and I'll be fine. Whereas if we spend nine minutes out of the 10 or 90% of the time talking about

the diet and nutrition change that might be impactful and only 1% on the pharmacy. So then I think that impacts what a patient thinks. And so I absolutely concur with that. I really think we need to do better as healthcare professionals at prioritising those conversations, albeit I recognise there are time constraints and I recognise that healthcare professionals, particularly in this country, are really dealing with incredible workload, time pressure. So I recognise it's hard. But the second point is that, you know, people were able to make those changes and it was cost-effective. And that is one of the biggest criticisms that gets leveled at this whole lifestyle medicine movement is, well, it's for the middle classes. It's too expensive. Low socioeconomic status is a big risk factor for

these things. And of course it is, and we will touch on that. So I think that's super important. But generally speaking, do you think that it is possible to eat well without, you know, blowing your whole budget? We know that it is because we did the really detailed investigation of this. And I mean, you know, the sorts of things we were recommending to people was very simple there were things like you know a um a whole wheat biscuit with a tin of tuna and some sliced salad or you know a tin of beans you can buy a tin of beans or a packet of dried beans so incredibly cheaply and they're just brilliant what sort of beans are you talking about like lentils or chickpeas or, you know, any of those, any of the legumes, they're really fantastic. Super, super cheap. Tinned fish,

frozen vegetables, nothing wrong with those and really convenient. And we really focused on suggestions that were very feasible. So things that wouldn't take much time, you know, making up a big pot of stew at the end of the week in the slow cooker, which you can get really cheaply. And just, you know, there's many ways that you can do it very, very inexpensively. You certainly don't have to be having organic food and, you know, organic blueberries and things like that. So I think that's a really important conversation and a bit of knowledge that needs to be transmitted. But of course, one of the key issues we have is that there's so many people with vested interests, including big food, who really benefit from keeping the waters very muddy about what constitutes a healthy diet. And that has led

people to be exceptionally confused. Now, I know that in the UK and in the US, something like 75% of junior physicians do not feel qualified to offer dietary advice to their patients. And a lot of that has got to do with the misinformation and the mixed messages that have come out of the diet gurus and big food as well about what is and isn't a healthy diet and what the evidence says about that. So I do agree that there's a massive challenge in clinical practice to tackle these things in the scope of a 15-minute consultation. And it may be in Australia, we're advocating that there is a Medicare item number for people with mental disorders to be able to go and see a dietitian, a clinical dietitian, because

we know from the meta-analysis that we've done that if you use a clinical or a nutrition professional to deliver a dietary intervention, you get a far better outcome. And that's because they know not just what people should be eating, but how they might get there, how they might achieve that. So, I think that that's one possible solution to the issue of, you know, having limited time in clinical practice. You can also have shared appointments where you, you know, a clinical practitioner might see a number of patients at once with the same information and then they've got peer group support. So there's different ways potentially of going about it. Yeah, absolutely. I just want to

highlight the point there that on this course that we run where we teach doctors, it's primarily doctors, other healthcare professionals as well. We actively encourage referrals to nutrition professionals, but I don't think that negates the need for doctors to know absolutely how powerful these interventions are because here's the thing if we don't know about it we're never even going to think to refer to a nutrition professional in the first place and i'm really pleased the feedback we're getting from the doctors who've attended our course is it is increasing their referrals you know if they've got a clinical dietician nearby great if they've got a clinical dietitian nearby, great. If they've got a nutritional therapist nearby, great. Whatever, you know, whatever services they

have available to them, they're able to refer out. They start off in, let's say, their 10 or 15 minutes saying, hey, look, have you thought about diet as an approach? And if a patient's engaged in this, they might give some preliminary advice, but also make that referral on to a nutrition professional who can actually go through that in detail. So I think that's a really, really good point. One thing I really want to go into the foods that were in the SMILES trial, what foods were these participants given? And then why do you think that these foods had an impact on moods? Great question that we don't have the answers for. So we base the dietary advice on the best science available and that, of course, the Mediterranean diet has by far the strongest

and the largest evidence base. What do you mean by Mediterranean diet? Because a lot of people don't say. And this is not a prescriptive diet, but it's basically a diet that is much higher in plant foods. So vegetables and fruits, legumes, your lentils and chickpeas, et cetera, nuts and seeds. So all these sources of dietary fiber, and we can talk about why we think that is particularly important

in a little while. And also healthy fats. So these are the mono and the polyunsaturated fats from fish and olive oil, et cetera, and healthful forms of protein. But we also included recommendations for three or four palm-sized servings of unprocessed meat per week, which is at odds with the traditional Mediterranean diet. servings of unprocessed meat per week, which is at odds with the traditional Mediterranean diet.

And that was on the basis of a study that I published where I saw very unexpectedly a very clear U-shaped relationship between red meat intake and depressive and anxiety disorders and even bipolar disorders in this large population-based sample of women. So women who had less than the recommended intake, which is this three to four small serves a week, or more than the recommended intake, when we took into account their overall diet quality, they were twice as likely to have a clinical depressive or anxiety disorder. Okay. I mean, this is super fascinating, especially with the growing movement to move to vegan diets, which is exploding really around the world in terms of popularity. A lot of

people are doing it for ethical reasons. And there's a lot of, as you well know, a lot of controversy in what I call the social media diets wars. It really highlights how complex nutritional research is because people seem to have the same paper and there's five different interpretations. And then people write their blogs about them. And then Joe Public is like, well, what the hell do I do? Because this expert who I respect is saying this, this expert who I respect is saying the complete opposite. And I think that confusion is causing big problems with patients. I see that all the time. They're just confused. And with doctors as well. And with doctors, exactly. And, you know, I'm sort of trying to keep on top of the research and even I get confused sometimes. I think, well,

hold on a minute, I thought that, and then now this trial is suggesting that. And it's, you've got to take that balanced approach. But let's dive into some of these foods. So red meat, right? Do you think red meat, right? Do you think red meat is good for our mental health? I have no particular opinion on it. I think our study was a really unexpected finding. It was a very clear finding and it's sort of concordant with other epidemiological studies where you see a link between vegetarianism and poor mental health. But we just don't know whether it's a causal relationship. It could well be explained by third factors that we haven't measured or haven't accounted for. So I would not hang my hat on that. I do hear a lot of clinicians saying that they

quite commonly will see young women who are menstruating, who are vegetarian, and they're really in a terrible state. And they get a lot better when they reintroduce red meat into their diet. I have seen that many times. I really haven't. I guess this is one of the reasons why I'm very diet agnostic and I have certain preferences and certain conditions, if I'm honest, because ultimately as a doctor who never got trained in this stuff at medical school, I was getting very frustrated

at just prescribing pills all the time for problems. And I thought there must be something more I could do. And I sort of, of my own back, would read the research and think, well, I think changing a diet is probably going to be helpful. And there's no downside to doing this. I'm going to at least do that as part of my approach. And I would see a lot of improvements in various conditions. And I do see that sometimes. But again, there are many people out there who have quite a bit of red meat and seems to do really well with their mental health. Other people I see, you know, they transform their diet from a heavily processed Western diet. They go whole food vegan and they seem to be thriving as well. And I think, well, hold on a minute. Different diets seem to do well for different people.

That's right. And I do think the microbiome is possibly the sort of core explainer there. So, red meat, you have no opinion on, yet you have seen some studies suggesting that if you're not having any, it might negatively influence your mental health. And it may be very much an individual thing. I mean, personally, I don't generally eat red meat because of the ethical and the environmental concerns, but my daughters who are menstruating, I do encourage them to have a small amount, but I really wouldn't hang my hat on that. And if you look at the second intervention study, the Healthy Med study, they were promoting a far more traditional Mediterranean diet that had very, very low meat intake. And they also

got a really positive effect. Now, I think one thing that we're seeing in the US, these advocations of very, very extreme diets, these ketogenic and these carnivore diets and all the rest of it. And I suspect that the standard American diet or the SAD is so awful, just so utterly terrible that almost anything you do to change it is better. What's interesting for me is that there seems to be a lot of short-term benefits from a whole variety of different diets. And I think you're right. Whenever we stop having that unhealthy, highly processed Western diet, anything tends to be better. There are some

trials from what I understand and what I can see showing that particularly in type 2 diabetes, ketogenic diets can certainly in the short term look very, very promising in terms of blood sugar markers. Long term, I guess, so I can only talk about my own experience, I guess, as a clinician, I have used on numerous occasions with someone who's got type 2 diabetes, in the short term, I often use a diet low in refined and processed carbohydrates. I don't particularly, I've said it before, I don't like the name low-carb diets in general because I think it's too broad and I think we've probably unfairly demonized fat for 30, 40 years. I think we're doing the same to carbohydrates by saying a low-carb. So really cut down on low and refined and processed carbohydrates. But then what I try and do with those patients to say is explain to

them that insulin resistance is driving their type 2 diabetes. So in the short term, this is going to help you just get on top of things. But then I try and repair things. So whether it's with increasing their muscle mass, which is going to improve insulin sensitivity, help them improve their sleep, which is going to improve insulin sensitivity, you know, help them manage their stress levels, which is going to improve insulin sensitivity. And as that insulin sensitivity gets better, I start to increase more and more of that, especially the fiber and a lot of, you know, things like sweet potatoes, all these kind of nourishing carbs that we know are great for the gut microbiome. And so I also think there's something in short term versus what might be the right diet for longevity? And I don't know the answer to that,

but I think about this a lot because I think a lot of patients follow these diets because actually they're not feeling great. And then they either read a blog or they see a clinician who has a certain bias and they try a diet and they feel fantastic. They go, hold on a minute, I used to feel sluggish and I used to struggle to lose weight and had joint pain. And now I've changed my diets. I just feel incredible. And so, you know, that's not science. I totally recognize, but in some ways you can't blame people for who are suffering as they're not getting help. Absolutely. They're going to do it, right? Absolutely. And I think that it's a really important thing though, is we don't know whether

it's what people are eating and what they're not eating when they change their diet. And this is true with the SMILES trial. We don't know if it was because they increased their vegetables and fiber, et cetera, or because they reduced their junk and processed foods. They did both at the same time. But if we look at the epidemiological literature, what I think is fascinating is that healthy dietary patterns and unhealthy dietary patterns are not related to each other. They're not just the opposite of each other. There'll be lots of people who have really,

particularly like kids, have lots of healthy food at home, but then they have lots of junk and processed foods when they're out and about. That is still problematic for mental health. There's other groups- That is so key. Say that again. That is really, really key because I think people think, I can eat what I want, but if I have a bit of broccoli now and again, I'm being healthy. That's right. And the evidence does not support that. In all of the incredibly extensive studies that we've done now, we see that healthy diet and unhealthy diet, wherever you sit on that scale, they're both independently related to mental health outcomes. So, if you are having lots

of healthy food, but also having lots of junk and processed foods, it's still going to be health outcomes. So, if you are having lots of healthy food, but also having lots of junk and processed foods, it's still going to be a problem. Similarly, lots of older people will not be going out and having Maccas and lots of junk and processed foods, but they'll be having a very limited kind of a white diet, whether at home or in a nursing home or what have you. And that's also problematic. So, they're not just the opposite of each other and we have to tackle both. Yeah, key, key points. Just taking a quick break in today's conversation to give a shout out to the sponsors of today's show. Athletic Greens continue their support of my podcast.

To be really clear, I absolutely prefer that people get all of their nutrition from foods. But for some of us, this is not always possible. Athletic Greens is one of the most nutrient-dense whole food supplements that I've come across and contains vitamins, minerals, prebiotics, and digestive enzymes. So if you are looking to take something each morning as an insurance policy to make sure that you are meeting your nutritional needs, I can highly recommend it. For listeners of this podcast, if you go to athleticgreens.com forward slash live more, you will be able to access a special offer where you get a free travel pack box containing 20 servings of Athletic Greens,

which is worth around £70 with your first order. You can check it out at athleticgreens.com forward slash live more in terms of the diet that your participants in the smiles trial um went on you mentioned what those foods are and you've also mentioned that we don't know what it was about it um in in my last book the stress solution there's a chapter on um you know fiber and how that, you know, with the gut microbiome and therefore stress levels. I quote some of your research. I quote some of John Kryan's research in there. What's really interesting for me is if we think about that diet, and I sort of, I think I wrote a paragraph on this. It said, for me, whilst we're waiting for more research, there are a couple of things there

which really spring out to me as it could be making a difference. You had fatty fish in there, I believe. There's fatty fish in the diet, was there? Yeah, fatty fish and lots and lots of olive oil as well. Yeah, so there was some omega-3s from the fatty fish. You've obviously got all the benefits of olive oil. So either of those independently,

you could make a case for thinking, was it that that did it? But then the big one for me, as well as that, was this whole point that you were encouraging a very diverse range of foods. And so let's talk a little bit about diversity of foods and let's talk a little bit about the gut microbiome and why that is so important. It's so critically important and it's so interesting. We can see that medical science has been transformed a little bit like how physics was transformed when they discovered the ultra small particles. This knowledge that these bacteria that have co-evolved with us have such an important

role in our health is really giving us some new insights that we can act on to, I think, improve a lot of health outcomes. on to, I think, improve a lot of health outcomes. So the bacteria in your gut in particular, very, very simply speaking, they break down the fibrous foods that our human enzymes can't break down. So fiber is found in plant foods, things such as vegetables, fruits, whole grain cereals, legumes, your nuts, your beans and lentils, et cetera. So all sorts of different types of plant foods have dietary fiber. The gut microbes break that down by a process of fermentation. And in that process of fermentation, they produce many, many, many metabolites. And it's the production of these metabolites that seems to be so important. And we know that they, for example, interact with every cell in the body through these

particular receptors. They influence gene activity. I mean, really importantly, most of what we know so far comes from animal studies. So, we always have to be a little bit cautious. But there are more and more human studies. And we're doing many studies in our center that is, you know, looking at this. That's the Food and Mood Center. The Food and Mood Centre.

The Food and Mood Centre, that's right. Absolutely love that name. Who came up with that? Well, it was a joint effort between myself and the comms department at Deakin. I think that's progress in itself. And in the 21st century, we actually have an institution called the Food and Mood Centre. I think that's progress. Well, it's unique in the world and it's focused on nutritional psychiatry research. And we've got more than 20 different projects underway at the moment,

many more in the planning stages. Trying to get funding for research, of course, is incredibly difficult, but we've had some traction with philanthropic funding, which has been great. But most of the studies that we're doing are looking at this diet, gut microbiome, mental health triangle, because we know that the gut microbiome is so important for our immune system, for our metabolism and body weight, for our brain health and right across the board. And we know this from a number of different sources of information. And there's huge amount of research that's being done across the world now in this field, which is wonderful because it means that we're getting advances in our knowledge very quickly. But at this point, what we know is that diet is the most important thing that affects the gut microbiota and that you can change your gut

microbiota and your gut health within a very short space of time, like even within days by changing your diet. And that's such a powerful thing to understand. So, do you have a certain recommendation you make for people in terms of diversity? Yeah. So, what we know so far, and again, we need more studies in humans, but on the basis of some pretty good evidence in humans, as well as many, many studies in animals, we know that obviously we need dietary fiber because the bugs can't do what they're supposed to do without the dietary fiber. And none of us are getting enough dietary fiber, not even close. In Australia, less than half a percent of children and adolescents get their recommended intake of vegetables and legumes. That's less than half a percent. So, this is not-

Less than half a percent? Yes. This is not just an issue for those of lower education or income. This is something across the board, less than 5% of adults in Australia. So, we're not getting enough dietary fiber. So, the bugs can't do what they're supposed to do. But polyphenols seem to be really important. These are the things that are in colorful fruits and vegetables and green tea and dark chocolate and things like that. And coffee. There's coffee lovers out there that can say polyphenols. Yeah, yeah. And really fascinating work, again, in animals, but showing that if you put one bunch

of rodents on a normal diet, they don't necessarily gain weight. But if you put another group on a high-fat diet, of course, they gain a lot of weight. But if you put a third group on a high-fat diet and then supplement it with polyphenols, they only put on about half as much weight. Yeah, you mitigate that. Yeah. So, incredibly interesting research. But then your healthy fats, your mono and your polyunsaturated fats in your quality proteins. But it might also be what you're not eating that's really important in your gut health. Again, from animal studies, we see that emulsifiers, which are ubiquitous in processed foods, seem to strip the gut lining.

We see that artificial sugars seem to have a negative impact on the gut. So it's very complex. We're really only just scratching the surface. But I think the key understanding is we already know what sort of diet is consistently linked to longevity. And that's a diet that is high in plant foods and high in a diversity of plant foods, because the more diverse your diet, the more diverse your gut microbiome, and that seems to be a marker of gut health. It's incredible. The Hadza tribe, as I'm sure you know about, there's this hunter-gatherer tribe in Tanzania whose lives are relatively untouched by modernity. I read that they have that they're exposed to

2 000 different plant foods in their lifetime i think they eat about 800 of them um and you compare that so i think about 60 of the world's food intake comes from three plants which is it's just remarkable to see and i believe that they have between 100 and 150 grams of fiber per day yeah per day and we're lucky to get 20 in the West. Yeah, we're lucky to get 20. And then your microbiome, you know, it sort of goes down the toilet, so to speak, because it can't do what it's supposed to do. And then you're losing microbial diversity. And we also see that this, you know, the large scale industrial food system and the changes to our global diets, not only is that, of course,

driving this massive increase in chronic disease, but also we're seeing a lot of autoimmune conditions and allergic illnesses. In Australia, where I am in Melbourne, it is the food allergy capital of the world, and it's certainly one of the asthma capitals as well. No one really understands why, but we think it's linked to the the asthma capitals as well. No one really understands why, but we think it's linked to the early life gut microbiome because based on what we know so far, the early life gut microbiota plays a really key role in the development of our immune system and also our brain development. Now, we've just finished a really important study in pregnant women at the Royal Children's Hospital looking at whether if you help women to change their diet during pregnancy, does it affect the infant microbiome?

Because we need to make sure that the infant microbiome is optimized, we think, to ensure that that child has a strong immune system and optimal brain development. a strong immune system and optimal brain development. Yeah, I mean, the implications of this are huge really because, you know, we saw stuff talking about the SMILES trial. So somebody who has got depression may start to get some benefits from changing their diet. That's incredible in itself. But taking that research on and thinking about what you just said, if early life is so important and if the diet of a pregnant lady is so important,

if we're trying to get to the roots of the roots of the roots of a problem, yes, it's great to be able to treat people who've got a problem, but wouldn't it be great if the research builds up where we know, actually, you know what when you're pregnant or or maybe when even pre-conceiving it's important then to focus on your health and your microbiome health the the implications in terms of the downstream effects could be profound that's right and i talk about that a lot in the book you do it's a really nice bit you know the the metabolic state so whether whether parents to be overweight or obese, whether they've got high blood glucose, all of those things seem to be very clearly linked to both cognition and other developmental outcomes in children. We led the first study looking at the role, the potential

role of mother's diets during pregnancy on children's emotional health. There's been many, many more studies since then showing that what mothers eat during pregnancy is linked to their children's emotional health, even when you take into account all sorts of other really important factors. And certainly if you look at the animal studies, you see that if you feed pregnant rats or mice or other non-human primates, those sorts of animals, a junk food, Western-type diet during their pregnancy, you see all sorts of impacts on the offspring that are relevant to mental health in humans. You see it in, you know, we talk about diets.

I wrote a chapter on touch when I was writing about stress and I was looking at this research that shows that pups who lick their offspring a lot when they're young, you modify their response to stress for the rest of their life. Because that sort of close contact with your parents at a young age, almost in many ways sets your stress responsiveness for the rest of your life. It's really quite incredible. But one thing, Felice, I think you do beautifully well in the book is you write with real compassion and when you talk about diets for pregnant women you also talk about wait a second let's not feel bad about this let's not put blame on people and I think it's really

important when we're talking about what a pregnant mother is eating because a lot of people will hear that and go oh no you know when I conceived I was having McDonald's every day and what impact has that had? And I think there's a, well, I'd love to explore what you think about that. It's not about making people feel bad about their choices, is it? No, that's right. And my jumping off point is always around public health and the fact that we need to make our environment supportive of healthful food choices. So in the West now, even if you go and fill up your car with petrol or anywhere you go, you are bombarded with opportunities and marketing to prompt you to consume these ultra-processed food products.

Now in the US, nearly 60% of energy intake is coming from ultra-processed food products. 60% of children alive today in the US will be obese, not just overweight, obese by the time they're 35, which is their prime child-rearing years. It's not quite as bad in the UK and Australia, but we're certainly getting there. And that's because the food environment supports really poor choices. We have very few limits on marketing,

so big food can market, you can market really with impunity. These foods are very, very cheap. They're very easy to produce. They've got a very long shelf life. They're highly palatable. I mean, we are designed to want those sorts of high-fat, high-sugar foods. And they're ubiquitous. They're just everywhere.

We can't escape them. So the food environment makes it very difficult to make healthful food choices. And I talk about this a lot in the book is that it's not about individuals. You know, yes, we want to empower people to make healthful choices in their life, but it shouldn't be that hard because the environment needs to support those healthful choices. I think you start off in the book talking about the Victorian times, don't you? And that's a nice example of this.

Well, it was such an interesting paper. I never heard of this before. No, no, it was a paper that I just came across and it was written by anthropologists and historians. And they talked about this incredibly brief period in the mid-1800s in Britain when the health of the population was exceptionally good. Such a good. So if people survived their first five years of life,

then they had a lifespan that's similar to what we have now, but their rates of degenerative disease were about 10% of what we have now. Now, the reasons for that were very clearly the environment. There were various political imperatives at the time that meant that governments were making sure that the population was getting access to the fresh food that was being grown in farms outside of the cities and brought in on trains. People were growing a lot of food themselves, so that they were having fruit trees or growing vegetables in their backyard.

They had chickens. People had a lot of access to seafood. They had chickens. People had a lot of access to seafood. There was a lot of, for a whole number of reasons, people had access to lots of fruits and vegetables, nuts. When people did eat meat, they ate all of the meat, all the organs and everything, but they didn't have that much meat. They, of course, had really unprocessed, unmilled bread.

And people were doing a lot of physical activity as part of their just, you know, working life. And at the time, people were exceptionally healthy and very, very strong on average. And then in about 1870, you started to see importation of canned meat with very high in salt and fat, canned fruit, very high in sugar, condensed milk, white bread and white flour, these sorts of things. And by the end of the century, the army had to lower its average height intake because people were actually stunted in growth. People couldn't eat meat and vegetables and nuts and things like that because their teeth were so bad because of all the sugar they were eating. And it just had such a remarkable impact on the health of the population on average in such a short time span in one generation. So, it just says this is

the food environment drives health or otherwise. It really does. It reminds me of a conversation I had with Dan Buetner on the podcast recently, who studied all the blue zones around the world, these little pockets of populations where they seem to live to a ripe old age and really good health.

And what he says is something that's been clear for it for a long time, which is that people in those areas, they're not trying to be healthy. They're just getting on with their lives. The environment just means that it's the easy choice. And then the only choice often is the healthy choice. Whereas we're living in an environment now where the easy choice is often the most unhelpful choice. And I'll give you an example. Literally last night, you met my cousin when you came in here today, who's staying with me for a couple of days. And we were driving back from a concert last night and I was chatting to him about

food and, you know, in his late twenties, working hard. He says he commutes, it's about a 10 minute drive from his office back to his apartment. And as he's driving back, if he finishes work at 7.30, he's obviously tired, probably stressed out from the day. And he says, on the way home, he passes so many junk food shops. He says one roundabout in particular, there's a strong smell of, I won't say what brand it is, but a very popular fast food chain from around the world. You can actually smell the food as you're driving through it. And it's almost as if he will have to fight temptation every single day. And you ain't going to fight temptation every single day. You are going to crack at some point. And then he also reports to me, this is just,

you know, we were chatting about it simply because I said, oh, he said, oh, I told him I'm interviewing you tomorrow. And he was interested. And he said, so in the interest of what I haven't had junk food for a while, I don't really crave it. But once I have it once, I kind of want it again later that week. Have you studied this at all? No, but it makes sense because we know that the high fat and high sugar foods interact with the reward systems in the brain, like any of the pleasurable activities, you know, whether smoking, drinking, gambling, you know, drugs, all these sorts of things interact with that reward system in the brain and basically train the brain to perform actions

that give that dopamine hit. And food is just another one of those sorts of drivers of the dopaminergic or the reward system in the brain. Yeah, it's incredible. So having that sort of food everywhere and the smells and the cues to consume it, it's almost impossible to not consume it. So, we have to change the environment. Do you get tempted? You know, you obviously,

this is your field, you know, I'm sure you practice what you preach as far as possible, you're human like the rest of us. Do you like, you know, you're traveling, you've got jet lag, you're sleep deprived, you're at train stations today, you're at airports. Do you find that when your defenses are down and you're traveling that you get, you're at airports. Do you find that when your defences are down and you're travelling that you get tempted to go down an unhelpful route? Look, I'm by no means a purist and I think it's actually really bad for your mental health to be really hung up on the details and being perfect with all your food choices. I go by the 80-20 rule. And certainly, if 80% of my food choices are good, that's going to put me way above the rest of the population

based on what we know about how poorly people are eating. You know, I had popcorn on the way up today because I'm really, really jet lagged but I also had a big vegetable soup that I got at the station and, you know, I find that you can make healthy choices nowadays which is great because even 10 years ago, there were no healthy choices from takeaway. But now you've got Mexican, you've got Japanese, you often can buy really nice soups,

you can get kombucha to drink in the takeaway. So, things are certainly improving. Sure. My recommendation is just try and avoid the ultra processed foods and have as much diversity of whole foods as you can. And so, what we call a plant-predominant diet, I do really worry about the low-carb and the high-fat diets. As I said, we're about to start- For longevity or for- because in the short term, people are getting good results on them with things like their blood sugar and certainly weight loss for sure. And some are reporting improved cognition in the short term.

So is your worry long-term or expand on that? It's long-term. So what we see from all of the evidence is that long-term diets that are higher in complex carbohydrates and lower in animal protein and fat are linked to longevity. But in the short-term diets that are lower in carbohydrates and higher in animal protein and fat are linked to leaner body weight and more reproductive success. I do want to touch on whole grains because whole grains have become quite a controversial area in the diet wars.

And I think that's because often what we consider to be whole grains are not whole grains. often what we consider to be whole grains are not whole grains. So, I think it's quite clear that there's pretty good research suggesting that real whole grains can have beneficial impacts on your gut microbiome and consequently on your overall health, including your moods. What do you see the problem with whole grains? Is it that interpretation? Is it that the food industry are marketing refined grains as whole grains? Yes, basically, yes. And I think, you know, people in the US where their food system is just so broken and has been for decades to the point where nobody alive today in the US remembers what normal food looks like. I mean, it really is.

It's a rarity. And for them, whole grain might be a brown bread that's still highly refined and full of all sorts of things. But if you look at certainly the epidemiological data, whole grain intake is out of all of the food groups, the most strongly associated with improved health outcomes. If you look at the gut and what we know so far, whole grains, and here we're talking about things like oats and barley and frica and spelt and buckwheat and brown rice. So things that are true whole grains are just a really valuable source of fiber for that fermentation process of the gut, but they're also anti-inflammatory. And they also help with satiety. They help you to feel full. Now, in Korea, they have these multi-stage meals, you know,

and you start off with and you have about 10 dishes or, you know, however many depending on the meal. But you start off with salads and then you move on to seafood and then maybe a little bit of meat and then right at the end you'll have a small pot of mixed rice, you know, wild rice and black rice and that sort of thing, right at the end, just to aid with satiety. And that's probably how we should be eating, with small amounts, but lots of diversity of grains. And for me, what I would just say is that people, half of their plate should be vegetables and salads. A quarter should be a

form of a whole grain. A quarter should be a form of a whole grain. A quarter should be a form of good quality protein and then topped off with some healthy oil in the form of olive oil. So it can be really simple like that. That's really good, simple advice. I mean, one thing I've seen clinically, and you see a lot of these case reports online, but I have seen it in people who've read them and have cut out all grains and they actually do feel better in the short term sometimes and i often wonder why that is is it because then i also look at the data showing that whole grains are really great for longevity and the health of the gut microbiome and sort of my hypothesis at the moment is that um many of us have got disrupted gut microbiomes

uh you know because of the way we're living our lives because of our diets because of our stress levels the fact that we're sleep deprived all these things that influence the gut microbiome and i think many of the patients who come to see me with who are not feeling well have already got a disrupted gut microbiome so sometimes when they eliminate certain foods in the short term actually because you could eliminate grains and eliminate a lot of the process stuff as well and so you start to feel great. And it doesn't necessarily mean that that needs to be the long-term approach. And I think this is a key thing that I'm going to explore more in the future is the difference between a short-term approach versus what is an optimal long-term approach. And I guess FODMAPs might be part of

the story there. That's right. One of my postdocs is one of the world experts on FODMAP, FODMAPs and low FODMAP diets and the impact on the microbiome. And what we know about FODMAPs is that they are a primary source of fermentation for the gut microbiota. In other words, they're probably the best gut food, gut bug food that you can feed it. But as you say, if you've got a gut that is not a healthy gut because of a long-term Western diet and stress and all of those other things, then you're going to have problems digesting those sorts of foods because your gut bugs aren't optimized to actually deal with them. And then a short-term solution is the low FODMAP diet, but it's never intended to be a long-term thing. It should only ever be

a short-term and then people can gradually reintroduce the FODMAP foods, but preferably do it, I would say, with fermented foods and maybe some probiotics. I know that there's a lot of work going into looking at whether supplementing with probiotics and or fermented foods on reintroduction helps the bacteria to adapt so that people can tolerate those foods more. But I do agree that a lot of people in the West, because our diets are so low in fiber and so low in diversity, they react poorly to whole grains, often to legumes and the foods that provide the substrate for the gut bacteria because their guts are just not able to deal with them. Yeah, absolutely. I think it goes back to this whole lack of training in

healthcare professionals on nutrition means that a lot of people go to their doctors, they feel very frustrated that they're not being offered decent solutions that make sense to them. So they're reading things online, they're trying them, feeling good in the short term, but then continuing that long term without any support. And yes again i'm not criticizing i totally get it one of the reasons why i like to do these podcasts every week is to talk to world leading experts like yourself and really just tease out you know practical experience research evidence where we're at just so people can start thinking because i think the more we can empower people you know i think the better able they are to make healthy choices but i also recognize ultimately it's the food environments that will make the biggest change um please look i could

talk to you about for hours on this topic but um i think we should start wrapping it up bring it to a close um first of all I want to say thank you because the SMILES trial that you did, literally I think will go down as being one of the most game-changing trials in terms of research on diet and mental health because it was a randomized controlled trial and the results were so stark.

So thank you for persevering and going through all the hard work and potential risk of actually falling flat on your face to go through it. No, so genuinely, I think it's incredible and it's helping to give real weight globally to the notion that our diet can improve our mood and our mental health. Where do you see this field developing over the next few years? What's next, do you think? At the Food and Mood Centre, as I mentioned, we're doing a lot of research to try and plug

some of the gaps. We want to see whether what we know about the link between nutrition and mental health is true in other disorders outside of depression and come up with more prevention and treatment strategies. Getting to this point where we can understand what works for whom under what circumstances, I think is really important. And the gut microbiota is the roadmap by which we'll get there, I think, these personalized recommendations for diet, but also medication use. But really, my focus now is on getting clinical practice changed. And so I've joined with a number of the strongest researchers in the world doing exercise mental health research and us doing the nutrition mental health research to push for this lifestyle psychiatry this idea of lifestyle medicine as a

fundamental principle and jumping off point in psychiatry not instead of other treatments but as the basis to support those treatments the bad rock upon which everything else goes yeah and we think that not only will it have enormous benefits for individuals, but it will have enormous benefits for the public purse because of the costs associated with mental disorders, particularly depression. Please do tell the listeners about this conference that you're sort of hosting in London later this year. So in 2013, I set up the International Society for Nutritional Psychiatry Research, and that was done to try and get more people researching in this area. And that now has more than 400 members from across the world. And we're having our second major international conference in October between the 20th and

the 22nd in London. And it's got some amazing speakers. It's going to be a really great conference. Healthcare professionals, this is for? Yeah, healthcare professionals, scientists, policymakers. Is there an event for the public as well? On the Sunday, the opening day, myself and Kimberly Wilson, who does the Food and Psych podcast,

is a previous winner of the Great British Bake Off. She's a psychologist. She and I will open the conference with a session that is open to the public. So, yeah, I think that's going to be really exciting. For those of you listening, guys, everything that Felice and I have spoken about today are going to be on the show notes page to this episode of the podcast, which is going to be drchastity.com forward slash brain changer. Brain change is the name of your fabulous new book. So I'll definitely encourage everyone who's interested to get it. It's so

full of actionable information. It's a really good read as well. I think it's very fun reads. So I think people should get that. But I'm also going to link to that conference. So if you are interested, you can go on to chastity.com forward slash brain changer and actually see some of the studies we talked about. I'm going to link to all of those. I'm also going to link to that conference so you can buy some tickets if you want to attend for sure. Felice, final question. This podcast is called Feel Better, Live More. And the reason is, it's pretty straightforward. I genuinely believe whether it was all about mental health, whether it's about anything, when we feel better in ourselves, we get more out of our lives. And so I always love to leave the listener with some top tips tips that they can think about

straight away and think oh god you know I think I could apply that into my own life immediately to change the way that I feel so I wonder if you could share you probably covered a lot of them already but just at the end here just to inspire the listeners what are Professor Felice Jacker's top tips what you eat really does matter to your mental and brain health in the short term as well as the long term. So pay attention to it, you know, and it doesn't need to be expensive or fussy or difficult. It can just be really basic peasant food, you know, cooked up without much in the way of complex recipes. It really does help. And getting regular exercise. If I don't exercise, I don't sleep

properly and everything falls apart. So, finding something that you really like doing, whether it's just big walks in the park or resistance training or whatever it is, just try and move because that has such a flow-on benefit to everything else. Fantastic. Thank you for that. Felicia, if people want to touch base with you on social media, what are your channels that you're active on? I'm primarily on Twitter. I've just started using Instagram, but I don't use it all that much. We do have a Food and Mood Centre Facebook page and that's probably the main. Yeah, fantastic. And again, we'll link to all of those when we post about the podcast. I'll make sure all those pages are tagged so people can access you and ask you questions on social media if they want to felice i hope the jet lag gets

better soon thank you for your time i can't wait to do this at some point in the future when you know that we'll have new research to share thanks very much and um yeah happy travels thank you so much it's been a great pleasure that concludes today's episode of the feel better live more podcast i really hope you enjoyed that conversation with someone who is arguably one of the world's leading researchers in the field of nutrition and mental health as always do let felice and i know what you thought of today's show has it inspired you to make some changes in your diet? Have you already made some changes in your diet and noticed a change in your mental health? Please do let us know on social media using the hashtag FBLM as much as you can so that I can easily find your comments. Felice and I talked about the need to advance medical education in the field of lifestyle medicine.

That is exactly why I co-created my prescribing lifestyle medicine course with some colleagues. It is fully accredited by the Royal College of GPs. And we actually discuss a lot of Felice's research in the course. The next one is in January, 2020 in London. You can check out all the details at www.prescribinglifestylemedicine.org. This course is open to all doctors, pharmacists, nurses, and we've even had a few physios come on the course as well. That link, as well as everything Felice and I discussed in the show today, is available at the show notes page for this episode, which is drchastity.com forward slash brain changer. So if you want to continue your learning experience now that the podcast is over,

do check it out. A lot of the dietary principles that Felice and I discussed today are very, very similar to the principles I outlined in my very first book, The Four Pillar Plan, which was also released in the USA and Canada with a different title, How to Make Disease Disappear. If you want guidance on the key principles of healthy eating patterns, as well as tips on actually introducing them into your life, I would recommend that you take a look. You can order it now in paperback, ebook, or as an audiobook that I am narrating. Of course stress is another key driver of mental health problems and pretty much all of us these days have more stress in our lives than

we used to. This can have serious consequences on our physical and our mental health and in my latest book The Stress Solution I help you identify where stress lives in your life but most importantly I give you simple, actionable tips to help you reduce it so that you can feel happier and calmer. If you feel that this may help you, I'd encourage you to pick up a copy. It's available in all the usual places, again, in paperback, ebook, or as an audio book, which I actually narrate. Don't forget, if you are looking for somewhere to discuss the podcast each week with other like-minded listeners, I have started my own closed Facebook community. It is called

Dr. Chatterjee Fort Pillock Community Tribe. There is a really great supportive community on there that is helping people to improve their lives. People are sharing their own stories as well as their own tips that they have found useful. It really is a great place to go to get some inspiration and motivation. And in just over six weeks, we already have about 4,000 members. Please do get involved. Just head over to Facebook to get involved. As I mentioned last week, I'm trying to video as many of these podcasts as possible. If you want to watch this conversation in video,

or if you want to share it with someone close to you who you think may prefer video interviews to audio ones, please do let them know. I'm really, really keen that we get this information out to as many people as possible. My YouTube page is available at drchatterjee.com forward slash YouTube. If you enjoy my weekly shows, please do consider supporting them by leaving a review on Apple Podcasts.

Whichever platform you listen to podcasts on, you can also help me spread the word by taking a screenshot right now and sharing with your friends and family on your social media channels. Or you can do it the good old fashioned way and simply tell your friends about the show. Either way, I very much appreciate your support. A big thank you to Richard Hughes for editing and

Vedanta Chastity for producing this week's podcast. That is it for today. I hope you have a fabulous week. Make sure you are pressed subscribe, and I'll be back in one week's time with my latest episodes. Remember, you are the architect of your own health. Making lifestyle changes always worth it because when you feel better, you live more. I'll see you next time. Thank you.