Feel Better, Live More with Dr Rangan Chatterjee - How To Use Food To Improve Your Mood, Overcome Anxiety and Protect Your Memory with Dr Georgia Ede #464

Episode Date: June 25, 2024

Over one billion people worldwide have some type of mental health diagnosis - a statistic that suggests the current approach to treating these conditions may not be enough. For those struggling, perhaps despite their medication, it can feel easy to lose hope of feeling well again.  In this conversation, I speak to someone who has been a psychiatrist for more than 25 years and who for many years, felt that her impact on patients was limited until she learned about the incredible healing power of food.    Dr Georgia Ede is a Harvard trained, board certified psychiatrist specialising in nutritional and metabolic psychiatry. Her 25 years of clinical experience includes 12 years at Smith College and Harvard University Health Services, where she was the first person to offer students nutrition-based approaches as an alternative to psychiatric medication.   She co-authored the first inpatient study of the ketogenic diet for treatment-resistant mental illness and is the author of the wonderful new book Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety and Protect Memory for a Lifetime of Optimal Mental Health.   Georgia explains that, almost unknowingly, many of us have been feeding our brains improperly for our entire lives. We explore what she considers to be the five foods that have the most potential to be problematic for our brain health and how quickly we can start to feel the benefits if we are able to cut back on them. This highlights a key point that both Georgia and I are extremely passionate about - that, for most of us, in the modern day food environment, what we cut out of our diet is more important than what we put in.   We talk about the relationship between blood glucose and brain glucose. Georgia outlines the whole foods that Georgia believes can be problematic, especially if we are having problems with our mood or have a mental health diagnosis. We also discuss why Georgia believes that the Mediterranean diet - whilst better than the Standard Western Diet is not optimal, and we cover Georgia’s clinical research about the potential benefits of ketogenic diets in treating mental health.   Georgia is a wonderful physician who cares deeply about her patients and is helping many of them gain relief and sometimes remission from long standing mental health problems. That being said, there is no question that some of her recommendations may at first glance appear to controversial.    Throughout the conversation, I have tried my best to provide clarity and make sure that you clearly understand why Georgia is recommending the changes that she is. But, as you are listening, please do remember, that there is no one dietary approach that is going to work for everyone, at every stage in their life. Buy tickets for my stage tour https://drchatterjee.com/tour. Thanks to our sponsors: https://drinkag1.com/livemore https://calm.com/livemore Show notes https://drchatterjee.com/464 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

If you want real, noticeable, meaningful change in your mental health, in your physical health, you have to make real, meaningful changes to your diet. You can't just sprinkle superfoods on top or nibble at it around the edges by taking some of the sugary things out. You have to fundamentally restructure your diet from the ground up in ways that make biological sense. And there's not the dietary patterns that most people hear about. Hey guys, how you doing? Hope you're having a good week so far. My name is Dr.

Rangan Chatterjee, and this is my podcast, Feel Better, Live More. More and more people are becoming aware that what they eat has a profound impact on their brain health and their moods. But do you know exactly what foods you should be trying to avoid and what foods you should try and include? Or are you getting increasingly confused with the tsunami of dietary information out there and the conflicting advice from experts? out there and the conflicting advice from experts. One of the reasons I believe that there is so much confusion about food is because of the widely held belief that there is one perfect human diet that will work well for everyone. But as you may have heard me say before, or you might have read in one of my five books, I simply do not believe that to be the case. However, I do think that there are some core dietary principles that hold true for everyone, the most important one being that we should aim

as much as possible to cut out ultra-processed foods and introduce as many whole foods as we can. But once we get to that place, I have seen that there are a variety of different approaches that can work. In fact, the most appropriate diet for you will also depend on your goals, your age, and your current state of health. Now, in today's conversation, I speak to someone who has been a psychiatrist for more than 25 years and who for many years felt that her impact on patients was limited until she learned about the incredible healing power of food. Dr. Georgia Ede is a Harvard-trained, board-certified psychiatrist specializing in nutritional and metabolic psychiatry. Her 25 years of clinical experience include 12 years at Smith College and Harvard University Health

Services, where she was the first person to offer students nutrition-based approaches as an alternative to psychiatric medication. She also co-authored the first inpatient study of the ketogenic diet for treatment-resistant mental illness, and is the author of the wonderful new book, Change Your Diet, Change Your Mind, a powerful plan to improve moods, overcome anxiety, and protect memory for a lifetime of optimal mental health. In our fascinating conversation, Georgia explains that almost unknowingly, many of us have been feeding our brains improperly for our entire lives. She also explains what she considers to be the five foods that have the most potential to be problematic for our brain health, and how quickly we can start to feel the benefits

if we're able to cut back on them. And this highlights a key point that both Georgia and I are extremely passionate about, but one that is probably not spoken about enough. That for most of us in the modern day food environment, what we cut out of our diet is more important than what we put in. We also talk about the relationship between blood glucose and brain glucose, the whole foods that Georgia believes can be problematic, especially if we are having problems with our moods or have an actual mental health diagnosis. We discuss why Georgia believes that the Mediterranean diet, whilst better than the standard Western diet, is not optimal. And we also cover Georgia's clinical research about the potential benefits of ketogenic diets

in treating mental health problems, something I had previously discussed with another Harvard psychiatrist, Dr. Chris Palmer, back on episode 396 of this podcast. Georgia is clearly a wonderful physician who cares deeply about her patients and is helping many of them gain relief and sometimes remission from long-standing mental health problems. That being said, there is no question that some of her recommendations may at first glance appear to be unorthodox and dare I say it controversial. Throughout the conversation, I have tried my best to provide clarity and make sure that you clearly understand why Georgia is recommending the changes that she is. But as you are listening, please do remember

that there is no one dietary approach that is going to work for everyone at every stage in their life. I wanted to start off with something potentially provocative in the introduction of your new book for many people, which is this. You write, most of us have been feeding our brains improperly our entire lives. Therefore, we have no idea how much better we can feel and how much more we can expect of ourselves if we eat right. This is true. I mean, it's really because we've been fed the wrong information about what a brain healthy diet should look like for really generations. And so if you give the brain what it needs, it actually, you can expect a lot more from it. Yeah. What is it that the brain needs that we're not giving it? Well, you know, we've been told for a really long time that the way to

protect the brain from damage and to nourish it is by adding special things to our diet, brain superfoods, supplements, nutraceuticals, things like that. And really what's missing in that message is that what the brain actually needs is no different from what the rest of the body actually needs. It needs nutrients. It needs all essential nutrients. So you need to nourish the brain. You need to protect the brain from damaging ingredients. Really protection of the brain is not about adding special things to the diet or special foods to the diet. It's about subtracting things from the diet

that are damaging the brain. And then the brain needs to be energized properly with the right types of fuel. If you give the brain what it needs, the right nutrients, and you remove the things that can damage the brain from the diet, and you energize it properly and you understand how to energize it needs, the right nutrients, and you remove the things that can damage the brain from the diet, and you energize it properly and understand how to energize it properly. And then

you stand out of the way, the brain will, evolutionary biology will do the rest. And you can just trust, you can trust your body and your brain to work properly if you give them what they need and nothing more. Yeah. It's fascinating. What's interesting to me as I read through your work, Georgia, is that you've been a psychiatrist now for several decades. 25 years. And in your new book, you describe yourself as an accidental nutritionist. It's quite an interesting term, that. accidental nutritionist. It's quite an interesting term, that.

Well, you know, four years of college, four years of medical school, four years of residency, we didn't talk about food in the brain once in all of that time. And really, nutrition in general, four years of medical school, we had maybe two or three hours worth of nutrition, education, and most of what we learned was incorrect. So I really never thought about the connection between food and the brain. It really didn't cross my mind. And so I practiced for 10 years without understanding how important it is to feed the brain properly if you want to have good mental health. And it really wasn't, and I know a lot of us have a similar story, and a lot of us physicians who accidentally stumble into nutrition, we have to accidentally

stumble into it and research it ourselves because we're not taught about nutrition and how fundamentally important it is. So it was through my own health challenges that I started instinctively experimenting with my diet to try to figure out if I could help myself because conventional medicine wasn't able to help me with some of the things I was coming up against. And when I started diving into nutrition, not only did I discover relatively quickly that most of what we're led to believe about nutrition is wrong, I also fell in love with nutrition science and food is fascinating and brain metabolism is fascinating and complex and interesting. You know, when I went to medical school, I sort of thought of nutrition as less than, you know, it's really kind of beneath the

doctor, physicians, really the hallmark of a real doctor is prescribing medications and doing procedures. But understanding how the body and brain work, it's just absolutely fascinating. And so one of the things I tried to do in the book was share some of that fascination, some of those really interesting pathways and how foods work in the body and what's inside food and all of that, all of that, those pieces of information that I fell in love with when I started studying nutrition, I try to share some of that with readers as well. Yeah, I think you've done a fantastic job in your book. And as I just mentioned to you in my kitchen, one of the things I love about your work and your book is that there's a real compassionate tone

behind everything you are writing about, everything you were talking about. And to me, it really speaks to an idea that I'm so passionate about. You are a real life clinician, okay? You see patients who are struggling. You knew that the tools that you had available to you in the past were suboptimal to say the least, right? And so you've had to figure out other ways of helping your patients if you're truly going to help them in the way that you want to as a doctor. And I find sometimes a lot of the commentary around health is often done from people sitting on the sidelines. In theory, we think this is the way you should do things. Sure, look at the science, see what it says. But unless you are someone who actually

sees patients, I think you're missing out on what it's truly like when you're one-on-one with a patient, they've been struggling for years, you can see the pain in their eyes, and you have to figure out, how can I help this person? And that's why I love your book so much, is because it's written, I think, from that mindset, from that perspective, that there are lots of people who are struggling with suboptimal brain health. I mean, you mentioned at the start in your introduction, over 1 billion people around the world have a mental health diagnosis. And at the end of that session, you write that psychiatric problems of all kinds are becoming so commonplace that we're beginning to think of poor mental health as normal and

inevitable. What's going on, Georgia? You know, I really, it's heartbreaking, right? So it's heartbreaking on a grand scale to think that, you know, our public mental health is deteriorating. But it's heartbreaking on a, as you said, as a clinician, you're dealing with one person at a time, hearing their story, feeling their suffering. And in so many cases, really the reason I wrote the book is because changing your diet can be a powerful mental health intervention. It can help people in ways no medicine can, but you have to know which changes, which dietary changes are the right ones to make or the ones that are worth making. And they're not the ones we're used to hearing about. So it's heartbreaking for me to hear people say, well, you know, I've already tried. So I've tried changing my diet. I've tried, you know, I've tried a Mediterranean diet, or I've tried eating more superfoods, or I've cut

out sugar, or whatever it is they've tried to do. They think that they've tried everything already. And they've tried sometimes 12, 13, 14, 15 medications. They've been in and out of the hospital. You know, they've tried psychotherapy for years and nothing's worked. And so people lose hope. And the thing that I think is so important for people to know is that they haven't tried everything yet. Because the dietary strategies that really make the most biological sense and have the most metabolic and biochemical power are not the ones we're used to hearing about. The interventions that we're talking about, they can help people feel better in days to weeks.

Even people with very serious chronic, so-called chronic, so-called treatment resistant mental illnesses. And so that's why I think it's so important to share this information because it is different, but we need a different strategy. You were saying, you know, how hard it is to be a clinician and, you know, be listening to people who are suffering and telling their stories that years or sometimes decades of pain, emotional pain, you know, it's really difficult to hear those kinds of stories. And, you know, really as a doctor, I was watching like all of my colleagues, my practice was filling up with people who just weren't getting that much better,

no matter what I did, no matter how many medicines I tried or how much psychotherapy I offered support. And I just, I had kind of run out of ideas for some of my patients. And I think if we're really being honest with each other, especially in psychiatry, I mean, lots of fields in medicine, but especially in psychiatry, the tools we have at our disposal in traditional psychiatry the tools we have at our disposal in traditional psychiatry are really limited yeah we're going to get into all the dietary strategies that you recommend those that you have seen work with people with quite intractable mental health problems as well okay before we get into that, I'd love you to outline

what you think are the most harmful foods in the modern food environment that are causing so much damage. Yeah, you know, when people say, you know, what are the foods that are most worth avoiding? I think it's probably no surprise to, especially to your listeners, because you've really done a wonderful job of educating the public about this. Of course, the refined carbohydrates, sugars, flours, cereal products, high amounts of fruit juice, that sort of thing. These sort of naked carbohydrates. Vegetable oils, which are factory fats, refined fats from seeds, things like soybean oil and cottonseed oil and grapeseed oil and canola oil. And so those are really the two signature

ingredients of the so-called standard American diet, which we've now exported around the world, or we'll call it the sad diet. Those are the signature ingredients of the sad diet that make it so damaging. But then there's also alcohol, which we often don't talk a lot about, but which is just as damaging as those ingredients. And then there are a couple of whole foods, which I think are really worth people avoiding if they can.

And this may come as a surprise to a lot of people, but they are the grains and the legumes. And I explain why in the book, why these foods are more risk than benefit. And so I would say those five things, if people remove those five things from the diet or avoided them as much as they can, I think they would be really doing themselves a great service. So let's go into these foods, right? Let's start with the most widely accepted, and then let's start moving towards the ones which perhaps are a bit more controversial. Okay. Refined carbohydrates. That's one category you mentioned that you would like us to think about cutting out. Why? Because refined carbohydrates are essentially naked carbohydrates.

They turn instantly into glucose in the bloodstream. So when you eat a piece of fruit or a starchy vegetable that contains carbohydrate, it's not a naked carbohydrate. That carbohydrate exists in a fiber matrix. It's got water. It's got nutrients. It digests more slowly, but you actually have to digest that food. And so it causes a sort of more natural rise in blood sugar that you're evolutionarily designed to handle. When you take in pre-processed carbohydrates, I mean, we're supposed to process

these carbohydrates ourselves. But if you eat a processed carbohydrate or a refined carbohydrate, a sugar, a syrup, a crystal, a liquid, a powder, these are naked carbohydrates like flours and sugars. These turn instantly into glucose in the bloodstream. It's so fast because they don't need to be digested. They're pre-digested for you. You get an unnatural, steep spike in glucose, kind of a tsunami of glucose molecules coming

into the bloodstream that were just not evolutionarily designed to handle. And then every time you get one of these spikes in glucose, it's a spike to an unnaturally high level. You also get a spike of insulin to follow. So, first of all, high blood sugar, even if it's just a brief spike after a meal, that's toxic. Glucose is really important and, and we need blood sugar. Lots of cells burn glucose. Glucose is not bad. Carbohydrates are not bad.

Cells need them. But you'd have too much of a good thing. So when there's too much glucose in the bloodstream, that extra glucose literally sticks. It sticks to proteins and DNA and fats and all kinds of important molecules in your bloodstream. So for example, and does damage. That doesn't sound good, does it? I don't want people to really hear what you said there, which is this excess glucose sticks to all these important molecules and substances in your body. Yes. It's not a good thing.

No, we become essentially caramelized from the inside out, right? So when this extra glucose sticks to these important cell components, it kind of cripples and disfigures those molecules into what are called advanced glycation end products or AGEs. And AGEs is a great acronym for them because they are one of the main drivers

of premature aging of various tissues in the body, including the brain. The other thing that the glucose spike will do is it's going to trigger an insulin spike. And the insulin spike is going to turn off fat burning. When your insulin levels are too high, you cannot burn fat. So your body doesn't even know it's there to be burned for energy. So when your insulin levels are running, if you're eating too many of the wrong carbohydrates too often, your glucose levels are going to run too high. Therefore, your insulin levels, which are, insulin is a hormone that does many, many things. But one of the things it does is it helps cope with and process all of that glucose, the incoming glucose molecules. When insulin is high, fat burning turns off.

And so you cannot burn fat. You could have hundreds of pounds of fat on your body, which is essentially just stored energy. You could have hundreds of pounds of body in your fat and not be able to lose it because your insulin levels are running too high. And the other thing is that whenever you get this glucose spike, high glucose, when glucose levels are running too high, neurons slow down. They don't fire as quickly. Your brain and your nervous system is more sluggish. You can't think as quickly. You might experience brain fog. You might feel depressed.

You might not have good energy, mental clarity, or mental stamina. And so everything is kind of taking a hit. You know, people with type 2 diabetes, that's a disease of chronically high blood sugar levels. That's kind of your later stage, which can happen for a lot of people. We all know very well that people type two diabetes, which is a blood sugar disease. It damages every organ system in the body, you know, to the point that people lose limbs. People have to go on dialysis, you know, and, and people have heart attacks and strokes. And people have heart attacks and strokes. They go blind.

They go blind. So it damages from head to toe. And so, again, that doesn't happen overnight. So keeping your glucose levels in a healthy range is one of the fundamental principles of good metabolic and good physical and good mental health is just paying attention to your glucose levels, which we can now measure at home ourselves if we wish. Yeah, there's so much there. This idea of a sluggish nervous system, this idea that when your blood glucose is running high, which frankly is most of the population these days in many countries particularly the uk and the us certainly for sure i thought that was interesting let me explain why it is that the neurons fire

more slowly these nerve cells fire more slowly because again trying to make this relevant to everyone well sure 1 billion people around the world have a mental health diagnosis of some sort, right? Well, that means 6 or 7 billion people don't. But it doesn't mean those 6 or 7 billion people are in fantastic health. Many people have irritability, brain fog, sluggishness, inability to focus, right? And you're directly saying that some of that may be due to high blood glucose level. So what happens when we have high blood glucose? How does that affect our nerve cells in our brain? Yeah, so every time you get a blood sugar spike in your general circulation, every time your blood sugar spikes, your brain sugar will also spike. So they rise and fall together. So something really interesting about brain

metabolism is that, yes, the brain needs some glucose at all times. And so the brain doesn't really filter. It doesn't really put up any barriers to allowing glucose inside. It really needs the glucose to come in. But it doesn't allow all of it in. So what it does is it keeps your brain glucose about 80% lower than your blood glucose. So they rise and fall together. They're not identical. They're not the same. It's supposed to be.

The brain glucose is supposed to be much lower. But it doesn't have an ability to put a cap on it. So if your blood glucose is too high, your brain glucose will also be too high. They rise and fall together. The higher the blood sugar, the higher the brain sugar. And when you've got too much glucose in the brain, not only will that glucose stick

to all kinds of important things inside the brain, but when you get these advanced glycation end products or these AGEs, these caramelized clusters piling up inside your brain, those can cause a lot of problems with brain cell signaling. They can really kind of gum up the works. But the brain has an immune system that's always kind of on surveillance and patrolling the area and looking for problems. And when it sees these caramelized clusters. It mounts on purpose an immune response. It deliberately creates, it releases inflammatory cytokines

to deliberately create inflammation and oxygen-free radicals to deliberately create oxidative stress. These are normal, healthy reactions to any kind of threat inside the brain or body. It's like the immune system's first responder system. So now, this is sound the alarm and clear away these clusters. But then there's supposed to be a healing phase that takes place that returns the neighborhood to peaceful serenity and all is well

again. But most people, if they're eating sort of the sad diet, the way most people eat, they're getting these glucose spikes inside the brain three, four, five, six times a day. So this process of inflammation and oxidative stress, which we now know are some of the main drivers of mental health conditions of all kinds and physical as well. Instead of this temporary targeted, controlled, healthy inflammatory response and oxidative stress response, you have now chronic uncontrolled inflammation and oxidative stress inside the brain. And when you've got too much inflammation and oxidative stress inside the brain. And when you've got too much inflammation and oxidative stress inside the brain, the brain is kind of in this crisis state all the time.

And that can destabilize your neurotransmitter systems. It destabilizes your hormone systems. And it causes physical damage to everything inside the brain, including the brain's learning and memory center, the hippocampus, the blood-brain barrier, which is supposed to protect your brain from risky molecules that might be in the general circulation.

And as dire as that sounds, it's very easy to turn this around by simply protecting yourself from these ingredients by removing them from your diet. Yeah. I mean, when you put it like that, it really makes you stop and reflect a minute. And I think it also highlights, I think one of the major issues around talking about food these days, Georgia, I'd be very interested in your perspective on this. But if we think about how we have eaten for most of our evolution, it is so different to how we eat today. So when people even suggest going 10, 15% back towards how we have always eaten,

percent back towards how we have always eaten, it sounds extreme. But it only sounds extreme relative to the norm of today. And the norm of today is that much of the population is sick and is functioning suboptimally. So I think this is one of the challenges when it comes to talking about food these days. Because many people with their busy lives, they're rushing around, you know, families, everyone's working and struggling to make ends meet. And they always feel they've got too many things to do. Then it can sound as though, oh, wow, now I need to overhaul my diet as well. And it can feel really difficult for people, but it's just our evolutionary norm. Right.

And I think that point doesn't get highlighted enough. It's such a great point because the diet we think of as normal is anything but. And the diet that those of us who have thought a lot about this and studied this for ourselves, physicians who have studied this ourselves, we can see how, we understand how we're supposed to eat and how most of us eat, how

different that is. And so we're facing a lot of obstacles here. And so one is the kind of toxic food environment that we live in. So we're surrounded by things that were never designed to handle, but we're also dealing with, you know, these ultra processed foods, which are designed to be addictive and irresistible. And they're convenient and they're everywhere. They're cheap for whatever reason. And so it's really an uphill battle for people. It's difficult.

Not only are we raised on these processed foods, but they're really hard to stop eating. So I know what this is like myself. So, I mean, I have a lot of compassion for people in situation, but I also want to say that there's a lot of hope here because if you, it doesn't take long, it doesn't take long to experiment with your diet and see real results. If you know which changes to make, like you were saying before, you can feel better really quickly. And that is going to be your motivation. Most people are, they've made the types of changes to their diet that they don't really help that much. And, you know, I remember seeing you on TV going into people's kitchens and pantries and just taking out the bad things.

Yeah. Just take out the bad ingredients. There's so much power in subtraction. We want, I know, as human beings, we believe in the power of addition. It's really appealing to think that all you need to do to improve your health is sprinkle some superfoods on top of your diet. Eat more dark chocolate, drink more red wine, whatever it is that appeals to you as a message. I mean, or even just more superfoods, right? So more colorful plant foods. That's, first of all, it's easy to do. And it feels positive and proactive and empowering. But those strategies don't work. There's absolutely no evidence that those strategies

work. The powers in subtraction, taking away the foods that are causing the inflammation and oxidative stress and insulin resistance in the first place, and that are destabilizing your hormone patterns and destabilizing your neurotransmitters and your brain chemistry in the first place. When you take those things, it's kind of a first do no harm strategy. Yeah, this is a really interesting point, Georgia. Okay, so let's really bring it to life. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show.

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forward slash live more. 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 that makes it really easy to fit into your life, no matter how busy

you feel. It's also really, really tasty. The scientific team behind AG1 includes experts from a broad range of fields, including longevity, preventive medicine, genetics, and biochemistry. I talk to them regularly and I'm really impressed with their commitment to making a top quality product. Until the end of January, AG1 are giving a limited time offer. Usually, they offer my listeners a one-year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to 10. And these packs are perfect

for keeping in your backpack, office 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. People have heard before that adding certain foods, certain superfoods have got all these kind of incredible benefits. But let's just think about it through the lens of what you just said. So let's say, as much of the population does, you're starting your day with a sugary bowl of cereal. Okay. This is very, very common. And most of the listeners to this show, of course, we're getting new ones all the

time. So I always feel I have to reiterate this, but a lot of people don't realize what it's doing to their blood glucose levels and how it's setting them off on a blood sugar rollercoaster, which they're trying to catch up on and chase for the rest of the day. Yes. Right. So they then hear something or read something online about blueberries being this really good for my brain health. Okay. So I go, okay, I'm going to have my cereal and add in blueberries for all their benefits yes now you say that doesn't work because the blueberries are not going to undo the big blood sugar spike from your cereal so maybe the blueberries have got some benefits and they do, right? Or we can discuss whether you think they do or not. But is it enough to undo the metabolic damage that has been

unleashed on your system from the sugary cereal? If you want real, noticeable, meaningful change in your mental health, in your physical health, you have to make real meaningful changes to your diet. You can't just sprinkle superfoods on top or nibble at it around the edges by taking some of the sugary things out or whatever it is. You have to fundamentally restructure your diet from the ground up in ways that make biological sense. And these are not the dietary patterns that most people hear about. So when you fundamentally restructure your diet from the ground up, that's where you've got the real power. It doesn't work for everybody. And I think you've said this as well. Of course,

nothing works for everybody. But this works for most people in terms of improving how they feel very quickly. And in many cases, allowing people to use less or even no psychiatric medication. And so if that's what you want for yourself, you can't just sprinkle things on top or nibble at it around the edges. You have to understand, kind of reteach yourself what food rules actually work. What are foods in the first case? Which foods do you first place which foods do you need which foods do you avoid and and just try it for a few weeks and see how you feel everybody's got yeah everybody's got six weeks right to try something new um uh what you know what do you what

do you get to this i think you highlighted a very important point and and whilst your book is primarily focused on foods, you also acknowledge that you're not anti-medication. Physical activity is important. Dealing with trauma is important. Relationships are important. Sleep, stress management. And it may be that changing each one of them is going to improve things by a certain percentage. And I don't know if you said this in the book, I think you did. I certainly said it in an interview I heard, where you said medications do not work for most people and they certainly do not get to the root cause. No.

And that's for psychiatric problems you're talking about. Yeah, you know, in psychiatry, you know, when you think about some of our more common Psychiatry, you know, when you think about some of our more common chronic health tragedies, things like obesity and type 2 diabetes and cardiovascular disease, we do have medicines now that are more effective at dealing with those issues. They're still not my favorite way of doing it, but we do have medications which can help people lose weight, that can bring their blood sugar into a normal range. We don't have medications in psychiatry that do a very good job. I mean, psychiatric medicines are really important. I still use them in my practice, and especially in acute situations or in situations where people can't change their diet or aren't interested in changing their diet or in cases where a mental health condition isn't related to diet. We still need medications as tools, as physicians. But if we're being honest with ourselves and if we look at the

data, psychiatric medications fail most people. They't bring enough meaningful relief to enough people and the price that people pay for the relief that they may get is often tremendous metabolic dysfunction and shortening of their life by many years obesity type 2 diabetes cardiovascular disease you mean it's a side effect from the medication yes exactly so a lot of our most effective psychiatric medications are the anti-psychotic so-called anti-psychotic medications which are now prescribed for all kinds of things not just serious mental illness they're prescribed not just for schizophrenia and bipolar disorder, but also for depression, insomnia, anxiety, irritability, mood swings, agitation,

all kinds of things, because most other medicines are not very effective. But these medicines cause blood sugar levels and insulin levels to rise within minutes to hours of the first dose. And they triple the risk for type 2 diabetes. So these medicines are very, yes, they can bring benefit.

And yes, we need them. But there's a cost. But there's a cost. Yeah. Back to these foods then that you feel are causing the most harm. Okay, refined carbohydrates. You mentioned how they raise our blood glucose,

that then raises the amount of glucose in our brain. And if that is done continuously, as it is for many of us, that can cause these advanced glycation end products. It can start to age us and it starts to slow down the functioning of our brain. So I think, I know there's many more things you could say about refined carbs, but that's, I think a pretty powerful case as to why we should reduce the amount of refined carbs in our diets. Yeah. Let's move on now to your second category, refined oils. Could you explain what refined oils are first? Because I'm not sure everyone is totally familiar with that term. Yeah. You know, we've been trained to divide fats into two categories for a long time, saturated and unsaturated.

Well, all foods, whether animal or plant, contain a mixture of saturated and unsaturated fats. It makes no sense to demonize one and glorify the other. I want to teach people to put fats into two completely different categories. Forget the saturated versus unsaturated. Those can both be healthy and good for you if they're in a whole food, right? I want to teach people to distinguish

between whole natural healthy fats, meaning unprocessed fats that are found naturally in plant and animal foods, and factory fats, refined fats that come, they may come from a whole food. So for example, sunflower seeds, safflower seeds, soybeans, these are basically all different types of seeds. And if you can imagine a bowl of soybeans sitting on your kitchen counter and trying to turn those into oil at home in your kitchen. How in the world would you do that? It requires a factory processing. To wrangle the oil out of those seeds requires 15 steps, including high pressure heat and

explosive solvents and all kinds of other steps in order to purify the oil from those seeds. There is nothing natural about soybean oil. And one of the problems with the so-called vegetable oils, which are actually refined seed oils, they're factory made, they're oils that are extracted from seeds using industrial processing. These oils, which are called vegetable oils, one of the problems with them is that they are exceedingly unnaturally high in a particular type of fatty acid. It's an omega-6 fatty acid called linoleic acid. And linoleic acid naturally exists in the world. It naturally exists in seeds and even in animal foods, but very, very small percentages. So we're designed to handle a

certain amount. We're designed to see a small percentage of linoleic acid in our diets. We are not designed to buy bottles of it and pour it over everything we eat or cook with it. And so the amount of linoleic acid in our diets is something like three to six times what it used to be. And you can see it when they do fat biopsies. You can see that the amount of linoleic acid in our body fat has been steadily rising for decades it's a very similar principle isn't it to what you said about refined carbs which is carbohydrates are not inherently bad if you have them from a whole food yes they come wrapped up in fiber right Right. So you have to work to digest it.

The blood glucose spike is much flatter than if you have it naked. Yes. Right? And you're kind of saying the same thing here about refined oils. If you're having that oil, that linoleic acid, as part of whole foods, it's in a smaller amount. Your body is adapted to tolerate that. But when you artificially extract it, put it in a very concentrated form and then pour it on everything that you're eating, everything you're cooking, you're pouring that over it, let's say,

or certainly the ultra processed food products that we're buying have got that in it, then you're getting much more than we are adapted to use. Same principle? Exactly. And this is the beauty of whole foods principles is that if, you know, for hundreds of thousands, 2 million years, all we really had available to us was whole plant and animal foods. We hunt and gather, you know, we ate animals and plants, and we figured out through trial and error, which ones were safe and which ones weren't safe to eat. And so lots and lots of evolutionary wisdom there. And now what we've got is, you know, factories that, yes, this is

the slippery slope for people. I think it's hard sometimes for people to figure out what's going on because yes, these oils come from plants, but that doesn't make them natural or healthy. When you extract molecules and concentrate them from any food, whether it's a protein powder or a vegetable oil or sugar or a syrup from a fruit, or a starchy vegetable, or a grain, those ingredients may come from whole foods, and they may be natural in a certain sense, but they no longer behave naturally in the human body. We did not evolve to see naked carbohydrates and factory concentrated fats. Our systems can't handle those things. So you explained clearly what these refined carbohydrates do to our brain. What do these refined oils do to our brain? So this is a very new area of scientific exploration. We don't know

very much about this yet, but I really, I researched this for the book because I wanted to bring people up to speed about where the science is right now. And so one of the things I came across, which I thought was the most concerning is that I wanted to know whether or not linoleic acid, this omega-3 fatty acid, whether it crossed into the brain and what happened to it in the brain. There are lots of people starting to look at what happens in the rest of the body. And there's, you know, potentially a lot of concern there as well. But as a psychiatrist, I want to see what happens in the brain. And it turns out that what we're learning is that linoleic acid, the brain absorbs linoleic acid quite well. But then after it crosses into the brain, the brain seems to not really quite know what to do

with it. And so actually what it ends up doing with it is it burns most of it for energy. That's not good. Okay. We need to understand why it's not good because we want the brain to generate energy, right? And you explain in the book, and maybe we'll get to it today, that we can either do that from glucose and or fat in the form of ketones is that right right the brain prefers to burn small molecules for energy either glucose or ketone and or ketone usually a mixture of both is what it like it's a hybrid engine that can burn glucose and or ketones yeah okay so now you're throwing in linoleic acid and you're saying that that's a problem if the energy burns that to make energy. Why? So ketones, they're tiny little

fragments of fat. So that tends to be a long molecule. The types of fats in our foods tend to be quite long, 18, 20, 20 to 24 carbons long, long chains. And then we kind of chop them up for energy. And we burn the, most many cells throughout the body can and do burn these longer fatty acids for energy, but the brain is different. The brain can't, doesn't really have the time to chop up a long molecule into little pieces and and so it prefers kind of pre-digested fats in the form of ketones which are very small very very small molecules so the little fragments of fat that cross easily into the brain and can be burned for energy linoleic acid is a very long molecule. So when the brain burns

it for energy, it creates a lot more inflammation and oxidative stress. And the brain isn't really equipped to deal with a lot of oxidative stress. It's too busy doing other things. It doesn't really have the machinery to deal with lots of these oxygen-free radicals that get generated naturally in the process of turning fuel into energy. Whenever you're burning anything for energy, any kind of fuel, there is naturally some inflammation and oxidative stress that comes along with that. But the brain is not designed to burn long molecules because those will, you can still, you'll still get energy out of it, but you'll also get a lot more oxidative stress.

Yeah. It's so fascinating when you think about that. And do you know then, or are we assuming that ancestral populations, because the amount of linoleic acid in their diets was so much lower than it is today for many of us, most of us, that less linoleic acid was going into their brains? For sure, there was less linoleic acid going into their brains, for sure. Because the diets that we used to consume a long time ago, they were just relatively low in linoleic acid. It would have been impossible to, there wouldn't have been any sources of concentrated linoleic

acid in the ancestral diet. So we're absolutely absorbing a lot more now than we ever did before. The whole issue around vegetable oils has become quite a hot potato in the health world, hasn't it? Not everyone agrees that they are problematic. Now, my own view is that whenever you look at the precautionary principle, or wherever you, I think this is pretty helpful in diet, if we'll start to go, what have we eaten for most of our revolution? If we haven't, let's just be a little bit careful about bringing large amounts of that into our diet. I think that kind of makes

sense to most people. Before we move on from refined oils, what would critics of your work say? Do you think about refined oils? What have they said? Okay, what have they said okay what have they said what would they say because the vegetable oil thing is controversial not everyone necessarily agrees with that correct so there are two arguments main lines of argument when people want to recommend continuing to eat the vegetable oils one is that that linoleic is viewed as an essential fatty acid. Okay.

So, but I actually disagree with that and I explain why in the book. The only reason that we would theoretically need to eat linoleic acid is to make arachidonic acid, which is the actual omega-6 fatty acid that we need in our bodies. But arachidonic acid is available from animal fats, so you don't need to eat any linoleic acid if you're including semiannual found in the diet.

So that's thing number one. Thing number two is that, well, you know, vegetable oil is, it's heart healthy. It, you know, it has no cholesterol. It has no saturated fat. Polyunsaturated fats are good for you. Saturated fats are bad for you. Vegetable fats are good for you. Animal fats are bad for you. And this line of reasoning, it's really confusing for people because when you talk to people who recommend a whole foods plant-based diet, there are a lot of good things about a whole food plant-based diet.

And I talk about this in the book. But all the benefits that have ever been demonstrated about a whole foods plant-based diet, so we're talking about vegan or vegetarian diets, as far as I can tell, may have only to do with the whole foods part rather than the plant based part, but it's never been tested, so we don't know. But when reputable physicians and nutrition experts recommend a whole foods plant-based diet, they are always careful to

use the term whole foods in front of it. How is vegetable oil a whole food? I can't square that circle. If you're recommending a whole foods plant-based diet and if a whole foods plant-based diet, and it has been shown in multiple randomized control trials that a whole foods plant-based diet is superior to a highly processed diet that happens to include animal foods,

then you really have to go all the way with your philosophy and not pick and choose which things you think are good and bad about it. So I really want people, I really believe in whole food principles, regardless of how many plants or animals you're eating. I really think following whole foods principles is key. Yeah, me too. And so no matter what else you're doing, get the junk out. And I think, I cannot think of a good reason

to include linoleic acid. It's all risk, no benefit. We don't know everything we need to know yet about linoleic acid, but because it's not even essential in the diet, why take that risk? Yeah, and I think that precautionary principle is always worth following if you can.

It hasn't been in our food supply for that long. It seems reasonable to proceed with caution there, whereas something like olive oil has. You know? Yeah. So there's many rabbit holes we could go down. Thank you for answering that. Let's get back on these five foods that you're suggesting people think about cutting out, straight reduce, right right we've done refined carbs refined oils okay alcohol yes what you know as a psychiatrist why do you think that's something we should be careful about well you know uh we often hear that red wine is good for the brain and you know can help us uh help us improve our cognitive and prevent dementia,

that sort of thing, that it's definitely a key component of the Mediterranean diet. When you see the Mediterranean diet pattern, if you see an image of it, you will usually see a glass of red wine next to it, right? So it's just kind of a grain and legume heavy triangle with a glass of red wine next to it. So what is that red wine doing there? Why do we think it's good for us? Well, we think it's good for us. I mean, the origin of that idea comes from what are called observational or epidemiological studies. We could talk a lot about that, which we may not today. But in any case, it basically was an assumption or maybe wishful thinking.

When, you know, when nutrition experts went to the Mediterranean and saw, oh my gosh, people in the Mediterranean seem to be healthier than Americans. I wonder why that might be. Let's look at what they're eating. Hmm, they seem to be enjoying some red wine with their meals. Maybe that's why. So it was a theory, perhaps even a wish that, you know, red wine would be good for us, right? And so they designed this pattern and they included the red wine in their pattern.

They never tested the red wine to see whether or not it was better for people's brain health. It would rather be unethical to design a clinical trial with human beings where you ask them to drink more red wine. And you as a clinician, a fellow clinician, will know how many of your patients come to you complaining of memory problems or depression. And you say, oh my gosh, it must be a wine deficiency. I want you to go home. I want you to drink more red wine.

Come back next week. I'm sure you'll be feeling better. I'm sure that's the problem. So no, of course not. It's ludicrous. This is a toxic, addictive liquid that causes tremendous amounts of oxidative stress and inflammation and can destroy every organ in the body just like high blood sugar can. So there's no reason on earth to think that red wine would be good for your health.

on earth to think that red wine would be good for your health. But there have been many, many studies of a molecule extracted from red wine called resveratrol, which is supposed to be kind of a miracle antioxidant that comes from red grapes. This resveratrol has been tested in multiple clinical trials, animal studies, laboratory studies, human clinical trials, trying to see whether or not it can improve brain health and protect the brain against dementia, improve memory, things like that. But none of those studies have shown any benefit. There are many reasons why red wine itself has not been used in clinical trials, not the least of which is that the amount of red wine you would need to consume in one day to reach even the lowest doses of resveratrol used in clinical trials would be 500 bottles a day.

Wow. There's so little resveratrol in a glass of red. One glass of Pinot Noir has maybe a milligram of resveratrol, and that lonely milligram of resveratrol is swimming in a sea of alcohol, which is a powerful promoter of oxidative stress. We talk all the time about eat more antioxidants, eat more antioxidants. Well, why don't we talk more about eat less pro-oxidants? Eat less of the things that are causing the oxidative stress in the first place. If you're drinking a glass of something that promotes oxidative stress and you drop a milligram of resveratrol in it, how effective do you think that's going to be?

That's why the superfood idea is so palatable. And again, I'm not blaming anyone. I get it. We like to do things that are easy as humans, right it's just an easier sell than well maybe you should cut that out if you die in the first place who doesn't want to believe that all they have to do to fight off depression or dementia is eat more dark chocolate and drink more red wine i mean sign me up because that you know i think that that would be a lovely life and and and it fun in the short term, but in the long term, it is tremendously damaging. And the other people who love this idea, isn't just us human beings, we like to rationalize all kinds of things, but also the food industry and the wine industry, it works for them. Our confusion about these things works for them because they can then say,

oh, I've got this, you know, 32 ounce bottle of fruit juice that contains 32 grams of carbohydrate. Oh, but it's also got these polyphenols in it that fight, that are powerful fighters of anti, well, 32 grams of sugar, powerful promoter of oxidative stress, and those polyphenols, good luck absorbing them. They do not work in the human body. And I think we all need to be aware that there's upsides and there's downsides and take into account them all. Exactly. So you don't just want half the truth. You want the whole truth, right? So yes,

these foods and products contain these molecules. What else do they contain? And what are the risks and benefits of those things? And marketers are genius at this, right? So they're always saying what's not in something. It doesn't have any cholesterol or it doesn't have any saturated fat or it doesn't have whatever it is. it doesn't have any gluten or it doesn't, whatever. But, okay, what does it have? What does it have? And so I want to know everything that's in there. And, you know, honestly, the best way for people to avoid falling for these, for this kind of smoke and mirrors tactics is to not eat things that need ingredient labels in the first place. is to not eat things that need ingredient labels in the first place. Whole foods don't need an ingredient label.

Any kid can walk up to a stalk of broccoli or an egg or a peach and say, I know what that is. It's got one ingredient. This is what it is. You can find it in nature. That's a whole food. If it needs an ingredient, if you're starting to read ingredient labels, you're in trouble already because uh it's it's nine times out of ten it's going to be a processed food that's bad for you

i just want to highlight another point here georgia if i may and i really appreciate your perspective on this as well the cost of living is going up in many countries around the world. Okay. So many people feel that it's harder for them to spend money on the things that they ideally would want to spend their money on. Okay. Now for many years, one of the things that often comes up when talking about whole foods is the expense of eating whole foods, right? And a lot of these ultra processed foods are cheap and you know you get all these offers on in the supermarkets and the stores in america right it's where you can buy buy one get one free or whatever it might be and then some people say we shouldn't be talking about this because certain populations can't implement these changes even though they may want to because of finances. And I completely accept

that that may be true. And there are certain people, I know in the UK, but I've seen stuff in America about these food deserts where you just can't buy whole foods and they're just full of fast food joints and it's just going to be impossible, right? But at the same time, I think that often causes a fear where we don't actually say the important stuff. And I have worked with poorer populations. And you know what? I'd often go to eggs with those guys. I'd often say, listen, I get it. But you know, do you eat eggs? And often they say yes. I say, you know what? Eggs have actually got a lot of good quality nutrients in that i think will help you and they can be really really cheap as well so the reason i want to bring

that up i'm really passionate about this because i think sometimes now we're so keen to be politically correct in how we communicate and again again, I also am. I don't want to say anything that people find difficult or offensive, right? But at the same time, I think that stops sometimes us communicating what people really need to know and want to know. And there are populations that I've worked with where actually they don't have much, but if you're honest with them and tell them how important you think those whole foods are, often they will make other sacrifices and put those things in

if you can guide them in the right way. That's been my experience. What's your experience been there? Well, absolutely. I mean, first of all, everybody deserves to know the truth about food and get to make their own decisions based on, you know, their own priorities within their family. But there is absolutely no reason, regardless of your economic situation, to not change your diet and to be healthier.

It actually can save you money in the long run if you know which foods are worth spending your money on and which foods are not worth buying in the first place. So my mom, I love bringing up my mom because she's my hero. So my mom is 90 years old. She raised us three girls on a shoestring, single mom, and worked really hard. First is for many years worked in hospital housekeeping department, eventually became the head of housekeeping in her hospital. And then when she retired, she refused to retire. So now she takes care of developmentally disabled adults in her home, even? And she is bargain Betty. So my mom is a champion coupon clipper. She is extraordinarily frugal. Her favorite thing to do on a weekend is go to a yard sale and then come back and say, guess how much?

So she still to this day is on a very limited income and makes the most of it. So my mom eats a low carb diet. My mom is and doesn't spend any more money on her healthy whole foods diet now than she did when she was eating differently. Why? Because some of the healthiest foods you can buy, especially the animal foods, like you said, eggs, are the least expensive. So you don't need the skinless, boneless chicken breasts. You can get the chicken legs or the chicken thighs. You can get a pork shoulder. Some of the healthiest animal foods you can buy are the least expensive because, and they're more nutritious, the dark meat, the fattier cuts, those are actually more nutritious

than the fancy, low--fat skinless things. So there's that. So first of all, you can save a lot of money if you know that. Another thing is that you will save a tremendous amount of money on food because you will eat less. Your appetite will be better regulated. You will find yourself naturally, if you eat the right way, that you only need to eat maybe twice a day, maybe even three times a day. But you're not going to find yourself hungry two to three hours after you eat because your appetite is so much better regulated. And the third reason you're going to save money, you're going to need a lot fewer

medications, fewer doctor's visits, fewer surgical procedures. In the United States, we have co-pays where we spend actually a tremendous amount of money getting healthcare, even when we have insurance, because you're going to be healthier. And so all of these things are going to save you money in the long run. Yeah, that's fascinating. It's interesting that that final point in the UK because of our National Health Service, you almost don't feel that benefit in the sense that because no one pays at the point of care, I agree that's a benefit. And it's just interesting to me for all the benefits of

something like a national health service. One of the things that is, you know, I've said this, maybe not for a couple of years on this show, but it's almost, you know i have said this i'm not maybe not for a couple years on this show but it's almost you know you're paying this insurance through your tax that the health care your health care will be taken care of but the healthier you are the less you're getting value from it right right so if and i'm not blaming people but but if, you know, you end up with type two diabetes, you get all the care, you got all the hospital visits, you get all the medications, you don't have to pay for any of it. Whereas perhaps in America, you will feel that. But in the UK, you don't actually feel, I don't think in the same way. It's fascinating, isn't it?

It is. There's no incentive really to be healthy, no financial incentive to be healthier. Yeah. And again, I don't want that to come across wrong. It's nice that we've got a system that people who are struggling are taken care of. Yes. But I think you bring up your mum was important. I think we both acknowledge that some people do find it very difficult. And as we said, though, we should be sharing honestly the information that we think is going to help. Let's get back to these five okay um we're on alcohol at the moment the third one what is your then advice about alcohol to people or to your patients because with all these things it might be impossible to completely eliminate so do you feel we get a lot of benefits from just reducing

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live more. 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. 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. So really, with anything where there's more risk than benefit, it's up to that individual where they want to draw that line. And I think that understanding that it's more risk than benefit, in fact, that it's almost all risk and very little benefit, having that information, I think, is useful for people because they then will not trick themselves into thinking that red wine is good for their health

and therefore they should consume some on a regular basis. So being honest with people is important. But then beyond that, of course, we're humans and none of us are perfect about our diet, including me. And so we make our own choices under different situations and we need to do so not just with the right information about the food or the beverage or the substance, but about ourselves. How does it affect me personally? What are the risks for me personally?

So some people can't control their intake of alcohol. And so one drink becomes five, becomes eight, and all kinds of health and other kinds of problems can ensue from that. And other people, fortunately, like myself, can have one drink and walk away. That doesn't make me more virtuous. That's just luck of the draw. The same isn't true for me with refined carbohydrates. If you put me in a room full of muffins, I'm not sure if I would survive. But so, you know, it's not a holier than thou thing. It's just we're different. And so some people can get away with or enjoy safely with minimal, minimal downside, you know, a glass of wine with dinner, right? And others can't.

And I think what I encourage people to do, because this book is really written for people with mental health issues, is explore that relationship. Take it out of your diet for 30 days and see if you feel any better and see what it's doing in your life and whether or not you think it's worth it to continue. Just really understand what's going on for you as an individual. Because for some people, they're going to need to take it all the way out. Others are going to need to be more careful with it. And others are going to decide, take it all the way out. Others are going to need to be more careful with it. And others are going to decide, you know what, this is worth the risk for me. I think this makes my life more enjoyable or more social, whatever it is. People are adults that can make their own decisions, but I want them to make those decisions in an informed way so that they have all the information they need to make it.

Yeah, I love that. And let's not kid ourselves that half a bottle of red wine each night is helping our brain and our future cognitive health and our heart health. Exactly. If you still want to have it, you're entitled to. Yes. But let's just be honest with people. Okay. What was four and five? Was it grains and legumes? Yes. Or was that one category? They're so similar, we can lump that's that's that will be covering the five right yes okay now i'm gonna say that i think most people agree about refined carbs i think you made a really good case for refined oils and i think there's you know a lot of people who would agree with that as well i think alcohol i think most people are in agreement with actually, you know, once you start increasing your alcohol intake, nothing really good happens for your health. Okay. I don't think that's controversial, but moving into grains and legumes, I would argue that for many people, your perspective

on this isn't what they're used to hearing. So'd love you to explain it before you do though i believe i don't know if you would agree with this that if people did the first three if they've never reduced those three and they make a concerted effort to do that and your plans at the end of your book will absolutely walk people through how to do that, you're probably going to feel way better than you currently do in all different aspects of your health. Yes. That's my belief. That's what I've seen. So first of all, would you agree with that? And secondly, then let's go into grains and legumes and why you let's go into grains and legumes and why you are encouraging us to be cautious. I 100% agree with you that wherever people can make a change

in the right direction, please do so. If it's just one of those three things, great, start there. If it's two of those things, even better. If it's three, even better, right? So wherever you're willing to start, start there and then see how you do. And if you don't feel better enough, you can move on to the next change. One of the things I do in the book is I give a list of single changes that people can make if they don't feel ready, if they're not really comfortable with the idea of completely

restructuring their diet from the ground up, which I think is of course what's best, but maybe they're a one atat-a-time person. Or maybe they only have it in them right now to make one change. That's great. Please do that. So, yes, don't let the perfect be the enemy of the good. That being said, grains and legumes, I know this is a tough one for a lot of people to hear or maybe to understand or wrap their heads around because we've been told for decades that grains and legumes should form the foundation of a healthy diet.

They are the foundation of the Mediterranean diet. The Mediterranean diet is one of the time outperforms the SAD diet, the standard American diet, for all kinds of health problems. three randomized controlled trials demonstrating that the Mediterranean, if you give people with moderate to severe depression, clinical depression, you switch them from the SAD diet to the Mediterranean diet, you will see noticeable improvements. Something like a third of people, depending on the study you're looking at,

will even experience remission from the depression. That's fantastic, right? So the Mediterranean diet is definitely better than the SAD diet for depression. It turns out that there's a diet called the MIND diet, which is a modified version of the Mediterranean diet, which was studied in a three-year randomized controlled trial to try to prevent cognitive decline, did not show any benefits. So with cognitive decline, it's a much tougher condition to treat, but clearly for depression, right? But just because the Mediterranean diet is better for depression than the SAD diet does not necessarily mean it's the best diet for depression or for the brain in general.

And there are good reasons to believe it's not. And one of the reasons is that its foundation, which are the grains and legumes, are the least nutritious and riskiest whole food you can eat. There are lots of foods in the world. There are grains, legumes, nuts, seeds, eggs, meat, fish, fruits, vegetables, seeds. Of all the whole foods, the riskiest to your health and the least nutritious, the one that I would argue is least worth spending your money on are the grains and legumes. Why? Because they're very low in nutrients to begin with. So low that most products made with them are fortified with extra nutrients because they don't have enough on their own to be worth eating. Another is that they're mostly starch. There's nothing wrong with starch if your metabolism is healthy.

But the growing majority of us now have insulin resistance and can't safely process high-carbohydrate diets. and can't safely process high-carbohydrate diets. So for some people, choosing to base your diet on starch, 40% to 60% starch, metabolically not a good idea. It's going to keep your insulin levels too high. You're not going to be able to lose weight. You're going to develop something called insulin resistance of the brain, which we can talk about later if you want. But, you know, lots of risks there metabolically.

of the brain, which we can talk about later if you want, but lots of risks there metabolically. But then beyond that, grains and legumes, they're essentially seeds. So grains are the seeds of grasses. Legumes are the seeds of legumes, beans and peas and lentils. And if you cut open a grain or a bean, a legume, you'll find a tiny embryo inside. That embryo is the future generation of the plant. Those foods, grains and beans, are heavily defended. They're protected by the parent plant. So, these seeds, grains and legumes, they may need to wait for years before the conditions are right to sprout. So they contain naturally defensive toxins to protect the embryo against predators. And they also contain what are called anti-nutrients, which hold on to, selfishly kind of hold on to the many of the nutrients that are inside those foods,

especially minerals and certain vitamins for the future embryo when it's ready to sprout. So just because these foods appear to contain certain nutrients doesn't necessarily mean that we can access them easily. So even the nutrients they do contain, many of those are not highly available to us. And these defensive toxins pose risks to the thyroid health, gut health, immune health. These toxins do breach barriers and can aggravate the immune system. Lots of reasons to avoid them and no good reason i can think of to eat them unless you are choosing a vegan diet you will really need to include some legumes some carefully prepared legumes that have been prepared in a way that will reduce their toxicity and improve their

digestibility and maybe even reduce their anti-nutrients because otherwise it's gonna be very difficult for you to get enough protein yeah well thank you for explaining your perspective there so grains one of the reasons you mentioned was because of the metabolic mayhem that can ensue i think that's a really important point. Again, when we look at these populations around the world who are seemingly living to a ripe old age with minimal health problems, I think we like to overly focus on one area of a multifaceted lifestyle.

But also, I think we sometimes forget about the base level state of our population. So in many Western countries, certainly in the US now, reports are that above 90% of the adult population have some degree of metabolic dysfunction. So the norm is to be metabolically unhealthy. Therefore, in that population, who are also a lot of the time quite physically inactive, is it a good idea to have a lot of grains

that are probably going to spike your blood sugar? I think when you look at it through that lens, even if you don't go anywhere near the anti-nutrients and the absorption of certain things, whether you can absorb them or not, I think there's a strong case there to say some of us need to be careful with that. Yes. In agreement? Yes. Okay. So that's the metabolic reason for that. But some people are going to be saying, okay, Georgia, I get that, but what about the grains that spike my sugar less, the less refined grains, the more traditional grains, real whole grain, not stuff that's marketed as whole grain, but real whole grains that have

a much flatter blood sugar response. What do you say to them? Those are better choices for your metabolic health. So you are less likely. So when you refine a grain and there's so much confusion about what a whole grain is, but you know, a whole grain, it's really quite simple. It's the intact kernel, you know, it's got its brand coding and it looks like a whole grain. As soon as you start chopping into pieces of any size, it's refined to a certain extent. And if you turn into flour, it's refined all the way into a powder, right? So the smaller the particle sizes that you're chopping it into or polishing it down to whatever it is, what you're doing is you're increasing the access to the carbohydrates inside the grain.

And if you're powdering it, then now you've got naked glucose molecules, right? So this degree of refinement matters for metabolic health. So if you're metabolically unhealthy or if you're metabolically healthy and you're trying to protect yourself from becoming metabolically unhealthy, yes, from a metabolic perspective,

the closer you get to whole, the safer you are because that intact bran coating is going to slow the digestion of those carbohydrates, may even make it difficult for you to access them at all in some cases because it's so hard to digest that bran coating down. Okay. So that's the grains. And I think the reason I'm pausing on all of these things is because as you acknowledge, these are the things that people are being told are healthy and they should be eating more often. To be really clear from what you've just said, you're basically saying that yes, the Mediterranean diet has been shown to have some quite profound benefits over the standard American

diet, the standard Western diet. But the case you're making is that it's not as good as it could be. I think we do a lot better. In fact, every diet that's ever outperformed the standard, I mean, lots and lots of diets have outperformed the standard American diet. Depending on the study you look at, whole foods plant-based diets have been able to do it. Low calorie diets have been able to do it. Low fat diets have been able to do it. Ketogenic diets have been able to do it.

Lots of diets outperformed the standard. Any change, just about any change you make to the standard American diet is going to be an improvement. It's not hard to beat the standard American diet. However, the Mediterranean diet does a better job in a lot of cases than a lot of these other diets do. So I do want to give credit to the Mediterranean diet and to the researchers who have shown, have done the hard work of showing that

because it really was the first randomized controlled trial was in 2017, showed for the first time, it was the first time that any dietary pattern had ever been rigorously tested in the treatment of a diagnosed mental health condition. That was Felice Jacker's work in the SMILES trial. Felice Jacker's work, the University of Dakin, exactly. And she's considered one of the thought leaders

in the nutritional psychiatry field. And so this is really important because it shows, it proves dietary quality matters. If you improve the quality of your diet, you can actually, in many cases, improve your mood. That's a big deal. But what if it didn't work for you? Or what if it didn't help you enough? I want people to know there's more they can do. Okay. And this is key, isn't it? Yeah. And this goes back to something I said earlier on in this conversation,

which is about what happens as a clinician when you have a sick person in front of you. Yes. Okay. Research is all great. It can take you so far, but sometimes, and it's great to get the research to support why what you're doing as a clinician works, but sometimes you have to go further. Yes. Okay. So you mentioned grains. I think we have to cover legumes and things like beans, because many people have been told that beans are a superfood. I know you don't like that term, but the populations who eat large amounts of beans, if they're properly prepared and they're soaked beforehand, which I know can help, that these are good for our gut bacteria. If we look at the blue zones, a lot of people will say, Dan Buetner will say, for example,

that beans are one of the key foods. So let's just try and tease this out because I don't think any of this is black or white. And let's take it to an extreme, or not an extreme, but something that's very common these days, autoimmune diseases on the rise massively. And it is uncanny how many people will tell you, and I know you know this, that their autoimmune disease symptoms have got dramatically better when they go whole food and when they cut out grains. Certainly for many years, I would see a lot of autoimmune illness. And I was just amazed by how much you could improve things by dramatically changing their diet. And sometimes you had to actually go quite extreme to get those changes. But I didn't have to with everyone. Sometimes just whole food was enough. But with some of them, it's like, yeah, actually, if we cut out all

grains, sometimes their joint pains would just vanish. So I think that nuance is needed and is missing from the discussion around food where people say, oh, they're good for everyone. No, they're not good for everyone, right? Some people get benefit when they cut them out. I agree with everything you said. I would add one other layer, which is the inclusion of, let's stick to legumes because those are more nutritious than grains. There's no reason for anybody to eat a grain. No nutritional earthly reason to eat a grain. But legumes, you could argue, well, they are the plant food along with nuts that are the highest in protein, right? And so if you're trying to meet your nutritional needs with plant foods, you must include legumes in your diet. Soy in particular, tofu is a particularly good example of a plant food that contains all of the amino acids that you need,

right? So it's a complete protein. So they're really, really important for people who choose to eat that way. That does not mean that legumes are good for people. And in fact, there's no evidence that legumes are good for people. All of the information about these populations eat beans and therefore they are healthier. Whole grains are good for you and they're an important part of a diet. All of that information is theoretical. When you look at a group of people in a blue zone or wherever you may wish to look, where they seem to be doing better than another group of people, you look at their dietary pattern and you think, hmm, that's interesting. They're eating this, that, and the other thing, and they're eating some beans. Maybe it's the beans. Maybe it's the beans that makes it healthier. We don't know that.

That's a guess. What are they not eating? What are those healthy populations not eating? Any study you look at that's observational or nutrition epidemiology, they're looking at junk. They're not eating all the sugars and cereals and vegetable oils and processed foods. That's the only thing they have in common. So we don't know if it's the beans or not. Maybe it is, but that's never been tested. We don't know if it's the whole grains. All the information about whole grains are healthier.

All the information about whole grains are healthier. There are countless studies of whole grains diets, including whole grains, beating diets, like outperforming other diets that include refined grains. We know whole grains are healthier than refined grains. We've got lots and lots of studies there. Do we know that a diet that contains whole grains is healthier than a diet that doesn't contain any grains at all? We don't know that. We are guessing about what's in those diets that's making them healthier. And my money is on what they're not eating as opposed to what they're eating. Okay. So in terms of then of making sure that everyone listening to this is not confused and is clear, right? Because one of the things i see a lot these days is um

i think the fact that experts disagree on dietary principles can often get really confusing for the lay public oh i just don't know what to believe. I don't know what I should follow then. Okay. So I think we've covered this, but just to be crystal clear, I think what you're saying, Georgia, and please jump in if I'm getting anything wrong, you're basically saying, look, you've been a psychiatrist for many, many years until you realized the power of food as medicine, you were unable to get people this well. Profound. And I know we haven't really covered many case studies today. There's plenty in the book from all kinds of things, depression, bipolar, schizophrenia. It is remarkable. Okay.

All of us, in your view, would benefit from trying to not be on the standard American diet, the standard Western diet, and make our diet as much as possible whole food based? Yes. I don't think that's controversial. No. Right. If you're able to do that. We're on the same page. Start there. Okay. As well as that, let's make sure we're cutting out as many refined carbs

as we can. Yes. As many refined oils as we can. Let's try and make sure we're being sensible with our alcohol intake. Up to there, I think people are going to go, yeah, okay, that makes sense to me. Okay, I'm going to try and do that as much as I can. I think what you're saying is in your view, the ideal human diet would not even contain whole grains or legumes. However, if you are choosing to be a vegan for a variety of reasons, maybe ethical reasons, environmental reasons, whatever, you know, there's many reasons why people choose that, compassionate reasons, then you're saying, actually, you're going to need legumes. You're less convinced on whole

grains, but I think you're saying maybe whole grains and legumes, maybe otherwise you're going to struggle. Is that what you said about that? Yeah, there's no nutritional reason to include the grains for anybody, but the legumes, because they contain essential amino acids, are important to include. Yes. Okay. And then if you are like, you've got a reason to go for optimal, you've had your own health challenges, which when you change your diet, you saw the incredible benefits and you've seen it with your patients. Not everyone has the motivation to go that far. Right. So are you saying with these final two categories, whole grains and legumes, listen, if you've made changes to your diet, as we've just mentioned, and things have

got significantly better, but you're still struggling, perhaps you want to consider a short trial without the whole grains and legumes just to see what happens? Would that be a reasonable summary of the sort of things you're saying? Absolutely. I really, and I try to use this, I try to emphasize this philosophy throughout the book is I want people to adopt a curiosity mindset. So meaning that if you're not feeling the way you want, there are lots of changes you can experiment with and explore to see how they affect you personally, right? And so I think it's really important. I can't, you know, if you come to me and you've got depression or anxiety or

mood swings or memory problems, whatever it is, I can't tell you exactly which diet is going to be the right one for you or the one that's going to suit your lifestyle best and get you to feel your best. But I can tell you from a biological, using my understanding of the biology of the human body, the biology of the brain, and the biology of food, I can tell you which changes are the ones that make the most sense, the most biological sense to try. And then what you decide to do and what you discover along the way may lead you to different places, but I can tell you which changes make the most sense to consider. And then it's up to you to decide which one of those you want to try. And then we just, when I'm working with patients, I never know where we're gonna go.

And we discover together. I say, well, let's discover together. When people say, well, do you think this will help with my psychosis or my mood swing or whatever it is? I say, well, I don't know. Let's find out together. Yeah, no, i love that and you know what i really do think the book is very very well written part one goes through

the problems with a lot of nutrition research and the conclusions that we've drawn so that's a really fascinating um part to the book the end, I would say sort of part four of the book, goes through these dietary strategies in quite a lot of detail, quite a lot of hand-holding for people. Before we finish, Georgia, you have published your own study, haven't you, on the ketogenic diet. And I think it'd be worth just sharing that because, you know, as people know, you're a psychiatrist. You see a lot of sick people with quite severe mental health problems. And you have found, like a former guest on this show, Chris Palmer, that ketogenic diets can have incredible therapeutic benefits for certain people.

Yes. So I use a lot of different nutritional strategies in my work and I share a lot of that with people in the book. This is not just a book about ketogenic diets for mental health, although the ketogenic diet has become the cornerstone of the work that I do. I work in a very flexible way with people. And I intentionally did not write a book just about ketogenic diets for mental health because, A, I know lots of people. For lots of people, that's going to be a non-starter yeah i'm going to say you know what i i that's not for me i don't want to do that i want people to know there are lots of other changes they can make

to improve the brain healthiness of their diet and and i really want everybody to have a seat at the table and so uh i include information for people who prefer plant-based diets or even who prefer carnivore diets and everything in between, right? So there's something in there for everybody. But the ketogenic diet is different than other diets because the ketogenic diet energizes the brain differently. So brain metabolism changes profoundly on a ketogenic diet, the whole body actually. It's really as though you are shifting all of your cells to a different operating system. And until you've tried it, people out there who haven't tried it and are wondering what the potential is, if you haven't tried it

for yourself to see what's possible, I really encourage you with certain caveats here. You don't just want to jump onto a ketogenic diet. It's a very powerful intervention that can change blood sugar levels, blood pressure levels, medication levels, all kinds of things very quickly. So, you you know you do need some support if you're going to do this but it's become the cornerstone of my work with patients because i have never seen anything else this powerful in terms of mental health treatment in my 25 years as a psychiatrist i mean i've seen a ketogenic diet improve people's sense of well-being, their mood, their behaviors, their emotions, their clarity of thinking, their memory within days to weeks in many cases of starting a ketogenic diet. So, a couple of years ago in 2022, I co-authored a study.

This was the work of my friend and colleague, Dr. Albert Dana. He's a psychiatrist practicing in Toulouse, France for more than 35 years, and he's nearing retirement. And he's, you know, and the reason why I get to go around the world and talk about his work is that he's really, he's at the end of his career and, you know, isn't that interested in spreading this information. So I'm really honored to be able to do this, is that what he did was he invited 31 of his most treatment-resistant patients with schizophrenia, bipolar disorder, or major depression to come into the hospital and under his supervision as volunteers to try a ketogenic

diet, a whole foods, mildly ketogenic diet under his supervision in the hospital setting to see whether or not it would help them. Because these were people who had been ill for an average of 10 years, some as long as 30 years. These are people who had, were taking at the time of admission to the hospital, an average of five psychiatric medications, not at all unusual in chronic mental illness. And all of these people had at least one marker of poor metabolic health, which again is pretty much the norm in people with chronic mental illness.

And they had been hospitalized before in this very same hospital system by this very same psychiatrist and not seen improvement. And so they came into the hospital, 28 of 31 of them were able to stay on the diet for two weeks or longer, which is what you need to do to start to see benefits. Every single one of them improved. 43% of them achieved clinical remission from their primary psychiatric diagnosis. 64% of them left the hospital on less psychiatric medication.

And all of their metabolic health markers improved, including significant weight loss. Even in people, the majority of these people were taking antipsychotic medications that are notorious for causing stubborn and severe amounts of weight gain. A remarkable, I think really hopeful experience that is helping now to spur more research around the world. Yeah. Amazing that you published that. Well done. And do we know how many of those patients were able to stick to it afterwards? Yes. So a third of them, when they left the hospital, a third of them, even those were people with a lot of challenges, opted to stay on a diet pretty close to what they'd been in the hospital. Almost two-thirds of them, when they left the hospital, continued with certain amounts, with certain changes to their diet. They didn't go back to the way they were eating before. And the reason why people were trying to stay on a ketogenic diet or close to it when they left the hospital was

because they'd never felt that well before. Yeah. Wow. I think this is a field of research that's going to just increase and increase over the next few years. And it's much needed because, you know, we can all have our own dietary preference but at the end of the day if you're sick you'll do anything that you can to feel better and that is again it's so obvious when you say it like that but this is why people are doing all kinds of diets around the world and experiencing benefit and trying to share that with people you see this a lot with the carnivore diets some people when they go carnivore which for people who don't know is a very meat-heavy diet, they are getting remission of their autoimmune symptoms. Not everyone, but many people are. And so we have to acknowledge that. We need to look at that and go,

well, what's going on here? And when people get quite divisive about this, oh, it's the wrong diet, you shouldn't be doing that. It's like, hey, listen, when you're unwell and you find something that makes you feel good, there's very little that is going to motivate you as much as that. Absolutely. What do you have to lose?

And who doesn't have six to 12 weeks to try a different diet to see what's possible for them? And I think one of the things I can really reassure people about is that the reason why, I mean, one of the many reasons why I wrote this book, I am tired of people having to accidentally stumble into these interventions, right? The reason why we have to keep reinventing the wheel as physicians, like, oh my gosh, I didn't know this about nutrition. Oh, I didn't know that. I didn't understand how brain metabolism worked.

I didn't understand, you know, that, you know, all the damaging ingredients of the modern diet. The reason why we had to go and study that for ourselves, change our careers, and come and start podcasts to help people understand what to eat is because the information that we've been fed about nutrition for decades has been wrong. It doesn't work. And because it doesn't work, people are left to their own devices to find something that does. So I encourage people to experiment and just let go of what they think they know about nutrition

and replace some of that information with biology and with curiosity and hope. Well, Georgia, I really appreciate the work that you're doing. It's clearly helping so many people, not only your patients, but now through the writing of this book, many, many people around the world.

The book is Change Your Diet, Change Your Mind, A Powerful Plan to Improve Moods, Overcome Anxiety and Protect Memory for a Lifetime of Optimal Health. Thanks for coming to the studio. Thank you very much for having me, Rangan. It's been a pleasure.

Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I'd be consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com

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