Psychiatry & Psychotherapy Podcast - Diet on Cognitive Function, Brain Optimization, Sensorium Part 2

Episode Date: March 15, 2018

What are the best diets for the brain and cognitive function?   How much does diet influence our sensorium? What particular foods are important?   How do we change our genes to optimize our brain? By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video. For PDF with citations and detailed notes go to: My Resource Page Ask David questions on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. Okay, and welcome back to the podcast. This is your host, Dr. David Puter. And today I am going to be a good to the podcast. And today I am going to be able to do. going to be talking about how to optimize total brain function, something I call Sensorium. This is part two in this series, and basically Sensorium is total brain capacity, which is used for focusing, processing, interpreting. It's, you know, how you feel sort of bright and chipper in the morning, and then as the day goes on, you may feel more sluggish. That's your Sensorium decreasing. It can be influenced by sleep, food, stress, exercise, drugs, medications,

long term it can be your genetics can change it's called epigenetics so you can downregulate or upregulate different genes and that will all influence censorium so in the first session on censorium i went through some stories of some different patients i've had and kind of painted the global picture of censorium i talked about severe censorium issues called delirium and in this episode, I'm just going to remind you of a study that I talked about on stress, and then I'm going to launch into how to optimize diet for increasing sensorium. This is a topic I'm passionate about. It's something that, you know, I don't get drug reps coming to my office telling me about the benefits of healthy eating for my mood and for my brain function. So there's not a lot of advertisements on

television for this, you know, or, you know, there's, there's just not the money behind it. And so in psychiatry, it's so important to focus on the things that may not get the sort of limelight. They may not be, you know, tons of companies clamoring to do studies on this topic. But there is pretty amazing stuff out there. I wish it was as prolific as some of the drugs and that kind of stuff, but it's pretty amazing. So just to kind of launch into it, when a patient comes to see me, and they're seeing a psychiatrist, maybe for the first time, maybe they've seen psychiatry for a while, you know, I think in my brain, as I'm going through their story, you know, did they have drastic changes in their diet? Sometimes people, when they get depressed or down, they start, you know,

eating more junk food or they, you know, their diet kind of disappears as in healthy food. And, you know, how does that sort of relate to their sort of pathway through life, through their journey, through the symptoms that they've had, so on and so forth. One study that I touched on before is on chronic stress. And in one study in particular, they looked at rats who were restrained by metal wires. So they had these rats and they were restrained so they were unable to move in these sort of metal wires for six hours a day. for 21 days. And those rats that were restrained like that had cognitive deficits. They had hippocampal damage. That's the memory area. Imagine your neuron is like a tree with tons of

branches. And these neurons in this, you know, stressed out rat actually had less branches, had less. The tree looked fundamentally different. These are what neurons look like. in someone who is chronically stressed. When we think about stress, because we're all going to face stress, not all stress is bad. Actually, stress can lead to adaptation. It can lead to getting stronger.

You know, how could this rat have been stressed in this way and gotten stronger? That's really difficult because this was 21 straight days, six hours a day. You know, did the rat have his friends to sort of discuss us and talk about the stresses of that cage after he had that stress, you know, or was he left alone for the rest of the day and just able to, to sort of, you know, spin the wheel. Did he have a wheel to spin? Did he have healthy food or did he have normal food? You know, all these things,

I think, will change the degree at which the stress will influence that rat. And although those factors weren't played into this study, we can see these types of, you know, studies by large in more global populations. And so I'm going to be going through different studies and how diet changes the influence of brain function. A lot of it, I think, has to do with what I would call recovery. Okay, so we have stresses in our life. We have periods of potential recovery, and then we have the potential for adaptation. And I think the right diet can change how stress is both recovered from and can also rewire our brains to basically handle stress differently. One paradigm to basically share at this point is that all stress is experienced in the

body in the same way. Now, there's different magnitudes of stress, but the stress pathways are all the same. Okay, we're always, meaning that, you know, the hormones released by stress are the same, you know, cortisol, all the noropinephrine, all those different natural sort of innate immune responses to stress are all the same, regardless of the type of stress. Okay. So, that's going to tie in as we go on. So first of all, how do we optimize our diet? Now, one thing that sort of comes into my mind as I think about diet is changing your diet can be stressful. You know, you go ahead and try to drastically change your diet. If you live with anyone else, it's going to be really hard. That other person is going to notice they're not going to like it.

If you're married, your spouse all of a sudden may be like, whoa, we can't eat the same foods we used to enjoy eating together. It can be really stressful. you know, to change your diet. And sometimes, you know, with some patients, when they're super stressed, it's not something I push right away. But when people get to a certain point, diet is something I engage them with. And one study that was really interesting, so this is more kind of like just a general picture of the influence of diet is there was a study in Israel where they followed eight judges for 10 months. And during these 10 months, these judges ruled over 10,000 applications made by prisoners to parole boards. You know, is this person going to get out early? Is there

incarceration time going to change? And the team found that, the people doing the study, found that the judges granted, you know, a lot more positive, you know, yes, or we're going to decrease the time of incarceration. Yes, we're going to let this person out early at the beginning of the day. And as time passed on, the numbers fell sharply, even reaching like zero. Like, no, I'm not going to let this person change. But after each of the breaks that they had, so they had two breaks during the day, and the judges retired, had some food, rested.

When they came back, they were a lot more lenient to sort of. of grant early parole and those types of things. So, I mean, we're talking about the difference between granting almost no, you know, change in the sentence versus like 60% positive changes, you know, 70% positive changes at the beginning of the day. So I'm going to put the graph on that on my website. If you want to follow the podcast to the website, you can see the little graph. It's pretty outstanding. And this, this is a picture of both, and the influence of food. You know, how food changes the brain, how people process differently when they're hungry,

when they're tired, when they're worn out, versus when they're fresh, they had a break, they had some food, and now they're ready to go back in. So one of the big things that I read in multiple studies is the importance of a more Mediterranean diet. and this is one of the most sort of well-studied things for brain function is the Mediterranean diet. So Mediterranean diet, in case you were wondering, you know, high fruits, high vegetables, high cereals. So cereals I would think of as like slow burning fuels, things like oatmeal, those kind of things, high legumes, so like beans, lentils, and it's low and saturated fats and higher in more of the mono-unsaturated like olive oil, higher in those types of fats.

And it's low to moderate in the consumption of fish and low to moderate intake of dairy products and low amounts of red meat and meat products. So, you know, the Mediterranean diet has been associated with lower rates of depression. It's been associated with better cognitive function. lower rates of cognitive decline and reduced Alzheimer's disease, lower rates of stroke, you know, it's been associated with lower self-reported subjective cognitive function in a study of 27, 842 people. They found that there was lower self-reported subjective experience of cognitive function. So the people who were on the Mediterranean diet, you know, felt like they thought more clearly.

In this particular study, they, you know, followed these people for 56 months and showed that those who are eating the most nuts, veggies, fruits, fish had lower rates of cognitive decline. So the people who are eating more vegetables, fruits, higher fish compared to meats and eggs. more whole grains, which is like, you know, good fibers, oats, beans, lentils, that kind of stuff, those people had lower rates of cognitive decline. And when they separated them into groups, so the people who are most following that type of diet and the people who are least following that type of diet, the healthiest diet compared to the least healthy had a hazard ratio of 0.7.6%, which means there were 24% less likely to devoutly to devise. develop cognitive decline. That's impressive. You know, I mean, this is a large study, okay? This is

following these people for several years. And, you know, so this is like an epigenetic phenomenon. This is not only epigenetic, but it's, it's, it's probably there's multiple bodily symptoms being influenced by poor diet, but all of that compounding to have the people eating, the sort of the most Mediterranean diet having the lowest level of cognitive decline. Okay. So in another study of 6,183 nurses, and they were studied for five years, and they had serial cognitive testing, showed that the ones with the highest saturated fat diets had more significant decline in cognitive function compared to those with high monosaturated, fatty acids, you know, like things like avocado, peanut butter, nuts, seeds, olive oil, and peanut oil.

So the people eating the mono-unsaturated fats had less cognitive decline than the people with the high saturated fats. Total fat and polyunsaturated fat, things like soybean oil, corn oil, was not associated with cognitive trajectory. Meaning, you know, In this particular study, people who ate a higher percentage of fat or a lower percentage of fat, in and of itself, was not associated with cognitive trajectory that, you know, did cognitive function decline? It was the people who were on the high mono-unsaturated fats who did the best. So, avocados, peanut butter, nuts, seeds, olive oil, peanut oil, those types of things. Okay, in a study of 1,449 people that were followed for 21 years, high saturated fat diets were associated

with poor global cognitive function and prospective memory compared to high intakes of polyunsaturated fats. Also, frequent fish was associated with better cognitive function and semantic memory. Both of these, you know, indicating sensorium was improved with fish. So higher pufa, you know, the polyunsaturated fatty acids to saturated fatty acids. So the people who had kind of like a higher proportion of puffas compared to saturated fats had better executive function and psychomotor speed. So here you go, two studies that I just went over on the importance of eating more of the polyunsaturated fats for long-term global brain function optimizations.

The next thing I'm going to mention is the value of omega-3 supplementation. So, you know, omega-3s versus omega-6s. So omega-3s are the ones that are going to be important. And omega-3s can be found in flaxseed and chia seed, salmon, and fish oil. I think that those are the sort of the big places where you can get high omega-3s without getting high- Omega-6s. I used to recommend, like, walnut, walnuts, and, you know, those can be good for other reasons, but those actually have a lot more omega-3s. So if you want to get, I mean, sorry, omega-6s, walnuts have a lot more omega-6s than omega-3s. So if you really want to get a lot of omega-3s, you get it through flaxseed, chea-seed, salmon, or fish oil. And for example, one animal studies showed higher omega-3 diet,

had better working memory and reference memory. One meta-analysis, which means they looked at multiple studies found that high omega-3 intake help those with cognitive impairment, but not dementia in terms of attention and processing speed and immediate recall. So, you know, people who already have dementia may be hard to treat, maybe hard to help, but people with some cognitive impairment, but not dementia, did have some improvement in intention, attention, you know, the ability to focus, concentrate, processing speed, so how quickly you sort of process things. In another study of children, age 7 to 9, those with lower DHA and EPA in their blood had a small associated poorer reading ability and working memory performance. What they found was that basically DHA and EPA, these are two different types of omega-3s when it was lower in the blood, which means that they have a lower diet with these being lower in the diet.

they have a lower ability to move them into the blood, okay? And these people with the lower amount of omega-3s running around in the blood had a poor reading ability and working memory performance. Okay, and this was in children age seven to nine. So what do I do? I give my kids some gummies with some omega-3s in it. And my son loves the salmon. And we do some flaxseed in the oatmeal.

we do some chia seed in the smoothie, give my kids some omega-3s. One study of 1,416 patients in France found that those who had fish weekly had decreased incidence of developing dementia over seven years, a follow-up. The hazard ratio was 0.66, you know, and there was no significant association found between meat consumption and risk of dementia. However, you know, the people who had the, who had the higher fish, had a decreased risk of developing dementia. You know, you have to take this in a context of other studies,

like how much meat is too meat, how much saturated fat is too much. You know, some of the other studies that I cited before pointed to more polyunsaturated fats. Sorry, not polyunsaturated, more, monosaturated fats. I'm like tied my head into a knot here thinking through this stuff clearly. So things like avocados, peanut butter, nuts, seeds, olive oil, peanut oil. Those are the monosaturated fats. You definitely want those. You also want omega-3 fats. That's a summary so far. And you want the Mediterranean diet type foods. Okay. On my next point, high sugar diets are not recommended. And so, you know, in one study in rats, high fat and high refined sugar diets had decreased brain-derived

neurotrophic factor and decreased neuroplasticity, which means that they basically were unable to sprout new neurons in the same way in the brain. You know, brain-dry neurotrophic factor is like miracle growth for the brain. neuroplasticity is important for new memories and memory consolidation. It's important for sensorium. And so, you know, super high fat, super refined sugar diets decrease these really important things in animal studies. In a study following 937 subjects for 3.7 years, found that those in the highest total carbohydrate group had almost double the risk for developing cognitive impairment, whereas those in the high protein and fat had lower risk.

When I looked at this study closely, I found that the highest carbohydrate group had the highest refined sugar and fruit, but not vegetables. So, you know, one thing that's important when you look at diet studies is to kind of kind of think through, you know, just because things are associated together doesn't mean that they're a direct cause. And, you know, I think in this group, it's probably more of the refined sugar looking at all the studies together. And it's probably not having enough vegetables. The summary of my diet is, here's what I recommend. Okay. So in the morning, think about oatmeal. Think about putting some almond butter and maybe some flax seed in the oatmeal. Okay. So you get your good

omega-3s from the flaxseed. You get your good mono-insaturated fats from the almond butter, and you get the oats, which is a very slow-burning fuel. For lunch, I really recommend doing some salad, and I like to put some avocado on my salad, some nuts. You know, I like to eat salmon a couple times a week. I do some chicken once in a while. And for dinner, I'll do another salad. And so I try to get two salads a day because I want a lot of greens. To make it easy, we do a lot of prepackaged salads, but I also like to make my own salad

dressings. I like to go downtown. There's this guy who sells olive oil, and I like to get his olive oil and use that because it's delicious. one thing I'll mention about olive oil is look at the back of the olive oil container and make sure that it says there are no trans fats. Because if there are, then they're putting something else into the olive oil. They can lie about what they put into the olive oil, like they can just say pure olive oil and there's other stuff in there. But they can't lie about they're being trans fats or not.

And so if there are trans fats, then you're looking at something where olive oil is, not 100%. Other things I recommend in terms of diet to most people is taking some sort of fish oil pill. Usually starting out three to four a day, it can decrease over time as you kind of change your diet around a little bit. So that is my summary on diet. I also recommend that you not go too overboard that once in a while you splurge and have some ice cream or, you know, enjoy your yourself. And my other rule is if someone makes me something, I usually try to eat it, at least some of it, because I think there's something of value in just collegiality and sharing food together with someone. And so, although on my own, I would prefer my salads. Oh, I get the prepackaged

salads from different grocery stores and just kind of, you know, throw some stuff on top of it. But there's some of my thoughts on food. All of that will help put the fire out. So the food will help the recovery process. If you eat good amounts of good food, your body will recover from stresses differently. Okay. That's my big sort of takeaway. So if you have any questions about diet, throw them up on one of my Instagram posts or my Facebook post. I'll see if I can address it. If this has been helpful for you, if follow my website. I'm going to have a PDF there. You can give this with all of the research and all of my advice to anyone you know who might benefit from it for free. I'll leave a free link to the PDF there.

You can download that. And, you know, I appreciate any positive feedback. If anyone wants to write a positive review on my iTunes, I would be most appreciative. And until then, I will see you next time.