Psychiatry & Psychotherapy Podcast - Which Foods are Good for Mental Health?

Episode Date: September 12, 2019

On this week's episode of the podcast, I interview Dr. Drew Ramsey, a nutritional psychiatrist. When I was a resident, I saw him give a lecture on diet and how it affects our mood, and I've been wanting to interview him for a long time. He is the author of several books about diet and health. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com. Sign up, sign in, take the test, and the certification is email to you in seconds. All right, welcome back to the podcast. Today I am here with Dr. Drew Ramsey.

It was, gosh, when I was a resident, I saw you give a lecture on diet and mood, and I read your book subsequently. I don't know if you remember that. I came up to you afterwards and said hi. And we've been Instagram friends, and we've talked about doing an episode for about a year now. So I'm glad to finally have you on,

The Apologist of Kale. Welcome to the podcast. We're going to make sure you like Kail. by the end of the podcast, David. It's really a pleasure to be here. I'm a huge fan of this podcast and what you're doing. Love to have a brother-in-arm

that's helping spread good words about mental health and how it works and about psychotherapy and meds and all the good stuff you do. So it's, and I do remember you coming up. And I think as everyone knows, that that helps us keep going. So thank you for that.

And it's great to be here with you. Yeah, and hopefully I can convince you to do your own podcast. I was thinking that kale cast or the Drew Ramsey talks about kale. I was just, we can just call it kale. Yeah, I'm trying to evolve from kale. I would say a few years ago, it was embarrassing to get the American Psychiatric Association meeting in a college street joking. I had kale mania and getting called Dr. Kale. So I've been trying to shed that evolve into brain food and and talking a lot about that these days and a lot about male mental health.

But definitely, having been co-founded National Cale Day, I get a lot of kale salads in my life. I actually, like, was a huge fan of Cale before you. And when you came out, when you came out with your book, 50 Shades of Cale,

I was so jealous. I was like, oh, he got to it first. That was a, well, thank you. That was a really, it was very simple after sheathed came about. I was living in the West Village with my wife, and we were, I'm from a farm, as you know, and we were right by a farmer's market. And it was really the first time since I went through medical school and training that, like, I'm eating a lot of farm fresh food.

There was a little farmer there, a great farmer, farmer, farmer Dave, muddy farms. And he had all these different varietals of kale. They got six or seven different varietals. And it was the same time 50 shades of gray was popping, and it was West Village. So, you know, lots of kale salads were hitting the menu. And, yeah, they just got, it was one of the last. those silly things get stuck in my head. That's awesome.

And now you're putting on like mini nutritional conferences and stuff like that. We have a clinical training coming up. I think it's the first one in the U.S., a nutritional psychiatry clinical training. And the goal of that is to, I mean, the whole hope of the brain food work is to get a conversation going around mental health and to help people who are thinking about the brain health with really concrete tools in terms of how it's really simple. like, what should you eat if you want to avoid depression or what should you eat if you have depression to just have better outcomes? And so kale was a way into that. And yeah, now there's been a lot of data, everything ranging from the new data on the microbiome to some great

studies around dietary pattern and correlation of rest, even some randomized trials. And so we're having a clinical training coming up in October. Okay, so let's say someone was listening to this who is like a total skeptic that diet impacts mental health at all. So give me your best, like, pitch. Everyone should be skeptical about nutritional advice because so much of the science is bad, so much of the advice is biased. So I would agree with the skeptics. I'm very skeptical about nutritional advice, especially as it applies to mental health

because we see so much silver bullet grandiosity, right, that if you just cut out gluten, gosh, everything will be better, or that if you don't eat sugar, you'll never have anxiety or depression. And anyone who's in the mental health game like we are and lots of people listening, it's much more complex than that. Mental health is complex. I would say the data that's really convincing for me in some ways is quite concrete. Where does the brain come from?

What do we make the brain out of? We make the brain out of our food. And the types of nutrients that you consume, your dietary pattern, there's a lot of correlational data and then now some randomized evidence showing simple things like how we understand that inflammation is related to depression what's the number one factor in your life that you have control over that has a hand in regulating inflammation for sure it's the food you eat so i think that there's that common sense argument for me i certainly appreciate we have a long history and mental health of not having the best advice or not having evidence-based interventions

and I'm a Columbia train shrink. Like you, I care about evidence. I think there's a lot of evidence. When I see that a Mediterranean dietary pattern score can reduce the risk of depression by like 40%. I pay attention to that in the sense that, yeah, I'm skeptical, but I don't know. Do I think the Mediterranean diet is going to hurt people with depression?

No. Do I think the Western diet harms people and harms brains? Evidence is ample. So I think the real question for skeptics and mental health is, why aren't we doing a better job talking with our patients about lifestyle factors in addition to the other tools that we know work? Probably because most people have a hard time making diet changes. Well, you're a psychiatrist. Do you have a hard time helping people make changes? I mean, I want to like, I want to be the skeptic here for a second, you know? Because, like, I mean, I'm a fan.

Like I did an episode on diet and cognitive function, and I have other episodes planned for doing deep dives into certain things like what we were talking about right now. But I guess, you know, when someone comes in who's like really, really depressed, getting them to even walk for five minutes a day is really hard, you know? Yeah, I mean, that's where I think that's where I agree with you that the place and the time for talking about food is a very important part of technique. As we all know, that there's a time and a place for different types of interventions. When I think about what are patients and people do every day that affects their mental health, there aren't lots and lots of factors that they have full control over, something, for example, like trauma. Trauma happens to us.

Food is something that I feel that people have lost their sense of control over. And so for somebody with severe depression, nothing should motivate them or does motivate them, especially as they're feeling a little better, more, than things that help them prevent depression, things that they feel they're doing to build their strength and resilience. And so there's, you know, beyond the nutrient data, I just like the notion that it's very empowering

for patients and individuals in treatment to give them more, not to overwhelm them with tools, you have to eat exactly this or that, but to help them understand there are good and better choices to make. So let's say someone comes to you and, you know, they've been told the way out of depression is to do, you know, this kind of very restrictive diet. Insert any popular diet, you've definitely heard it, right?

Let's say, like, they think ketogenic diet or the carnivore diet is going to be, you know, the solution for depression. What are some of the basic principles for where you see the sciences today for what you would recommend as like a basic diet for depression or mood. Right. So the basic brain, most of the data revolves around the Mediterranean diet, but I think it's really important to translate that because I've spent a lot of time in rural Indiana, Mediterranean diet, you know, that could be like some pasta,

some pizza and like a hero, like yum. Like that's, that's not the Mediterranean diet that we know helps the brain or we think helps the brain. When people come in with an extreme diet like that, diets like that, a carnivorous diet, which is getting popularity. Vegan diets is something I see a lot of where people have been conventionally. They've only eating plants is good. Firstly, just try to listen and understand what their motivations are and what their morals are.

When people are truly seeking health through food, I think the data, people feel very confused by it, but it doesn't seem that confusing to me. Most people should eat more plants than they eat, and they should eat plants in a less processed form. Most people should take an accounting of their diet and see there's a prodigious amount of ultra-processed foods in your diet. And so the first step should be thinking about replacing those because we all agree those are bad. No one's going to argue that vegetable oils and sugar and refined carbohydrates are good for any aspect of human health. So then in terms of how we work in our clinic, we work with food categories. So Dr. Laurel LaChance and I have looked at all of the data about every nutrient and every vitamin in men.

and that has a study about it and depression and found that 12 nutrients have significant evidence both observational data evidence but also rite trials for example adding something like a folate supplement to an antidepressant these 12 nutrients have significant evidence that they're involved in the path of physiology of depression so that's a simple question of like what foods have the most of those nutrients for the fewest number of calories when you look at what those but for clusters you see these are called food categories, which is how we try to talk with patients about food. So the food categories we

emphasize are leafy greens. We have this little like seafood greens, nuts and beans, and a little dark chocolate. But when you look at food categories, it's not just about kale. I love the kale, but you could never eat kale and be perfectly healthy. People have never eaten kale throughout the history of mankind or humankind, and then fine. But eating leafy greens is quite important. They're very nutrient dense. And focusing on aspects of food like that, instead of calorie counting, focusing on nutrient density, making sure you're getting a lot of nutrients for calorie. That's both key to keeping a normal weight, but it's also really key to seeking out the

foods that are best for the human brain. We focus on rainbow vegetables, right? Again, trying to help people eat a more plant-forward diet. And then we focus on really helping people improve their meat choices. A lot of people just eat really poor quality meats, you know, eating lots of chicken breasts and lots of burgers. That's not the way you should eat meat. Instead of helping people go to less processed meats, using meats as flavorings, avoiding deli meats, processed meats, and then really helping people with seafood. Average American eats 14 pounds of seafood per year.

And just look at the basic recommendations, public health recommendations. For example, pregnant women should eat two servings of fish per week. Talk to any pregnant woman about fish and the first thing they worry about is mercury. And if you look at the data pretty clearly, there are lots and lots and lots of benefits of eating low mercury fish and seafood during pregnancy. So those are the food categories that we try to emphasize modeled on both the data and then trying to apply the Mediterranean diet. Things like most Americans don't have a relationship with anchovies.

It's a joke about the stinky stuff on bad pizza as opposed to really understand. there are lots of ways to make anchovies incredibly delicious and there's a lowest cost way for you to get long chain omega-3 fats, lots of calcium, lots of protein, lots of B-12 for very few calories. What do you think about salmon? Salmon's one of my favorites just because it has the high omega-3s, it's delicious. How does that compare to some of the different other fish that you would recommend? So when we look at what seafood we want people to eat, we focus on the fatty deep water fish. So wild salmon in particular is a great example of a fish that's very high in the long chain omega-3 fats.

If you look at the science behind this, people, omega-3 fats, the ones that really matter are EPA and DHA. DHA is the longest fat we eat, and it's structural fat. It's the only omega-3 fat that's transported into the brain. EPA is a blood thinner, and it gives right to acosteroids, which are anti-inflammatory. or compounds. And so salmon, wild salmon in particular, has lots of these omega-3 fats, EPA, and DHA. It's a great example of just wild salmon is in my rotation. It's in our family rotation. It's a food that I like to feed my kids a lot. It's also great to, because look at what kale taught me about food. Kale taught me that we want foods that are nutrient dense. Lots and lots of

We want the nutrients for calorie. We want foods that are culinaryally flexible. I do a lot besides the kale salad with my kale. It's in the mac and cheese. It's in my smoothie. I make kale soup. I make kale chips. And the same thing with wild salmon. You can do locks. You can prepare all kinds of different ways. You can do it as a salmon salad. You can do a salmon burger. So it's just one of those great core go-to foods that should be accentuated in most people's diets. What do you think about like organic versus not organic, local versus coming from far away? How much does this matter?

Are there certain foods where it does matter? Yeah. So first with the organic issue, what matters most to me in helping people, because also I spend a lot of time in very poor rural Indiana where there, unless you're going at yourself, there is an organ, there is not an organic section in the grocery store. and if there is, it's unaffordable. And so I'm very sensitive to the fact that for a lot of people, organic means unaffordable. I think what's very important is to not eat pesticides. Pesticides are neurotoxins.

There's not a tremendous amount of data that they're bad for you, but I just try not to eat or feed my kids neurotoxins. It's just how pesticides work. There's a lot of pesticide residue on produce. Cale, right? I would always advise you to eat organosons. organic kale, anything that's a leafy grain, try to go organic, go to a farmer's market. Just because a small farmer isn't organic, talk to a farmer, you can find produce that's grown

without chemicals or with minimal chemicals. I think that most of us look to the environmental working groups guide to produce. They have their dirty dozen, things like strawberries and kale that have more pesticide residues on them, and then they're clean 15, things where you're not eating the outer layer like an avocado or an onion. And so it's a much better choice if you don't want to buy something that's organic. In terms of local, I have a small local farm. I love small local farms. I think everybody in America should spend as much of your food money as possible with the farmer that is closest to you. Go find them, go shake their hand, make friends with them, eat their food. I think that's

a central aspect for me of nutritional psychiatry is how we use food to build. connection and community and the connection and community are at the center of our mental health. I know here in New York City, when I'm going to a weekly farmer's market and I'm talking with folks and seeing folks and buying fresh foods and seeing my community, I'm in a, I just leave there with a smile as opposed to when I just go to the grocery store and, you know, do my loop, stuff my cart. So local matters to me in that way. Yeah, yeah. I have a farmer's market and I'm always telling my patience. Go down, talk to my fish guy. Tell him I sent you. There's this amazing fish guy where I live. And he has like fish that it's like sushi grade coming out.

And you could just, you could just eat it raw. What I love about the farmer I've got experienced too and that fishmonger is a great experience is how you learn that, that, you know, he'll have a fish that you haven't tried before. He'll want you to, you know, he never had smelt. He'll throw a little one in, right where there's that relationship that you begin to build with a purveyor of food that grows your life and experiences an eater. I think about all of the sort of interesting foods over the years. The first time I saw it and tried it was it was at a farmer's market. Yeah.

Yeah, that's really good. Okay, so you said greens, nuts, beans, and a little chocolate? A little dark chocolate. Seafood greens, nuts and beans, and a little dark chocolate. But just as they know, lots of other foods like that, like clams and bivalves. I'm a huge fan of those. I'm a huge fan of those. Easiest thing to, if you really want to boost brain food, quotient of your diet,

start eating muscles a couple times a month. Really? Yeah, muscles, clams, and the things they don't teach us in medical school. You'd think, because you know B12 is important. Everybody knows B12 is important. B12 is the largest B vitamin that you eat. And B12 is incredibly concentrated in muscles, clams, and oysters. The top nutritional source of vitamin B12 are clams.

Wow. So, okay, tell me a little bit about nuts. What do you do nuts-wise? So nuts are great because they're a wonderful snack. They help also people address that. Americans have really been misled about nutritional science. A lot of people are still very convinced that fat is bad. A lot of people feel that nuts are like a little calorie bomb and is going to make them gain weight.

nuts are great because they're a wonderful mix of fat, protein, and slow burning carbohydrates. They're packed with minerals and our brain is mainly made of fat. So one of the kind of rules of looking for, as I look at food, is thinking about fat and fat quality and nutrients that dissolve in fat. And so nuts having a lot of fat means a lot of those fatinutrients and things like vitamin E. You find more of those in nuts. are also great because you take 25% off of what the calorie count is. So they're actually much more nutrient dense than it looks because the USDA issued a statement

a couple of years that all nut calorie estimates are off by about 25%. So I tell patients like, you know, if you're worried about calories, which I'd suggest you shouldn't be. And nuts are satiating. And then they're a great snack. Everybody likes like a crunchy, you know, snack sometime in the afternoon. Look at this. We're talking. I'll get my bag of raw cashews here.

Oh. Walking the top. And so, yeah, with your nuts, get them raw. I'm going to eat a few right now. Do you have to eat them raw? Like, because most almond butter is like, I think, roasted almond butter smashed up. I could eat that. I eat that by the spoonful.

You know, I think roasted is okay. I think with most nuts, I buy them all raw. If I'm going to roast them, I'll roast them myself in the toaster oven or something like that. I think the idea is, I like the monrock because I know I'm getting good fresh nuts. Oh, okay. Tell me about that. Like, do nuts lose their nutrient intensity over time? Like rancid, you know, because it's a fat.

So it's a, no, the other reason is if you look at fats that just everybody agrees, like everyone agrees, olive oil is good. Well, olive oil is a mono-unsaturated fat, will the egg acid. It's also the main fat that are in nuts. So, you know, think about a nut is like a little, little portable, non-bruisable transport nestle for vitamin E and, you know, those good fats that are an olive oil. Yeah. Plus, I love cashews because they have iron.

The thing about nuts are really great as minerality. So great, great snack, especially for pregnant women, breastfeeding women, cashews. Really, really nice. I'm going to have to send you some olive oil. I have this guy at my farmer's market who, like, Like, he presses it. I don't like move in here. I like here.

I like, I don't, I mean, like, I'm racing around. I have my farm. I don't have a great farmer's market. I don't have a fish market anymore. I want to. Can you move out here and we can podcast all the time and we can just talk about, you can cook for me? Like, shrinks cooking and surfing. Is that, that sounds like the new podcast?

We just talk about the wave we caught. Oh, David. If you caught yesterday. Yeah, bro. Remember that. It would be more like the wave that caught me. that would be more like my story. That's how it goes.

That's how I was supposed to go. You shouldn't try and get it. Okay, so you said beans. Talk to me a little bit about beans. How do you get beans? Oh, beans are a great traditional food. They're the top source when people are wanting to eat more plant forward, a lot of people get concerned about protein.

And you find lots of protein in beans and in nuts, certainly not in any way as much as you find it in meat. And it's not a complete protein. but, you know, it's very rare for people to get protein deficient on a plant-based diet. So there are protein in beans. And then beans are interesting for lots of reasons. One, their fibers are very interesting in terms of how those nurture and feed a healthier, more diverse microbiome.

They're inexpensive in terms of very nutrient-dense food. And they have lots of better nutrients. One of those we're talking about things to eat rainbow vegetables I mentioned earlier. And the reason we want people to eat the rainbows, when you look at those different colors, you're actually seeing different phytonutrients, different plant-based nutrients, things like lycopene, for example, or anthocyanins, which Lycopene make things red, anthocyanins make them blue and purple. And there's data that these bows really shift and shape the microbiome, but also some of them like lycopene and other beta and

perotinoids get directly transported from the end of our fork into our brain, through our gut, that into our brain and likely serve some kind of antioxidant functions in the brain. So I like beans for all of those reasons. Yeah, that's great. Okay, most important, I heard you mentioned chocolate. Dude, I'm going to have to send you some chocolate. We have this, like, amazing local chocolate. Everybody's going to want to be on your podcast.

It's like we get some chocolate, we get some olive oil, we get invited to move out there and, like, just podcast. This is awesome. I'm in. I'm going to send you some. I'm going to send you a shirt, a psychiatry and psychotherapy podcast shirt. I'll send you. I love psychiatry and psychotherapy swag like that. Like I'm always wearing, you know, Neen that Stanford has the brain innovation lab. I'm always wearing that shirt everywhere. I was carrying my APA bag. It's like, I don't know, I don't belong to lots of clubs. And, you know, but I feel, yeah, I will definitely wear your psychiatry and psychotherapy podcast t-shirt. Oh, man.

Dark chocolate is a great example. All right. What's trending? Plant-based foods. Hey, dark chocolate's plant. Beans and seeds. Dark chocolate's bean. Fermented foods.

Dark chocolate's fermented. Foods that are stimulating and give your energy. Dark chocolate's packed with theobromines. Foods that can grow your brain. There's only actually one molecule that's ever been shown to reverse age-related memory decline. And it's one of the flavanols that's been extracted from dark chocolate in a study by Scott Small up at Columbia. So dark chocolate is a great example also of a core principle of everything we talk about

in our clinic of nutritional psychiatry, which is that we eat to enjoy life and to have joy in our lives and that food should be filled with pleasure, not with rules and calculations of calories and neurotic angst. Food should be filled with love for us. And so dark chocolate helps remind us that. It's a great example of food that you don't have to eat a lot of. I have one piece of dark chocolate or two or three, whatever, but just really enjoy it. It's a great example of food that's been hijacked by the food system.

I don't eat milk chocolate. God, don't eat white chocolate. White chocolate is just sugar made to look like something chocolatey, but there's no actual chocolate in white chocolate. No, no, no, you can't do that, yeah. You have to do like 70% and you have to try the different countries because every country's chocolate tastes slightly different. It's amazing, those little artisan, regional, and it's one of the things I think it's great about food is the more that we support those sorts of efforts, small growers, sort of the terrier that exists of all foods. Chocolate wine tastes different from different parts of the world because the land is different. And I think it allows us to connect to our environment and value that and help our food dollars go to support that.

So yeah, dark chocolates. It's a great example of how an industry can get shaped and the environment can be, I think, preserved. Yeah, we do some mindfulness chocolate experience. I've done that with my medical students and residents for years. And specifically, I'll like, I won't tell them what I'm passing around, you know, like what country it's from and they'll try it you know and when you do a chocolate mindfulness experience you have to um you have to put the chocolate in your mouth and you try not to swallow it for a very long time essentially you try to you try to focus in on the food you know and let it melt

let it get to the sides of your your tongue let it get to the edge of the back of your throat right and notice where you can taste the chocolate in the different parts of your mouth and then when you swallow, notice the increased sensation from the back of the taste buds in the back of your mouth as well. And, you know, even if you feel like you cannot tell the difference between dark chocolates, like if you, you can build up your ability to tell the difference, just like coffee, you know, like I'm kind of a coffee snob at this point, or a coffee connoisseur where, you know, I can tell the difference between like a good Ethiopian versus Guatemala or, you know, and it's a good way to support these other countries as well.

do you teach mindfulness at all in like in how you teach people how to eat or just like rethinking how they eat it's it both was a part of um my last cookbook eat complete which was thinking of the non-nutritional aspects of how mental health relates to food and and it's not just you know eating these nutrient dense foods there's also a real stance that we hope to move people towards as a mention of joyfulness And part of that is really being present with your food. And so that really does involve transitioning from, you know, our hashtag too busy lives into being an eater and being present with all of your sentences when you're describing exactly with coffee and with dark chocolate. We've all had that experience where you look at the plate and the food's gone.

And you've just been in your brain and you've been eating an autopilot. But yeah, I thought I had another half sandwich. Like, oh, no, you ate that when you weren't paying attention at all. Yeah. And so we really try and emphasize simple things. People not picking up your silverware right away, having a moment of gratitude for your food, taking a deep breath before you eat anything, pausing after a few bites to take a deep breath and relax. And so often people are hungry and wanting to eat and they don't pace the eating in a way that makes it hard to digest.

chewing, right? It doesn't matter if you eat the salmon. If you don't chew it, you're not going to get most of the nutrients from it. If you don't chew your beans and your vegetables, you're just limiting the power of your digestive system. And so there are these, all these elements of mindful eating that are really, really critical for people to think about in addition to the types of foods we've been talking about. It's not just those. It's sort of like the difference of you could eat brain food but if every meal were delivered to you that might sound nice but you're going to miss the experience of chopping vegetables with your partner or of making something you've never made before probably my favorite part of cooking i'm not a very

good cook but i just i just think it's like i don't know not that hard like got some olive oil got some vegetables got some spices like got an oven i don't know it's like tastes good it's And so it's that invitation to be creative, I find really a wonderful part of tying my food to my mental health. Totally, totally. Yeah, I never make the same recipe twice. And I never use cookbooks at this point. When I read a cookbook, I'll read it as if I'm looking at the proportions. I'm looking at how, you know, what proportion of fat to what proportion of greens to what proportion of things.

And then you can really exchange any fat for any fat. Right. If you're using dana line greens, you can switch it up and use arugula. Yeah. And the cookbooks I flip through, I find, I enjoy finding like the inspiration, especially for plants. I mean, I like cooking plants. As much as I like it's simple.

I flip through, like, there's a couple of, well and good has a new cookbook out, which is all these different kind of wellness influencers in one recipe. And that was just really interesting in terms of things that I just don't cook at home, like a little, I don't know, like snow pea dumpling or something like that. So I find that the Sakara has a great, Sakara women have a great book out on. Really, they're a plant-based food company, but they have this great just way of making plants a little bit more fun and delicious. But I'm like you, I like flip through it, get inspired. And then go have fun making it up. You know, one of the, my research interest at Loma Linda is medical education.

And so in one of the studies I'm working on, I haven't published yet, we videotaped a bunch of medical students talking about their most connected supervisor and their least connected supervisor. And one of the interesting themes in the most connected supervisor is that usually they fed them, or at least, they prized allowing them to get food. And I told this story at Dermatology Grand Rounds, and about one month later, a dermatology, you know, a medical student on dermatology emailed me, and he said, thank you so much, because for the rest of the month that I was there,

my attendings took me out to eat, they fed me, and we sat at the table and talked, and I felt like I was a real person. I wasn't just a number. I wasn't just a name. Oh, you're a nutritional psychiatrist. I mean, that's just a great example of something that can get so easily lost for us, that, you know, amazing part of mentorship and of being in it.

We all remember those moments in medical school or a residency where we got to go sit with these folks who look up to so much and we're so nervous about because we're always being obsessed and obsessed. We're always being observed and evaluated in medical school. And then to be with them as real people, And it's such a, yeah, that's great that you're fostering that. Yeah, it's something occasionally, rarely, occasionally though I can't help myself. I mean, I have great boundaries, but, you know, as a clinician, sometimes when I've got

something good grown on the farm, I'll bring some with me. And every now and then, just can't help myself and we'll cut up like a fresh cucumber, fresh tomato from my garden and serve it to one of my patients in New York. Oh, yeah. And I love it to feel that that's like a really kind of like heavy, risque move, right? But to me is like a person that's just like who I am, right? And it's something that I had, I grew some hops. I had one of my patients the other day.

I had a bag of hops. I said, oh, close your eyes. And what do you think this is? It has, you know, smear feel and flour. Okay. I don't know. There's definitely this, yeah, this rich, richness that happens when we share and exchange food with people that's really, if you think about it, kind of forbidden in our field. Well, I mean, I bring in, I think one way of thinking about it would be like a mindfulness experience.

You can do mindfulness with your patients, so I do some chocolate mindfulness with my patients. I used to do snacks in the waiting room. What are the strangest thing? I have, not the straightest, but at my practice, I usually get, you know, off people like a can of seltzer. just because I have a fridge full of salpcer and I drink and and it's been striking to me like how much we need to do in the medical system that that is like first class service. I'm like shocked there's cold salpzer. I'm thinking, you know, this is, I don't know.

Like, it should be better. But anyway. Oh, that's so good. No, I think food, you know, also if you think about how the just the parasympathetic system works to get into more of that rest and relaxation. nucleus ambiguous, myelinated, parasympathetic nervous system, we need, or food kind of moves us there naturally. So I think historically, food and eating together has always been a time of connection. It's always been, you know, rest and digest. That's what they taught me the parasit. I remember the

parasympathetic nervous system. It's always, you know, there's such a high amount of gastron gastrointestinal issues, bloating, people having gastroesophage or reflux. And I think there's a real significant and accurate critique of the way that most people are handling those illnesses. That in medicine, we now approach that from, you know, our goal is to treat it. Like if, you know, you have GERD, get on an acid blocker. And that's great for the symptoms. But there's that way that we're really not taking care of our gut health in America.

Sort of like we aren't taking care of our sleep hygiene, which, you know, is I think probably quite related. We eat late, we eat a lot. And it's just we somehow obscure the amount of disability that this causes us, these bad food choices that we kind of almost joke about in our culture now. Right? And everything is, I don't know, I guess, concerned about our health. Yeah, yeah.

We just because we're moving forward doesn't always mean we're moving the right direction. Yeah. Yeah. So, no, I really, I've really enjoyed this conversation, but I definitely want to have you back on in the future and we'll continue to maybe dive into it. I'd love to hear more and talk more, especially about some of your work and how psychiatry is changing. And it feels like there's such a nice dialogue that's going on now more than ever. And I think your podcast is certainly a part of it, really giving people access to a thoughtful conversation. conversation about mental health. And I love how that just nothing fights stigma like that and nothing gets people into help like that. So I just really throw it what you're doing. And I'm going to be happy to come on any time and look forward to it. Excellent. Well, in the show notes, I will put all the links to Drew Ramsey's stuff to his website and this conference that's coming up and you know if you have any questions um for him or for me shoot shoot me a DM he's also

on instagram like i said before and twitter and facebook right i think you're on those too i'm on all those i think that yeah the news i've got a yeah and i'll give you a preview i'm doing a my third tedx talk in november and for everyone listening i love that we're getting more mental health awareness but recently i was really inspired by a patient who had a lost suicide in his family. I've been increasingly finding myself talking about taking mental health action, I guess just for everyone listening. I think that you're listening to David for a reason,

and I hope it's inspiring you to take action, because that's really what all of our work is about and taking action for all of us to build mental health, and to not just think about this as a lens of mental illness and things that other people have, but it's something that we all have, all struggle with, and most importantly, all can do a better job building. Yeah, and I know you do therapy. I know you do traditional psychiatry as well. And so I think you're one of those people who are in the field right now, who are public about their ideas and about sort of, hey, this is our field, this is mental health.

You know, no drug rep is going to come to your office and try to get you to eat more kale, but we're going to promote it in the means. that we can. And you could be the kale lobby. I'll be the dark chocolate lobby. How about that? Jack chocolate and olive oil. You're going to win. The olive oil and maybe some almond butter, spoonfuls of almond butter at night. I get asked once, you know, if I was going to be stranded on a desert island, which five fruits would I have. And I think we've got four of them now, right? Almond butter, kale, olive oil, and dark chocolate. I think we add in a little wild salmon. We'd make it. Oh, salmon for sure. For sure, yeah. Actually, I tell him, well, if we're on Desert Island, we can get fish and buy valves, so we don't have to bring those with us, right?

Oh, man. That would be fun. Hey, it's a pleasure. Drew, it's fun to connect with you, and I'm sure people will benefit from this. Do psychiatrists talking in real time over the internet? I mean, gosh, this kind of thing didn't even exist when we trained, right? I know, right? And now other people can listen to the conversation as well, and hopefully benefit.

But I know actually taking action, I'm going to take some action, Drew, from my conversation with you today. It was a good reminder that I need to eat more plants. I'm a big salad guy, but I definitely need to eat more. That is a real big challenge that actually, that most people when I say eat plants they eat salad. And I would really challenge people to count all. Salads are great, big, colorful, fun, salads, lots of stuff in it, but to challenge yourself

to really look for plants in other places in your day. diet than just salad. Look at that plate. Is it mostly plants? Because there's all kinds of fun ways. The oven roast is my, is my favorite way where you just get that. It doesn't matter. Russell sprouts, broccoli, cauliflower, all the brassicas. They just roast so nice in that oven. And you can flavor all kinds of the spices, but you know, olive oil, a little bit of salt, a little bit of herbs. See, I'm like getting free food coaching right now. I feel like I should be paying you. like what's not at all that that's just a beautiful of vegetables you know all right man it was good um we'll have you back on thanks a lot