The Dr. Hyman Show - Is Food To Blame For Your Anxiety And Depression? with Dr. Uma Naidoo

Episode Date: January 3, 2024

View the Show Notes For This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Get Ad-free Episodes & Dr. Hyman+ Audio Exclusives Dr. Uma Naidoo is a Harvard-trained psychiatrist, a professional chef graduating with her culinary school’s most coveted award, and a trained Nutrition Specialist. Michelin-starred chef David Bouley described her as the world’s first “triple threat” in the food and medicine space. Dr. Naidoo founded and directs the first hospital-based Nutritional Psychiatry Service in the United States. She is the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) and Director of Nutritional Psychiatry at MGH Academy while serving on the faculty at Harvard Medical School. This episode is brought to you by Rupa Health, ButcherBox, Pendulum, and BiOptimizers. Streamline your lab orders with Rupa Health. Access more than 3,000 specialty lab tests and register for a FREE live demo at RupaHealth.com. ButcherBox is giving new members FREE ground beef for LIFE with their first order. Visit ButcherBox.com/Farmacy and use code FARMACY. Pendulum is offering listeners 24% off their first month’s subscription of Akkermansia for gut health. Visit PendulumLife.com and use code HYMAN. Expires 1/31/23. This month only you can get a FREE bottle of Bioptimizers Magnesium Breakthrough. Just go to MagBreakthrough.com/HymanFree and enter coupon code hyman10. In this episode we discuss (audio version / Apple Subscriber version): Understanding the role that food and diet play in mental health issues and treatment (12:53 / 10:55) Exploring the root cause of anxiety and depression (18:23 / 16:27) How to eat to calm anxiety (21:12 / 19:15) The link between inflammation, mental health, and gut health (24:52 / 22:55) The bidirectional relationship between anxiety and gut and autoimmune connections (47:01 / 42:41) The link between psychiatric conditions and food sensitivities and allergies (50:44 / 46:24) The connection between metabolism and anxiety (57:07 / 52:47) Nutrients and micronutrients to help reduce anxiety (1:01:27 / 57:08) Putting together a low-anxiety plate (1:15:41 / 1:11:19) Get a copy of Calm Your Mind With Food. Connect with Dr. Mark Hyman on Twitter, Instagram, Facebook, and YouTube

Coming up on this week's episode of The Doctor's Pharmacy. Moving towards a healthier whole foods diet is going to help us change or evolve our metabolism and maybe we might even lose weight when we do it, but it's going to actually affect anxiety pretty significantly. Hey everyone, it's Dr. Mark. They say knowledge is power and that's definitely the case for those of us who are functional medicine doctors or practitioners. We need the right data to determine and eliminate the root cause of our patient's health issues. But that often means ordering a bunch of labs, which, let's be honest, can be an administrative nightmare. I'm sure many of you can relate

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For a limited time, new subscribers to ButcherBox will receive ground beef for life. When you sign up today, ButcherBox will send you two pounds of 100% grass-finished beef free in every box for the life of your subscription and $20 off. To receive this offer, go to butcherbox.com forward slash pharmacy, F-A-R-M-A-C-Y. That's butcherbox.com forward slash pharmacy, F-A-R-M-A-C-Y. That's butcherbox.com forward slash pharmacy. And now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, and this is a place for conversations that matter.

And today's conversation is going to matter to all of you because it's about mental health and the failure of our mental health system of psychiatry to deal with the ever-expanding crisis of mental health in this country from deaths of despair, depression, anxiety, and a whole range of mental health issues that are being poorly treated by traditional medicine with psychiatric medications and therapy. And there may be other reasons why we are suffering. There may be biological reasons. And it speaks back to a book I wrote many, many years ago called The Ultramind Solution. And today, we're really excited to talk to an incredible psychiatrist from Harvard, medical pioneer in this space,

Dr. Uma Naidoo. She's a Harvard-trained psychiatrist, a professional chef graduating with her culinary school's most coveted award, and a trained nutrition specialist. Michelin-starred chef David Boulay described her as the world's first triple threat in food and medicine space. Her nexus of interests have found their niche in nutritional psychiatry. Now, she's founded and directs the first hospital-based nutritional psychiatry service in the United States. She's the director of the Nutritional and Lifestyle Psychiatry Program at Massachusetts General Hospital and director of nutritional psychiatry at MGH Academy while serving on the faculty at Harvard Medical School.

She was considered Harvard's mood food expert and has been featured in the Wall Street Journal, Goop, Live with Kelly and Ryan, and more. Dr. Naidoo is also the best-selling author of This Is Your Brain on Food and the newly released title, Calm Your Mind with Food. Now, in this coming episode, Dr. Naidoo and I start a conversation by exploring the limitations of how we diagnose mental conditions, and she shares the two pivotal moments in her life and her career that led her to understand that what we eat has a great effect on our mental health. Together, we explore what's driving such high rates of anxiety in our current world and how food has been overlooked as both a driver and a cure to this issue. We dive into how microbes in your gut can influence your mood,

and we discuss the connection between neuroinflammation and the incidence of aggression, division, and polarization that's happening in society at rates we've never seen before. There is a connection between our inflamed brain and our inflamed moods, and we explore that connection. Dr. Naidoo explains that medicine may have had the wrong idea when it comes to understanding the link between anxiety and conditions such as irritable bowel, ulcerative colitis, and autoimmune disease. So we often thought that people who are anxious are causing these problems for themselves, but it may be the other way around. An irritable bowel may be causing an irritable brain. And we talk about how food sensitivities, allergies, and compounds in our food,

like gluten, sugar, can all play a role in anxiety. We also get into the relationship between our metabolism, our metabolic health, and anxiety. In fact, how does sugar play a role in our mood and insulin resistance affect that as well. And finally, Dr. Naidoo tells us what vitamins and minerals can help reduce anxiety, as well as her tips for putting together what she calls a low anxiety plate. And now let's dive into my conversation with Dr. Uma Naidoo. Uma, it's so great to have you back on the Doctors Pharmacy Podcast again to talk about one of the most pressing issues I think we're facing today, which is our mental health crisis. And it's been something that is accelerating in ways that I'm just sort of shocked to see the level of anxiety, depression, suicidality, diseases of despair, addiction, and the list goes on and on, bipolar disease, and worse.

And the question is, you know, why is this happening? Because, you know, I think most of us, I think in particularly my medical school training, I learned about what we call the DSM-5, which is the Diagnostic and Statistical Manual that determines how we diagnose psychiatric illness. And it's based on descriptions. And I remember when I was in medical school in 1986, I spent a month in the psychiatric ward, not as a patient, but as a medical student. And I was just so fascinated with the way in which we were dealing with mental health because it was really phenomenological. It was really descriptive. It wasn't talking about the causes. It was simply saying, okay, if you meet these criteria for these symptoms and you

fit in this category of depression or anxiety or OCD or schizophrenia or whatever it was. And I was like, this is so perplexing because it doesn't talk about the deeper either spiritual issues behind it, the psychological reasons behind it, even the biological reasons behind it. And at that time we had a very psychologically focused framework. You know, there was, there's a famous saying that psychiatrists pay no attention to the brain and neurologists pay no attention to the mind. But that's all changing. And you're at the forefront of that. Yeah, you're at the forefront of that. And we're going to dig into this today, but I know I'm going a little bit of a diatribe, but I want to set the stage here before we get into the topic. Years ago, I was practicing functional medicine at Kenya Ranch, and I

started to treat people's physical ailments, their autoimmune disease, their bacterial overgrowth in their gut, their nutritional deficiencies, their heavy metals. And I began to see these people have secondary side effects, let's call them side effects of their mental health problems going away. You know, treating their blood sugar, for example, one moment I was having panic attacks all the time. And then I ate this way and my panic attacks went away because I guess my blood sugar got back in balance. So something that's simple as that, or sometimes it's deeper. So I think our current diagnostic model and framework is so wrong. It's just phenomenological, it's descriptive, it's not causative. And the work you're doing at Harvard is so important because you're bringing to the forefront this new framework of not just that it's a, quote,

chemical imbalance in the brain that needs these psychiatric drugs, which typically don't even work that well or highly addictive or has side effects and massive symptoms, but you're talking about the biological causes of things like anxiety and depression. So you were trained in this model. I was trained in this model. And how did you start to go, wait a minute, what, what was your aha moment and how, and how do we need to think differently about mental health given the paradigm shift that's happening in psychiatry? And I'm saying paradigm shift, you know, from our perspective, right? Not, not, not the general psychiatric field, although I think it's moving forward. Tell us more about, about how you came to understand that what you learned in your psychiatric training you know as a harvard trained uh you know psychiatrist what what shifted for you

well mark thanks for having me it's always so great to talk to talk with you and and i've always like you said we call you the accidental psychiatrist right because you were you were you were doing this stuff way back and you know you know, you're absolutely right. I have such a big issue with now what is DSM-5-TR. So it's even more revised and it really yet hasn't changed that much. And we are not able to get into the nitty-gritty of diagnosis. In addition, there was a huge study done and published in the British Medical Journal last year, which really looked at the serotonin hypothesis. And is that really the basis we should be looking at in terms of even medication management. So you're actually right. This is more from our perspective in the lifestyle, functional medicine, nutritional

psychiatry space, looking at things like metabolism and also underlying causes. It's a movement that I hope we can grow. But my two aha moments were one when I was in treatment myself unexpectedly for cancer and realized that I could up my game in terms of how I was managing my nutrition. And that actually helped me fend off very serious side effects. My doctors would ask me all the time what I was doing. And the other was an incident with a patient who was a very junior resident and he yelled at me for prescribing the SSRI. Oh, really? I realized, yes, yes, and said to me, I was a timid resident and he worked in construction and he actually had come

in overweight, Mark, because I knew from my medical record in front of me. And he, but as you were sitting chatting with me, kind of admonishing me because you'd read the one side effect and he assumed that was the cause. And he'd only just started the medication. So I knew that it wasn't, wasn't Prozac, even though it can cause that. But he was also had, as you know, Massachusetts massive cup, 20 ounces of Dunkin' Donuts coffee. And I said to him, you know, let's call him bonus. Yes, exactly.

What did you happen to put in that today? And a donut. Right, right. He had the donut in the car. The quarter cup of ultra-processed creamer and eight teaspoons of sugar. Only eight. So even though I'm not a massive calorie counter,

I was able to calculate for him nutritionally that those were empty calories before he even ate breakfast, right? And he was thinking of the donut as a snack. So I saw his eyes light up. He stopped yelling. He listened. He wanted to do something different. And the treatment really changed to be much more therapeutic because he was starting to understand that I could help or we could work together to offset the weight issues and things like that.

And to me, that was a life-threatening moment because just interpreting a little bit of information to someone. But in short, Mark, that was sort of got me on this path of the more we can educate our patients and the more we know as doctors, the better that we can actually help inform treatment. And no one was asking what a patient was eating, yet we know these medications were causing weight effects, metabolic side effects. So I think that, you know, for me, that was where it grew from as an interest. And I was glad to be supported within my department when there was an opportunity to start a clinic. Yeah, that's powerful. You know, I think you're at the forefront of a really radical paradigm shift. And I think that people don't understand it in the general public. I think they still misappropriate meaning to certain diagnosis.

You know, you're depressed and you're anxious, and that means that it's a psychiatric problem. But it might not be a psychiatric problem. You know, I always say if you have a swollen joint, it hurts. But if your brain's inflamed, it doesn't hurt, but you get anxiety, depression, autism, Alzheimer's, bipolar disease, OCD, schizophrenia. These are all brain inflammation diseases. And it's really a key part of your new book, which is just so fabulous, called Calm Your Mind With Food, really talking about how our inflammatory diet is driving, not the only cause, but is

driving so much of the changes we see in our mental health and in this world. And I guess the question I would have for you is, you know, how do we start to change the paradigm? You know, how do we need to think differently about mental health given this paradigm shift in psychiatry? There's people now at Harvard like Christopher Palmer, your colleague who's written a book called Brain Energy. He's been on the podcast talking about curing schizophrenia with ketogenic diets and using bipolar disease treatments using diet. I mean, this is just a radical concept that food has something to do with that.

Sabani Sethi at Stanford has a department of metabolic psychiatry. We're talking about psychedelics and trauma. This whole field is just undergoing this revolution. So how do we sort of need to think differently as a society about mental health from the perspective that you now are taking, which is it's not just all in your head. Correct. It's not just an above-the-neck concept. Well, it does not mark that. Globally, more than about 70% of people with mental health issues receive no treatment from a healthcare professional, and this was proven in research. We also now know that since the pandemic, speaking to what you shared earlier, that even something published in The Lancet showed that anxiety has increased by 25%. So as we put all of these things together and realizing that even with telehealth, people are not getting the care that they need, there simply are not enough clinicians to cover everyone and help everyone,

I feel like we need more solutions. And my way of bringing this forward has been starting this clinic some time ago at Mass General, continuing the research and offering these different solutions. In my first book, This is Your Brain on Food, I outlined the different, including discussing the ketogenic diet for bipolar disorder, schizophrenia, and that was published at the beginning of the pandemic in 2020. And the idea was to offer people a roadmap with alternatives to how you can feel mentally well. And that food was something we were all overlooking. Like my patient, we were not thinking of it. And when Zoloft went on shortage at the early time of the pandemic, it showed us that there were so many

new prescriptions. We were getting notifications from all over that we had to adjust Zoloft dosages, change and not order new prescriptions for Zoloft. It showed that how many individuals with new diagnoses of anxiety and depression were popping up. But it also sort of said, you know, with the heightened processed food sales at the beginning of the pandemic, when everyone was panicked with what was going on, the food manufacturers actually went back and started manufacturing more things like canned soups at that time because there was such a demand, and that continued. So I feel that one of the reasons, in addition to all the acts going on in the world today, one of the reasons is how we almost, in some ways,

relied heavily on processed foods during the pandemic as one thing. That in the context of the standard American diet, I think it's many things. It was already bad. It was already bad enough. It was already bad. It was already bad. But I think it worsened. And not everyone. Some people got healthier during the pandemic, but there were a smaller number of people.

Yeah, they call it COVID-19, but often it was referred to as the COVID-19 pounds that you gained. That's right, exactly. But so much changed. And I think we do have to look at it that way because it's one of the things that impacts our metabolism and metabolism impacts our mental health. So it's sort of a huge, it's a cyclical effect. So you're at Harvard. I mean, I imagine, you know, your average psychiatrist at Harvard is not thinking like you do. There's a couple of rogue characters like Christopher Palmer and

yourself who are trying to pave the way for a new way of thinking about mental health. But, you know, I just want to point to the fact that, you know, these drugs that we use, particularly the SSRI drugs or the anxiolytic drugs like the benzodiazepines, you know, these drugs that we use, particularly the SSRI drugs or the anxiolytic drugs like the benzodiazepines, you know, they're problematic. And I think people don't understand the data around these medication. You know, I think, you know, when I took a deep dive on this, it was sort of shocking to see how poorly they worked. You know, they can be helpful for some people with severe depression, but for mild to moderate depression, they really are no better than placebo. And yet they're among the top selling drugs in the world. I mean, the top is statin drugs, the second are psychiatric drugs, and the

third category are stomach drugs like acid blockers, right? And these are a huge business. And yet, you know, depression or anxiety are not Prozac deficiencies, right? There's something else going on. And the benzos, which we use like Valium and other versions of those are really not great for long-term use because they're highly addictive. They cause long-term side effects. And, you know, it was sort of the Valium generation. I don't know if you followed the Sackler family story, but they were the Valium people too, not just the Oxy people. And they were hugely marketing this in the 60s.

It was a way of sedating women so they wouldn't be upset and want to have more autonomy and power. It wouldn't be hysterical. Yeah, it was sort of anarchitizing the female population at the time, suburban housewives who were miserable and anxious. It would be hysterical. when it comes to these symptoms that we have. And we often, like I said, misappropriate meaning. If you have depression, we typically label people with a disease and we think the label is the cause of the disease. So we say, oh, I know why you're sad and hopeless and helpless or why you're anxious and why you have all these symptoms.

It's because you have an anxiety disorder or you have depression. Well, depression isn't the cause of those symptoms. It's the name of those symptoms. And the causes are myriad. It could be your gut microbiome. It could be an omega-3 deficiency. It could be acid blockers you've taken for years that inhibit B12 absorption. It could be heavy metals that cause anxiety. So there's all these things that we actually now know how to diagnose and treat through the lens of functional medicine. And in your book, you really talk about how so many people suffer from anxiety, like 33.7% have anxiety in their lifetime.

40 million Americans have anxiety every year. And you say, you know, this is the most diagnosed mental health condition. It's even underdiagnosed. So let's take kind of a dive into the sort of root causes at a high level. What are the root causes of this problem? Is it what? What do you think from your perspective of looking at this? I have my eye views, obviously.

I'd love to hear your perspective on this. Well, I definitely love to hear what you think as well. But I do think, Mark, that when we dive deep into the research, we know that one of the biggest things is that the world is in a state of chaos. COVID-19 has happened. But we also know that what COVID-19 has sort of uncovered a mental health crisis that was already there. Things have worsened. We know anxiety is massively large. And there's interesting data that came out and it was published, even though it was published in research, was shown in the

LA Times recently, that even though suicide has increased and was increased in 2022, it's specifically increased in geriatric with older folks. And I think that also is speaking to that loneliness component that the pandemic drove and the fact that the world is in, so much is going on right now. So one of the things I did is I sort of outlined in my book, Calm Your Mind with Food, six pillars to calm your mind, the six things that we can try to do. If we look at root causes, I do feel like the way that our world is stressed these days, the way that people have no time to prepare a meal at all. Parents are running, families are different. And there's a lot that people are coping with when they look at the world. If it's not a war, it's some other conflict.

There's an increased level of gun violence. There's so much going on. And people are finding time to find a way forward. The world's a mess, and that causes anxiety too, right? The world's a mess. But there's also things that amplify it. If we don't take care of ourselves, we're going to be more triggered by what's going on in the world, right? Correct.

And one of the whole things is that, you know, we mostly eat the standard American diet. You've done a lot of work on this over the course of your career, Mark. And I think that it has shifted the needle. But for the most part, many Americans are not eating whole foods. They are really tapping into processed, ultra-processed, junk foods and fast foods. 60% of our diet is adults, right? That's huge.

It is huge. And then a lot of – we talk about colors of the rainbow, but the truth is in my book I really dove deeper into the micronutrients and broke down what these nutrients are that people should be – and I call it a kaleidoscope of colors because it's much more than just the rainbow. And if we actually understand that these foods we can lean into are offering us so much, we will actually start to improve, even start to change, you know, turn that needle on how we're eating. So we need to magnify

those micronutrients and prioritize those healthy fats, but also avoid those anxiety-triggering foods. I think that what tends to happen in this country is that people fall into what we have is the diet culture and the eat this, not that cultures. Take, for example, the ketogenic diet. It has excellent results in certain conditions. It's not for everybody, but it's not for everyone because we, you know, we work out of Massachusetts and I trained and did some of my work in group homes in Massachusetts and individuals who are, live in a state aided facility are given sliced white bread. You know, they don't have a choice to choose a better, healthier. So we've got to

tweak this. And even from experience in my own clinic, it has to be personalized to the individual much more than it used to be. And some of that is, you know, stuff that you and your audience already know, the fine tuning of the microbiome and the fact that there are certain, we now know there are certain, you know, lactobacilli, like lactobacilli rhinosis targets anxiety through GABA receptors. So now that we're learning that, it can be different points of target. Yeah, well, there's a lot in there. We're going to have to unpack all of that because it's really important. All the foods, the things that harm you, the things that help you, the things that you can use to upgrade your microbiome, to actually improve your mind.

Actually, just to sort of jump on a tangent for that for a minute, I, I have been studying a lot about acromantia, which is a really important microbe. And it's sort of the, one of the keystone microbes in your gut. And it protects the lining of the gut from being damaged, prevents leaky gut and inflammation regulates immunity. Uh, but, but, uh, a woman who i know who has a company called pendulum therapeutics basically has been able to culture and grow acromantias the first probiotic company to do this and what she said was they were growing it and they noticed there was they were sort of analyzing what was in the soup basically they grow it like in a in a kind of a microbial stew and it grows these bacteria. But bacteria,

people have to understand in your microbiome are not just bacteria, they're producing all sorts of molecules. Their DNA is just like our DNA. They're expressing proteins, they're expressing molecules, they're producing metabolites. In fact, probably a third of all the metabolites in your blood come from the microbiome metabolites. And she said what was so shocking was that they found extremely high levels of GABA in the soup, meaning this particular microbe was spewing out basically this anti-anxiety neurotransmitter. It's something that our bodies make. And when you take Valium, that's how it works. It actually works on the GABA receptors. So it's like a body's natural Valium. And it just, this kind of speaks to the kind of paradigm shift.

It's like, wait a minute, how does a bacteria in your gut affect your mood, affect your anxiety level, maybe cause depression or inflammation? Now we're looking even at the brains of people who died, for example, of depression. And we can do autopsy studies, or we can do neuroinflammation studies with imaging. And we see there's high levels of inflammation. So people don't think that, oh, I'm depressed, my brain's inflamed. But it actually is. When you look at the amount of inflamed emotions in this country, whether it's anxiety, whether it's divisiveness or the aggression or polarization. I mean, the stuff that people put out on social media just shocks me.

I mean, it's like they hide behind anonymity, and people have this sort of pent-up level of aggression and hatred and violence. And it's incredible to me. And I think we don't connect that often to what we're eating or to our overall health. And I think this is such an important part of the work that you're doing is you're highlighting these connections for people. You're helping them understand this is not just woo-woo science or woo-woo medicine. This is really deep science that we're now learning about these connections. This is exactly where it's at.

And I think that, you know, inflammation was seen very differently when, say, I was first studying in medical school and was part of psychiatry training. It was not something that you were taught. But inflammation has burgeoned forward as we understand the gut microbiome and that science. And we now see studies that link inflammation to conditions like depression, anxiety, cognitive disorders, and more. And one of the things that I thought that was really interesting is that, you know, SSRIs have actually, they're not my favorite medication, but they actually have been shown to have an anti-inflammatory effect. So it makes me think, well, should we be looking at medications that are anti-inflammatory to be treating these conditions?

And I happen to think that a lot of that fine-tuning of the science can actually be around the gut microbiome. Like you said, you know, finding where the GABA is produced, where it's hanging out, and other cool things that, you know, that are related to anxiety, like lactobacillus plantarum influences dopamine and serotonin levels. So the more we know, I think the more that we can use that's not necessarily a prescription medication. So instead of Prozac, we're going to be prescribing personalized microbes that are

targeted at your particular issue, right? Yeah. It's interesting. Which is exactly, which is the direction of psychobiotics, right? Which we hope. Psychobiotics. This is a great term. Psychobiotics.

What is a psychobiotic? Does it turn you psycho if you eat it? I know. It's kind of not the best word. You're absolutely right about that. But, you know, it's this emerging field of research where what we basically are trying to do is you're using beneficial bacteria like the ones we've talked about, for example, or, you know, support for some of these bacteria and support can be in the form of a prebiotic

that influence bacteria brain relationships, right? So psychobiotics exert anxiolytic and antidepressant effects characterized by these changes, right? And so I'm very excited that maybe that's a direction mental health should be moving in because it would be using the basis of food as medicine, but then taking the deeper science we're learning about acumencio or whichever lactobacillus it is and more to actually offer treatment through those mechanisms while also, of course, adjusting the diet, right?

So, yeah. Hey, everyone. It's Dr. Mark here. Have you ever heard of the blue zones? Well, in short, these are areas around the globe where people tend to live the longest. Now, there are a number of characteristics in blue zones that people share, many of which have to do with their gut microbiome. For instance, people in these regions have some of the highest levels of something called acromantia in their guts, a beneficial bacterial strain known for strengthening and

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forward slash hymen free and use the coupon code hymen 10. Don't miss this opportunity. It's a limited time offer for this month only. And now let's get back to this week's episode of The Doctor's Pharmacy. I think this is important because I think, you know, a lot of the ways that the gut mediates disease in general, not just obviously the diseases of the mind, right, or the brain or however you want to think about it. But inflammation is driving heart disease, cancer, diabetes, Alzheimer's, obviously autoimmune diseases. It's the singular biggest driver of almost all disease. And up until now, we hadn't realized it was connected to, to the brain in terms of its, its expression of mental health disorders. And now I think we're really understanding this and the, the, and again, it's not, like I said, it's not just depression, anxiety, it's all kinds of things. ADHD, autism, OCD. I mean, it's quite amazing,

aggression, behavior issues. And the food is such a big driver. And part of the way that food mediates inflammation is by changing the microbiome. Because guess what? You're feeding that whole garden of bugs in there that lives and thrives on what you're eating or you're feeding it stuff that's actually turning it into little zombies that are causing inflammation that are basically destroying your health. So this is a really important sign of discovery. And I think, you know, we often get sidetracked. You go, oh, wait, inflammation seems to be affecting mental health disorders. So I read a study that made me want to like vomit and tear it up and burn it, which essentially said that we should be using TNF alpha blockers to treat depression. Now, these are drugs that are used for autoimmune disease. They cost $50,000 a year. They have significant side effects,

including immune suppression, increased risk of cancer. And scientists are going, well, yeah, inflammation in the brain, let's treat them with anti-inflammatory drugs that basically like shut off the inflammation. Let's use chemotherapy to treat depression. I'm like, wait a minute, this is crazy and not focused on what we should be doing, which is what you really are focused on in your book. Well, I appreciate you saying that, Mark, because, you know, I'm kind of joking about, you know, another use for anti-inflammatory medications and that kind of stuff.

But in reality, I think that we have this backwards. And that's what the Buddhist medicine movement is trying to reverse, right? Because we're practicing defensive medicine. It's always pulling out a prescription pack or electronic prescription. And it's not looking. And you've pioneered things like functional medicine along with other people. So I feel like we have it backwards. And now we're trying to catch these diseases and the level of inflammation and the level of metabolic disruption and fix it.

And it's hard. It's just hard to do. Yeah. I mean, it is. And it's the inflammation and it's also the changes in the neurotransmitters that happen, right? As we as we eat certain foods, right? So when we eat sugar, we see or starch, we see and even oatmeal, which we think is a healthy breakfast, shows an increase in cortisol, cortisol and adrenaline. These are your stress hormones.

So literally you have a bowl of oatmeal and your body thinks you're in fight or flight and fighting from a tiger. And this is driving more health consequences and making you feel more stress. It's driving more health consequences and it's driving stress. You're actually right. And not many people realize that because I was trying to comment on this one, a media piece recently that it's really, it's marketed as this healthy breakfast. And once in a while, if you're going to have it, okay.

But, you know, this should not be what we're eating. But it's a lot of changing, changing how we think. You know, so when the gut microbes are basically involved in how they break down food, you also get the synthesis of different neurotransmitters that are modulated by this gut microbe so how we feed them is so important because their their actions like the short-chain fatty acids and the bile acids you know some of the studies have shown that the metabolized produced by the gut microbiome now include things like the neurotransmitters GABA you mentioned you mentioned, serotonin, dopamine. But they also, you know, some bacteria encode genes for specific enzymes that can catalyze the conversion of substrates into certain neurotransmitters.

So it's going much deeper now. And, you know, my only point being that where does it start? It still starts with how we're eating. So if you are heading to the fast food restaurant every day, you are feeding the wrong microbes in the gut, right? And then their breakdown product is going to be toxic. So unpack what you just said because I think you skipped over pretty quick, which is that when you're eating certain foods, you're making differential bugs grow. And it's not just the neurotransmitters that are produced by these bacteria.

It's also other metabolites. You mentioned short-chain fatty acids. Can you explain what that is, why it's important, and how it affects mental health? Sure. And why we're all starving, why we all have very, very low levels of these short-chain fatty acids. So the simple way to say it is that when we consume different foods, especially healthier foods, the gut microbes basically break down

the foods. But one of the things that we want them to be producing are the short chain fatty acids. And these are actually good products for the brain. They are good products for mental health. And there are a subset of fatty acids produced by gut microbes during the fermentation of basically partially digested polysaccharides. And the highest levels of the short chain acids are found in part of the large colon. And they actually interact with enterocytes and are transported across the single cell lining of the gut. They have been associated with, and by the way, they have names, they are acetate, propionate, and butyrate. And we want the formation of these short-chain fatty acids to help our mental well-being. What tends to happen is the opposite of that.

When we're eating the standard American diet, the breakdown products are toxic metabolites that start damaging that cell lining of the gut. And over time, not immediately, but over time, not only set up inflammation and dysbiosis, but start to damage that lining and you develop things like leaky gut, intestinal permeability. So the more times that we're eating that, those kaleidoscope of colors, the healthier foods, we are building up the short chain fatty acid production. And we know that this affects our neurotransmitters. So do we have an understanding of what, when you just said that certain foods produce more toxic metabolites,

what those metabolites are, what the mechanism of action is, and how they work to influence our health, and particularly our mental health? What I do know about it is that they are usually toxic metabolites that actually pierce that cell lining. They are formed. You mentioned foods like sugar. So the level of high fructose corn syrup and added, you know, we know there's a repository of about the last time I checked, 262 other names for sugar on food labels.

So we actually are consuming so much more sugar than we ever did, right? And one of my favorites is, you know, brown rice syrup. And people think, well, brown rice is a healthy grain, but brown rice syrup, as you know, is just sugar. So there's all this trickery going on and we're consuming all the sugar. This sugar, the breakdown products

are very damaging to that cell lining and really produce a toxic byproduct compared to a healthier short-chain fatty acid by the good microbes. Yeah. And also, when you fertilize bad bugs and you eat junk food, they produce also a compound called lipopolysaccharides or LPS. These are endotoxins. These are literally poisons produced by the bacteria that get absorbed across the lining of the gut and trigger your immune system to say, hey, this is bad news. It's actually what's produced when you have a bacterial infection and your body is trying to fight it. Your immune system goes to attack these

lipopolysaccharides and it can create insulin resistance, obesity, weight gain, mental health issues, brain inflammation, as we discussed. Really important. I think that this topic is just beginning. We're just learning at the frontier of what's going on here. We're going to be able to really understand how to modulate our microbiome differently. We're going to understand what psychobiotics are and how to use those instead of psychiatric drugs, maybe to treat mental health issues. And I think, speaking of this sort of short-chain fatty acid topic, I'm just going to sort of dive into that for a sec because it reminds me of a study that I found on breastfeeding infants versus actually bottle-fed infants.

And just to kind of back up on this, you mentioned butyrate and acetate and propionate. These are short-chain fatty acids. And propionic acid in high levels can be toxic. And in animal studies, they've literally injected this into brains of rats and it makes them autistic. It literally makes them autistic in very short time. And when I looked at the study of breastfed versus bottle fed babies, I think 35% or 25% of breast milk is something that's completely indigestible for the baby. Now, why would nature put in a third of the calories or the information in the breast milk that the baby can't absorb?

It's food for the microbiome. And so when they actually were consuming breast milk, these oligosaccharides were fertilizing good bacteria and causing a high amount of butyrate, which is anti-inflammatory, prevents cancer, helps regulate your immune system and helps feed the lining of the gut and many other things. When the babies would feel bottle feeding, they didn't have these oligosaccharides in them. And these babies end up having extremely high levels of propionic acid and a higher risk of autism and neurodevelopmental diseases. Now, I'm not saying you shouldn't

breastfeed. I mean, bottle feed. I think some people have to bottle feed. But now they're actually upgrading these by putting these oligosaccharides in them, by putting DHA, you know, because it's like, oh, it's just milk. Yeah, because we didn't even know what we're leaving out and it was causing all these consequences that we're seeing. So yeah, because, because we didn't even know what we're leaving out and it was causing all these consequences that we're seeing. So I think this is such an important thing. It's affecting not just depression, but all these mental health issues that are so,

so, so challenging. I also appreciate what you're saying from the perspective that as a, you know, practicing psychiatrist, it, it, we are seeing so much more autism.

People are asking me all the time. Why, why is there there and i'm not saying it's just a bottle feeding but i think it's linked to what's really standing about propion exactly what is what we're understanding about propionic acid and these different um breakdown products that actually sometimes they're toxic sometimes they're helpful and as we uncover it i think we'll have more solutions. That's certainly the goal. Yeah. I mean, that's really the thing that's so impressive to me is now we're beginning to unpack

the root causes. It's like we're looking at the stars and had no idea what they were. And then we get a telescope and we can actually see what's going on or a microscope. We don't know that there's... So we're just... Science is getting so much smarter. And I think the application of AI and machine learning to the complexity of our microbiome, because in our microbiome, there's 100,000 petabytes of data, which is, you know, no matter how smart we are, I went to Cornell, you went to Harvard, like, it doesn't matter. We're never going to be able to think about how all those interactions are, how it works and track things over time.

So I'm very excited about where this is going. But I can imagine, you know, your psychiatry colleagues are, you know, sort of confused if you want to do a stool sample, right? Like when someone comes in with a mental health disorder, why are you checking their poop? I mean, not because they're full of you-know-what, but because, you know, I think it's important. It's so important. And there's a lot of really exciting microbiome research being done in the private sector. And I think that these companies are actually looking at the microbiome. I think it's just unfortunate that as of yet, they're not integrated into a panel on, you know, that is covered by insurance in a hospital.

So a patient who wants to get that type of testing, even from a functional gastroenterologist, really has to seek this out privately. And it's kind of costly to do that. But I think, you know, wherever we can get those things tested, and so, you know, I think it's important so we understand more and we can offer more solutions. Yeah, I think it's so important. And I think this neuroinflammation is just so widespread. It's not just causing anxiety. And in a way, things like aggression and violence and these things come from this overwhelming sense of being out of control and anxiety. And I remember reading a study that looked at kids in juvenile detention centers. And these kids were sort of fed one group healthy

whole foods and other group was fed their standard crappy institutional diet. And they found that the kids who had the whole food diet had, and these were troubled kids, right? And they were in juvenile detention centers, had a 97% reduction in violence in their juvenile detention center data, 75% reduction in restraints, and get this, Uma, 100% reduction in suicides. And, you know, in teenage boys, it's the third leading cause of death. So you think you're going to eliminate suicides in this group simply by giving them the right food. That's the power of what you're doing and what we're talking about.

So do you think that this dietary factors that we're talking about that affect everything from our nutritional status, our micronutrient status, to our lack of phytochemicals, to our changes in our diet that affect our microbiome, do you think this is driving some of what we're seeing in our society today, these inflamed brains that are leading to divisiveness, aggression, conflict, polarization that we see now around the world and in America particularly? I feel that's just an excellent question because I do feel it's related. And, you know, I think you're right. Neuroinflammation is not just one condition in psychiatry.

It's really how our brains have changed. One of the things that, you know, one of my colleagues and I have spoken about in terms of neuroinflammation is even the fact that just like our bodies may have nascent cancer cells and nothing may happen if we're kind of living a healthy lifestyle and aging in reverse and eating the right foods, nothing may ever happen to those nascent cells. In a similar way, there are cells in our brain that are sort of hanging out and can actually lead to cognitive problems and dementia and other things. And what drives those cells to alter and change is inflammation and neuroinflammation. So simply by adjusting how we are eating, we can actually step back from, you know, developing those cognitive disorders. We don't have a cure for all the types of dementias yet so i'm not saying that but i am saying just like the cancer cell can can take up the wrong turn our brain cells if they are less inflamed by eating those you know

the kaleidoscope colors the whole foods diet as much as possible we are making that adjustment and i think that's one place to stop because we know that such a high percentage of us are metabolically unfit in this country. So we know that- Only 93% of us. Okay. You know, only 93%. So with that being said, you know, that neuroinflammation, the inflammation is going to help many conditions across the board. The reason that I focused in on anxiety is because the stats are through the roof. And that was all I saw during the pandemic, more than anything. It's true. And I think, I think, you know, you know, we, we often,

I know, I'm sure you learn this in your training too, but we often had this very pejorative term in medicine that we used when we thought people had psychosomatic illness. We used to call it supratentorial illness. And it was sort of a medical joke, inside joke, where you say, it's all in your head. It means above a certain part of your brain, right? And a supertentorial just describes a part of your brain that is above the basic primitive nature. So meaning it's all psychiatric and particularly things like irritable bowel syndrome. I mean, I was trained that it's anxiety and people's psychiatric illnesses that are driving their irritable bowel or even things like ulcerative colitis, you know, or to, oh, people who are anxious and neurotic get inflammatory bowel disease and autoimmune

disease. But it turns out it may be the other way around. It may be that the inflammation in the gut in these conditions is driving neuroinflammation, driving these psychiatric issues. And there was a beautiful article in the New England Journal years ago, I don't know if you saw it, but it was describing this phenomenon of how we have both the microbiome in our gut, but we also have the enteric nervous system, which is the gut nervous system. And that feeds back to our brain, driving all sorts of things. So maybe the link between things like autoimmune disease, inflammatory

disorders, and you're about, can you kind of just unpack that when it comes to anxiety and when it comes to mental health disorders? Because we really misappropriated this meaning here, I think, in my view. We sort of said it's from the top down, but it may be from the bottom up. Right. I feel as though we, again, looked at it the wrong way because, for example, intestinal immune cells affect the gut microbiome. So it turns out stress in the mind actually could be beginning in the gut. But at the same time, we've always seen it as, well, if you have the cerebral syndrome, you must be anxious and that must be causing it. But, you know, we're learning a lot more.

So there's this influence of brain functions linked to stress and depression. And the fact that 70% of our immune system is in the gut, this is something we know, but we're understanding it even on a deeper level now to show, you know, what it is that we could in fact be changing the immune cells, you know, in gut-linked conditions. Experiments in both mice and humans, identified particular intestinal immune cells that impact the gut microbiome, which in turn affect brain function linked to stress-induced disorders such as depression. So I think that it's understanding how they, firstly, when I commented on medicine earlier, I do believe that some of what leads to the issues we have is the way in which we are highly specialized and siloed. In a similar

way, I think that, you know, we not only as psychiatrists are not learning about the microbiome in medical school, I guarantee that. They're not learning about the microbiome. And, you know, I've had patients, Mark, say to me, they would go to their gastroenterologist and they were told leaky gut doesn't exist. So there's all of these different factions of beliefs. But how do we make, just like we need to understand how these cells are communicating, how do we get clinicians to communicate about all of this? So I think, you know, I just feel like it's an important direction for us to go in. It's so important. And I think as we begin to more unpack this, it's becoming clearer and clearer that these things are all linked.

So anything that drives inflammation, particularly inflammatory processed food, environmental toxins, allergens, and we'll talk about that in a minute, all can affect the brain. Can we talk a little bit more about other factors that are related to food that may be causing inflammation in the brain? Not just how it affects the microbiome, but food sensitivities or food allergens you write about. Can you talk about that? Because I think people have a lot of confusion about that. And I've personally seen this remarkably effective. When you put people on an elimination diet and get rid of all the inflammatory or potentially allergic foods like gluten and dairy, their psychiatric problems get better. Can you speak to that? This is so true. Yes. So, you know, what I try to do is adjust and tweak a nutritional psychiatry plan for what that person eats. But in conditions like anxiety,

gluten can be problematic. And the form of gluten, the type of gluten, and the source of gluten are also key. There are individuals, some of my patients who travel to Italy and eat pasta, but they can't eat it here, right? It's true. I got Italy just so I can eat pasta. Exactly. So it's very different. But if we were to think about it for a second, the way in which our food has been industrialized and the way in which agriculture has taken a turn, a lot of the foods that we're eating are just, not only is this the problem with the processed, ultra-processed fast foods, but they're also just the engineering of what has happened causes these foods to be hyper-palatable, taps into our cravings we know that you know these highly sugared foods tap into the dopamine reward pathways the same as sugar and basically you know act like street drugs such as cocaine so we deal with all of this in the food that we're consuming the foods that have the wrong types of fats like the hydrogenated fats and the trans fats that

are shelf-stable and that you see in cakes and pastries that are on grocery store shelves, these foods are also just driving inflammation in the wrong way in our bodies, in our brain, causing the gut inflammation that causes the neuroinflammation. But then there are also allergens in our environment that we may not identify or realize. Mold is a big issue that people don't. There are books written on this and doctors who have studied this. Oh, yeah. I almost died from mold.

I get it. Right. And I remember you sharing that with me. And I feel like these are things which we can't just look at one thing. So we need to be very wide and broad-based in our approach in looking for the cause. Food is a very big component of that, but it's also these. There was a really fascinating study that showed that when you, the food thickener called carboxymethylcellulose,

it was an animal study, that when this was used in the food. Which plant is that grown on? Carboxymethylcellulose. It was an animal study that when this was used... Which plant is that grown on? Carboxymethylcellulose is grown on... Just kidding. Why are we eating something called carboxymethylcellulose in our food? That's right. But it thickens food, right? And what it does is it leads to a low production of short-chain fatty acids in basically the gut microbiome of these animals. So we know that all of this engineering is not helping us, but it's also the allergens in our environment, things that we're overlooking, and also stress.

Stress is a massive part of what's driving our systems in the wrong way. So, you know, I think that between metabolic health and our kind of the level of burnout that's going on, these are all combined. Yeah, I want to get into the metabolic health in a minute, but I'm going to just loop back to what you said. These compounds in food, we don't even know are there. Sometimes it's on the label, sometimes it's not. And there's something that food scientists use. Food scientists, which basically are producing frankenfoods.

They use something called microbial transglutaminase. Now, that's a big mouthful. But essentially what it means is they produce gluten-like proteins. Gluten is called gluten because it's glue. It's like glue. If you ever made bread and you know how sticky it is and it gets all over your hands and you can't get it off, that's because of something in it that's glue-like. And that's why they call it gluten.

And one of these proteins is called a transglutaminase. And one of the ways we diagnose celiac disease is by measuring antibodies against transglutaminase. Now, these food producers use a bacteria to manufacture extra transglutaminase, and they put it in the food because it makes it stick together and not fall apart when you eat processed food. And this thing we know drives leaky gut. Gluten is one of the biggest things that drives leaky gut by affecting something called zonulin, which you get increases in zonulin, which breaks the junctions between the cells.

And then you get this leaky gut, which leads to more food sensitivities, like whether it's dairy or gluten or other foods that people may become reactive to. And that causes another set of inflammatory systems to activate in the body, driving systemic inflammation and brain inflammation. So one of the most amazing things I do for people is just do an elimination diet. Just do a 10-day, I call it the 10-day detox diet. I've written a book about it. And it's like a miracle drug. I can't tell you how many people just do that and end up having a resolution of so many symptoms, including psychiatric symptoms. I think that's exactly true.

And short-term elimination can be extremely helpful in different mental conditions. And that's how I discovered that gluten can be very problematic for people with anxiety. And it's largely the type of gluten that we eat in this country, but always worth checking to see. Yeah, and the reason is, just so people know, the wheat that we grow here is different. It's dwarf wheat. I went to Sardinia and they had something called grano capelli, which is this ancient wheat they use to make their pane carasal, which is this sort of shepherd's bread that they would use and dry it.

And they would go in the goat herds or sheep herds for days and they would eat this stuff. But that didn't have the same amount of gluten. The dwarf gluten, which was a hybridized form in order to grow more wheat for the growing population globally, the guy won the Nobel Prize for it, actually has much higher amounts of gluten and more inflammatory gluten. And that's why we see this in this country. It also has glyphosate often sprayed on it, which damages our microbiome even more. So it's a big network effect here. But I wanted to sort of dive into the next topic. I think that's important that you talk about in your book, Calm Your Mind, which everybody should get a copy of. It's Calm Your Mind. And it's kind of how do you change your brain with food, basically. Calm Your Mind with Food. And it has to do with this concept of

metabolic psychiatry. Now, nutritional psychiatry is one aspect. And there has to do with this concept of metabolic psychiatry. Now, nutritional psychiatry is one aspect. And there's, I mean, we could kind of divide it up into all sorts of things. But a lot of people are now focused on the role of metabolic health, insulin resistance. We're seeing, like you said, 93% of people have poor metabolic health. It's basically meaning they have high blood sugar, high cholesterol, high blood pressure. They've had a heart attack or stroke or overweight. And that's 93.2 actually percent of the population. And it's associated with insulin resistance, prediabetes, septal diabetes. But it also goes beyond our physical health. It's not just about getting diabetes or heart attacks or cancer or dementia or stroke, it's affecting our mental health.

And this is called metabolic psychiatry. And Shabani Aseti at Stanford is doing a lot of this work. Can you talk about the correlation of anxiety and markers of poor metabolic health and what the connection is, what the science is behind this? Yeah. It turns out that the heartbeat for anxiety in the brain is actually parts of the brain that actually deal with metabolism. This is one of the things that I was very excited about in uncovering kind of solutions for people for anxiety. So the amygdala and the hippocampus are usually the parts of the brain that are firing for, you know, conditions like anxiety. But when you also then understand that, you know, in a similar way, this is where metabolism is being impacted, you start to realize that this connection must also exist if we're seeing this uptick of anxiety.

Where I think metabolism and metabolic psychiatry can be so powerful is helping us understand that, to your point, Mark, it's not just the food that we're eating that's about our waistline or the number on the scale. It's actually about these other parts of the brain that are being impacted. And tweaks to a certain type of diet can actually help a condition like bipolar disorder in a similar way that moving towards a healthier type of diet can actually help a condition like bipolar disorder in a similar way that moving towards a healthier whole foods diet is going to help us, you know, change or evolve our metabolism. And maybe we might even lose weight when we do it, but it's going to actually affect anxiety rate pretty significantly. Not something that I was thinking about when I first treated anxiety, to be honest.

Yeah. Once I mentioned, when you eat sugar, and from these studies, it actually jacks up adrenaline and cortisol, which are the stress hormones, right? So sugar literally causes anxiety when you eat it. And when you see people who, you know, when you're kids, you feed them a bunch of sugar at a party,

they're bouncing off the walls, they're hyper, they're overstimulated. It's just like they took speed, which is what basically essentially a stress response is. It gets you to go faster and be stronger and run away from a tiger. But it's not good if you're doing it all the time because it just drives into diabetes, right? That's what it does. You know, to manage your metabolism, the brain has to communicate with the autonomic nervous system, the immune system, the endocrine system. The endocrine system, of course, secretes our hormones like insulin.

And so you start to fill in the gaps of this sort of intersection of the amygdala, the hippocampus, and then our metabolism. So the more that we can be eating in a way that is improving, fending off that neuroinflammation we spoke about, taking care of the gut microbiome, helping our immunity. All of that is ultimately going to help anxiety. And I think that this was what I was most excited about in this book because I think that overall nutritional psychiatry is about finding the different conditions someone has and tweaking their diet in a particular way. So nitrates actually in things like processed, ultra-processed meats can actually drive

depression. So it's finding those little things. But then for anxiety, there is a real life solution for people. And while it might be thought of as, oh, just eat whole foods, it goes deeper into the nutrients, micronutrients that our bodies need. Yeah, let's get into that. So in your book, you talk a lot about not just the food quality and obviously eating whole foods and reading the kaleidoscope of colors and eating more fiber, which is very important for the microbiome. But you also talk about the nutrients and micronutrients like vitamins and minerals. And our diet is pretty depleted in those. And people think, oh, people are overweight, they're well-nourished.

And no, actually, people who are overweight are often the most malnourished when you look at their nutrient-luxury, nutrient-poor food. They're eating ultra-processed food, which is basically calorie-rich and nutrient-poor. So how do vitamins and minerals help us reduce anxiety? What can we do? What are the things that really work? So one of the things that is very closely associated with anxiety is iron deficiency. And a very large percentage of women in the world are iron deficient, especially those of childbearing age, as well as children.

And with children and adolescents, iron deficiency is associated with a high level of anxiety, which is one of the reasons I talk about things that are easily accessible for people. We love chocolate, but extra dark natural chocolate is, in fact, the largest source of plant-based iron, not heme iron iron which we get from meats so the trick is to always pair that with citrus root because have extra dark chocolate citrus root because that helps the absorption the vitamin c helps the absorption so these are little things that you know dark chocolate covered uh dried oranges is good it isn't dehydrated and sweetened probably not but you can do it with the fresh whole food too.

But, you know, these are things like we don't realize we're taking in a lot of fortified foods. But why aren't we actually eating and feeding kids, you know, the whole foods that we should be eating to actually nurture our bodies? So iron deficiency is a big one. We know that magnesium, there are a lot of people. Before you jump to magnesium, tell us about iron. Tell us about iron. How do we diagnose iron deficiency? Is it anemia or is it just a low ferritin?

Or how do we diagnose that? What's your criteria for diagnosing that? Right. So usually if I'm suspecting iron deficiency, anemia, I'll work with a primary care doctor to order an iron panel. Usually it's ferritin, TIBC. We look to see what it is that they need. Are they so depleted that they actually need a supplement form or can they be trying to

eat food? My feeling is if we were just along the way always tweaking our diet, we could be in a healthier position for our iron. So usually we get the levels and depending on that conversation with my, one of my colleagues, either it's a supplement or a supplement, but you can always add food. Just, you know, food is always the first thing you go to, but you can always speak to your doctor about a supplement. Iron deficiency anemia will appear as, you know, exhaustion, a lack of energy, just really a lack of vibrancy in your life. And women really should be checking on that,

especially if they are trying to be pregnant and other things. So if you're hemoglobin's low and hematocrit's low and it's because of low iron, that's clear. But what if your ferritin is low? Because, you know, I co-founded a company called Function Health, and we found in over a million data points, over 20,000 people, that 12% of the population had a ferritin less than 16. Now, in my book, that's not the optimal level. That's like the minimum level, right? It's optimally

probably 45 or more. And even, you know, in that low range, which we think is normal between 16 and 45, we see all kinds of things like fatigue and hair loss, insomnia. So, so what is the sort of way that you say, oh, your ferritin should be, should it be anything over 16 is okay? Or is it, do you want to see it 45 or more what do you think about ferritin when you think about looking at iron right so when you look at ferritin right it's the blood it's the it's a blood protein that contains iron and the ferritin test will help your doctor basically um talk about your iron stores in your body so for me it's like what's in the bank account right exactly um so i will you know i try to work as a team with most private care doctors and a lot of my service in nutritional psychiatry is

to complement what we're doing so i usually have a conversation with the primary care doctor and figure out what we need to replenish. Does the person need a supplement? But what we're looking at with ferritin is the body stores of iron. And that's where if it's low, we definitely need to supplement. And we always, in addition to that, we'll be working with individuals and food. Yeah, interesting. So, yeah, my view is that it's not just a true iron deficiency anemia, but even a low ferritin. And like I said, 12% was at the level that was not lower than 45,

but it was lower than 16 in this population. That's over one in 10 people who's walking around with this and a generally, quote, healthy, health forward conscious population who are doing these function health labs, which is quite amazing to me. Now that you're about to start talking about magnesium, let's talk about magnesium because it's a really important mineral when it comes to mood and anxiety and even depression. And magnesium is easy to get from food. However, I think that what we don't realize is that so many Americans are deficient in magnesium and it's certainly linked to anxiety. So it's one of those minerals that you, and micronutrients that you want to be thinking about all the time. You can certainly supplement for

this, but you can also, if you are supplementing, you know, test, don't guess, make sure you're checking your electrolytes or your doctor. Because remember, things like magnesium, potassium, and all of these, they're interacting with very delicate body systems. And, for example, they can be associated with cardiac arrhythmia. So you want to be careful and not just take these without having them checked or having a conversation with your doctor. The other one was vitamin D. You know, a very large number of people in the Northeast could be... Wait, wait, wait.

I want to dive deeper because there's so much gold here. I don't want to jump off magnesium so magnesium i i always call it the relaxation mineral and and from my understanding it's it's it's uh you know involved in over 600 different enzyme reactions it is it binds to the gaba receptor so it's i call it the relaxation mineral. It also inhibits the NMDA receptor, which is stimulated in a way that creates more anxiety. Also, even we find NMDA overactivation can cause dementia. One of the drugs, Nemenda, inhibits NMDA receptors. So magnesium is sort of a natural way to do that. An Epsom salt bath is a way to get magnesium.

Does it matter the form of magnesium? Because there's a lot of forms of magnesium. Magnesium threonate seems to be more active in the brain. Is that a better one to take for anxiety? Yes. So a lot of the time, I have preferred magnesium threonate, and my patients tend to do well with it. I think that sometimes we have to tweak the dose to see what they specifically need, but it's one of those that I do think is also one that I find my patients prefer

for even kind of how it is handled in their gut. So I am a fan of it, and I definitely think it's an option if people are thinking about supplementing with magnesium and something that you can take to your doctor. Magnesium glycinate is another one that can be taken up to four times a day, and it helps mood. It helps anxiety. And it is pretty gentle on the digestive tract.

So both of those are pretty decent options. And there are also ways to improve your bioavailability of magnesium. And you can therefore supplement. I like people to have their vitamin D levels checked if they're struggling with depression, anxiety anyway, but you can supplement with vitamin D, which increases the cellular uptake of this mineral. That's right. So vitamin D is important, not just for calcium, but also for magnesium. And we see such a widespread magnesium deficiency. It's about 45% of the population. And a lot of the drugs that we use

in medicine, like particularly acid blockers, also the third leading class of drugs, Dr. Statton's psychiatric drugs, they actually dramatically inhibit magnesium absorption. If you're taking diuretics for blood pressure or for heart issues, you lose magnesium. If you're under stress, you lose magnesium. If you drink coffee, you're losing magnesium. So we do a lot of things to lose magnesium. And the thing we don't eat are magnesium rich foods. So what are the magnesium rich foods we should be eating? Yes. So one of my favorites actually also has a healthy fat in it, which is, you know, your avocados, rich in magnesium fiber, and something that, you know, we're encouraging

people to eat anyway. You know, I prefer people to not go towards the fortified foods, but rather have things that are just things like beans, legumes, plant foods. Start with those. I want them to be eating their leafy greens. These all have a pretty significant amount of magnesium in them, and they are pretty healthy. Another one is actually the extra dark dark natural chocolate a very good source of um of actual magnesium you know small

that's right for small one ounce of extra dark chocolate has a good amount about 15 percent of what you you need for your daily magnesium. Nuts, different types of nuts, which we want you to be eating for your fiber anyway. Great source of almonds, cashews, Brazil nuts. Brazil nuts gives you a double value because you get one or two Brazil nuts and they give you selenium for your brain, right? So there's – GSCs, pumpkin seeds, all those things are great. Exactly.

But these are also – they're kind of targeting a few different things. They're giving you fiber. They're giving you the magnesium you need. And, you know, even if you, there's tofu. Tofu is another one if you're plant-based. And some types of fatty fish. So a lot of the foods, you know, that we are talking about as healthy foods, one of the things I wanted to do is break

down the different micronutrients people hear buzzwords they hear macronutrients macronutrients is protein important is fiber important and this gets very confusing it turns out that a whole foods diet with specific tweaks towards these micronutrients can actually help anxiety that's great so so we done magnesium you're about to jump into vitamin D, and let's talk about vitamin D and then the few other key things, because there's a few other key things that really matter for this. Right. So with vitamin D, places, you know, you can actually get a good amount of vitamin D, 80% of your vitamin D, by spending about 10 minutes in actual direct sunlight and daylight. Now through a window, unfortunately, after the 10 minutes,

I say to people, put on your sunscreen or sunblock, but it allows for about 80% of your buildup of vitamin D that you need. So not difficult to do if we try, but then you can also do this through the different foods that you eat. Things like eggs are rich in vitamin D. Low vitamin D is associated with both anxiety and depression. We also know that depression and anxiety tend to run together. So it's a great nutrient to be supplementing or eating through food and really obtaining

so that you are fending off these particular conditions. Pretty straightforward to do as well. Yeah, that's amazing. So we've got magnesium, vitamin D, and I mean, you need vitamin D up with K2 as well, and you need sunlight that can help, but it's usually not enough. What are the other top two or three micronutrients we are missing or low in? By the way, 80% or more are deficient or insufficient in vitamin D. This is a widespread problem with magnesium. Again, huge deficiency problem in America. Right.

The other large group of vitamins that I think I always say to people, your B vitamins are really primarily, they're for many parts of your body, but I want people to think about it for their brain. So vitamin B1 is thiamine. You can get it in things like lean pork and beef. This is extremely important just for brain function. You know, raw B2 is riboflavin, often found in dairy if you consume that, but it's also in fatty fish. So depending on what you eat, vitamin B9, one of my favorites,

is in leafy greens because it's folate. And decades ago, we did research on using supplemental form of folate, lethal folate, and found that low folate is associated with a low mood. So just very important. Vitamin B12, easy to obtain if you eat animal products, super important for the brain. If you happen to be plant-based, maybe tap into things like nutritional yeast, which I think is key. And then I think, you know, we touched on calcium. There are the minerals. We touched on iron. We looked at magnesium.

What about omega-3s? Omega-3 is a huge group that we know has been studied and we know has a lot of data for both depression and anxiety. Easy to obtain through fatty fish, you know, smashes the mnemonic. So it's salmon, mackerel, anchovies, sardines, and herring. But you can also get it from plant-based sources. But the short-chain omega-3s from plant-based sources are really not sufficient because of the absorption and the conversion. So an algal oil supplement, a vegan supplement, is one way to go for that.

So I think it's about putting together that nutritional psychiatry. Those are the superstars. Those are the superstars. And it's putting together that anti-anxiety plate where one, people to be leaning into the kaleidoscope of colors, a little bit of your healthy fat, a smaller bound of your whole grains, not the way the food pyramid taught us, quite the opposite. And then your healthy sources of protein, whatever it is you might be eating. Well, this is such an amazing conversation.

There's so much more we can unpack. I mean, you have a whole topic about bioactives and polyphenols and phytochemicals, herbs, and your book is really a roadmap to understanding how we need to reimagine psychiatry, how we need to reimagine our approach to anxiety and depression, and to use food as medicine, and also to understand the complexity of the story about neuroinflammation, the microbiome, nutritional deficiencies. And it's typically not how psychiatry is practiced, but you're paving the way and you're really a light and beacon out there for so many suffering. And again, this is one of the biggest threats we have. We think diabetes is the worst problem or obesity. Actually, it's mental health. Mental health crises is far greater. It affects so much more people.

It's so poorly addressed. And this is a really a revolutionary new way of thinking about our mind and our brain and our mood and our mental health. So thank you so much for the work you do, Uma. Keep doing it. We want to hear more from you. And good luck with your book. Everybody should get a copy of it called Calm Your Mind With Food. It's available everywhere you can get books. It's out now. of it called Calm Your Mind With Food. It's

available everywhere you can get books. It's out now. Show it to me. Yeah, there you go. Yeah, your copy is on the way. So they were just literally hot off the press. Hot off the press. So everybody grab a copy. I don't think there's anybody who hasn't suffered from anxiety at some point in their life. And most people don't connect what they do and how they eat and how they live with their level of anxiety or mood disorders. And obviously there's other things that matter, the management of stress and dealing with trauma and so forth.

But this really is a great deep dive into the story of food and mood and what we know about it and the deepening science. So thank you so much, Uma, for being out there and doing this work. Thank you, Mark. You're always such a leader and someone I can learn from. And I have thanked you before, but thank you for your mentorship and how you've always been as a colleague in this space. So thanks for having me and I look forward to our continued conversation. Oh, thanks so much, Uma. We'll see you next time. See you. Bye-bye.

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