The Food Medic - S7 E4: How to look after your mental health using exercise with Dr Brendon Stubbs

Episode Date: January 26, 2022

This week Dr Hazel is joined by Dr Brendon Stubbs from season 1 episode 2 of the podcast. Brendon is a Physiotherapist and a leading researcher in physical activity, exercise and mental health and the relationship between the mind and the body. He has published over 650 International academic papers, and his research has had substantial impact, for instance informing several World Health Organisation guidelines. Find Brendon on Instagram @brendon.stubbsIn this episode they cover: - The link between lifestyle and mood- Food and mood research - How exercise can support our mental health - The role of supplementation in mood and mental health - Sex/gender differences in mental health- Advice do you have for clinicians or students who want to get into research- Brendon’s tips for spotting pseudoscience onlineIf you loved this episode make sure to give it a review, rating (hopefully 5 stars) and share it with your friends and family. @thefoodmedic/www.thefoodmedic.co.uk Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello and welcome back to the Food Medic podcast. I'm your host, as always, Dr. Hazel. This week I have one of my very first guests back on the podcast, Dr. Brendan Stubbs. I think he was episode two from season one and I will make sure to drop the link in the show notes below if you want to go back and listen to that episode first. Brendan is a physio and a leading researcher in physical activity, exercise and mental health and the relationship between the mind and the body. He has published over 650 international academic papers, which just blows my mind. And his research has had substantial impact, for instance, informing several World Health Organization Guidelines. Brendan is currently an invited expert advising the World Health Organization on their global response to mitigate the mental health impact from the COVID-19

pandemic, so super important work. Since 2019, he's also been recognized by the Web of Science as being a world highly cited, i.e. one of the world's most influential researchers from over 8 million in the fields of mental health psychiatry psychology. Brendan and I stayed in touch since season one and since then he's obviously continued to just do incredible research and do great work in the field of mental health. Personally I really admire him and his dedication to research so I'm super grateful that we could just grab him for an hour of his time to have this chat today. We've obviously discussed the link between mood and our mental health and the relationship between exercise before in the podcast and I want to pick that conversation back up and expand into other

factors that influence our risk of poor mental health. For those listening who are keen to get into research, Brendan also shares some helpful advice on how to do this also. I mean, first of all, I'd just love to start by asking you a little bit more about you. I know we've done this before, but for people who don't maybe know who you are or what you do, tell us a little bit more about you and your kind of professional and academic background. Sure. So my professional background is physiotherapist and I've taken an extremely unorthodox route in path in both my clinical and research work so I've on and off been in mental health services for almost 20 years and that was very unorthodox back then as a sort of newly qualified physio to go and work in you know inpatient mental health services but it was

great and I was immediately hooked and saw the value that physiotherapy and movement and helping people could bring. And I've gone off and done standard physio type things in the interim, like musculoskeletal physio, helping people with aches and pains, sports physio, hospital-based physio, that type of thing. And I've kept coming back to mental health because it's just a place where I feel really at home and I can help and add value to people who are in hospital and it's just it's an enormous privilege to go in and help people and somewhere really randomly along that journey quite early on I got involved in some sort of lunchtime and evening research and then

it's just kind of grown from there and if you ask my sort of friends and colleagues at university, who is the least likely person to be involved in any academia, any science, it would be me. And that's what I sort of do now. So I'm in a position where I do a day clinical work, and then I'm mainly funded to do research, looking at the relationship between the mind and the body by the NIHR, which is the NHS arm of the research

arm and then I do various other studies primarily looking at movement and how it can help keep us healthy and happy that's always been my sort of primary interest and a few different studies looking at we started recently research on how exercise can help cognition or development of new brain cells an exciting project we've got and we're looking at can we improve neurogenesis within the brain and does a gut microbiome play a role in that and then I just get involved in all sorts of places that I didn't expect to be in. Yeah and so when you first came on the podcast I think you had published over 300 papers, now what number are you on dare I ask? I've stopped counting Hazel but I know it's over 650 but I really want to emphasize although it's like quite a big number and it's quite a big

number it's you know research is a team endeavor so it's very much reflective of working with good efficient teams and you know and when you're doing stuff you're passionate about it's just really good fun and you're working with people who are fun to work with. Yeah, that's really good to hear. And also, like you said, you know, maybe a couple of years ago, or when you were in uni, you wouldn't have thought that you would be someone who would be publishing all these papers. And I guess for people listening who may be on that journey, or they're just doing clinical work and want to go into research, that's reassuring that you don't have to be doing this from a very young age or in the beginning of your academic journey. Absolutely not. I struggled at school. I wasn't allowed into sixth form. I got into college. I just got into university. But, you

know, the key thing is I found something which I was really interested in. And fundamentally for me, that was really important. And that was, you know, exercise and mental health and mental health more broadly. And then it clicked. And I I thought this is really interesting I would really like to understand and know more about this particular area I didn't have much research training but some very patient mentors would listen to me with all of my balls of ideas and just say okay let's try and bring this into an actual research question and walk me through the process and mentors have been enormously key for that so for anyone who does not have a great deal of research experience or is daunted by you know research or reading research I was all of those things and if you

find your passion then you can absolutely get involved too no doubt about it. Amazing so let's go back to what we first spoke about on the podcast a couple of years ago. And that was the link between our mood and physical activity, which is, I guess, your primary area of research and interest. And I imagine that the research has moved on a little bit, maybe not so much. But let's have a recap as to where we are and what do we know in terms of the link from a preventative point of view and maybe curative point of view or from a treatment approach? Yeah it's been such a wonderful journey and this is kudos to people all over the world many collaborators who I could just keep talking about and fill all of our time so I won't but to gain any traction

and credibility within sort of healthcare systems policy we really had to push quite hard and look at the evidence base across both prevention and also management and key areas really are that we've you know quite strong and convincingly shown when we look at cohorts of people so we look at people who are not depressed or not anxious and we follow them up over long periods of time we've done big meta-analyses now showing whether you're a child, you're an adult or an older adult, that there is a direct relationship between being more active in your daily life, there's caveats around that for certain populations, can help protect and nudge the cards in your favour to prevent possible mental health conditions. And I don't want to come on here to say that if you move more this is going to solve all of your life problems or

prevent you having a mental health condition. It won won't know will any other intervention I'm aware of as part of a package of things that we do in our life it can have a really positive impact on people and I think the really interesting thing since we last spoke which is built upon this observational data in terms of prevention is there's been some really smart Mendelian randomization studies and I want to give a shout out to Carmel Choi who is an amazing doctoral researcher or she's finished a PhD now at Harvard University and she's been looking at this type of study which looks at the causal relationships between genes and an outcome and what she's done is she's looked at huge data of people wearing objective devices such as accelerometers,

which are really, really accurate devices that you may wear, typically wear as a consumer on your wrist or on your phone, and found that there is a causal relationship between how active objectively you are and your risk of depression in the future. And it doesn't go the other way. And this is a really sort of technical way of doing the analysis and the good news of this is the paper which she did for all of us is that even if you're genetically predisposed because genetics environment lifestyle all plays a complex interplay about why we may get depression or anxiety is that if you're more active you can still offset your risk of developing depression so she did really one smart study in depression and anxiety published earlier this year 60 000 people that looked at all of their genetic makeup and all of these people were genetically predisposed to developing depression

of equal weighting and she looked to objective device measured physical activity and she found that even if you are genetically predisposed, being more active compared to those who are not active, you can offset your risk. So in this context, 60,000 people, great physical activity data, great depressive data. You know, your genes are not determined necessarily your risk of depression. And I think that's really, really powerful and a bit about treatment. So I think we're moving very very very fast in terms of implementation I think you know we've unequivocally shown that exercise as part of a package of care for people and as part of a menu can have a really positive impact whether you have depression anxiety post

traumatic stress disorder you know any one number of these things that adding on physical activity or exercise can help reduce your mental health burden and we know about the other health benefits from doing that one of the main criticisms of exercise if i just take depression as an example and this is just to illustrate how useful it is is that research studies if typically a short term in follow-up so less than six months um so we're just like, okay, you can do exercise for three months, you feel better, great, then what happens? So there was a really good study in Sweden by a colleague called Mats Hallgren, and he looked at big numbers as well, because if a study doesn't have enough people in it, you can't really be confident in the outcomes of the study. So Mats recruited 1,000 people living in in Sweden living in the community with mild to moderate

depression and he followed them up for 12 months and they're randomly allocated into three groups and then everybody got treatment as usual which is best practice care seeing your doctor or psychiatrist psychologist or a combination of all of those things one group got that the other groups got that too and another group got CBT delivered via the internet and another group had exercised as an intervention and everybody was followed up over 12 months to say what happens in this well-powered well-designed long-term follow-up study and to add you know great credit Matt's found that exercise had just as good impact on depressive symptoms as CBT. CBT is wonderful and I fully recommend that

anybody who has that should take that as they should any treatment recommended by you know medical practitioner or otherwise but Matt's found that exercise and CBT were just as effective as each other that's not to pitch them up against each other because why not use both tools I mean if I needed it today I would but it just goes to show how powerful it was and they're both significantly and clinically meaningfully so it means something better than just standard practice care within Sweden so that is a really good randomized control trial and since we last spoke we've had a great infiltration into guidelines nice guidelines within the UK we've written European guidelines recommend you know with very eminent psychiatrists psychologists people with lived experience recommending that as an option as part of a whole package of care physical activity is using the prevention and the treatment of people

with mental illness so we've had good penetration a national European and international level in respect of the evidence and people don't change policy if the evidence is not good so it's it's exciting times that people are considering this as a an actual serious intervention that people can have as part of a menu yeah absolutely and the question that always comes after people ask about the link between exercise and depression is how much do i need to do in order to reap the benefits yeah it's a great question so if we're looking at prevention, Carmel, who I mentioned previously, did that really nice study and she recommended that you could just do, you know, 30 minutes a day would be enough to prevent you from developing depression. Again, this is

looking at population, so big, big data on an individual level. For anyone who's experienced depression, know somebody with depression, you know it's really complex and multifaceted but you know Carmel has shown that this can help nudge the cards in your just 30 minutes over the course of a day and if you actually do have a diagnosis or you're struggling with your mental health then you know 15 20 30 minutes can help you per day spread you know three times a week the most important thing for people who are struggling, and I work in a hospital where you don't go into hospital unless you're really well, is just getting started. So we had the World Health Organization new guidelines come out earlier this year, and they've slightly revised the lower band and the upper band about what people in a general population should be aiming for but they really really caveat it for people with conditions whether it be a physical health condition or a mental health condition and just say if you're struggling for any reason just getting started today with you know two minutes

five minutes is really really important to get people moving on that activity continuum. Yeah absolutely I think that's a really good message just kind of you know we have the guidance we know what the research says, but from a practical point of view, every little helps and just getting people moving is the most important thing maybe. Absolutely. Yeah. And then moving on from physical activity to food and the whole kind of food and mood

is such like, it's a big topic that's thrown around a lot. And, you know, people are told about various foods to eat to boost their mood what is the link there what kind of diet or dietary pattern do you think has the strongest evidence when it comes to influencing our mood yeah well I've had the great privilege of working with some of the giants and pioneers in this area and the best evidence at the moment and it may be because most of the evidence has focused on that is really around the Mediterranean diet both in terms of the prevention so there was a systematic review looking at prevention earlier on this year or the year before showing a Mediterranean style diet particularly when we talk about low inflammatory foods can help protect against

the emergence of onset of mood disorders and also for the treatment of depression too so it appears a mediterranean style diet is a very beneficial approach within this particular context whether or not that is just an artifact of people studying that the most i think that's to be determined but that is where most of the evidence lies at this moment in time yeah yeah i would agree and it's you know when it comes to the Mediterranean diet I think everyone's probably sick of hearing about it there's so much evidence for it supporting lots of different aspects of our health from like our mood our cardiovascular health hormonal health you know it's it's very much the one diet that fits all but it's not very prescriptive diet per

se you know it's very flexible and And yeah, I think I'm super interested in Felice Jaka's work and her SMILES trial is like, you know, one of the most landmark trials that really set the scene for this field of research. It's incredible. And Felice is, she's a pioneer, you know, she's literally transformed the landscape of nutrition and mental health in terms of the research evidence base and her smiles trial which she did was just you know face value it was audacious in many ways and saying you know against you know in addition to conventional medical care you know can we introduce you know mediterranean style diet to help people's symptoms and i know

from speaking to felice um you know quite a lot and she shared this openly as it was very difficult to get that study funded because you know who wants to believe that particularly in psychiatry what you eat could really be an active part of people's treatment but kudos to Felice and her tenacity her vision she has driven this forwards and demonstrated within a randomized controlled trial that it can really help improve people's mental health symptoms and one of the other barriers which she did which is just so incredible was demonstrated that it doesn't have to be expensive so she actually found she did a like a health economic analysis within that trial demonstrating that it's actually cheaper to go out and buy these you know the whole sort of foods rather than the sort of standard american or sort of sad diet and you know sort of you know

ultra processed food that we may have which is one of the sort of misconceptions about you know Mediterranean style diet eating is that it can not be accessible to all people and you know clearly that's that's an issue for some people but it doesn't necessarily have to be more expensive than you know what may be a standard sort of western diet yeah i agree and then that kind of brings us on nicely to supplementation and definitely in london anyway there's this like huge wellness market that's really booming at the moment and there's lots of like nootropics and various supplements that claim to improve your mood and i know that you've been looking at this and so as like a kind of overarching umbrella are there any supplements that are really standing out in the crowd or are

there any supplements that people are shouting about that you you don't feel like the evidence is really there yet? So we looked at this in the context of nutritional supplementation in the treatment of different mental health conditions. Joseph Firth was the first author in a paper in World Psychiatry. And so, you know, what are the best nutraceuticals or nutritional supplements which can help people with different mental health diagnosis? And the good news is, is it appears that almost all of them are safe. So that's good if you're happy to part with your money. But the evidence is not quite convincing as you hear from people who get very excited about this issue or if I walk into one of my local stores and people often tell me

about various supplements that cure lots of things and I always find it very interesting but the best sort of evidence at the moment is you know obviously vitamin d particularly in the winter there's good evidence within that particular context some of the omega-3s and and six uh also and there's interesting sort of data on on pre and probiotics as well but uh yeah it's definitely an emerging field and i definitely think it's a field which should be good to catch its breath before it catapults into everyone's cupboards across the you know the city or anyone else is because the data is still trying to catch up with the enthusiasm which is in the the market and joe presented that paper at you know a well-known

nutritional conference and effectively ended it saying that you know the good news is that you know all of these are safe but the not so good news is that most things don't work at all or anywhere near as good as they say it was a pretty unpopular uh ending to a conference presentation but there is some there is some there is some evidence definitely around some omega-3s vitamin d some other supplements too so yeah and then one supplement in particular that is popping up quite a bit is cbd and that's been kind of brewing around in the background for the last couple of years for anxiety ins insomnia. And now it's like, you know, I see it really marketed towards like the kind of sports and athletic community

for recovery. And there's all these claims that are being made about it. Obviously, with supplements, they're not regulated in the same way as medicine. So in terms of the quality, like, you know, that's something that people need to be aware of but I would love to know your stance on whether there is strong evidence for its anti-anxiety effects. Yeah so you know I've witnessed and seen the enthusiasm and I've got people close to me who you know swear by CBD and it's cure all and I've sat in shops and talked to people who've told me you know no matter what I go in and say I would talked to people who've told me, you know, no matter what I go in and say I would like help with, CBD will cure it. And, you know, when we look at the science behind this, for some of the reasons that people commonly use it, you know, science in terms of

top quality evidence around randomised controlled trials is catching up. Before I touch upon mental health, where I think there is a bit more promising evidence, I'll briefly touch upon some of the other common reasons that people use it. So there was a recent systematic review in randomised control trial pooling, so a meta-analysis looking at the possible benefits and the possible side effects across two different papers. And the authors found that CBD-based products across a number of randomised control trials. So this is double-blind.

So the participants don't know if they're getting CBD or if they're getting a control placebo that's one of the good things about doing nutraceutical research and the people giving it don't I've been involved in the vitamin D study in first episode psychosis so I know it's it's quite easy to do double blind randomized controlled trials and they found in this paper in neuropsychopharmacology earlier this year is that you know interestingly in in the quote-unquote healthy population that cbt reduces your appetite and it doesn't have any effect on your sleep and the impact on pain is negligible in this particular randomized control trial

remeta analysis so that is in that particular context and again looking in the general population some colleagues where i work looked at what are the adverse events or side effects, which we would do if you look at any particular medication in the treatment of any particular condition. And they found some quite concerning side effects for people, which I've not heard many people talk about. So for instance, side effects such as increased risk of withdrawal due to side effects, twofold increase compared to the placebo group. There was an increased risk of almost tenfold for abnormal liver function tests. There was an increased risk of diarrhea by two and a half times compared to control conditions, an increased risk of sedation during the day, fourfold increase, and a fivefold increase in pneumonia compared to the control conditions. This is double-blind, randomized control trials. And the paper, the first author was Edward Chesney in neuropsychopharmacology,

published in 2020 in one of the nature journals, I work with that particular team so I don't think that's one of the things that we particularly hear about is the potential adverse side effects reported and this is a supplement which I can go down to the local shop and buy heaps of and no one's ever told me that it could result in all of those different things that being said just before I talk about mental health I've got people close to me who will literally you know swear by the power and the healing that it's done across many different facets and I think within this particular context until we're met with good data I'm continuing to sort of sit on the fence and look at this a bit skeptically the power of the placebo is real it's very very powerful if I

go to a shop and I don't know and someone tells me all of these wonderful things it's going to make me feel better and all of this stuff then you know it's almost like even before I've tried it I'm like wow you know I've got my new product I'm going to go home and try it and I start to feel better and whether or not it's due to the placebo people feeling better on an anecdotal basis or not is yet to be confirmed in the general population if we look in clinical populations and mental health specifically so there is some tentative evidence that it may help people's mental health particularly anxiety there's some tentative evidence and I use the word tentative quite strongly that it may help people's depressive symptoms and there's some interesting

data looking in schizophrenia and schizophrenia spectrum as well, that it may be a possible helpful treatment for this kind of people who experience those symptoms. of adverse events which have been reported in you know pre-registered randomized control trials and the evidence for the health benefits in randomized control trials is not anywhere near as clear as people report in their own experiences or people will tell you when you go into a shop or you go on a company's website yeah absolutely and i think there's so many anecdotal reports here for CBD and I know like a lot of people have used that and I did my own little experiment obviously not blinded because I'm giving myself CBD but I decided to take it for 30 days and see how it affected or influenced my WOOP data in terms of sleep recovery mood and what I found was because I'm pretty skeptical about all of this I've read the research when it comes to supplements I am always very cautious

anyway and had this initial boost in my recovery green streak on whoop and all of my markers were improved and then this kind of dropped off after like eight nine days and came back to a baseline and I like you know I finished my month and I decided not to continue taking it first of all it's like 70 pound a bottle and I'm like that is there's so many other low hanging fruit when it comes to improving your mental health that like I just don't want to waste my money until someone can show me very good evidence that it's going to make an improvement and so how I explain or how I'm kind of interpreting this initial increase in recovery is like was that placebo effect but also I'm probably doing things

subconsciously around that time I was you know having CBD before bedtime probably getting into bed a bit earlier doing all the other things that are like confounding what I'm doing with CBD. So it's so hard to tease apart what's happening. And I think for a lot of people who are interested in CBD, they're already doing lots of the good things already. They've probably invested in like things like blue light blocking glasses, they're getting into bed, they're not using technology, they're eating a well balanced diet, they're exercising. And so it's very hard to say, yes, it's the CBD that's made that difference to you. Yeah absolutely it's it's literally impossible to say you really do need randomized controlled trials to compare you know

people who don't know what they're taking against people who you know are taking CBD and when you look at that the evidence is not clear and in fact it points to people may have side effects again never underestimate the power of the placebo I'll never i'll give you one anecdotal example of how i saw this very early on in my clinical training as a student and this was a bit bad of me but i did tell the person the next time this person came in with some back pain and i put on what's called a short wave diathermy machine which is some electrotherapy device which has i think subsequently been debunked but we got taught how to use and I put it on this person's painful neck at that particular time and shoulder and after the end 20 minutes I said wow that felt amazing and then I realized I didn't turn it on

after they said that it was absolutely incredible and then they came back the next time and I was a nervous anxious student didn't know what to say I told my educator in time and came back next week and said you know ever since that last week I felt incredible and then I had to sort of say I'm really sorry I didn't turn the machine on so that was my first early experience of real world yeah placebo taking don't underestimate the power of the mind. Yeah absolutely and also just like the therapeutic experience of seeing a practitioner and then like physical touch and them actually doing something and listening to your problems I feel like when I'm seeing patients 80% of what I'm doing is like reassuring and listening and that's therapy in itself and people like walk away feeling like their ailments even physical

ailments have improved purely because they've gotten a load off their chest absolutely and and i invite students or qualified people or anyone to come in and spend time with me in my clinical practice and i always say to them at the beginning i said you're not really going to learn much from me physiotherapy wise because most of my time is spent talking listening reassuring encouraging people to engage in treatment and you know people in hospital who are really unwell just really benefit that time and that space to be reassured that if you are having aches and pains you know it doesn't mean your back's going to crumble and snap so I'm very much in my own clinical practice uh you know two ears and one mouth and I continue to try and use it in that proportion if

not more yeah absolutely so we kind of touched on a little bit about like marketing around mental health and products and things like that and you know there's some really incredible marketing tools out there and they can be very convincing and if you don't have a scientific background or you're not willing to go look at the evidence yourself, you're kind of having to take things at face value that you see online. And so I get a lot of people sending me various posts or advertisements. Hazel, is there evidence for this? Can you debunk this? What would be your best advice for people to look out for in terms of red flags for pseudoscience? So in terms of pseudoscience and lack of clarity, be careful, particularly normally if there's a new pseudoscience or area, there's normally a guru or a face of someone who is a sort of

leader of that particular movement. People who practice pseudoscience, particularly new areas, claim that it helps many different areas and they tend not to subject themselves to the scientific process. What we've talked about in terms of testing within randomized controlled trials and seeing whether it really does work. So if you ask that person about their new amazing product or their new amazing therapy or their new amazing theory and you ask for their research or even go into their websites and this can be you know very confusing in its own right because most websites say you know we're evidence-backed we've done this research and if you get down into it the evidence base is actually really really you know poor and quite shoddy so I'd be quite careful about what you do and don't take on board but what I'll often typically hear

is if I engage with people who are talking about pseudosciences, I often hear that it's just so complex that, you know, scientific methods can't capture this, such as, you know, we'll call it Brendan's therapy. Brendan's got a new therapy that works and releases new energy. I'll just say this as an example, new energy within your body and makes you feel amazing with this new Brendan special therapy you know and of course it normally comes with a prolonged I'll call it babble because often I don't understand what people are saying and that's just because it is literally just not interpretable so I would be cautious for any of these particular therapies treatment approaches which do not submit themselves to the scientific process and if they're using lots of lingo and scientific terms and jargon which are making it sound overly complex. Yeah I agree and the other thing that

pops up quite a bit is like I've done my research or like do your research and research is such a big term and I'd love you to kind of just briefly touch on that and kind of the hierarchy of evidence and what we look for when it comes to good research as clinicians and researchers. So the top of the evidence hierarchy pyramid is someone who looks absolutely amazing when they take their top off or looks great in their gym gear. I'm just joking about that. But no, in terms of the evidence based hierarchy pyramid or public health policy, when we're making decisions, we tend to use, you know, what we call quote unquote expert opinion is interesting, but it's not really good evidence. So not that I'd consider myself an expert and giving an opinion on anything else, but, you know, take anything I say with a pinch of salt, really look at the science. And then as we move up, we start to collect data and we look at case series. So, you know, we talked about anecdotes so a researcher may get a series of anecdotes where they may give amazing product to a you know group of people over a week and look at some outcomes

before and after using standardized metrics whatever they want to measure physical health mental health metrics and then if you want to get a bit better you could go up to sort of cohort and cross-sectional studies so you could look at surveys and capture data from larger numbers of people and you could even look at people over time who don't have a condition and look at their symptoms say mental health over time when they're taking amazing product or they're doing brendan's therapy and you can see how they improve at the end but really that's association data you can't really say whether it's Brendan's therapy or Brendan's amazing product that's making a difference. So if I give you like a real world example of how we can confuse associations between causation, there is an almost perfect, perfect correlation between grey hair and dementia as one example. Does grey hair cause dementia? Of course not. But do people in that

age group who are often older and may have grey hair, you know, at the end of the sort of spectrum 60 plus, are they more likely to have grey hair? Absolutely. So, you know, it's really just an absolute confounder that grey hair is related to dementia. So that is the interesting thing, but the thing we need to be really careful about when we're looking at observational data. So if I want to say whether Brendanndan's amazing therapy works or brendan's amazing new pill which has everything under the sun works it needs to be tested within a well-powered randomized control trial which is open has good numbers of people in and it doesn't have me evaluating all of the data internally and saying oh I think you know these 10 people they look really motivated I'm going to pick those people and and some of these friends

and some friends that I know to take the product because I know they're going to do really well whereas my mate Dave and Stuart and others they can't be bothered to do anything and they're not in a great space so I'm just going to give them the placebo and not tell anyone. Randomized control trial moves you know that like sampling bias, many other biases right at the start. And it really is the only way to reduce all of that bias to understand whether something truly, truly does work. And that is the top of the evidence-based hierarchy in terms of primary studies. And then to get a bit more boring and a bit more confusing, one study is never enough. So never, ever just believe one study. You know, we always need

replication within studies. And we see this phenomenon within new areas of research, new areas like CBD or Brendan's therapy or Brendan's nutraceutical. We see new study effect sizes. And this has been shown time and time again, that when we see a new product or a new intervention launch, we see great results. Then when you get other people replicating it, saying, can we really get great results from Brendan's therapy or Brendan's nutraceuticals, we continually see the effect size shrink, if not go away over time. So we need to be wary. One study, even if it's a randomized control trial, is never enough. And that's why we need replication. And meta-analysis is one way, pooling of individual studies and data to try and understand better the answer

about whether a product or an intervention actually truly works yeah that was a really good overview um one of the areas that i've been really interested in and have like spoken to you about before is research into female mental health and mental health for women and we know like historically a lot of the research has been based on a typical white 70 kilo male but when it comes to mental health there's really important sex differences and we're starting to understand them a little bit more can you speak to that a little bit sure I can so I'm you know I've certainly read on this I've published a number of papers on on women's on women's mental health, particularly after birth, before birth as well, and across the lifespan.

So I can share a bit about my understanding of the area. So I was on a talk this morning, and thank goodness for that, with a professor from the Great Ormond Street Hospital, a paediatric psychiatrist. So I'm fresh off some latest knowledge. So she was emphasising that for all of us, concerningly, 50% of mental health conditions, the first time people get them is under the age of 14 years. And that is just like incredible. So if, you know, we really need to protect our young people. And obviously, that is a really important, on average, time of change for lots of people in different areas, in terms of social circumstances, you know, being much more aware of friends, and obviously this huge, you know, physiological event in terms of social circumstances, being much more aware of friends,

and obviously this huge physiological event in terms of puberty and going through the puberty process. So what we tend to see in terms of the epidemiology or the patterns of mental health conditions is females on average have puberty and have additional factors that happen around puberty in terms of menstru menstrual cycle beginning etc before men well boys at that stage so females are twice as likely to have mental health symptoms in this critical stage at around the the puberty stage and that's due to you know a huge you know hormonal change body change you know all of these things which all of a sudden get you know and i'm not speaking obviously from personal experience but all of a sudden get, and I'm not speaking obviously from personal experience, but all of a sudden get put upon young women.

And all of this together with increasing societal pressure at that age can really predispose young girls to be at increased risk of depression. So that is a really key milestone for young people, particularly young females. And then we tend to see as boys catch up a bit later on in terms of the prevalence of common mental health conditions later on and then we see a much more static pattern in terms of common levels up until females get around you know other key events which matters they're not experienced I'm going to talk about these before I talk about social aspects you know in terms of childbirth for instance you know the huge hormonal changes that you know changes in circumstances that happen before a birth after a birth and then this postnatal phase is an immense period of adaptation

for females both you know socially but then also in terms of changes in hormones particularly estrogen has been heavily implicated within you know key areas of processing emotions within the brain and predisposing people to an increased risk of mental health symptoms and then looking along the life cycle of females is we're increasingly recognized and we've looked at this recently is that the perimenopausal phase and then the postmenopausal phase again another unique another unique but very, very important phase, which females go through that men obviously don't. And this is a huge time of change of hormonal changes, body changes, tiredness, fatigue, et cetera.

And this is another sort of risk time where we tend to see an increase in the prevalence of mental health comorbidities within females. And then later on, as we move into older age, we tend to see males and females flatten out in their prevalence of mental health comorbidities within females and then later on as we move into older age we tend to see males and females flatten out in their prevalence and caveated within those key changes across females we've got all of this and again speaking from reading not from personal experience increasing sort of social pressures on females in many different domains you know equality you know pressure and sort of terms of child care responsibilities unequal burden inequality in the workplace inequality in working hours

just looking at those factors it's no surprise that society discriminates against female gender so much that groups of females is you know a high risk population for mental health comorbidities yeah absolutely and i think it's really important what you said there and that what we see is in these kind of major hormonal milestones there's almost a period of vulnerability where there's like a blip or a spike or increased risk of mental health conditions whether it's postpartum depression or perimenopausal depression but during those transitions there's typically a lot more happening outside of the kind of physical and physiological body and usually women are going through a huge change in their life as well and Dr Sarah McKay

she really talks about this so elegantly and that like hormones are so easy to blame and they're definitely often the most loudest voice in the crowd but they're not the only voice in the crowd and it's very easy to forget about the other things and we know that you know social support and social connection is one of the biggest predictors of good mental health and so if a woman feels unsupported after she's had a baby that's one thing that we could be offering more help and advice with to help women kind of get through that really daunting transition from being pregnant to a new mum. Absolutely and just distilling it to you know a hormone or a series of hormones we'd be doing you know as you said complete injustice because there's so much more going on in terms of roles responsibilities you know far beyond what

I've ever you know could possibly imagine and you know it's definitely a much more holistic issue in terms of support that is needed within people I think within research what we tend to do is hormones are easy to measure and they're objective when you start to look at you know other factors such as social support or you know inequalities in the workplace and how that may be impacting mental health we're starting to do a bit more but it's just been less easy to measure which doesn't do the whole story justice whatsoever. Yeah what's also difficult with the research when it comes to mental health in particular you know we're looking at biological sex male female but then

we also have like gender which is a social construct and whether people identify as a woman or not or non-binary and the research fails to capture that like we're not there yet and so when we're thinking about mental health it's such like a complex web of factors that influence that and so it's not just our biology it's how the world perceives us and kind of what opportunities we get and you know what environment we're grown up in and how people treat us and so it's it's fascinating but I think like we definitely need to start considering those factors because not everyone identifies in the same genders as their biological sex. Absolutely not. And it's just it's really sort of important that more research is done within this particular area to understand people who, you know, their gender may not be what their sex was when they were born. And we recognise from sort of epidemiological data that there is an increased mental health burden in people whose gender identity may change over time. And it's great to see new research coming through. So where I work, for instance, I'm not

involved with this. We've got Professor Louise Howard, who's a women's health psychiatrist, and her great team. And they're doing some wonderful work looking at all of these types of issues in terms of you know gender specific mental health conditions what could be contributed to that how can we support people doing that you know and also supporting you know females have been through horrific times whether that be trauma related issues or you know shan aram is a another wonderful doctor doing some really fascinating and such important work looking at people who've been like trafficked as an example and females in that instance and huge needs and

such important work to be going on within this particular area so I think there's more investment happening but it can't come quick enough and you know the key thing that I'm really personally interested in in this context more broadly is okay let's let's do the research but let's get the information out there let's really start to action this so we can support people you know across the spectrum regardless of you know genders you know socioeconomic status let's help people yeah i agree and so this is probably a really difficult question um to summarize but if you could write a mental health prescription for everybody what are some of the kind of key pillars that you would love to see people starting to engage in sure well I if I'm going to start from an assumption but this could work for someone who

is struggling with a mental health hazard diagnosis and health condition I'd recommend that the absolute fundamentals to keep on top I do many of these myself have a position of gratitude I personally have written a gratitude diary for 10 plus years and I sit and spend time with that every particular morning and it shifts my mindset because I naturally wake up and I'm having conversations throughout the day and more often than not I'm projecting worse outcomes so it helps shift me in terms of you know focusing on the positive so having like a positive mindset and a gratitude journal is absolutely fantastic for that making time for physical activity is really important so you know even me that spends a lot of time you know and is privileged in many many ways i diarize time in to make sure that you know it says diary with myself

and self-care that i get outdoors and i get active um also nutrition we spoke a lot about that there's really good evidence in both the prevention and promotion of better mental well-being today we know about sleep you know if you're doing all of those things if you're not feeling great and you get two hours of sleep or no sleep at all you're going to feel pretty rotten and also other techniques if we don't talk about you know some of the medication related stuff you know in terms of like mindset and mindfulness is just so important in terms of being present acknowledging emotions and you know being part of a social network too feeling part of something and and that is really really important

so feeling part of a connection within a community a group of friends is really really important for people and if you are struggling with your mental health it may be very difficult to do some of those so just start off with perfecting one don't think you've got it all yeah and I think the the message is really nice in that you have to be compassionate with yourself and it's very easy from a to to list out these things but like you said if you're struggling with your mental health sometimes it's just not it's not practical to expect someone to implement all those things at once and so can always be integrated on a stepwise approach but I think that's a really nice way to kind of round up the podcast.

Before you go though, I have three questions that I ask every guest. And the first one is, what is the number one takeaway that you want people to take from this episode? The number one takeaway is be interested in evidence and be sceptical. It's your time and your health.

Do your due diligence on anything that you take up that's a quote right there and this one's a little bit different to what we spoke about but if you could go back and give your 18 year old self one piece of advice what would it be I'd sit down with 18 year old Brendan I'd put my arm around him and I would tell him everything's going to be okay it There's going to be a few bumps, but it will be all right and don't take yourself too seriously. Yeah, that's a good one. And finally, what is one book that you recommend everyone reads? So one book that I recommend everybody reads, and I'm going to be a bit geeky with this because it's my area of interest, is Bad Science by Ben Goldacre. If

you're interested in science and why science works and why science is the best way to understand research questions still, it's imperfect. And Ben Goldacre is the author who's a doctor at Cambridge and he's written a fantastic, really accessible book looking at how science, whilst it is the best way to understand the safety and benefits of anything that we do in our life it's imperfect and he very eloquently outlines what are some of the flaws in science yeah that book actually was in my first degree I was in a biochemistry lecture and professor Morton who was my lecturer back then recommended that we all read that so that was probably 10 years if not more

ago um so that book's been around a while but he it's one of the kind of most groundbreaking books when it comes to telling you or showing you how to spot pseudoscience and I found it super eye opening because as a young science student you just want to believe in everything and you want to evidence is evidence and it takes a while to hone those skills of looking for good evidence I love that book as well so yeah it's a great book and um you know I'm still doubting a lot of my own science too and I think that's a healthy thing and it's better to uh disprove your own hypothesis in your own research than other people do it for you so we're continually trying to disprove what I've said so I reserve the right to continue to be wrong and I continue to change my mind about certain

topics too. That's another good takeaway you know be willing to be wrong and yeah if you're not willing to if you're too proud then you're never going to evolve. So if people want to read more about like the work that you're doing or touch base with you where is the best place to contact you so instagram now brendan.stubbs is my handle so you can contact me there and i post about research mainly and then the odd random stuff amazing thank you and thank you for all your work and research as well thank you hazel thank you for your advocacy and pushing evidence-based the masses it's It's amazing. Keep up the great work. Thank you so much

for tuning in today. I think the power of exercise on our mental health just really isn't spoken about enough and I'm still blown away by the abundance of research we now have to back it up. Make sure to subscribe

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