The Food Medic - S9 EP8: How food can support your mental health

Episode Date: February 27, 2023

In this episode we discuss how diet plays a role in our mood - and which foods or food groups have been linked to positive and negative impacts on our mental health. Our guest today is Felice Jacka - a Professor of Nutritional Psychiatry, Co-Director of the Food & Mood Centre at Deakin University, and founder and president of the International Society for Nutritional Psychiatry Research. She has written two books including Brain changer & the very popular children’s book “There’s a Zoo in my Poo”.This episode covers:*what is nutritional psychiatry?*The role diet plays in our mental health.*The SMILE’s trial *foods that support our mental health - & those that don’t *The gut-brain axis *The role of supplements Please note: if you are struggling with your mental health you should seek the advice and support of your GP as a matter of priority Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

What's better than a well-marbled ribeye sizzling on the barbecue? A well-marbled ribeye sizzling on the barbecue that was carefully selected by an Instacart shopper and delivered to your door. A well-marbled ribeye you ordered without even leaving the kiddie pool. Whatever groceries your summer calls for, Instacart has you covered. Download the Instacart app and enjoy $0 delivery fees on your first three orders. Service fees, exclusions, and terms apply. Instacart. Grocer $0 delivery fees on your first three orders. Service fees, exclusions and terms apply. Instacart, groceries that over-deliver. Hello and welcome back to the Food Medic Podcast. I'm your host, as always, Dr. Hazel.

One of my favorite topics is how food and diet impacts our mental health and vice versa. So today we're taking a deep dive into that topic with one of the world's leading researchers in this field. For this episode I'm joined by Professor Felice Jaka whose work I've been following for a long time and often share her research in my content on social media and on the Food Medic Hub so excuse any fangirling moments in the episode. By way of introduction, Felice Jaka is Professor of Nutritional Psychiatry, Co-Director of the Food and Mood Centre at Deakin University and Founder and President of the International Society of Nutritional Psychiatry Research. Professor Jaka has been responsible for the development of the highly innovative field nutritional psychiatry establishing diet as a risk factor and treatment target for common

mental disorders. She has written two books including Brain Changer and the very popular children's book There's a Zoo in My Poo. In this episode we discuss how diet plays a role in our mood which foods or food groups have been linked to positive and negative mental health outcomes. Today's episode is brought to you by Whoop. If you're a weekly listener to the podcast, you already know what Whoop is because I'm always talking about it. So you probably already know that Whoop is a digital health and fitness coach that specialises in breaking down your recovery, sleep and workouts via a non-invasive wearable device and companion app. But it's probably also worth talking about what Whoop

doesn't do. It's not going to ding on your wrist when you get a text. It's not going to call you an Uber. It doesn't tell you the time. What it does track is every heartbeat throughout your day and break down all your data for you so you understand everything you need to know about your body. As a medical doctor, PT and nutritionist this is the kind of data I love to geek out on and over the years since wearing Whoop it's been amazing to see my trends slowly but surely improve. So I know I'm becoming healthier, I know I'm becoming stronger and fitter start tracking your health wellness and fitness at a deeper level today head over to join.whoop.com slash

the food medic to get started you'll get your first month on me I guess where I would love to start is to just learn a little bit more about you and your background and what got you interested in nutritional psychiatry? Yeah, it's an interesting one. And I actually talked about this in a book that I published, you know, in 2019, because it is, I came to this area through quite a circuitous and non-conventional route. So my first degree was in fine art. I was an artist. And then when I was in my thirties, I went back to study. And that was largely to do with my personal experience of common mental disorder, so depression and anxiety. So I'd had quite severe anxiety, panic disorder, and also major depressive disorder during my adolescence, which of course is really common. And as I grew into my 20s, I gradually

recovered. And part of that was really to do with exercise and sleep and focusing on lifestyle factors. But I'd always eaten pretty well because I came from a background. My father was a naturopath, a very non-evidence-based naturopath. But what I did glean from him, I guess, is this paradigm of food being the fundamental, the platform, the driver, the petrol for virtually every system and every process in your body. So when I was doing psychology and I started to realize I didn't want to be a psychologist, but I was really interested in statistics and brain and sort of more the hardcore psychiatry aspect of psychology, I started to do some work with a psychiatric unit in the area I was living and with one of the world's leading psychiatry

researchers. And he's a psychiatrist. And when I started doing this bit of work while I was studying, I realized that there was just nothing in the literature regarding the possible impact of food and diet on mental and brain health. What was there was there was a lot of rubbish, a lot of misinformation, this orthomolecular thing, and, you know, a couple of decent, you know, little tiny trials of supplements or observational studies focusing on individual nutrients, those sorts of things. But there was nothing that really looked at the whole of diet. And of course, nutrition as a discipline had really started to move away quite rightly from that very reductionist approach. And around this same time, there was this emerging understanding of the plasticity of this region of the brain, hippocampus that was very important in learning and memory and there were animal studies coming

out of UCLA showing that you could really modify hippocampal plasticity brain plasticity by modifying diet and of course there was also this emerging field of psychoneuroimmunology so understanding that the immune system was working quite tightly in a bidirectional manner with mental and brain health. And of course, diet is a really important predictor and driver of immune function. So there was a lot of good reasons for me to think that there was something there to look at. So I suggested that I wanted to do this for my PhD and there was a lot of sort of, you know, but, you know, my supervisor, he said, well, I don't know anything about nutrition or epidemiology, but off you go. And so I had

to sort of kind of take the techniques from nutrition research and meld it all together and kind of figure it out as I went along. But that then formed the first study to look at the link between overall diet quality and aspects of diet and clinical depressive and anxiety disorders. And it ended up being published on the front cover of the American Journal of Psychiatry, which now I think is, you know, it's kind of cute

that we've got this cross-sectional observational study. But it had an impact because it was the first time I think that had been looked at like that. And it was part of this emerging recognition that mental disorders and mental health don't just exist in the brain. You know, we are a whole integrated, highly complex system and you can't really separate brain and body. So I was just, it was one of those things of being in the right place at the right time with the right idea. And then of course, I went on and did a lot of more observational studies and then moved into the intervention randomized control trials. Amazing. It's interesting to hear the response that you

had initially when you decided that this is going to be your area of research. And now people are so fascinated about it. And there's so many articles about what to eat, what not to eat for to improve your mood. And so I'd love to start there. What is the impact of our diet on our mental health? Well, what we know so far, of course, the field of nutritional psychiatry is really, you know, my paper was published in 2010.

So it's just over a decade old, which is relatively young in scientific terms. So a lot of the literature has come from observational studies. So these are where you get a lot of information from people on what they eat and then their mental health and other factors such as their income and education, body weight, other health behaviours, et cetera. Use statistics to look to see if there's a relationship, but you can't show causality from that. But then, of course, we've got the SMILES trial

and three other randomised control trials now that have all used a Mediterranean-style diet and shown that you can treat even very severe clinical depression with this dietary approach. Now, a typical Mediterranean diet or the traditional Mediterranean diet is one that is very, very heavily studied and it's certainly got the best evidence base and partly that's because it's been heavily studied. But it's a diet that is ideally high in lots of different plant foods, lots of foods that have fiber and flavonoids and these sorts of things, healthy fats in the form of seafood, et cetera,

a little bit of fermented food, and then whole grains of various types. That's ideally and low in unhealthful and ultra-processed foods. So the diet or the dietary strategies that we know is good for our physical health, for our heart, for our gut, is also the one that seems to be very good for mental and brain health. Which is good news for everyone. It makes it more simple. I would love to dive into the SMILES trial, which you just mentioned. And it was my introduction to your work initially. And it's widely cited. It also has a great name. It's one of my favorite, favorite named trials. So let's talk about the trial. What were you looking at the different treatment arms and what were the kind of key findings from the study so as i said before um you know i did my phd which looked at the link

between diet quality and depression and anxiety in adults then i went on to do a lot of work looking at this right across the lifespan in different countries different cultures and from very early life, pregnancy, children, right through the old age. And so then we had a very well-developed evidence base, and others, of course, were contributing to this from the observational literature. But that doesn't tell us that one thing causes another. So it was very important to do a trial. But doing a trial with diet or exercise or anything that you can't readily blind people is very challenging. And I'd never done a trial before.

I was in the first year of my postdoc. So, you know, I asked everybody and just worked out what I thought was the best protocol. Now I would like to build on that and do things a bit differently. But at the time, what we decided to do was to recruit people with moderate to severe clinical depression and randomly assign them to either have three months with a dietician. That's just a clinical dietician who does what clinical dieticians do, which is working one-on-one or sometimes in group-based settings with people to gradually help them to set their own goals and to improve their diet. So to reduce the intake of the unhealthful foods and to increase the healthful foods. The control condition was social support. It's called a befriending protocol.

It's often used as a control condition in psychotherapy trials. And we know that social support is helpful for people with depression. So they saw people, a researcher for the same amount of time over a three month period. Now we had enormous problems recruiting people. It took us three years to recruit the small number of people that we managed to recruit, which was less than 70. We had hoped to have a far larger sample size, but there were no clinicians referring to the study because no clinicians thought at that time that diet would have anything to do with mental health and certainly not treat something as serious as a major depressive disorder. And people, I think, didn't nominate themselves for the study for the same reason. So it took us a very long time. And because of our relatively small sample

size, we certainly didn't expect to see a difference in the results in the different groups at the end of the three months. And we nearly fell off our chairs when we did the stats and we saw that there was a massive difference. And in the people who got the dietary support, roughly a third of that group went on to have full clinical remission. But there was a very large decrease in their depressive symptoms. There was also a decrease in the other group, but it was a much smaller decrease. We saw that the degree to which people improve their diet was very closely tied to the degree to which their mental health symptoms improved. So basically, the better they did at adherence, the better off their mental health was. We also did a very

detailed cost analysis and costed every single thing that people were eating and what they were eating when they came into the trial. And we showed that our diet that we were advocating for, which had a lot of things like, you know, dried and tinned beans and tinned fish and frozen veggies, very easy, simple recommendations, was actually quite a bit cheaper than the junk food heavy diet people were eating when they came into the study. And then we did an economic evaluation, and we showed that there was a very large cost saving, roughly two and a half thousand Australian dollars, because people experienced a benefit to them that extended beyond mental health. They saw other health practitioners less often. They lost less time out of their daily roles.

So it was sort of really pointing to the fact that this addresses the whole person and their functioning and not just, you know, an individual aspect of their physiology. Yeah, absolutely. Such fascinating results. And I know people listening will want to know a bit more about that diet that the dietitians were recommending, that modified Mediterranean style diet. What were some of the key kind of food groups that were recommended? So it was an interesting thing because, of course, the Mediterranean, traditional Mediterranean style diet has, as I said, the very strong evidence base. But a traditional Mediterranean diet is pretty low in red meat and animal products. I mean, it has fish and it has a little bit, but it's pretty low in red meat

and also not very high in dairy either. When I was doing my PhD study and we had all of these data from a very large, more than 1,000 women across the age range that were highly representative of the Australian population. We had very detailed dietary data on them. We had clinical diagnostic assessments of depressive and anxiety disorders. We had information on income, education, all these other factors, body weight. What we saw was that there was a very clear relationship between diet quality and whether or not they had these depressive or anxiety disorders,

independent of all those other factors I mentioned. But I'd come into my PhD, I'd been a vegetarian for most of my life. So one of my hypotheses was that animal foods would be associated with worse mental health. And what I found when I was doing my statistics and my results was not that at all and something quite different. And so I delved into it. And what I saw was that there was a very clear connection between the intake of red meat. Remember, these are women and these clinical depressive and anxiety disorders. And it was a really obvious relationship that was U-shaped.

So basically what we did was we got all the women that were in the study, statistically speaking, not in real life, put them into groups of those who had less than the dietary recommendations. So these are the Australian Dietary Guidelines, which are for three to four small servings of unprocessed red meat a week. So we're talking here beef and lamb, not pork, but just beef and lamb, the red meat, women who had less than that, women who fit into that category, and then women who had more than that amount of red meat. And then we controlled for overall diet quality. Because of course, if you're eating a lot of red meat, you might also be eating a lot of chips and, you know, Coke and those sorts of things. Or you might also be eating

a lot of vegetables and other healthful things. we took that into account age into account everything and what we saw was across the disorders across anxiety major depressive disorder and even bipolar disorder this complete u-shaped relationship so that women who were having less than the recommended intake of red meat or more than the recommended intake of red meat were twice as likely to have those disorders. So because of that, we melded the Mediterranean style diet with the national guidelines for red meat intake and also dairy. So it was a bit of a mashup, but it focused also very much on reducing the intake of ultra-processed foods. And actually, we've just done an analysis of that. And I won't go into too many details

because we haven't published it yet. But it does look like a reduction in the junk food might be the biggest driver of improvement or certainly a very big driver of improvement in mental health. So you've got two things going on, haven't you? You've got increasing the good stuff, so feeding your body and your gut and everything else with the fiber and the polyphenols, etc. But then you're also reducing the bad stuff. Now, in our observational studies, we use techniques that allow us to pass out the data into healthful and unhealthful. And what we see is in every study, these are two separate factors. They're not just the opposite of each other, because you can get people who eat lots of healthful foods,

but then they also eat a whole lot of junk and processed foods. So they're getting, for example, young people at home, they're having lots of veggies and the good stuff at home, but then before stuff, are both independently linked to worse mental health outcomes. So understanding what thing is driving improvements is really important and also really interesting. And it looks like a big chunk of the improvement is driven by reducing the junk food. Yeah, that's so interesting. I'd love to circle back to the red meat association

and what the hypothesis is behind why that might be an association. Is it vitamin B12 or iron? Why do we think that that link is there? No idea. Because really, this is observational. Very difficult to do a randomized control trial here. And these are women, so it may be driven by, you know, menstruation and iron. But there were women right up until their 90s. So only about half the sample were premenopausal. You know, food doesn't have just one or two, as you would know, different, you know, nutrients. It has a whole food matrix and a whole food profile. So all of those, the things that you mentioned and the zinc and the iron and the, you know, there's many, many components of it.

It's very nutrient dense food. And it looked like, you know, everything comes back to this idea of moderation, doesn't it? You know, that if you're having too much or not enough, it's problematic. There are quite a few observational studies that link vegetarianism to poor mental health. But there's a pretty good argument that that's driven by psychological factors like neuroticism so neuroticism can give rise to neuroticism not as in our typical pop culture understanding of it but as a psychological factor it is associated with you you know, extreme diets. It's also associated with poorer mental health. So there's no way of knowing whether it's cause or effect.

The interesting thing in our study was that we took out, there was only about 20 vegetarians out of the 1,000-plus women. We took them out of the analysis. So we're really talking about women who do eat meat but just not very much or they eat a lot of it, or they eat the right amount. Quick one, I have a new and exciting membership coming out, and I want you to be the first to hear about it. I started the Food Medic over 10 years ago, and my mission has always been to bring evidence-based health and nutrition information that's easy to follow and practical to implement. And if you're listening to this podcast,

I'm going to make an assumption that you're someone who prioritises their health and seeks out high quality information from trusted sources. So that's why I'm inviting you to join our new and exclusive membership, the Food Medic Hub, which allows you to take charge of your health with support from the most trusted experts in their field.

Inside, you'll get access to hundreds of easy and healthy recipes including breakfast, lunch, dinner, desserts and snacks so you can enjoy nutritious delicious food every day. A library of expert written articles on nutrition, health and fitness to help you cut through the noise and implement the latest scientifically proven advice. A rolling full body strength program to keep you feeling strong and energized in your body. And with our Food Medic Plus membership, you'll also get access to our library of CPD endorsed webinars worth £30 each that dive into the latest developments in health and nutrition with leading experts. Every month,

the Food Medic Hub will continue to grow with new recipes, articles, workouts and webinars so that you're always at the forefront of wellness. Whether you're just starting your journey or looking to elevate your health, the Food Medic Hub is your number one support system and resource to achieve your goals in 2023. Head over to www.thefoodmedic.co.uk to join now from $9.99 per month. It's been a couple of years now since the SMILES trial's been published and you've published work since. To you, what do you think is the, in quotation marks, the best diet for mental health? Well, based on every bit of evidence that we have from right around the world and from the, we've got got four randomized control trials now, all showing very similar things to smiles.

A diet that is higher in plants. It's very it's that when you think about gut health, it's the same message. We know that the gut and the bacteria that live in the gut and the bacteria that live all over us, in fact, it's very complex. It's computationally complex, biologically complex, all the rest of it. But what you should be eating to have a healthy gut seems to be pretty straightforward. So lots of plants. And here, we're not just talking vegetables and fruits. We're talking, you know, whole grain cereals. We're talking, very importantly, legumes, beans and legumes, peas. we're talking you know whole grain cereals we're talking very importantly legumes beans and legumes peas we're talking nuts and seeds herbs so plants is a much larger group

diversity because the more diverse your intake the more of those different compounds and the thousands of different things that are in food that you're taking in. So lots of plants, lots of diversity of plants, healthful fats. So these are fats that are, you know, the mono and polyunsaturated fats, the sorts of things that you get from extra virgin olive oil, avocado, nuts, fish, seafood, these sorts of things and very importantly avoiding the unhealthful foods particularly the ultra processed foods so the foods with added sugars added salts added emulsifiers etc etc i would say although the evidence is not there yet in the nutritional psychiatry or you know it's certainly something everyone's working towards that you would probably want to throw in some fermented foods as well. Fermentation and the fermented, the products of fermentation, the postbiotics have a multitude

of actions within the body that also seem to interact with the brain. So I would say include some of those in your diet as well. So it's actually pretty basic. You don't have to be vegetarian or a vegan. It's really about that, you know, unprocessed whole foods and lots and lots of different sorts of plant foods. Which has far-reaching benefits beyond the brain as well. Yeah. And you keep coming back to gut health

and the link between the gut and the brain. I'd love to explore that a little bit more because it's a two-way relationship, right? Just as much as our diet can affect our mental health, our mental health can affect our gut and our gut microbiome. Could you speak a little bit to that? So we've known even before we were able to sort of measure and I guess and then we're still in the preliminary stages of identifying the different bacteria that live in the gut and what they do we've known for a long time about this gut brain axis this physical connection via the vagus nerve with about 10% of the signals going from the brain to the gut and about 90% going from the gut to the brain so the gut is basically feeding information back to the brain all the time about the food and what's being ingested. And it's not just food. Of course,

there's medications and pollutants and all sorts of things that are going in and being taken up by the body. But that bidirectional relationship is really important because the brain is sending signals to the gut and that influences all the sorts of things that are going on with the digestion and motility and it's it's a complex relationship but then now we have this understanding that there are just all of these bacteria not just bacteria fungi viruses all sorts of things that live in the gut but also in the mouth and the lung. There's all different areas in the body and that they interact very closely with our food, the air we breathe, the soil, everything about our environment. So we're really symbiotic beings with these bacteria. We can't live without them. They can't live without us. They've co-evolved with us. Diet is one of the things that really affects the

composition and the function of the gut microbiome. Now, when you think on a very basic level about what the microbes in the gut do, they're there to break down the components of food that our human enzymes can't break down. And that's primarily plant fiber and polyphenols also from plants. So that's what they do. The bits of the food that are not digested further up make their way down to the large bowel. The bacteria break that food down. And in that process, they release many, many, many molecules.

And those molecules interact with virtually every system in the body. Certainly, the immune system is a big one about 70 percent of our immune system is thought to be in the gut but our metabolism and and body weight and the way our genes express themselves and certainly the evidence is there for it also interacting with the brain and brain health. So because we know that by changing your diet, you can change your gut microbiome, or certainly its function based on what we know so far, very quickly, and that that can therefore, you know, theoretically, then very quickly affect your mental health. This is a nice concrete sort of concept for people to grasp. They get it, you know, put food in and it goes in and does stuff. And it's very immediate. I mean,

if you think about the public health messaging around food for so long, for decades, it's been based on metabolic health and body weight. It's all about body weight. Now, that's a stupid end point because, well, A, it's stigmatizing, but B, that's a very complex thing to change. And most people cannot change their body weight readily, or if they can, they can't maintain that change. And so people just give up. If you say, look, just forget about that for the moment. Let's just focus on the quality of the food that you're feeding your gut and your brain, and you will start to see the benefits really fast based on the evidence. That really cuts through for people. And it's something that I feel I can do something about

without having to worry about restrictions. So it's more about nurturing and putting good petrol in the tank. And that's a far more palatable message. It's something that people can get their head around. And if they know that it's as simple as just more plants, more different types of plants, and this is including whole grains, legumes, all those other things, not just fruit and veg, and reducing the junk food,

and like you could make it that simple, that's easy for people to get their head around. And finally, it doesn't have to be expensive. It doesn't have to be, you know, artisan sourdough from the, you know, exotic bakery. It can be, I mean, what I live on, you know, tinned and dried legumes and frozen veggies and frozen legumes and, you know, tinned fish, these sorts of things. Things that you can do really simply and quite inexpensively. Yeah, I love that message. I think oftentimes people are looking for something new and exciting, but you can't make it as simple and as straightforward

as that. With the kind of gut microbiome in mind and the rise of probiotics and things like that. What do you think about the use of probiotics in mental health? I think they term it psychobiotics. Look, it's very early days. There's some evidence for some bacteria formulations in people with clinical depression, but there's so much that we don't know. And I think that we're really only just scratching the surface. And we have new data that I can't go into too much detail about. And I don't know how much we can hang our hats on it, but it seems to suggest that there might even be an antagonistic. You know, if you're having probiotics

and they're not maybe the right bacteria for you or something that potentially they can, well, I don't know if you'd say cause harm, but not be beneficial. So I think that there's a lot we still need to know. We need to do clinical trials. And gee, it's so hard to get funding for research. It's really hard. I mean, I've tried for many, many years to get funding for randomized control trials of probiotics without any luck at all. So it's one of those things where we need more research to really know, but there's all these other things that need to also, we need more insights into. And these are, you know, just

the technical stuff, the gene sequencing and the computational approaches to understanding how the bacteria work together, because it's not just a matter of single species doing certain things. I mean, bacteria can all do a whole host of different things. So sometimes they might be doing good things, they might be doing bad things, and might all be to do with what other bacteria they're hanging around with, or what's coming in or going out. So it's just very complicated. And that's what I love about that message around the food. All that stuff, all that science stuff is super, super complicated. But what you need to do to have a healthy gut is actually pretty straightforward. And I would say that it has real salience for some very, very important things. So while the area of microbiota gut brain access research is still very much in its early days, and most of what we know comes from animal studies, not from human studies,

although we hope to address that this year. We've got many studies coming out. But in other fields of medicine, it's more advanced. And here I'm really interested in cancer. Now, I cancer twice I've had breast cancer twice this whole new area of immunotherapy in cancer is yielding so much promise I mean in some cases really quite miraculous you know people who've had very widely spread metastatic cancer having almost complete cures etc but only about 40 percent of people respond to immunotherapy and cancer treatment and what it looks like from the evidence from these large human cohorts is that this seems to be very much

influenced by the diversity as a marker of good gut health. So that people who have a more diverse gut, which is like you think of a rainforest, one that is diverse is more robust, it's more resilient. And it generally reflects a more diverse intake of plant foods. That seems to be a really important predictor of cancer treatment outcomes. And it's not just in immunotherapy, we see it in chemotherapy as well, I think stem cell treatment. But having a healthy gut, a diverse gut, really says your immune system is going to be in a much better state. So you're going to be in a much better position to both prevent and treat cancer. Now, we're in a situation where cancer

incidence in young people is increasing, you know, as well as all sorts of strange cancers like lung cancers in young people who have never smoked. I suspect maybe this is around the lung microbiome and our gut microbiome is so impaired by exposure to antibiotics through the food system, through the clinic, through Western foods, non-diverse diets, that, you know, without that immune surveillance, you get more cancer occurring. So feeding your gut will have that benefit as well. It should benefit every aspect of your physiology based on what we know so far.

Absolutely. And, I mean, from what you've been saying what I gather is that you have a food first approach with when it comes to these things and supplements are something that would be secondary. Are there any supplements that probiotics aside that maybe you think do have some merit to them or some emerging evidence with the role in mental health? We've done some big systematic literature reviews looking at this and there's a couple out there that big meta-analyses. There's some evidence for some forms of folate supplementation in some people with clinical depression, but as an adjunct,

so alongside other treatments. There's a little bit of evidence for various things like vitamin D, but it's not great evidence. There's emerging evidence for N-acetylcysteine, which is an amino acid that upregulates glutathione, which is the brain's own antioxidant. I think actually that food components like, for example, the pericarp of mangosteen or the new, I'd love to do some research on mushrooms and some of those really, they've got so many different biological components that we think are super bioactive and really so this idea of specific foods as medicine but understanding what works for whom under what circumstances is a big challenge so this personalized nutrition personalized treatment and this is something that

we're really doing a lot of work on now what I would say is that the future looks bright for nutritional psychiatry in that in Australia, lifestyle, what we call lifestyle medicine essentially, so improving diet, improving physical activity, improving sleep and reducing smoking and other substance use is now the foundational step in the Royal Australian New Zealand College of Psychiatry clinical guidelines for the treatment of mood disorders. First time anywhere in the world. They say before you do anything else, you've got to address this stuff. And this is not about doing that instead of. It's just saying that without that platform of health, all the other treatments have a far less likelihood of working.

And for some people, it will be sufficient in and of itself. Now, we're running big clinical trials, national clinical trials on looking at this. We also set up an international task force to develop the first set of international guidelines for the application of lifestyle medicine in mental health treatment. They were released at the end of last year. So there's a lot of interest in this. And really, it's just getting back to basics, I think. Human body system is insanely complex. It's just crazy how complicated it is. But we know that it needs good food, sleep, movement,

and not to put stuff into it like cigarettes. That's not, you know, that doesn't take rocket scientists to work out, but it has been ignored for a very, very long time. That's amazing, and it's incredible to see that it's being recognized within the guidance I was actually hoping to ask you a little bit more about that in terms of outside of nutrition the other kind of factors in our control within our lifestyle that we know have a big impact on our mental health and you alluded to some of them like sleep and movement. What are some other really important factors that people should be focusing on as that primary pillar? Diet, exercise, sleep.

They're the three main ones and they're all synergistic. You know, it's very hard to eat well and exercise if you haven't got enough sleep. And then you don't sleep well if you don't exercise. So they all are mutually beneficial. And they're what we call gateway behaviors in that if you improve one of them you often find that the other ones start to improve as well but we have also looked at with the with the guidelines things like green space you know and you know stress reduction yoga those sorts of things those and there's mind body meditation those sorts of modalities as well I'm very interested in the green space and the blue space thing

because I think it's always been assumed that this is purely psychological. You know, it's just so nice to be outside and in a forest or next to the sea and it's what your eyes are looking at. But now as we understand much more about the microbiome in the air and the aerosol transmission of microbes and how they interact with our health, it's becoming increasingly clear that it's far more than that and is actually a direct biological effect of the microbes we breathe in.

Now, the research is very much in its nascency, but based on what I've been reading and what's coming out, I think that this is going to be another big area. And it just speaks to, again, the absolute interrelatedness of us with our environment and how when we lose biodiversity in the environment, we're losing biodiversity in ourselves and we're just going to get sicker and sicker.

Yeah, I think that area of research is fascinating and it'll be great to see some more come out in that space. I would love to wrap up by asking you three questions, which we ask all our guests. The first one often floors people because it can be quite challenging to think about, but what is one thing that you've changed your mind about, whether it's in the field of your work or maybe just outside of your work? I think it probably was the red meat thing because I grew up as a vegetarian and I, you know, I was a long term vegetarian. And part of that is environmental and ethical. But the results of my research, certainly when I was younger, they certainly prompted me to to start to eat a bit of red meat. And the way I get around the environmental and ethical things is that I, you know, the

animals in Australia like deer that are an environmental pest and they're culled anyway. And so I think, OK, well, that's a benefit to the environment. They're not farmed, so there's less of an ethical issue. So I just eat those pest species for a bit of red meat. And so do my daughters who are still at menstruation age. So it's probably the vegetarian red meat thing. Although I don't think there's anything wrong with being a vegetarian. I think you can have a very healthy diet with that as well.

Yeah, it's interesting how you can change your mind about these things. And also nutrition and research is forever evolving. So we may change our mind again, but I agree with you on that one. The second question is, what's a non-negotiable in your day? Coffee in the morning. Me too.

I just cannot live without my coffee in the morning. And yeah, that's probably my non-negotiable. I think that's good. And I guess it feeds into the gut microbiome. The polyphenols from the coffee is good as well. Yeah, yeah, absolutely. And finally, what would be your death row meal? Gee, I think about this sometimes.

I did think that if I ever got stuck on a desert island and I could only take one food with me, it would be oats because I just think you could eat porridge for breakfast, lunch and dinner. Well, I could anyway, quite happily. Death row, it would certainly involve ice cream and probably hot chips as well. Potato chips, like fries. Amazing. And I completely agree with you with the oat based breakfast, lunch or dinner. It is something I can continue to eat and not get sick of.

Amazing. Well, thank you so much for giving us your time today. I'm sure this conversation will spark a lot of interest and people want to find out more, learn more about your research. Where's the best place to direct everyone? So go to the Food and Mood Centre website. We've got a great website that's got very, you know, it's for the public, a huge number of like blogs and resources and people can go and actually download the published version of the SMILES trial protocol so they can

actually see what was in the diet. I've written two books. One is Brain Changer that's really directed at adults. It's sort of explaining nutritional psychiatry how it came about and just the basics but then we've got a kid's book as well my husband and i wrote the called there's a zoo in my poo and it's designed to get kids to make these healthy choices because they love it and you know we hear they say things like mama mum, I'm eating a banana. The bugs in my bum are going to be so happy. But kids get it. And if you give them that information, they take it up and then they start making good choices themselves. So that was also really fun. But the website's probably the best one. And if you're interested in the actual research research, you can go onto Google Scholar and just look up my profile and you'll see a bazillion of the publications.

Amazing. That's so good. I need to check out that book. Thank you so much for your time today, Felice. And I look forward to hopefully meeting you in the future when you come to London. Yeah, look, I'm president of the International Society for Nutritional Psychiatry Research, and our last conference in 2019 was in London and it was fantastic we had yeah all sorts of people coming and opening it and everything else but as I said I'm often in the UK so it would be great to touch base because this year we're going to have a host of data published after COVID lockdowns and everything so this year and next year watch this space there's going to be so many studies coming out in this field. Great. I look forward to it.

I hope you found the episode interesting and hopefully inspiring. I think what we can learn from this episode is that what we eat can clearly impact our mood and brain health in a number of ways. But it's important to say that so many factors impact our mental health and diet should not replace other interventions like medication and therapy but support it to work alongside it. Please do speak to a loved one or your GP if you are struggling with your mood or mental health. That's all from me. See you again next time.