Your Brain On Food: Dr. Uma Naidoo On The Intersection Of Nutrition & Mental Health

28:08They may have PTSD and anxiety or they might have focus issues and trauma. It could be many different things. So categories of things have helped the system move it forward, but they don't capture everything. In a similar way, I don't necessarily know if I'm evaluating you for medication and I'm checking that symptom checklist in the hospital and going through the multiple sort of mood scales and anxiety scales that we are trained to do in an evaluation. You know, am I dealing with this? But we tend to go to an SSRI as a way to help you or an anxiolytic or something else. Food is not that different.

28:47I don't always know that that is low, but I can take from the history, from understanding their lifestyle, from understanding poor sleep. You know, maybe it was eating differently during the pandemic, picking up an unhealthy habit that's sustained itself beyond the pandemic. A lot of that has gotten, you know, people into great difficulties is 25 % more anxiety since the pandemic worldwide. And that was published in The Lancet. So we know these things. Very similarly, a comprehensive diet to then help the individual kind of improve. And then what I do is track a lot of the symptoms through scales, through report, through things like sleep, even appetite, things like brain fog.

29:34A lot of those are just built into the system of how we track it. Yeah, I saw some alarming statistics. 26 % of Americans struggle with diagnosable mental illness, 29 % will experience a depression diagnosis in their lifetime. I mean, it's basically one out of three, 31 % of people have a chance of experiencing anxiety. Like these are epidemics and they don't happen in a vacuum. They're cofactorial, obviously. Correct. Before we dig any deeper into this, maybe it would be worthy to kind of define what anxiety is, what depression is, how these things differ, because they don't stem from one thing.

30:16They're biological, psychological, and social. They are environmental, genetic. So there are multiple factors. Depression is primarily a mood disorder where you are just not feeling yourself. You are not sleeping well, perhaps. Your family is essentially telling you, your friends are telling you, you don't go out with us anymore. You're staying at home sleeping. You're not making it even onto your Zoom meetings. You're not making it into work. You might lose weight or you might gain weight because atypical depression can be slightly different and people have an increased appetite often. And more often we see sort of a loss of weight or loss of appetite, just a loss of flabidinal energy just across the board, someone who's struggling that way.

31:03But usually my clinical experience leads with that mood and affective disorder. interestingly with anxiety, because they do often kind of travel together. With anxiety, sometimes I think the biggest thing is people don't realize that they have anxiety and it may be presenting as poor sleep, you know, in the afternoon, not being able to focus. And they think, well, I have a problem with the tension. But when you dig deeper, ask the questions, evaluate more and start to treat, even if it is with a medication. In fact, they realize that but they're calmer with the medication. That's if the medication works and they frequently don't work.

31:45So we do need more solutions. So it isn't that different. And then of course, the set criteria that we go through from DSM-5 to you. If you have a patient that is diagnosed with anxiety or depression, and they are a good candidate for a nutritional intervention, what is a typical diet plan look like? What are the foods that you're looking to increase in this person's rotation that might ameliorate some of the symptomology? So with anxiety, the way I think about it is I have an acronym calm foods. And I also think about it in terms of finding out what they like to eat. What is their level of cooking expertise or can they get help with that?

32:29Can they buy partly prepared foods and put together a meal based on really simple. And I speak about it in terms of an anti-anxiety eating plate. And what I do is I've created kind of a protocol that they can go through with different foods. And the foods listed there have the nutrients which really target anxiety, things like cruciferous vegetables that are higher in sulfurophanes. And then there are little trips and hacks, tricks, I should say, and hacks around how you prepare these foods to really make sure they're nutrient dense. With things like broccoli, for example, research has shown that was published in the Journal of Agriculture that if you especially chop the broccoli fine, let it rest for about 90 minutes, it actually has a higher level of sulfurophane.

33:17So I give my patients tips like, prepare it the night before, let it sit out, put it in the fridge and then cook it up the next day. Or when you do your meal prep day, we try to make it as easy as possible for people. So that's just one thing. So the protocol walks through recipes that are linked that you can pretty much go make that recipe that are meant to be simple and follow this eating plan for week one. The way that those are targeted on a plate is I want people to lean into plants, like the Blue Zones calls it in Pauna and the Plantsland. I want them to focus in on plants because these are low calorie, high fiber, highly nutrient dense foods with multiple phytonutrients.

33:56I like to say instead of rainbow, you know, a kaleidoscope of color because they're bringing so many things to your brain and body. And then when you think about the rest of the plate, Unlike the food pyramid that we learned in school, you know, it's really reversed that. A small portion of some healthy grain, like kinema, and then your healthy fat, this could be avocado, olive oil, and then a clean protein. Whatever that for meat would be, you know, like a nicely flavored, seared or oven-baked piece of tofu or legumes and lentils. For someone else, it could be chicken or beef or whatever is their choice.

34:32So when they think about it visually, it's really largely vegetables and these other three components. Then of course, they always should be hydrating with things like water or kind of a calming tea. You mentioned the kaleidoscope, which is basically a way of saying increasing the diversity of plant foods on your plate, which is one of these six pillars that you have to calm the mind. So maybe walk us through what those six pillars are. So one of the pillars is eat whole, be whole, the antidote to the standard American diet, which is don't reach out for the store-bought orange juice, which has no fiber and added sugar, but just eat the orange, just eat the orange.

35:11So whether that's an apple or an orange, eat the whole food more times than you can. The idea there is to encourage people to really move away from the processed, ultra-processed version of things. Whenever there's a so-called better food or new food that comes into vogue, take cauliflower, for example, it turns into cauliflower pizza crust. Now, nothing wrong with that. If you're making it at home or you have a sense of what's in that, there are healthier versions, but it's still processed in some way, right? So just eat when you can, eat the whole food. Another one is magnify micronutrients, which comes back to that kaleidoscope of colors.

35:50One of the things that the World Health Organization has told us is that 30 % of people worldwide, especially women and children are deficient in iron and often goes undiagnosed. So magnifying micronutrients, things like magnesium, many Americans are short on magnesium, becomes important. And so that just is really a reminder to include these when you can through foods. Another one is, you know, exclude the anxiety triggering foods. And this is not a surprise, But again, people don't always associate ultra processed foods with causing anxiety or certain junk foods or fast foods or highly sugared foods or sodas.

36:31That connection is often not made. And very often someone will say, well, but I feel good when I eat that donut. You know, why shouldn't I eat it? It's the long term effect. It's that in that short term, you may actually feel really nice. But very often, if you've eaten one donut, 10 minutes later, you need a second or third. So these are not sustainable options, especially if you're a metabolic health. So another one is consistency and balance. And what I mean by this is 80 % of the time, I want this to feel comfortable for people to do and not be about food rules and make people feel uncomfortable because they took their child to a birthday party and cupcakes were served.

37:13These things happen. This is life. But 80 % of the time, if you are mostly trying to follow this, it's an opportunity to course correct on those unhealthy foods you may have started eating or you may be concerned about. Another one is prioritizing healthy fats. And it's where we get the fats from, right? It's, you know, avocados, it's extra virgin olive oil, it's nuts and seeds. These are highly nutrient-dense foods which are bringing in the healthy fats to our body but also to our brain. When we talk about omega-3s, the short-chain omegas ALA from things like nuts and seeds, the little things like the fact that turmeric actually activates and can help the conversion.

37:55So this is why my chia puddings often have turmeric in them. You know, it's to help that absorption if you're obtaining your omega-3s from nuts and seeds. So little things like that are meant to really help people and focus in on these pillars. Thank you.

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41:46These pillars, which you describe as a protocol for calming the mind are basically just good advice for how you're gonna guide your nutritional priorities going forward for all aspects of health, of course. Like some of them are very straightforward, probably not new information for many of the people who are listening to this. But I'm interested, you mentioned anxiety producing foods. We all know, you talked about the donut, but like we all know what it's like to gorge on processed foods and then it tastes really good while you're doing it. And then you feel lousy and you're lethargic and you have brain fog and you feel terrible afterwards.

42:26But what is going on physiologically when you eat foods that are ultra processed that has a direct correlation or relationship with enhancing anxiety or some of these negative mental health indicia? So I think you raise a good point. I think that there's a lot of these foods that we want to eat for our overall health. But here's the thing, most people are not, right? Because a very large percentage of Americans have struggles with mental health, the statistics you just quoted, and are not really familiar that food can be a way that they can not only maybe clean up insulin resistance and other things, but also improve mental wellbeing.

43:11So it becomes powerful in that way because it's an additional tool that someone can use. Often as a side effect, some of my patients lose weight. And it's again, because they're moving towards healthier principles. Mechanisms that cause this include inflammation, dysbiosis, which is again that disruption of the negative and the healthy and unhealthy microbes in the gut. Also setting off metabolism because of how we're eating. So when you are leaning into ultra-processed foods, you may in fact develop leptin resistance. So the leptin receptors no longer work effectively. They essentially start not telling you what they should, which is, you know, you've eaten a plate of food and you fall.

43:57It's time to get up from the table. They malfunction and you lose a sense of satiety and satisfaction when you eat. That can lead to metabolic health factors. is in fact, most of your metabolism gets set off. And yet studies have shown, you can actually walk yourself back from leptin resistance by adjusting your diet through lifestyle and healthier foods. But what that sets off is very high levels of anxiety. Because you're metabolically dysregulated, you're de facto neurotransmitter dysregulated as well, right? So the signaling to the brain gets screwed up in some way that is... It gets disrupted.

44:38And one of the interesting things that happens is that the actual receptors malfunction in leptin. So you get a high level of leptin, but they're not reaching the receptors. Your anxiety gets set off. And it's really all, I think you might've probably also heard that some people use the term, type three diabetes for conditions like Alzheimer's because there's really this through line of not only metabolic health problems, but also inflammation that is underlying so many different conditions. So these become mechanistic ways of how we are understanding things right now. And they also then provide intervention points to walk ourselves back from some of these symptoms.

45:22Well, let's talk a little bit about inflammation. There is this connection as well between the immune system and mental health. The immune system, the majority of which resides in your gut microbiome. and this growing awareness that chronic inflammation is incident to all of these chronic lifestyle ailments that most people are dying from or suffering from. So define inflammation and the differences between acute and chronic and why it's important to understand this and the impact that it's having. So interestingly, the type of inflammation that comes into play and is so important for healing is you're running a marathon, you follow up on trip and you scrape your knee.

46:10Well, inflammation needs to help you heal that wound, help the pain and create new skin on that scraped wound. And that is incredibly important just for normal functioning. When we're talking about this in nutritional lifestyle and metabolic psychiatry, we are talking about the chronic insidious inflammation that gets set up through how your lifestyle factors are working. So poor sleep can be one of them, but also through how you're eating and what you're eating. And very simply, you know, if you are consuming, if you kind of tapping into the six pillars we spoke about, and you're trying to adjust your diet towards healthier norms, the breakdown products are actually good and positive.

46:55and really the gut microbes are making short-chain fatty acids, which we need. And the short-chain fatty acids in the gut microbiome help create balance because gut microbiome is almost like its own, it isn't an organ yet, but it's performing so many functions. It's helping with sleep and circadian rhythm, which is our internal body clock, vitamin production, hormone production, immunity, mental health, so many things and more. So when you are healthy in that area and you are eating in a way that is keeping that balance okay, short-chain fatty acids are helping us. As are the breakdown products of the foods that we're eating, the interaction of the plant polyphenols with the microbes all lead to healthy substances.

47:40But if you're tapping into the altered processed foods, there are microbes that are unhealthy that live there as well. and their breakdown products are toxic, toxic polysaccharides, which start to circulate, create inflammation in that environment, and ultimately lead to piercing and penetrating the single cell lining of the gut, the endothelial layer, and then you enter the circulatory system. So you're out there, you're going to reach the brain, and this process of inflammation gets set up. And again, you can walk yourself back from that. And one of the most powerful ways are lifestyle and nutrition factors.

48:21So when you're eating these ultra processed foods and you're seeding your gut with a certain type of microorganism that is metabolically producing quote unquote toxins, the immune system is triggered to respond. It rushes in and produces inflammation. How does it do that? Is it like increasing blood flow to the area? Like how does that translate into a less than optimal kind of cellular lining to your gut? Is it like a T cell response? Like what is happening specifically? Like I'm still trying to, like I understand you break a bone, when you cut, you get swelling, your immune system is responding to repair the damaged area.

49:07We talk about inflammation all the time, still not quite clear on like what that looks like in its chronic form. Yeah, so you get inflammatory cytokines being produced, you get these toxic breakdown products from food that are going to pierce that cell lining of the gut. And they all sort of interact in this environment to flip the balance of healthy microbes and healthy breakdown products in concert with everything else in that environment to really set up for things like inflammatory markers that have been found. There are certain things you can look for. They're not traditionally done and they're not something that a routine blood test for sure because it's in hospital-based systems.

49:54A lot of that is dictated by insurance, but that can actually show up as inflammatory factors and inflammatory markers. So it's linked in that way. In turn, what's happening in the brain as a result of chronic inflammation and how is that translating into anxiety, depression, or other indicia of mental health issues? So once these, let's just call them toxins, or these inflammatory substances reach the circulatory system, They're going to circulate throughout the body and the brain is vulnerable. You know, they get through the blood brain barrier and they start to impact neurons and ultimately lead to neuroinflammation, which is essentially brain inflammation.

50:39And, you know, one of the things that one of my mentors always talks about is if people understood, and I think it'll tie into what we're saying here, that many of us, just like people walk around with nascent cancer cells, then nothing happens to them. You know, one person develops cancer, someone else does not. In a similar way, we also have some imperfect neurons in our brain, and they could lead to cognitive impact and cognitive changes, and we know this. But one of the most powerful factors is neuroinflammation and how one of the things that impacts neuroinflammation is how we eat. If we dealt and worked towards improving our neuroinflammation in the brain simply by dietary and lifestyle factors, we could actually fend off cognitive changes.

51:29This is a mentor who pretty much, I think, discovered the first Alzheimer's gene or something like that, but something important. So I always remember that because it was a really seminal moment in my understanding of what we can change in brain health in that way and impact neuroinflammation, which if we start to work on and food is a factor, lifestyle is a factor and lifestyle is a factor that we can really improve our ability to fend off cognitive changes over time. So then what do we know or not know in terms of the relationship between chronic inflammation or dietary choices and more longer term brain deterioration, diseases, dementia, Alzheimer's, and the like?

52:21What we know is that food and lifestyle, like I just said, are factors. I think that we're not at a point of finding that cure for Alzheimer's. We know that we can ameliorate a lot of things through things like the process of inflammation. We can improve things through certain types of eating patterns. Certain people will use fasting, time-restricted eating. We can choose certain nutrients. We know that things like turmeric with black pepper, blueberries, certain foods are targets for cognition. Beyond that, I think that there's a slow, we have a way to go with the research and I'm glad it's ongoing.

53:04We had Dr. Sarkis Mazmanian in here the other week. Are you familiar with his work at Caltech? Not all of it, but I know of the name. Yeah, it's quite fascinating. I mean, he's looking at the relationship between the microbiome and neurological disorders, specifically Parkinson's and autism and finding this connection between the nature of the gut ecology and the incidence or onset of these disorders. And there's still a long way to go to figure out what an intervention might be or how to actually deal with it. And these are all studies that are done in mice, not in humans. So it's a leap, but I think it underscores this idea of just how powerful and significant the microbiome and in particular, like the health of the microbiome is in terms of all of these things that we think of as being different or unrelated.

53:59Like the human brain likes to categorize things and separate them and put them into buckets. The brain and the body as two different entities and we treat them separately. When in truth, we are holistic creatures and these things are not separated, they're interrelated in ways that are much more integrated than we would suspect or imagine. And I love what you're saying because not only do I agree with it, but mental health is no longer an above the neck concept. We are understanding that it is so related to other parts of our body. Understanding that we are holistic beings and that one thing impacts another that becomes so critical with food being one of the pillars.

54:42On this idea of the bi-directional relationship between gut and brain, how does it work in reverse? We've been talking about how the microbiome can influence the brain, but how is our mental state influencing the gut? And maybe more specifically, how does anxiety affect metabolism? Because this is going not just from bottom to top, but top to bottom as well. So a few different ways that we know so far, the research is always evolving. So I always want to remain humble in that space, realizing that it changes, but this is what we know. And this is how I understand it so far. There are a few things.

55:21When we are anxious, we know that say you have a bad day and you have an argument with someone or whatever it might be. We know that actually those emotions are transmitted to the microbes and that they respond and they show changes and they evolve. Just like when you eat, whether it's healthy or unhealthy or less healthy, they are responding. You don't see the effect immediately. So we know this from the research that our emotions - And is that from the vagus nerve? Sorry to interrupt. Yes. Like how is that messaging getting translated? One of the strongest pathways is through the vagus nerve.

55:55So whether it's neurotransmitter changes that are being transmitted down to the microbes, we know that our emotional health gets transmitted. When it comes to things like stress and anxiety, the other thing that gets set off is our, levels of cortisol. And this is not something that we're unfamiliar, but we know that something gets set off. and our metabolism changes, all of these things really start to drive anxiety. Like we know in the brain that the amygdala and the hippocampus are related to sort of the hotbeds or the hot spots for anxiety. We understand that with so many people having some struggle with metabolic health that this is impacted as well.

56:43So our mind state, so to speak, actually impacts the gut directly. One of the most direct mechanism is through the vagus nerve. It becomes powerful because that's where alternate holistic and integrated practices like meditation and breath work can be very powerful. Like I always make sure that my patients learn a breath work exercise. and research published in early 2020 that was looking at pranayama yoga, breathwork yoga and cardiac disease secondarily showed that it improved depression and anxiety. So we know that there are ways that we can modulate this through these external factors and improve mood and certainly lower anxiety.

57:30And in turn, is there a sense or an understanding of how something like pranayama or another form of breath work or yoga or anxiety ameliorating behavior in turn. aids with metabolism or the nature of the gut microbiome? Does it work bi-directionally and in that way as well? You know, I think that with metabolism, it's more complicated because you have the interplay with leptin, you have other factors going on, you have the potential of insulin resistance being impacted. So I don't necessarily think it's that exact same way, but we know that when our metabolism is set off and is sort of not in check, and we know many Americans are struggling with this, that our anxiety levels kind of pop up.

58:22And we know that that's related in part to leptin resistance. Walk me through a day in the life of food for somebody who, I wanna be very practical here. Somebody who's listening to this and it's like, just tell me what I should not eat and eat. You know, like, what does my breakfast look like tomorrow? What does my lunch and dinner look like? What should I be snacking on? If I'm just looking to, you know, kind of care for myself a little bit better in terms of reducing anxiety or perhaps even taking the edge off some form of depressive condition. Sure. So some of the foods, and I'm gonna go through different meals with you, but some of the foods I'm gonna be leaning into ones we've spoken about, and then I'll try to pick up on certain metabolites and factors that are involved.

59:10So let's think about breakfast. You know, I think breakfast is a choice these days because some people choose to use intermittent fasting and time-restricted eating. For mental health, we don't have long-term studies on whether fasting or time-restricted eating is improving mood. Anecdotally, my patients who do fast will notice that they have more energy and have a little bit more focus that they speak about, but they're also being monitored by a team of physicians. They're not just out there deciding how they should eat. They're a little bit more careful. Is there an optimal windowing of time that you've noticed that works better than another?

59:49No, not really. I think it, honestly, it comes back to personalization. It varies with people. And we know that the windows are different in men and women. But there are a lot of patients, or my patients who wake up and they're hungry and they may need to be taking other medications. So it's important for them to eat. So good choices are, I like things like chia pudding, great source of ALA, simple recipe with literally a plant-based milk of milk of your choice, a drop of honey, and I do mean, you know, very little, just for some sense of sweetness. Or I prefer cinnamon, which is not only a spice that helps control of the sugar levels in your body, but it allows for sweetness.

1:00:32And I like nuts and seeds and berries on my chia pudding. And it's very, it's sort of nutrient dense. It's fiber filled and protein rich. So you don't need a lot of it and you can make it ahead. I also like choices of a tofu scramble. So I add in spices, I add in lots of vegetables. If I'm making a large portion, I can save some for the next day as well. So I use my tofu, I kind of chop it up or blitz it in a food processor. And I love to really pack that up with those vegetables that add in biodiversity. I'm always adding spinach or some green because the folate, one thing they have iron, we know that many people are iron deficient, but the folate is rich in vitamin B9 and low vitamin B9 is associated with low mood.

1:01:18So adding those in becomes important. I also like to use a different way of making an omelet. So I was raised vegetarian. So I always like to have options for what different people eat. And so another thing is to use chickpea flour and to make sort of a chickpea scramble for which I have a recipe in the book. Another great way to add in spices, herbs, flavorings, all of which have powerful nutrients for your brain, but also vegetables and adding in your plant slant there. Snacks that I like are basically like a granola, but made from raw nuts, some extra dark natural chocolate chips. There are vegan versions of this that I actually am really liking.

1:01:58And often, you know, coconut chips just for the crunch. And it can actually be a really nice snack on the go, even if you're traveling. Or some berries or just a handful full of nuts on the go. And then lunch, I like to, some people want a heavier lunch and light dinner and some people flip that. I like to think of a really large salad with lots of greens, same nutrients we're talking about here. But remember, we're also getting the fiber that really feeds the gut microbes. We're getting the biodiversity from that kaleidoscope of color, bringing different nutrients to the gut. We talked about the plate variation.

1:02:37Proteins, there could be a clean protein. So for someone, it could be tofu, tempeh, some legumes, lentils. For someone else, it might be chicken. And then I like avocado or olive oil. Sometimes the olive oil is just the dressing for that bowl. And one of my favorite grains, because I can make a small amount ahead in the week, is something like quinoa. But I really use a lot of spices because it doesn't taste good at all. It's got to be flavored up. And same, you can interchange the afternoon Snacks also like to add calming teas into your day. So passionflower, lavender, chamomile tea, mint tea, just made with French mint leaves, are great in the afternoon.

1:03:18And mint contains an antioxidant called luteolin, which helps with brain fog. Often my patients will say, you know, I feel sluggish in the afternoon. I don't have enough energy. It's a great way to, and green tea does, green tea is rich in, you know, L-theanine and EGCG. and it also gives people a little bit more focus without the buzz from caffeine. And for dinner, you know, I go in the direction of always bringing in spices when I can. So I like cauliflower steaks and I'll make a tikka masala spice on that, use my air fryer, add in tons of veggies around that. Someone else in the family may eat a different protein, but lots of vegetables.

1:03:56I like a side salad or I like lots of side vegetables along with that. Some of my favorite choices are broccoli, you know, different colors of broccoli, like purple sprouting broccoli, the beautiful orange, you know, cauliflowers that we get, whatever it is that you like, green beans, you know, choose the vegetables that you love and add them in. Because not only are those satiating, they're flavorful and they're good for you. So, you know, that's sort of how I'd walk people through a day. And I have options for, you know, people who love dessert because you can make almost a chocolate pudding from using avocado and extra dark cacao.

1:04:36People do innovative things. And so you don't have to exclude these things from your life. And there are things like extra dark natural chocolate, which I learned in culinary school. And I thought that, you know, clementines or oranges paired with extra dark chocolate was a flavor profile until I understood that extra dark chocolate is the highest source of plant-based iron. And since we know many people people are anxious and many people are iron deficient, you need the vitamin C from say the Clementine or the orange. Right, for the bioavailability. For the bioavailability. So it's a lovely pairing for people who want a nice snack and it's great for kids too.

1:05:12Yeah, to your point about iron deficiency, obviously you wanna be sourcing all of your nutrients from food, the matrix of the foods that you're intaking is the optimal way to source all of that. But if somebody is iron deficient or they do a blood panel and they realize, oh my goodness, my vitamin D is low or this is off and that's off. That's very important. Where is your head in terms of supplementation? Does that have its place? What does that look like? What are some of the more common supplements that you would recommend? Obviously, it's gonna be specific to that individual, but is there a tether or a relationship between certain supplements or deficiencies and mood disorders like anxiety or depression?

1:05:55I think that's an excellent point you made about iron deficiency, because sometimes people are so iron deficient that they need iron supplements. And that's where - So it takes a long time to deplete those stores and then in turn a long time to build them back up. Correct. So they might actually need to do both. They can always eat healthy and add in those iron rich nutrients, but taking a supplement may be what their doctor recommends and they really should do it to get to that point where they're at a healthy level. And they might be able to talk to their doctor about coming off that supplement, but when they've normalized, and that does take time.

1:06:27But generally, I'd really feel there's a place for supplements. And the reason I feel that is many of us, including myself, don't eat a perfect diet. And supplements actually fill those nutritional gaps that we have. Some of the ones that are very related to mood and anxiety are things like vitamin D. I live in the northeast of the country. Many people are vitamin D deficient and should have a check. Yes, you can get 80 % of your vitamin D by spending time in daylight, not only making sure you're attending to your circadian rhythm, but also absorbing before you put on sunblock or sunscreen, absorbing some daylight, doesn't work through a window, but low vitamin D is associated with high levels of anxiety and a low mood.

1:07:11Another one that I sort of favor is magnesium because so many Americans are magnesium deficient and magnesium is involved in so many other biochemical reactions in the body. There's also like seven different types of magnesium. So walk us through which type of magnesium you would recommend and the various applications or uses for those different forms of magnesium. So let me explain my position here. So I feel like magnesium can do so much from helping constipation to helping anxiety that there's a very wide range of uses. So I want people to be aware that there are few that I talk about that will help with anxiety.

1:07:54But for the most part, they really should be speaking to their doctors about it because magnesium does so much. And with any of these supplements, there should always be a way in which you're following the recommendations of the dose. Because people think, well, let me improve this by having a ton of the supplement can be unsafe. So the other ones that I love... And also, sorry, I keep interrupting you, but like, I think it's important to point out that, again, these things are operating in the context of a holistic system. And I think our brains are like, well, if I take this, this happens. But if you're taking a bunch of different supplements, like how are those all interacting with each other?

1:08:34How are they interacting with the foods that you're eating? And it becomes very complicated very quickly, right? So the solution isn't just a sort of binary, you know, X does Y, you have to really take into consideration, you know, multivariate factors. I agree with you. And I think I was more answering your specific question around which supplements impact mental health than specifically mood and anxiety, but completely. One of the things that, you know, kind of led from my early days of spending time with my grandparents is this holistic and integrated approach. So how someone's sleeping, you know, what are they doing for hydration, Being dehydrated can actually precipitate anxiety sometimes.

1:09:17And people sometimes wake up just because we've slept overnight with dehydration. And just having a glass of water at their bed stand is important. So it is always an integrated and holistic approach with these different factors. And it's individual to that person. I've had a patient who came in with a biological relative who had an opposite reaction to the same healthy food. And I think to myself how incredibly personalized our approaches need to be. So all of these things are hugely important. And what works for your supplementation may not work for me. Some general guidelines, test, don't guess.

1:09:59So let's make sure we know what supplement you need and how you can replenish it. Involve a provider because they might guide you, or maybe you have a different system where you get your blood test. There's so many different ways to access care these days. maybe you do it that way, but usually there's a nurse, there's a practitioner, there's a telehealth visit involved and then assess what needs to be replenished. If you have vitamin B12, I grew up vegetarian. So I would get with pediatric or adult visits, get a vitamin B12 test and see if I needed to get that. But you know, there are options now, like nutritional yeast, which I use in many of my recipes.

1:10:38So there are ways to get other supplements. A lot of foods like the plant milks, et cetera, are fortified with B12. Do you have a sense or a preference around the type of B12? And this is for the plant-based people, methylated, methicobalamin, cabalamin, like there are different forms and there seems to be some confusion about which one people should be opting for. So it's interesting because my understanding is that the oral supplementation It may not be as effective. You might need to take it as a shot, as an IM injection. So speaking to your provider about that is important in terms of supplementing it.

1:11:22And the one that I tend to lean towards is methylcobalamin.

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1:13:11You mentioned calming teas, which made me think of the role of adaptogens. You talk about ashwagandha, what is an adaptogen and how are these working in concert with everything else and impacting our mental health? So, interestingly ashwagandha is sort of a root that was used and does not taste good, it tastes very better, which is why a supplement is a good idea. It was used in ancient diabetic medicine for eons and for different conditions. But it has actually ended up having a good number of human trials helping anxiety. So I've really come to embrace it as more than just my cultural roots, but something that can help individuals who are looking for a few solutions that are not a prescription medication.

1:14:04You know, what an adaptogen does is uses the mechanisms of your bodily systems to actually improve a certain condition. And in this case, with ashwagandha, we know that people actually have some relief over time for anxiety. So it's a good supplement to consider. Saffron is an herb that I love to, you know, spice I love to cook with. It's expensive and you don't use a lot of it. Yet Saffron has a number of trials showing that it helps with a mood and helps with anxiety. So Saffron is another one that I like to suggest as a supplement. And anecdotally, individuals have told me on podcasts and other places that, you know, it's something they've given their children because it's something they found to be safe.

1:14:51They've spoken to a pediatrician. They don't want their child to take a prescription medication. So it's just an interesting thing to consider. What are your thoughts on so-called like quote unquote, super foods? Not in the sense that they are panaceas. I think they get perhaps too much attention. They're sort of the cherry on top of the sundae and the sundae being like the pillars that you already referenced. Like they're great as long as you're doing all these other things. But there are benefits to incorporating things like turmeric or moringa, things like this that perhaps are a little bit more exotic for most people.

1:15:29but have a wide ranging array of like positive benefits on the body, turmeric, of course, being a powerful anti-inflammatory. Yeah. Often I might be asked by media around, what is a certain superfood? And I have to tell you, I try to - Food is food, right? Exactly, exactly. I try to say like all foods are super, exactly. It's like the food of the day. Well, it's a lot sexier than a whole grain. I mean, let's face it. So it's like, you know, eat your quinoa. No, not really. I want a superfood berry or whatever it is. So I try to, you know, push back if I'm asked that because I feel as though it's so important.

1:16:07You know, we talked about biodiversity of the different foods, the colors, the kaleidoscope, the nutrients in these foods. It's really every food has some super powerful effects. It's what you choose. It's the sourcing. It's the portion, you know, rather than people counting calories, for example, I'd rather they have a bowl of broccoli as their side dish because we know that that is rich in sulforaphane. We know that this is going to have positive effects. So I try to step back from that a little bit. And if someone says, well, is blueberry a superfood? Well, blueberries are fantastic. One of my favorite, but the other berries are great too.

1:16:44Maybe you have access to black raspberries. Maybe you have access to other delicious berries, but these are all going to be good for you. I just don't want you to go, you know, get a, I was going to say a lollipop version of them, you know, because that's not the idea. I think that's where marketing food companies and the whole something you're very familiar with is just, it's leading people astray from the healthy, obvious choices that the pillars may talk about and actually helping people go back to what probably the way our grandparents, our great grandparents were eating. Beyond anxiety and depression, there's a whole litany of other mental health considerations.

1:17:30What is your sense of the impact of dietary choices and ancillary lifestyle choices on things like OCD or ADHD or something I personally suffer from, which is seasonal affect disorder. I get very down when the days are short and it's cold and dark out. Yeah, it's a very real thing. The OCD has some interesting factors. I mean, my book, This Is Your Brain on Food, I go through the different conditions and nuances. So in OCD glutamates actually in some healthy foods like different types of soy sauce, certain mushrooms and things like that can actually offset symptoms of OCD. And what is helpful for people to know if they're struggling with these symptoms is to work with a clinician to figure out excluding even those, or tomatoes, you know, some of those foods that are relatively healthy, or miso, actually, for example, that they might want to cut back on to help.

1:18:31A study done in Shoran with ADHD showed that omitting breakfast actually was not helpful because it worsened their symptoms and was harder for them to maintain focus throughout the day. And this is interesting because if they prescribe medications, there's a litany of medications that are being prescribed to children with ADHD and focus and attention, they suppress appetite. Yeah, you don't wanna eat. You don't wanna eat breakfast. They're stimulants, basically. Exactly, so you don't wanna eat breakfast. So little nuances like that, that I think help guide in the different conditions and that food can just be a tool not the only tool, but a tool that people can use to bolster how they're feeling emotionally.

1:19:17You know, things like light boxes, things like having that access to sunlight becomes hugely important. And especially, you know, in different parts of the country, seasonal affective disorder is huge, again, related to sometimes the level of sunlight as well. If I want to enhance my focus and my cognition, I want to sit across from you for a couple of and be completely dialed in, present, paying attention, alert. What are some of the foods I want to avoid? What are some of the foods that are gonna possibly enhance that? So let's get rid of the ones we wanna cut back on and just be more. Well, I'm not gonna eat a pizza.

1:19:58My eyes will swell up. I don't have celiac, but I can tell you, I feel like my head grows two sizes after I eat something, like refined grains. Refined grains, yeah. Or sugar and crash and all that. Of course, there's the obvious sort of thing. Exactly. You're not gonna wanna do. I'll tell you the one that, so we know sugar's obvious, we know sodas and things like that. But people, I can't underscore this enough, that people don't realize that an ultra-processed packaged and a processed food just has a ton of, It's the colorants that die as a food stabilizer. There's a study done in mice published in a reputable journal in 2022, I think it was March, looked at the gut microbiome, given our conversation earlier, and a food thickener called CMC, carboxymethylcellulose, and showed that in these animals, when they were fed this, it actually led to actually no production of short-chain fatty acids in their gut microbiome.

1:21:05And this is frequently used in our foods to thicken things. If you read the labels, you might see it. So yes, it was an animal study, but a lot of our research in medicine starts with animals. You know, aspirin did, many medications did. So all I'm saying is that I think, you know, we're starting to find this connection. So let's underscore ultra processed foods because they actually are very damaging. And it's not that we can avoid them, but let's be mindful about the choices we make around that. The seed oils, the issue with seed oils is more that our standard American diet that many people are eating is kind of flips the ratio of omega-6 and omega-3 in the favor of omega-6, which can be pro-inflammatory.

1:21:50We need some omega-6s and we should be eating them, but that ratio becomes important and that's where we go wrong. And then artificial sweeteners. So the old artificial sweeteners are problematic to the gut microbiome. They trick our systems, our bodies into thinking that sugar's going to reach us. And that is one of the reasons that people using a lot of artificial sweeteners, say diet sodas or foods that they're eating can actually develop cravings and eat more and may gain weight. So just something to watch for. That is a controversial take though, is it not? There are other people who say otherwise when it comes to artificial sweeteners.

1:22:27I think people have a varied number of opinions. I'm not saying that I'm 100 % perfect or right, but I am saying that's my understanding of the science. And I think the new sweetness, which actually have been shown to, right now the research is not showing anything bad, but a lot of stuff that's in diet sodas and things like that can be problematic, certainly to the gut microbiome and to these signals in the body. So, but the things that we can be dialing into, one of the things that's sort of a hidden pharmacy in our kitchens is our spices. You know, they can be bought in small quantities. If you can get organic, those are obviously a better choice.

1:23:08But the power of the plant polyphenols and things like turmeric that you mentioned, capsaicin from chili peppers, the luteolin from mint, all of these things actually help not only flavor foods, they can flavor your tea, they can flavor your food, but they also enhance your meal with no little calories because if they're just a pure spice, you're adding flavor without sometimes needing to add less of something sweet because of the cinnamon. And then leaning into the berries, the nuts, the seeds, my cruciferous vegetables are some of my favorites, your leafy greens are just some components of how I think, well, how am I gonna stock my fridge this week and then your choices of protein.

1:23:49Is there something specific I should be thinking about though if my focus really is to improve focus? Like what are the key foods that are gonna do the best job at elevating my ability to, like I said, be present, stay focused, concentrate? Sorry, you did not say vitamin C is one of the important nutrients with focus and omega-3s is another one. So those two definitely showed up in terms of helping probably one of the mechanisms is the anti-inflammatory effect again, but it's becomes important because, and then, sorry, green tea, EGCG and L-DNN are super helpful for people with kind of focus. Oh, that's good to know.

1:24:35I don't drink enough green tea. What are your thoughts on caffeine? There's two sort of things, two threads to pull on here, I think. Yeah, so I'll tell you what I think. So caffeine is part of coffee, but coffee on its own has a lot of plant polyphenols that can even help organ systems like the liver. And this has been outlined by one of my colleagues who's a hepatologist at Harvard and really feels like coffee, and I've read the books, he probably drinks more coffee than I want him to, but drinks a lot of coffee, is okay. It's the caffeine that often sets off some issues, especially in conditions like anxiety.

1:25:16So my guidance is around coffee is when you can get clean sources of coffee, what you put into it becomes important because going back to the start of our conversation, my patient was putting a quarter cup of processed cream and it's sugars. That's setting it off in a different way. So I'm a fan of coffee for anxiety, have it early in the day. If you tolerate it, if you drink a sip of coffee and you get jittery, it's not for you. That's, you know, paying attention to body intelligence. I have noticed in myself that more than two cups, you know, early in the day, what I can tolerate. I forgot this recently before a television interview, and it was around the holidays and I had family over and we were drinking coffee with, you know, the early afternoon.

1:26:03And I literally went to the interview very jittery and I thought I should know I know better, so you know that about yourself. Yeah, of course. Also as a sleep dysregulator, I mean, it has like a seven hour half-life, right? Exactly. So if your sleep disrupted in any way and you're not getting your solid eight hours and getting the restorative sleep that you need due to some level of caffeine consumption, then you're gonna be de facto dysregulated in every other way. and that's gonna affect your mood and everything. That's gonna affect. The downstream impact of that is? Sleep and mood and anxiety and all of that is huge.

1:26:42And metabolic regulation and - Correct, because sleep impacts that as well. So my cutoff for what I say to people is 12. I'm guiding someone in a plan. I'll usually say 12 noon, but usually that gets pushed about 1 or 2 p.m. But I like to create that cutoff certainly for myself. And I think it works for most people because if they're having an early dinner, that hopefully gets the caffeine metabolized and it's not impacting their sleep. So I'd like them to have it if they can tolerate it for the other benefits of coffee and pay attention to what they add to it. Alcohol. Alcohol, the other hot topic.

1:27:20So my position on alcohol is we know the negative impacts of it. We know that it can be neurotoxic. We know that it can be hugely problematic. But I also in mental health feel strongly that I need to address more of the people that I'm treating. And it's harder for me to say to people, I want you to just stop drinking this entirely. Can I say to them, let's work on this plan that is improving different elements of your health overall to improve your mental wellbeing. And can we start cutting back on this? Because one of the things that happened in the pandemic is many, not many, but some people got into a little bit of difficulty with that because people were at home.

1:28:02and I evaluated someone in a telehealth visit once who I was sort of surprised and I had to ask you know as part of this initial evaluation are you drinking wine because it looked like a wine glass it looked like wine I thought maybe it's ginger ale but I'm not sure and I asked and it was and she had gotten to the state of such extreme anxiety on her own during the pandemic that in order, and my meeting with her was like a 12 noon meeting. It was her first meeting of the day that she couldn't get onto her first meeting without a glass of wine. And she was kind of all siloed on her own, struggling with, you know, what had become this devastating anxiety.

1:28:45And so people got into different types of issues around that. So only in moderation, you know if people are advising you that something is a miss pay attention you might need help and if it's not for you please don't start drinking alcohol because i'm not saying there are some great benefits for you i'm mostly trying to address that many people than not i think more people than not may consume alcohol in my practice and if they do how can i work with them to feel better? I would just tell them to cut it out. I know, it's just that easy. I mean, look. Just like with ultra-processors, I can't say to people to cut it out.

1:29:25Yeah, I mean, just give them the hard facts, Uma, come on. I understand if somebody's in a high stress situation or they're experiencing anxiety, it's like, I wanna have a drink, it takes the edge off. It ameliorates that anxiety. But what it also does is set in motion a chain of events that are gonna make your sleep less stressful. Like it's ultimately going to exacerbate the anxiety that you're looking to treat. And similarly, you know, with excessive or chronic use in the same way that marijuana operates, like a lot of people use that to calm themselves, but ultimately it ends up being a situation where their anxiety is way worse and then they're dependent upon it because without it, the anxiety spikes.

1:30:11but in truth, it's the causative impact of a lot of that experience. I respect what you're saying. I also want you to know that the studies in alcohol are quite mixed and I'm not saying that I agree with them, but I am saying that I have to offer, just like I was raised vegetarian and really never ate meat growing up, I have to be flexible with someone in mental health because they may come in with a different diet. But I will tell you that, you know, there is a sober curious movement that I'm really behind in terms of helping my patients. And there is education that is provided to people. But just like you mentioned marijuana, I'm very mixed about the psychedelic movement.

1:30:51So what are we doing in the big picture of things? And I'm not saying one is right or wrong, but where are we headed with this? What is that big picture view of how do we help our integrated? I'm sure you have people come in and they say, well, I heard this about ketamine therapy or psilocybin, et cetera. Certainly, as you know, like there is some really interesting research coming out about this. And there's no question that it's helping certain people in certain situations, veterans with PTSD, et cetera. But I do think that there is still some misunderstanding around how powerful these compounds are and our relationship with them feels a little bit too casual.

1:31:39And I think it's human for us to think, well, I just need to, if I do that thing, it'll solve my problem. Right. I think the search for that solution is always the case. And I agree with you. I think that it's honestly, in brain science, I think it's too soon for us to know definitively. And I am very cautious, you know, and I'm not trained in ketamine therapy. And I'm, as the reason I didn't go in that direction in my career. I'm not saying you're wrong. It might be for a person in guided treatment with the right clinician, but I don't think it's the be all solution and neither are psychedelics.

1:32:17You mentioned the importance of like working with people and meeting them where they're at. In your experience with all the people that you've seen and that you work with, what is the differentiator between the person who can take the counsel that you're providing and put it into action and make those changes and experience the results and sustain them over time versus another person who sits across from you and you tell them what to do and they just can't quite do it. I think of that first hook, that first, and I mean positive hook to get them started as a positive gateway effect. So meaning that if I can identify that and it's a critical part of that evaluation.

1:33:07One thing that's bothering them that we can change because if someone is sleeping better within the first week, has more focus or energy, these are powerful in someone who is struggling with anxiety or a mood condition. That for me is one very huge factor. And the times that I've really run into, honestly, for one of, I'm trying to say this in a nicer way, but people who don't make it, They don't get behind the plan. They can't get behind the plan. It's often a condition that I see a lot in my practice called orthorexia. And it's not identified by NADA, which is the National Eating Disorders Association as an eating disorder, but it is a fixation on a certain healthy food or healthy food group.

1:33:53And they really do struggle to work with me around, can we adapt this? Can we add this in? Can we take that out? Can we change? Because they tend to come back to, well, but this is what I've done. And I can't really explain to them that they're overwrought anxiety might be related to the rigidity of holding onto those principles. So that's where I've had the most difficulty. Which of course is rooted in a control issue that is driven by some kind of latent fear that they have. Right, I mean, as a psychiatrist, in thinking about the mechanics of trying to guide somebody through a lifestyle change, all these things come into play, orthorexia, of course, but also what is this person's sense of self?

1:34:43Are they insecure? Are they self-loathing? Do they have a muted capacity of what they're capable of and trying to figure out how to like get in there so you can inspire and motivate and educate and guide them in a way that's going to work for them. and it becomes very complicated. But I'm really fascinated with this difference between people who are like, oh, you told me to do that and I did it. And people who are like, yeah, I tried or it didn't work for me or I couldn't do it. Or how do people change? Like as a psychiatrist, what have you discovered or experienced in the treatment as a clinician that gets people over that hump and feeling empowered enough to make changes and sustain them?

1:35:31I think that's a great question. So we're just going back to the orthorexia. That's where a team is helpful because having someone, you know, be the primary therapist, we train in therapy. But if I'm in this role, having them work with someone to work out the fears, the underlying issues may take time. And that becomes a key part of that almost treatment team approach. But it's people get, you know, advice all the time. I'm a firm believer that people generally know what healthy foods versus unhealthy food groups are. But effecting change becomes extremely hard. Behavioral change is hard. And for me, it's trying to work using almost my skills training as a therapist and in psychiatry to find my way in to their psychological space in a safe way that I can help them to grab onto the one thing that they want to change.

1:36:28And sometimes it doesn't work initially. Sometimes someone struggles for a little bit, you know, I can't get that. And sometimes it involves other factors we need to put into place. Exact meal planning, assistance from a nutrition coach, having them in addition to checking in with me, having them get help from a dietician who works out the plan with them, helps them implement things. a family member who helps them shop, whatever it might be. It sometimes takes a while to get to that point. But when I mentioned that gateway effect, when they click with something that shows them, like the coffee of the gentleman at the beginning of our chat, it becomes the fulcrum of change because then they want to do more.

1:37:13I've learned in my practice - Right, they have to have like a tactile experience where they do something and they experience that result. Some positive result. And that sets in motion like a chain of events that engenders encouragement and motivation. And works towards that. You've highlighted a very important thing, which is behavioral change is really hard. So providing someone with just a plan is not enough. There has to be a relationship involved and a way to understand what's going on with them psychologically that they want to make a change. And so sometimes finding a way to understand what's bothering them.

1:37:51They've come to me for a reason, they've been referred, but what is bothering them about their eating? Yeah, there is the individual who's like, oh, I read the book and I just went and did it all and changed my life. They don't need any accountability to anybody or any community aspect of it. And then there's the other person who has to have their hand held and walk through the tiniest of change and constant kind of accountability to a team of people. and those are very different individuals. I don't know what distinguishes them psychologically, but yeah, every person has their different levers, I suppose.

1:38:27And it's only a trained person who can divine what's gonna get that person to make changes. I suspect though, overall, kind of on the James Clear atomic habits thing, it's like, give them a tiny little thing that they can succeed at and let them experience what a win feels like. And then that will embolden. Right. And part of my method and my protocols were not the same when I first started because I had a different view. I thought it should always be food first and there wasn't a place for supplements. And I already admit that. And I also thought, well, I need to give them five steps to follow.

1:39:04And I learned the hard way clinically. Working with individuals, five is too many. You know, people need a supplement because they just may need to fill that nutritional gap to help them with what they're eating. And a lot of that was education for me in how to adapt meeting someone where they're at and honing the method, you know, it's not perfect. It's always evolving. Yeah, also like the paradox of choice. If you're like, well, you can eat any one of these 10 things, like that's like paralyzing, like just give me the thing to do. Just give me one thing. And then on top of that, getting them to take ownership of it for themselves because I don't wanna take responsibility.

1:39:43I want you, Uma, you do it for me. This is why I'm here, I'm paying you. You're gonna fix this for me and I actually don't really have to shoulder that responsibility or do any kind of hard work because you're gonna fix it. Right, and honestly, that's where, that has been the power of a prescription, right? In the US medical system. It's been, you know, the urgency, the immediacy of coming. I need this fixed right now. You know, I need that SSRI, I need that medication to help my anxiety. And it's a system that's failed us. So it's helped people. There's always a place for those medications, which can be lifesaving, but it's not the whole picture.

1:40:23And so many people either suffer the side effects or don't recover in terms of anxiety from medication that we have to think more broadly about not only where the responsibility lies, but how do we help people be guided with changes? It's not easy. You said something along the lines of, if we're not looking at lifestyle factors, diet, sleep, exercise, et cetera. It's not in terms of like mental health outcomes. Like it's not even worth having the, I'm misquoting you completely, but something along the lines of like all the focus is on medication, pharma interventions. We're overlooking all these lifestyle things.

1:41:10What we really need to do is look at the lifestyle stuff first, because if we're not addressing that, none of the other stuff matters. I feel like that's a quote that got you in a little bit of trouble. It's a bold statement. Is that something you stand by? Is it more nuanced than that? Like what is the role of pharma interventions, psychiatric pharma interventions in the context of these lifestyle choices? My assumption is that these things need to be kind of handled in an integrative way together. But what is your, I mean, you touched on it earlier, but I just wanna make sure I understand your perspective.

1:41:44Right, so let me reframe this. I feel that mental health is a very big topic that's a very hot topic right now. And I feel that unless you've, you know, been on the front lines kind of working with suicidal ideation and helping someone and working through those factors, that opinions about mental health are very different from clinical care and research. And I think one has to be cautious about that. So I would never, you know, say lifestyle factors first, you know, eat these foods. I think that they're all integrated. And what I do is sometimes individuals are referred to me who are already on a medication and they may stay on that medication as we work on lifestyle choices.

1:42:28I still prescribe medications when needed, but I am more thoughtful and my career trajectory has taught me to be more thoughtful about when that's a better choice than not. So they are meant to be a holistic and integrated approach and would never think it's one or the other or that we should push medications aside in favor because someone could be unable to get out of bed and so severely depressed or so warped with anxiety that they can't make it out of bed to get to their first meeting or their shower. That's when acute conditions and where medications are absolutely needed. And so that food can't help, but it wouldn't be the first line.

1:43:09So it's always that integrated approach. If somebody is listening to this, Obviously we're just touching the surface of what you address in your books, which in addition to being, canvassing everything that we spoke about and going more in depth on all of the subject matter also provide like you have recipes and meal, all kinds of guides. But if somebody is looking for a little more handholding and they don't live in Massachusetts, like is there like a directory of people who do what you do or something similar that people can find out more about this field and find a clinician who's kind of on your page that they can reach out to?

1:43:52I don't yet have that, but it's a plan for me to build that out. And I mentioned earlier, Rich, that I've pivoted from immediate direct clinical care to building out the resources because what the books brought forward is a need for this. And not just within the country, a need for it from other parts of the world as well. They're definitely doctors practicing and using these methods. I don't yet have that directory, but I'm planning to build one. And I'm sorry that those resources are not yet ready. Okay, so fair enough. Beyond your books though, is there some place you can point people to where there's more available information and resources that they can edify themselves with?

1:44:32So one of the things I write extensively for media, if you Google nutritional psychiatry, you will come up with a few doctors to do this sort of work. You might wanna check within your state if there's anyone practicing this way. We are trying to build out resources through things like IFM, the Institute of Functional Medicine. There's some private entities. So there are ways that we are trying to improve the resources in this field. There also are courses that people can take if they're clinicians. Actually, coaches can take the course as well. Where are those courses available? So there's a course at Massachusetts General Hospital online, the psychiatry academy.

1:45:14We have a course cooking for mental health clinicians, and we have a course on as a nutritional psychiatry primer. There's a course on my website for just basically learning to get deeper into this knowledge. And it's a slow and steady growth. Those are for clinicians only though, not - No, the one on my website is for anyone. It's actually intended for people who, who it's almost like they wanna get deeper than just the book. If you were to wake up in a parallel universe and found yourself to be the Surgeon General of the United States, I always ask this type of question to the doctors, what is your initiative?

1:45:52Like where are you placing your focus? The exact integration we just spoke about, bringing food as medicine forward, but in a way that's integrated. So no one is saying you shouldn't take a medication or you shouldn't be using allopathic medicine primarily as what you're doing. But why not we integrate? Lifestyle and nutrition is the one remediable factor across all chronic diseases. We know this. This is not unknown to doctors and to clinicians, to all of us. So integrate that. Make sure that as we are having a discussion with someone about their blood pressure, Is it at a point where we can help them intervene with lifestyle measures?

1:46:34Can they come back three months later and go through an exercise program and eat differently and lower their blood pressure before we prescribe that? What about statins? The same thing. What can we do as an integrated system? I'm not denying the use of medications, but bring that food is medicine movement more front and center. That also includes systems around hospital food, school foods, which California is definitely on the forefront of changing that. And I'm always impressed by that, but there are different things that would be linked to it, not just, you know, eat this versus that. It's building out the system, the ecosystem of integrating food as medicine at medical school levels, in schools, things like community gardens, learning or teaching kids to have a little garden in school that they could work on, just understanding food from the ground up.

1:47:27So it would be a whole ecosystem, but it would be that primary motivation. And given that you would be wielding great power and on this subject of systemic overhaul, would there be certain policy initiatives? Like I'm thinking about the hospital insurance, industrial complex, some of the aspects of the great bureaucracy that are at odds with or are counterproductive in terms of the type of care that you would like to see people get? For one thing, you know, even at, I feel like with primary care visits, with certainly for mental health visits, there should be an integration of a food prescription.

1:48:12And by that, I don't mean this food is gonna cure your depression. I do not mean that at all. But the integration of how can we integrate food into how we are offering solutions for people at a very basic level. So it wouldn't work in the emergency room, but it would work in primary care and outpatient visits, lifestyle medicine doctors, lifestyle psychiatry, all of that. And I think having ways to make this part of the conversation, maybe it's educational materials, maybe it's video materials, maybe it's something you can access on your phone. It's helping people get to that point of why it makes a difference.

1:48:50I have to let you go. We're almost out of time here, but I wanna end this with some real practical takeaways. Like if there's one core precept concept that you want people to take away from the work that you do, the message that you're putting out in your books and you're writing, you're talking, et cetera, how would you distill that down into something that is gonna lodge in people's brains and activate change? Start with one thing. Start with one thing that's bothering you about something you're eating or drinking. It could be the coffee. It could be the diet soda. It could be ice cream. It could be whatever it is.

1:49:32Something probably bothers most of us. And it is the way, if you truly feel you're ready to start. So pick one thing, start there and work your way into a bigger plan once you start to experience the positive change of better sleep, feeling more focused, having more energy at work, whatever that might be in your life, I think is a good way to really dip your toe into this nutritional psychiatry lifestyle measure to see if you wanna do more. Beautifully put. I'm thinking if there is a question that can be coupled with that, Like what is a question that you want all of us to ask ourselves that would help us kind of clarify what change we might wanna make?

1:50:24Like what is the question you could ask that would trigger something to help us reflect more deeply on the relationship between our lifestyle choices and our dietary choices and our mental health outcomes? It would be, am I living a joyful life right now? Am I, and maybe that's a too strong a word. Am I enjoying my life right now? Is everything perfect? You know, for most of us, it wouldn't be, but I guess I'm trying to reach what am I in control of? Because that's where food is very powerful. We can make the change. We can make the difference. We don't want to make a change, but it's within our control.

1:51:03It's not a prescription. It's not something I have to remember to take. I can literally, when I leave, go to the supermarket and make a difference in what I choose. So am I happy with how I'm living my life right now? Is a good way to start. I like it. Thank you. Thank you. This was great. We did it. How do you feel? I feel great. The books are Calm Your Mind With Food. That's the newest one. And this is Your Brain On Food. You can find them wherever you buy books. You can find them on your website. WomaniduMD.com. Yeah. And is there anywhere else you direct people to learn more about your world?

1:51:45Social media, I'm at D-R-U-M-A-N-A-I-D-O-O on all social media channels. And I have a new mood food newsletter that we have updated and evolved and you can sign up for that on my website. Yeah, I saw your Instagram post about that. Very cool. This was great. Thank you very much. I loved it. Peace and plants. and hopefully we'll talk again soon. Thank you. I hope so. Thank you so much. Appreciate it.

1:52:25That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guest, including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change, and The Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and or comment.

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1:54:22Thank you.