Feed Your Mental Health

Introduction to Doctor Talks and Nutritional Psychiatry 0:00

What's missing in the space is someone tuned for lentils and someone reminding people that you can do it, and it doesn't cost that much. And it's delicious. And it's really central to you taking care of your mental health. The data has just been so robust at this point that people like sure. Of course, eating more avocados is going to be helpful for brain health and more fatty fish and seafood and more vegetables. Rainbows is about one of these simple ways. How do we translate all this science into its dinner time?

This is doctor talks. Doctor, Drew Ramsey. I love talking to you. You are a wealth of knowledge. I love your Ted talks. I love listening to you because you funny, you fun. And I'm so excited that you are co-hosting these doctor's talks. You know, in the first we were first approached, I thought, oh yeah, I love talking with someone. I love interviewing other people with a co-host. And then I was disappointed to think, oh my gosh, we have to do it separately. So this is so cool that we can actually interview each other, you know, would have been really fun to both of us interview a person at the same time.

So welcome back to Dude Ramsey. You're an amazing, such an inspiration. And thank you for doing this. Well Doctor Caroline Leaf, thank you and everybody. It's just been a treat. We've about in the middle of this behind the scenes here. So we've been interviewing experts and talking about all of the great solutions that are out there for symptoms of depression, struggles with mood, symptoms of anxiety. And so yeah, it's been a really treat. I love our overlapping networks and also some of the new people that I'm meeting and getting introduced to.

And then also just, you know, all of the exciting science and all of the movement going on around mental health and us all doing a better job taking care of ourselves. So what a treat to be with you and everybody. Thanks so much for all of your support of our Solutions Summit. I mean, it's just been really exciting. And yeah, it's a treat to be with you too. I agree with you so much. So thank you for that. Will do. I really want to dive into what your expertise is. And and maybe you can just take two minutes to tell people who you on what you do.

And then there's so many great things that we're going to cover this morning that are going to help people tremendously. Well, sure. Everybody. So I'm a psychiatrist, mostly, mostly. And this is my couch. I love having it in the summit. I love it, the people by zoom. I really always been a clinician, which to me really means working for patients. And I love that because there's so much going on in mental health. There's so much new research. Patients like yourselves are so much more informed. Those of you who are in clinical care, you know, the ability to to learn about the mind and mental health and how things like nutrition affect mental health.

That research just exploded over the last 15 years. Altered. And so. So mostly I'm a clinician, I'm a psychiatrist, I'm spend most of my career in in New York City, pre-pandemic, I was there for about 20 years. I was on the faculty at Columbia University. I worked in the Department of psychiatry, doing a lot of different types of teaching of psychotherapy. And mostly though I'm known for nutritional psychiatry, which is this marriage of thinking about food and mental health, and began that work really through my interest in how do we get people more excited about mental health and how do we meet people earlier?

You know, so often there's this idea you're going to meet a psychiatrist. It's like, oh, you're at rock bottom, you know, and it's horrible. And I, I hate that. I love working with people and they want to optimize their mental health when they're struggling with maybe a symptom or a trauma or a memory or just, you know, something that they have a question of in their mental health and how to improve it, whether it's their mood stability or their sleep or their motivation or their focus. And so nutritional psychiatry for me really has become part of this mental fitness movement.

And thinking about it as a as a mental health clinician and as someone who wants to influence this conversation, you know, one of the things we really want people to do, because oftentimes it's like we're we're all against stigma, but there's still a little bit of an avoidant stance when it comes to what we do. You know, often because we call it, you know, it's treatment. So recently I've been really interesting in this idea of healing the modern brain. It's an e-commerce, and it's a new book that's coming out, which is about these tenets of mental fitness and nutrition is one of them.

And that's been a big part of my career. As I say, I grew up really rural Indiana. I've grown a lot of food. I lived on a farm where my with my parents and my wife and kids for about four years, in between New York and where I am now in Wyoming. And then I guess the other thing, I'm sitting here, my new clinic in Wyoming is Bruce Mental Health. We've got a wonderful team of psychiatrists and clinicians of a psychedelic medicine program here, really trying to prepare ourselves. We don't know what's going to happen in terms of the next steps of psychedelic medicine, but we know, yeah, there's a lot of interesting new research.

And so as a clinician, you know, I just wanted to be prepared because whenever you introduce new technology, new techniques into an established system of evidence based care, it's just, you know, there's all kinds of, you know, I've never had a an animal spirit creature card deck in my office before Carolyn, but now I do and I love it.

Drew Ramseyu2019s Background and Mental Fitness Approach 5:00

And it's an it's a real shift as a doctor to go from sitting with individuals really in a, in a, you know, integrative but somewhat conventional stance, listening a psychiatrist often listen, you know, to symptoms and, and then to shift and to, you know, these other stances really thinking about prevention, getting excited about whether people know how to make pesto or not. I would say that now, in terms of my got me waxing on about my career so we could get into specifics here a little bit. I think the bottom line is I'm a psychiatrist.

I love talking about mental health. I love creative media and getting people excited about their mental health. I've started a podcast recently. I've got some great books like to Depression and Anxiety. There's a lot there's more about me in the show, notes in the bio. But but Doctor Leaf, let's get to your questions. Let's get to the solutions that exist for the nutritional psychiatry mental fitness. So everybody who's listening can really leave this talk getting the very best of what I can offer.

Well, I think you do. I I'm glad you said that because I just want to reiterate, I'm really glad that you said what you said, because there's not many psychiatrist in this current day and age that are still doing psychotherapy, still have the couch, still are really focusing on proactive, preventative, as you say, not coming to the psychiatrist when things are falling apart so bad that you can't function, but actually proactively taking charge of your mental health. I also love how you say in your Ted talks, how you talk about the fact that we should not be focusing on mental illness, but on mental health.

You know, you say so many things and I'm much older than you. I'm 61. I've been in this field for so many years. And so when I hear someone like you talking in the way you do, I get so thrilled and excited because I have watched over the last 40 years, I have watched what's happened in psychiatry, and I feel like, you know, this is where things were. So it's almost like we've gone back to the best and going forward with better. And you know, you embody that. So thank you for that. So great stuff.

So I love the couch and I do see it as one of your talks. You said something about one of your patients spoke about the brain bows. And I thought this was just so cute. And oh, this is like I would I got right on here. I see you as the building brain bows, doctor, you know, so, I mean, just a fun thing because you're so into helping people in a proactive way. So let's talk about nutritional psychiatry. As you say, for the last 15 years, this has been a big deal. I actually wrote a book almost 15 years ago as well, around 12 years ago around this topic.

And it was really like when I first talked about this, people thought I was crazy. And, you know, now it's really common and people have a better understanding, but you have a wonderful way of explaining it. So take the floor. Tell us about there's so many angles we can go in. I'm going to let you lead the way. I'll jump in with some questions. But you know let's talk about these brain bones, microbiome, all these amazing things that we can actually do supplemental that sort of thing. Because I know you have a very unique stance on supplements because it's very overwhelming for people.

So the floor is yours. Well thank you, doctor. I think we'll start out with I like being your food guy. And so I like thinking, you know, because there's a lot of talk the supplements, medications and all these things, lots of evidence, you know, and I think about some of those for sure. And but mostly I felt like what's missing in the space is someone chewing for lentils and someone reminding people that you can do it, and it doesn't cost that much, and it's delicious. And it's really central to you taking care of your mental health.

And so this is called nutritional psychiatry. And they're really a handful of us, you know, folks like myself and Doctor Emma Naidu at Harvard, Chris Palmer Georgiadis, Emily Deans, I mean, you know, really small cadre of few folks I'm sure I'm missing. Somebody said it's Stanford individuals in mental health thinking about how nutrition is called nutritional psychiatry or metabolic psychiatry is really I guess those are two different things, but ways that what we do in our lifestyle and in what we eat and consume influence our mental health.

I define nutritional psychiatry is the use of nutrition. And by that again I mean food. Like you say, magnesium. I'm like, what's your favorite food source? You say folate. I'm like, you love lentils, don't you? I'm going to say lentils. A lot of times in this half an hour, that's going to be my main. Everyone, this is your main takeaway for me. Lentils. Lentils loves lentils, rainbows and lentils. What does this talk about? Rainbows and rainbows and lentils. And so the use of nutrition food to optimize brain health.

A lot of times we'll see this statistic like 1 in 5 of us are struggling with depression or a mental illness at some time during any given year. And I really don't like that statistic so much because it kind of others, all of us who are struggling with our mental health and instead of really like thinking like we are all arm in arm, all of us want to optimize our brain health. And we all know everyone in medicine, everyone in psychiatry that lifestyle factors like nutrition are at the heart of that.

And you and I are really compatriots in a way that I started early to. And there's a little bit of push back. But the great thing about food is it's such both common sense, and everybody knows the data has just been so robust at this point that people like, sure. Of course, eating more avocados is going to be helpful for brain health and more fatty fish and seafood and more vegetables. Brain bows is about one of these simple ways. How do we translate all the science into it's dinner time and you're looking at your plate, or you go to lunch after this talk and you go to maybe the cafeteria where you work and you look at your plate, how do you know that?

It's great for your brain health. And and so one way is to think about the colors on the plate and we have agree with one of the experts in the solution summit, doctor Diana minnick, who is all about polyphenols. And so the colors and plants, you know, they're appealing to us visually. You know, it's not just Instagram that made us love making food beautiful. You know, food styling has been around for us since there have been pictures and cookbooks since before that. Right. Think about all of the, you know, great masters.

When we paint with paint our food, it's like exactly. It's the brain those are thinking about. Look at your plate. Are there three colors? Can I add another color? I always ask my family for another color in there. Chop up a little red pepper. I love to dribble on these microgreens that are just wow, so packed with phytonutrients. And so bring those are about trying to get more polyphenols, more colorful flavanols or carotenoids. So phytonutrients. So molecules that we find in plants. A lot of times we'll hear like obviously some negative misinformation like, oh, you know, plants are protecting themselves with all these toxins like you.

Sure, there's some of that going on in plants, but our interaction with plants, it's so nuanced, it's so complex. You know, if you're worried about, you know, anti nutrients that's you know, that's why we cook our food. And for the most part, you know, again looking at all of these whole natural foods, whether it's the kale I grow my greenhouse I've got oh that's a leaf. I've got these two La Senado plants right now that are just they're going off. It's called I'm so know I mean dropped down 45 last night 45°F.

So and and and so that causes the the kale leaves to start to kind of sweeten up a little bit. Back to nutritional psychiatry. We want to optimize brain health, all of us. And then to get down to the science, I treat depression, anxiety, mental health disorders and psychiatric conditions. The goal of this work is can we do a better job preventing those conditions with lifestyle interventions? Can we help teens eat better? Can we help college students eat better? Do we have some emerging evidence that in doing that we can prevent depression?

Yes, we do. That data now exists. And by we I mean mostly Australia, because most of the data is coming out of the Australia, the Food and Mood Center, they're led by Felice Jacka, Michael Burke and their team really, really kind of changed the landscape for the evidence over the past ten years for nutritional psychiatry and prevention and treatment of mental health disorders. So I see someone with clinical depression prior to maybe ten, 15 years ago, we wouldn't ask that patient, hey, tell me about your diet.

What do you eat? And just put yourself in our shoes? We're treating, let's say clinical depression, right? If I have someone who is a vegetarian or eating a vegan diet, right. A lot of times in medicine there's like, I don't know, red flags with that. Whereas in nutritional psychiatry, that's at the center of some of our curiosity, what you're eating, what?

Brainbows, Nutrient Density, and Food as Medicine 13:00

Well, if you're a vegetarian or vegan, you're doing such a better job on fiber. You know, such a better job with the microbiome. Those are often the folks who are eating so many fermented foods. Also, we want to go over all the amazing things these individuals are doing and then think from a brain health standpoint, okay, in the larger data sets, you see lower intakes of things like zinc, iron, protein. What is this again clinical situation. What does this individual in front of me my patient. How do they interact with those foods that contain these nutrients.

Are they one of the veggies or vegans who are like way up on, you know, they get nutritional yeast on their popcorn and they're eating lots of B12 and they know all about that, or they're somebody who may be getting into this lifestyle because of more, maybe some ethical reasons. And they haven't thought about some of the nutritional implications. And there's some goodness there. Fatigue, you know, there are some, some of maybe like brittle nails or hair loss or, you know, some of these symptoms that are mysterious are actually just they're not having enough of, let's say, iron or B12 or zinc in their diet.

And so, nutritional psychiatry is really about trying to understand your relationship with food, you know, both the nutrients and then these big food categories. And a lot of my talks to you, Amy Ryan, my seafood greens, nuts and beans and a little bit chocolate and dark chocolate with all of the Academy and where he's now, it's hard to. But I still I still think dark chocolate is essential. It's that yeah, it's essential. And it's such a great example for us with our biases. Right. We think dark chocolate like, oh, it's, it's my guilty treat or you know, it's a way of making dessert better.

Or we take dark chocolate and put it on a cake. And we're like, brain health is brain health cake. And it's like there no, that's how it works. And so but thinking about these food categories, you know, I'm guilty of of promoting kale a lot and thinking about singular foods. I'm getting excited about singular foods kale, lentil, kimchi kefir because we eat singular foods. But but my thinking really expanded, especially when Laura Lynch and I published the Antidepressant Food Scale, which is the open source paper.

You kind of see our thinking of just trying to begin a conversation, really, of if you wanted to think of the most important nutrients for depression, not from a content side like, oh, we all know omega threes are great, but from a data side, what does actually research say 12 nutrients emerge. And we just ask this really simple question what foods in the natural food world have the highest nutrient density of these 12 nutrients. So the most of these 12 nutrients per 100 calories and it was just really fascinating to see what emerged, because if you look at this, you can look at the list.

And watercress is the top plan. And you know, some people eat that. It's a traditional food in Haiti. It's almost every meal I've been told. But a lot of people have never eaten watercress and their mental health is fine. So it's obviously not the secret. Eat more watercress, eat more oysters. Some people don't like those foods or never eat them. Yeah, but it's more of those groupings, right? What are three of the top five? On the animal side of things are bivalves, mussels, clams and oysters. And that was something that was never part of my diet growing up in Indiana.

But as I began to eat more seafood, as I began to explore nutrient density, you know, calorie per calorie kind of nutrient density, basically, it's hard to beat a bivalve. You get so much. B12 clams actually are the top nutritional source of vitamin B12. Do you mind if I quickly interrupt you there trying to help because you're saying the most incredible stuff, and I don't want people to miss it. You mentioned you give a great example of the, you know, calories. We shouldn't be eating calories to try and lose weight, Bishop eating calories for food density. And I love that.

And you talk about how a kale salad is 140 calories in a sodas 140 calories. And you know, it's a such a great way of people. I just want to underscore that to people don't think that you're trying to push calories, do you actually try to help people understand calorie, the density of foods, the quantity of what you're putting inside the body? I think that the way you explained it, and I'm trying to push nutrients with this idea that calories are useless, useless unless we calculate nutrient density.

And it's not a complex calculation. And in some ways, you know, you skip the math if you want the math hacks, you're not like, oh, you know, 62 calories. Like, oh, right. The math hack really is looking at these food categories and these foods that we highlight in all the work. This book, you know, highlights lots of foods. Great stuff because that's where you're going to find the nutrient density. When we're talking about a clam and I say B12, what I mean is that if you eat a few ounces of it with your pasta vongole, you got 1,200% of your daily need of vitamin B12.

And vitamin B12 is one of these nutrients that we store these four years of vitamin B12 in your liver. So it's a really nutrient density for me as a physician who'd been raised in that, like, calorie world was really exciting because calories in, calories out. That's very true. It's very important people are eating too many calories. But one way that I guess I think about that is what if you envision that your mind, your brain is is seeking calories because it's not getting enough of certain things.

It's not getting enough magnesium and folate. You know, 90 plus percent of Americans aren't getting enough fiber, right? Getting protein often. And what are we getting? We eat too much protein and not enough fabric is running. People aren't eating plants and so, so nutrient density really excites me. That shifted how I thought about food, how I thought about what I was feeding my kids, the types of foods I buy and get excited about. It just really helped me. And so I hope it's all for everybody watching.

I appreciate you highlighting it. Caroline. That idea of a can of Coke 140 calories, small kale salad, 3 to 3 cups of chopped kale, and a little olive oil, salt and pepper. Maybe I'd put something interesting in there that doesn't have a ton of calories, like some microgreens or a little cumin, or who knows, about 140 calories. And in what I'm getting olive oil, I'm getting in. That's like so much vitamin K, vitamin C, fiber, like all the all the stuff, plus all those brain bowl, all those phytonutrients you find in the dark greens.

So you get all of that for 140 calories versus, you know, a can of soda where you just, you know, it's nothing. Apparently you're opening a can of happiness. But I don't think so. You know, you're right. Yeah, yeah, that's sort of sugar and a little bit of salt. And, you know, again, not that you can never have that in your diet. It's just an example of those are empty calories and being balancing. Yeah. You gave another example in one of your talks as well about one of the few patients that came in and was really battling with depression.

And you did all the, you know, the traditional things of pursue great psychotherapy. I'm just I'm so glad that you still do therapy, as I keep saying thank you for doing that. And then she you turned out that you decided, well, it wasn't working. And you also will what are you eating? And she hadn't eaten breakfast. She was on some juice fast. She was no fat, no eggs because of this in the calories. And so all these things and messages, true that we've been getting over the years of, you know, don't eat butter, don't eat eggs, don't eat too many calories.

It's been all the wrong stuff, and it's created so many problems. And, you know, I'd love you to. I just enjoyed that. And Matt, I'd love you to just sort of carry on teaching. What you teaching, but just wanted to tell people how I've, I found that really exciting when you asked that question and found out that stuff and not that you saying don't do juice fast, but you know, be careful. And I think that's what's kind of the case with balance. Yeah. And there's a time and the place for extreme moves.

And I think the Kitty Jenny diet is a good example of that. I just had a wonderful talk with Austin Perlmutter, who we also have in the summit. Yeah, I love everyone. Check out this. I love how Austin talks about what he calls extreme diets. And there's a time levity. There's a different for general recommendations. There's a way to do things safely in a way not to do things safely. Colonel, I just to get back to the first of all things you said about psychotherapy and talk therapy, I think, is everyone hears throughout the summit, you know, there's a a level of introspection and a caring of the self and one of the core tenets of mental fitness and and healing.

The modern brain and kind of the, the orientation and the framework I've been thinking about is around unburdening. Unburdening is a way that a lot of therapies, whether it's internal family systems or psychodynamic therapies, you know, think about the processing of trauma and whether those are the explicit traumas we think about violent and traumas or, you know, subtler or not so subtle developmental traumas being ignored, being in competition with the parent or a sibling. You know, there's so much that happens to us.

It's so deeply personal. And as I said in the Ted talks, you know, this is the most complex brain scanner in existence. The core I love this. I'm want to hear it in your words, in your own personal narrative and experience. You know, what's getting you is is one of my mentors. Another great solution summit guest I'm sorry to keep naming everyone. I just love all these great legends. But Doctor Jim Gordon really talked about, you know, our whole approach to trauma is kind of off. So the I love you mentioning that.

And for anyone in mental health psychotherapy is really at the core of your work. And if you're if you're struggling in integrating these ideas, if you're something's resonating with you right now, something that you haven't worked through or as we said, processed, it's a great it's a great place, I hope I hope this, this, this summit really brings you to someone's couch to get to that work because it makes all of these interventions much more powerful. So, you know, so thanks for saying that, Carolyn.

About about psychotherapy and about talk therapy is just a core piece of this work and a core piece of mental fitness. Love it. That's beautiful. Up you. So let's pick back up on the we were talking about the food groups. And I'd love us to also talk about the microbiome, which these people have become so much more educated. You have the microbes saying that you have such a cute way of saying that. You say you go to doctors to get rid of bugs, and now we're telling you to put bugs in your in you.

So I know it's it's like our favorite of these two things happened. I think it was 1912. That is sort of a couple things that happened. We discovered penicillin. And so for the first time, and this is like changing changes, World War one, right? We have this idea that, wow, we can kill bacteria. You're not going to just die from an infection. It's like amazing. And bacteria, the enemy things go super sterile. Like we want like stainless steel. We want sterile stuff. We want antibiotics. What else do you want? Sterile. We want our food sterile.

And how are we going to achieve this? Well, another great discovery in 1912, Crisco. And so Crisco literally comes across the pond, comes across as a German biochemist, he told The Strain, the happiness date. William Kaiser, I have this image in my head of him on like a boat, right? And he's got like a little vial of of basically this is, you know, partially hydrogenated. It was cottonseed oil back then. And they're going to turn this food waste product into a food. Right. Cottonseed. Cottonseed oil is not something we ate.

They partially hydrogenated. They create Crisco. It pushes trans fats into the food supply. And and sorry, it's it's this big period of change. And so all these things sort of shift 1912 nothing that happens. We have the cigaret rolling machine gets invented. I'm not a big history buff, but a few of these change like this year.

Microbiome, Fermented Foods, and Inflammation 24:00

Just what's significant. It also we discover the first vitamin. And so this era right where vitamin B1 is like wow there's actually this thing called vitamin B1 and it's defined thiamin. And so there's this real, you know, very recent revolution and kind of how we, we think about food, we, we, we and we think about things like bacteria. And so yes, as physicians we love to kill bacteria. And then all of a sudden now we're asking people to eat live bacteria, eat refrigerated, you know, foods from the refrigerated fermented section.

Make sauerkraut yourself. Think about yogurt and kefir. All of my smoothies and all of my books have a fermented food component. They have kefir because I found, you know, people like yogurt for the most part. If you're not totally against dairy and fermented dairy is really quite interesting, but mostly there's all these curfews, these colony forming units. There's just a higher concentration and a larger diversity than you find in things, other fermented foods. And so given the patients, you know, are a little unfamiliar, often with fermented foods, it's just an example of, a really fun food category for people to think about is, you know, maybe it's a real radical shift in your health.

Maybe it's not, but that that's one of these, again, new ideas. You think about this quickly kind of feels like you take us back to the beginning of nutritional psychiatry. It's my parent, my parent, which is in some ways one of the parents of nutritional psychiatry at this moment, I had with the patient called K, and she'd come in whose juice she's doing all this kind of trendy stuff to lose weight. She'd been at like a 5 a.m. workout. And it struck me in the midst of this depression. She was and she was working so hard, and she wanted to lose weight.

And part of this shift in how I was thinking probably is a therapist. And probably what that couch has taught me is the way that we think about bodies, the way we think about health, the kind of oppressive nature of the patriarchy, of thinking about women's bodies and women's health around weight, around certain parts of their bodies. It's just been so damaging to mental health. It has been terrible for eating disorders, and it's been awful. And then the way that we approach it in medicine, right, that if, for example, you're a veggie or a vegan or you are on an anti-inflammatory diet or a carnivore or whatever, you know, these, these so many.

Yeah, we often approach it through curiosity and, and we often don't ask about it other than maybe, you know, a door handle. I remember when my wife was pregnant with our news, our son, that we, we got to the door and, and the only joy and and keep, keep, keep eating healthy. And I thought I was, like, really grateful she said something. Yeah. And maybe it's also, you know, you know, I'm a physician. I'm supposed to know something about nutrition. But I thought it was also striking that for a lot of people, that's helpful encouragement, but it's not so sure what to do then for lunch.

And so I really appreciate you kind of taking back to this moment of nutritional psychiatry. This is, for me, about 2004, right when I finished residency and I started in practice. Then we think about now, what are these new concepts? I go through them. I need to beat depression and anxiety to kind of say, hey, depression and anxiety. It's shifted now. Yeah, we still think about development. I still love talking to you about all of the details of who you are and your unique internal world. You know, there's a lot of new evidence and a lot of new research, you know, around other treatments for sure.

But but the result is this, you know, robust and growing set of evidence around food and, and, and these new concepts inflammation, the microbiome. Again all the organisms living in our gut inflammation is is this idea that we have this amazing alarm system. It's amazing. It learns. It's like the the immune system's incredible. It's really getting turned on right now. And as everybody knows, I sometimes give an analogy like if you if you were in high school in America, we take this test, the SAT to get into college. Right.

And and you in to take the S.A.T. and someone pulled the fire alarm, and you're sitting there with your little bubbles and his. And the sprinklers turn on, you know, and the and the the, you know, sirens are blaring and the flashing lights are going, but you've got to finish the S.A.T.. There's no do over here. Yeah, you're going to get it done. I believe in you, right? But you're going to do worse. You're not going to do as well because you can't focus, right? Because the alarms are going off. And so excess inflammation is really, really one of the things so many think what 60% of Americans now are, obese.

Maybe I'm getting that statistic wrong. I saw that recently, though. It's a very high number. It's a high number people around the world are struggling with, you know, all types of metabolic struggle challenges. The issue. Also, since you're talking about depression and anxiety, there's all kinds of ways that inflammation is triggered by these disorders, right? About 30 to 40% of patients who have treatment resistant depression an awful phrase. Everybody agrees. Right? I've never seen anybody resist treatment like, oh, there's this depression.

Okay. Like, I know it's such a forward. It's a horrible. But for folks who we haven't helped yet in terms of understanding their depression and better treating their depression, you know, there's such a connection between inflammation for some of those individuals and and their mood state and their depression. There's a lot of data, for example, individuals who are on an anti-inflammatory plus a medication. Those meds are like twice as effective. And so there's a so inflammation new concept in mental health.

That by the time the summit comes out, those now will start being more data about the GLP one medication. Yes. Let's put those in wait. But boy, so many of my patients take them and stop smoking. Don't want to drink anymore. Their self-esteem shifts, the chatter that they've just said. The addictive problems. Yeah. It's just so, you know, we're in this very exciting time where new concepts like inflammation are being applied directly to mental health. And again, the idea that after this, you eat a really nutrient dense meal full of rainbows.

And then you think about some of the advice in the summit and you call a friend you haven't talked to for a while and you just catch up, or you just send them a picture text, hey, I was thinking about you. I see you work on connecting. You work all these elements of mental fitness that we're talking about. It's really wonderful to think about these different systems. So let's also watch some fermented foods to affect the microbiome. But these different systems that are influencing our health and our mental health and helping us, I think, also feel this notion that we don't have total control, we have some, structure to patient.

This week was really like they've been doing really well and just kind of crashed and wasn't clear why I needed a session. I kind of squeezed an extra session and, and I met with her and, and she had this really a very clear and kind of poignant assessment essentially, of, you know, she's doing very well, but it just kind of modern life had gotten a little overwhelming for her. And and it was just a, you know, to me, lovely moment about how the modern world does require a new extra set of skills.

It's really about healing. The modern brain is about thinking about your mental fitness and thinking about these new concepts. Neuroplasticity. Also got to say I'm sorry to keep going on Caroline, but this is new ideas like you can make your brain, or help your brain grow and repair itself. It's been my life's work. Neuroplasticity. So I cannot agree. I'm so glad you brought that concept up. It's it's it's incredible to know what I'm hearing you saying, gurus. It's very encouraging. We have moved over the last 40 years from within 50 years from being quite holistic prior to 40 years of neural neuro reductionism.

And then there's just now this move back, and it has been creepy to think of ever went away, the holistic approach. But there was a very dominant neuro reductionistic approach. And now there's this holistic approach. And you very much embody that in the, in your in the work that you do in, in helping a person. And you've got to talk, you've got to connect. We got a text, we've got to watch for that. And these very specific, awareness that we need to have of how our diets have changed and the role that that plays in depression and anxiety.

So could I know that we coming close to the end of our interview and, and this is so much more I want to ask you, and I know you've got books that people can get their hands on and so much great advice. How would you summarize sort of overview? We can we can people start to process the microbiome these different diets and and and I love that you don't just push one diet. You very end to that. You very much about getting natural holistic foods that are healthy and not going to be later on full of hydrogenated fats and that kind of thing.

How does a person begin? Because it's, you know, some there's just so much it supplements. What do they do? What is the first. Can you give us a few steps to just get this process going? Yeah, for sure. And thank you kindly for bringing it back to that. Let me just share what we do in our clinic and we have a wonderful, lovely, wonderful food coach and chef, which is where Emily Berner Emily has been such a wonderful partner with me as Samantha Crieff on my team, who is now a full time therapist, kind of came to us doing a lot of work in the food world as a chef and as a coach.

And so I've really been inspired by a lot of the members on my team who understand food, and it's just a really want to, you know, mention them. That's one of the first places that I have people start. But in clinically, when I assess food and when I sit with individuals, I really want to hear about your dietary pattern. And I'm looking for opportunities. I'm looking for things that you already know you're struggling with. I'm also looking for some of the things that you're doing great, or some of the things that you're close to doing great.

You love avocados, or you like to snack on raw unsalted nuts, or you really love yogurt. You just haven't eaten in a long time. I'm looking for your relationship again with that little rhyme seafood, greens, nuts and beans and dark chocolate and thinking about these food categories. And then I'm thinking about some of the, you know, we'll get pegged as controversial, but, you know, eggs, meat, dairy, but people eat those. And so again, as a clinician I think, what do you what do you do when, you know, eating a ham sandwich every day or you like smoking a brisket in your backyard with your buddies?

Those are different. Those are different meat experiences. And those affect your health in different ways, in my mind. And so for everyone watching where I'd ask that you start is settling down just for a moment, you know, taking a breath and crossing your legs, you know, and and just appreciating how incredible it is that you can eat so many different things and you can create a human consciousness with it. I mean, that's the part that still blows my mind, whether it's an avocado or a eliminate iced tea or a shrimp cocktail.

Right. You know, or a salad like you. Yeah. You know, maybe a different mood state over time or anxiety state with some of these dietary patterns per the data. But it's kind of amazing to me that everything functions. And so I try to appreciate that. And I try to think about some of what my body's asking for in a real way. You know, so often we don't take this seriously and we joke or, you know, parties asking for more ice cream. I have a bit of a sweet tooth. So I really differentiate that type of craving or desire or, you know, things that make me salivate to, you know, really what my body's asking for.

You know, a lot of times for me, that's more plants or I live at altitude over a mile up in Jackson. So a lot of times for me, that's water. Yeah. And to think about, you know, what? You're what you're asking for needing. And a lot of times I see with patients, you know, it often doesn't start with food or diet plan.

Practical Steps, Supplements, and Personalized Nutrition 35:00

It starts a space. The people don't have any space for honoring their nutrition, their self nourishment, for seeking out the foods that, you know, a lot of people love pears, watermelon, raspberries, cucumbers. Is this TikTok phenomenon right now? The cucumber guy. But all the different ways he makes cucumbers? I think it's so wonderful because cucumber is such an awesome vegetable. Yeah, it is so easy. So, so starting out with again what you're knowing you need and and then thinking through these food categories very in a very kind of looking at your dietary pattern.

You know think about Doctor Leaf brought up rainbows. Think about colorful vegetables. I love the recommendation of Tim Spector that we should be trying. He's a top microbiome researcher. Wonderful. Follow on Instagram. Incredible individual. I love him for inspiration, but he encourages us to eat 30 plants a week, 30 different plants a week. And I love it when I look down. I'm like, I got nine plants on the plate. This this very meal, you know, like, I would be proud. So getting those crunchy vegetables in there again and keeping it simple, folks, I think so often we get caught up with like this complex real macro ratio and, you know, I don't like to use myself as an example too much.

But I've really tried to live this lifestyle eating a whole, mostly whole foods diet other than my ice cream and sweet problem, really trying to keep it simple. And so those are some of the places to start looking at those food categories. If you want to get specific for anxiety and depression. I really like people looking at their seafood and meat consumption patterns, thinking about where are those fatty fish, wild salmon really recently. It's a lot of focus on plants. I just find that people are really struggling to do that well, to do that deliciously, a lot of people are actually in depression, anxiety, like, I have a pesto formula and here.

So you can, like, make your own pesto, you know, whether it's pistachios or Rebecca Katz, the great mood food chef was telling me about traditional Sicilian pesto being a pistachio based. Yes. And I had no idea. So there's there's so much just wonderful, wonderful ways to approach food. I think another thing people struggling with who have anxiety and depression symptoms, you know, and I just want to honor this for everybody's, you know, not feeling a lot of motivation or hopefulness or energy or optimism.

You know, this stuff is easy to say and a talk here and get enthusiastic and excited about if you're feeling really depressed or having a hard time getting out of bed, you know a coffee or a smoothie with four ingredients can just sound like way too complex and overwhelming. You know, anybody who struggles depression sometimes, I'll tell me, like the grocery store is a little bit of a litmus test if I'm in there and I'm really, like, not excited about all of the opportunity, you know, whether I'm trying to save money and be economical with it.

I'm trying to get more diversity of plants or whether I'm trying to explore more seafoods. It's really, you know, for for most individuals, a lot of individuals, there's an incredible diversity of options now for all of us. That's true. And and when I'm not excited that I'm in there, you know, I know something's kind of off with my mood. Or if I'm racing through and I know there's something off with my kind of anxiety and organization, I'm not there in the way that I need to be. So that's a long winded answer, everybody.

But I guess for I'd like to ask you to start, is it really at the heart of nutritional, of the soul, of nutritional psychiatry? Why go all the way back to that patient in 2004, sitting with her, I think what would I ask people to do is really think about the heart of nourishing yourself with food, taking care of your mental health, feeding your mental health, and doing that in a way that really, you know, honors the nutrients that your mind needs and that you can find those in these food categories by adding more of them in it.

You're really taking care of a lot of the challenging deficiencies people have and things like fiber, live bacterial containing foods, polyphenols like the brain bows. And in getting out, a lot of the stuff that you know, we know are causing problems ultra processed foods, you know, all the stuff that's quick, that's easy, that's delicious. That is at the heart of American food often, right? Hot dogs and pizza and hamburgers and French fries and just really honoring the science. It's not that you can't have any of those things, but those actually can't form the core of your diet.

If you want to optimize your mental health and your brain health, it just can't. It's not compatible with healthy physiology. And just going hand in hand with that is that you can't go and eat like that and then just think you can supplement your way to health. And there's obviously a role for everything, but it is in the could you just in a minute or so sort of talk a little bit because it's a question people are thinking asking. It's very common. What about the supplement industry, which is overwhelming?

I have one I think about I think about the supplement industry, like I think about the the pharmaceutical industry. There are the exact same. So there's not any different to me there. When I went off to college, my mom pulled me aside. It's kind of a hippie, and she sort of looked at me and she said, look, no pills, no powders, and, and and I don't think she meant that in an anti-Islam or anti psychopharmacology way, I prescribe lots of medications. I help people sort out their supplements. I have lots of patients that take lots of things.

But but for me, as I said, I like being the food guy and thinking about food first philosophy. And I and I and I think all of us need to we have that hope. We have that hope that there's going to be that slow kind of silver bullet solution. It happens sometimes. I've had a few, you know what all of us and I think of as home run, someone comes to see me and they have nail biting or they have OCD and and they, they take in acetylcysteine it goes away, you know, just like some medications, some people have symptoms and that, you know, it just really resolves.

But, you know, I was like starting to really understand what in your lifestyle is contributing and and not from a blaming individuals way. We're saying supplements or meds or therapy shouldn't be part of your journey for sure. I like all those things, all of it. Everything. And I like people seeing the full menu. I think in my practice in my clinic, if you come in and you don't like meds, okay, I don't want to turn you away because you're coming to ask for help with your mental health. If you come in and you've got a really complex supplement regimen, that might not be what I would do.

But, you know, I'm here to work with you. Yeah, I work, you know, I, I, I work for you. I mean, it's like I'm here to advise you. I'm here to be to do my best of understanding and my own biases. You know, there's certain way that I think we should approach mental health. Those are my biases. Some of those are evidence based. Some of those are just how I think we should do it. And but really be a partner for individuals. The supplements, you know, there are some where there's a lot of good and interesting evidence.

You know, when you look at how Germany treats adolescent depression, they use Saint John's wort often, right? Saint John's wort trials in America haven't been positive. That said, it's an interesting compound. We look at some of the new data on, like L-theanine or Rhodiola rosea. You know, I think just like with medication supplements, you know, there's some positive studies, there's some negative studies. And so again, this notion that I rather you eat fish or take an omega three fatty acid supplement, I'd rather you eat fish.

What if you were like me when you were 21? And when I say fish, you get nauseous? You know, those are the kinds of situations where supplementation makes sense. Or, you know, certainly for people, again, who are on a more plant forward diet who aren't eating their clams. Right. For sure. I want you taking a B12 supplement and checking, most importantly, also checking your B12 level. And then, you know, is is some of my colleagues often point out and I think it's a really important thing to point out a lot of people with compromised medical status situations, metabolic disorders, GI disorders, they struggle with some absorption and supplementation.

And some of these individuals really makes a lot of sense. And so, you know, I don't want to come across as like, you know, anti balance. It's a great answer you've come across with a great answer. There's a menu it's bio individuality. Everyone's unique. There's no one talk. You can't tour everyone with the same brush. And that's what I really like about your approach. It's everyone's different. There's a whole lot of ways of approaching us and it's a combination and everyone's unique and that's what really counts.

And it makes me think that last 16 years interviewing you today, obviously, I mean, waiting dinner last night, we had some friends over and I was making the set of maybe make a drew salad here. And it was like, this is how I tell you I've to the person was we made two different salads and the one was just we put the greens in and then added some avocado and added some burrata and added some cut paper juice and sprinkled with olive oil. It was divine. And then the other one was peach and and the peaches and big tomatoes, you know, the whole not the tiny little ones, big ones sliced with, basil leaves, fresh basil.

These are all organic and, you know, farm to table. And then just was a sprinkle of, of some vinegar. And I mean they were amazing. And their combination, I mean, it was so good. And it was pretty actually. The effect the inside of the burrata, the fresh straight stretch your chili cheese. I told you that combination was amazing salad. But I had to tell drew what I ate last night because it was. I was just thinking of you when we were eating this. So thank you for your inspiration, your guidance, your work, your books.

And as I see, I'm so excited I'm co-hosting this great summit with you now. Thank you for your great information. Will. Thank you for, thinking of me during meal prep. That's such an honor. Anybody watching someone and any time that I get to drop into your kitchen in your mind, I just think. I think it's such a great, honor and a privilege, and I love. I want to hear me cheering. I love this dish. First of all, everybody's heard me. Let's get into the nutrition. We talked about phytonutrients. This is one little rule that's in basil I just posted a little social media post of these are these are the greens that I eat more of in kale because basil is just I love it.

Lean a little is the same molecule. It's in lavender. And they're actually studies of lavender aromatherapy that your little blood level goes up and sleep quality improves. And I think anxiety decreases. I mean, not the biggest studies but just just again this fascinating molecules I love that you've gotten that in there.

Closing Reflections on Cooking, Connection, and Healing 45:00

And then I love it. Everyone can see a piece of nutritional psychiatry. See the intention, how Carolyn lights up, the creativity, the flavors, the taste, and also that it's with friends. It's not one salad, it's two salads. Right. Delivered beautifully. Yeah. Oh. Together communication. All of it was involved. The whole making the making the food together as a family, laying the table, making look beautiful. Great conversation. That's the holistic. We all felt better that hour that you're talking about the making, the prepping, the set.

I think this is one of the most powerful moments and kind of social structure, family for healing, for our mental health, for this, you know, kind of what we want to be lost in the process of connecting with each other, loving each other, creating something together, nourishing one another. It's such a wonderful, wonderful image for for us to end on. Doctor leave. I thank you so much, everybody. It's such a treat to get to share all of this information with you all, and I hope to be in your kitchen.

I hope you join me Cheering for lunch. All snow and wild salmon and basil and pretzel and peaches and all these wonderful foods that we're surrounded by that really are here to help us heal and help us on our journey to find creativity and connection and deliciousness. Oh, what a treat. Thank you so much, doctor. Thank you, Doctor Ames. It's been a pleasure and I look forward to chatting again soon. Thank you for tuning in to Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health.

Each day is a new opportunity to make choices but empower your wellbeing. For more insights and strategies, subscribe to our podcast and visit our website. WW dot doctor talks.com. Stay connected, stay healthy and join us next time on Doctor Talks. Real talks from real doctors on the issues that matter to you most.