In this episode, I am speaking with Uma Naidoo, MD – a Harvard-trained psychiatrist and a trained nutrition specialist.
She is the author of the national bestseller This Is Your Brain on Food where she shows cutting-edge science, explaining how food contributes to our mental health and how a sound diet can help treat and prevent a wide range of psychological and cognitive health issues from ADHD to anxiety, to depression to OCD and others.
This is a deep and wide-ranging conversation with a lot of value where we talk a lot about depression, anxiety, neurotransmitters, and different kinds of foods and nutritional factors that relate to your risk of these conditions, the gut-brain axis, and so much more.
Table of Contents
In this podcast, Dr. Naidoo and I discuss:
- Four different ways that your brain is affected by the food you consume and their effect on mental health
- Naidoo’s thoughts on what the recent collapse of the depression-serotonin hypothesis means for the future of mental health and SSRI prescriptions
- Why the gut-brain axis is essential to consider for better patient outcomes
- The specific foods or diet plans to lower the risk of depression or anxiety (and the most pro-inflammatory foods you must avoid)
- Why you should include fiber, omega 3s, herbs and spices, prebiotics, and probiotics in your diet to stabilize your mood and lift daily performance
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Transcript
Ari: Hey, this is Ari. Welcome back to the Energy Blueprint Podcast and with me today is a Harvard trained psychiatrist, a professional chef graduating with her culinary school’s most coveted award and trained nutrition specialist. That is a very unusual combination to see somebody with a strong background in nutrition, who is also a psychiatrist.
Hence why Dr. Uma Naidoo is today’s guest and why I brought her onto the show. Her nexus of interests have found their niche in nutritional psychiatry, and this is really where she specializes. She wrote a book called, This Is Your Brain on Food, which is a national bestseller, which I highly recommend. She founded and directs the first hospital-based nutritional psychiatry service in the United States. She’s the director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital, and the director of Nutritional Psychiatry at MGH, Massachusetts General Hospital Academy while serving on the faculty at Harvard Medical School.
She was considered Harvard’s food mood expert and has been featured in the Wall Street Journal. In her book, This Is Your Brain on Food, she shows the cutting-edge science, explaining the ways in which food contributes to our mental health, and how a sound diet can help treat and prevent a wide range of psychological and cognitive health issues, from ADHD to anxiety, to depression to OCD and others.
This is a deep and wide-ranging conversation with a lot of value. We talk a lot about depression. We talk a lot about anxiety, about neurotransmitters, about different kinds of foods, and nutritional factors that relate to one’s risk of these different conditions. Things that disrupt the gut, the brain through different mechanisms. What are those mechanisms, the gut-brain access, and so much more. I think you’re going to learn a lot and love this podcast, so enjoy. Welcome to the show, Dr. Naidoo. Such a pleasure to have you.
Dr. Naidoo: Thanks, sir. I’m really happy to be here.
Using nutrition to heal the body
Ari: I would love to get started by talking about the fact that you are somewhat of an anomaly as far as conventional medicine psychiatry goes in the sense that you have a lot of focus on nutrition. Your new book is This is Your Brain on Food and, obviously, it’s focused heavily on the interplay of nutrition and mental health and brain health, which is what we’re going to be talking about in this podcast but I’m curious, how did this start for you? First of all, why do you think it’s so unusual for psychiatrists to talk about nutrition and how did you become an exception to that rule?
Dr. Naidoo: I think that the way that in the US and psychiatrists are trained, I’ll stop there, is that we focus on medications of therapy as main methods of treatment, and there’s several others, which we are also trained and study but I would say that for the most part, people are guided towards medications. Here was where I felt there was a problem because having grown up in a home where people– I was doing the daytime when I was a kid, spend time with my grandparents because my mom was in medical school.
I learned yoga and meditation really to entertain. They wanted to entertain me and have me learn something and it, therefore, was just very much a part of how I grew up. For that reason, when I came into the field of psychiatry, I couldn’t figure out why we were using and prescribing medications that had devastating side effects.
Now, I want to be clear that I still prescribe medications, they’re life-saving for many of my patients, but they also have problems. They also really impact our metabolic health. I was noticing this and wondering why we were not asking other questions. There were two very life-changing moments in my career which were eye-openers. One was early on in my psychiatry training, a patient was very upset with me because he felt I caused him to gain weight from a medication I had prescribed and it was Prozac.
He also had a 20-ounce cup of Dunkin Donuts coffee in his hand, which is a favorite in Boston. I said to him, partly to distract him, Ari, I said, “Tell me what you put in your coffee.” This 20-ounce cup, he had more than a quarter cup of processed creamer, and then he had sugar. I said, “How many packets did you put in?” “Well, six to eight.” so when I calculated, I’m not much of a calorie counter for the long term, but I was able to show him on my computer the number of grams of sugar he was consuming and the processed unfortunate ingredients that were in the coffee.
Coffee on its own was fine, but he was adding so much to it and the empty calories that he was consuming and I saw his from being upset and angry with me. He changed into being– His eyes lit up, it was almost like a light bulb went off. I thought, “Wow, if he can understand that a simple tweak like that makes such a big difference and can help him maybe lose weight over time or eat healthier,” I saw the power of it.
That really made me change how I was speaking to all of my patients. We grew to have a great therapeutic relationship. He didn’t need a high dose of Prozac. He over time lost weight and really was inadvertently my first test patient because I saw the power of interpreting good nutritional advice to someone. Then the other aha moment with me was an unexpected one where I myself ended up the patient and wasn’t by choice.
I was diagnosed with cancer when I was facing my first chemotherapy treatment, I found myself questioning how, why I feeling, super anxious, a lot of angst, and partly because I knew exactly the side effects I was about to face that day. I was making myself a cup of tea that my grandmother taught me [unintelligible 00:06:35] me for Golden Child as a kid and trying to calm myself down.
I realized as I was making that, why was I not leaning into what I knew and what I had been teaching and educating and helping people clinically at work to do using nutritional psychiatry principles? It’s funny when you’re the patient, you lose sight of a lot of stuff because it’s such a different situation. I made a conscious choice to really lean into everything I knew so I became my own test case, but not by choice. I realized how powerful and every week that I would go for my chemotherapy treatment.
My doctors would say, what are you eating? We want to know what you packed for lunch. What are you drinking because you just, you’re coming in and you’re doing well, you don’t have side effects? It was a very powerful message, especially for me. These two moments really spearheaded what I feel has become a mission around my book, This Is Your Brain On Food to help people use nutrition for improvement of their mental well-being. Of course, it’s a holistic model, so it’s more than that but one of the pillars is nutrition.
How nutrition ties into brain health
Ari: Excellent. I have a big question for you. It’s okay if this requires a very long in-depth answer or certain-
Dr. Naidoo: Like the one I just gave.
Ari: Many layers of an answer. Well, this one’s more sciency, less personal. I’d like to create an overview for listeners of how nutrition actually interacts with brain health. What are some of the key, maybe three, four, five different physiological mechanisms or pathways that nutrition is actually affecting what’s going on in our brain and how that ties into mental health?
Dr. Naidoo: That’s a great question. As research evolves we understand that there are different mechanisms by which the brain is impacted by food. Some of them include things like oxidative stress as well as I think what is the most important in my opinion, but amongst others, the gut-brain connection. This is newer science because it really has evolved in the last one to two decades. Even though Hippocrates nodded to this and [unintelligible 00:09:01] said he made eons ago.
Hippocrates really is considered the father of modern allopathic medicine. It took science a long time to catch up. Now that we understand there is this connection between the gut and brain, we were able to understand further that the gut and brain originate from the exact same cells in the human body, the neural crest cells. These cells then divide up and form two different organs in the body, the gut and the brain, but then they remain connected anatomically by the 10th cranial nerve, the vagus nerve, which I like to call a two-way text messaging system.
These organs are communicating all the time but one of the things that we also need to put together is in the gut, we know that serotonin and other neuro-transmitters are working. We know that they are involved with the brain, but 95% of serotonin is made in the gut and also several receptors, about 90% of the receptors are there. You realize then that the gut has this location for serotonin. Then there’s this communication mechanism, and you realize that as we are eating food and it’s getting digested and it’s going to the gut, the food is going to interact with neurotransmitters. It’s also going to interact with the trillions of microbes that are in the gut microbiome. Those microbes are really there to support our health. We should be taking care of them, and there are trillions of them. When our food is broken down, the good microbes on the days that we are eating a healthy meal, the good microbes are able to help with that process, and the breakdown products, things like short-chain fatty acids, which are great for the gut, help to lower inflammation and now anti-inflammatory foods another great way to explain this mechanism.
[unintelligible] if we are consuming more of a sugar-laden or say a fast food diet, what we need to also understand is the breakdown products of those foods can be very toxic to the gut environment. There are bad microbes that live alongside the good microbes and when they are fed with sugar and fast foods and stuff like that, their breakdown products are toxic to the single-cell lining of the gut. When they damage that lining over time conditions like leaky gut arise and the condition and the gut of inflammation is called dysbiosis.
We start to therefore unfold that the food mood connection evolves based on this connection between the gut and brain. There are several other mechanisms, anti-inflammatory foods, the mechanism, oxidative stress, how we combat that, understanding neuroplasticity, and more. There are many more different ways, but the one that I feel really captures it for people is when you understand how your food is digested and the fact that the actual digestive products impact that environment and impact your gut. It’s a very simple way to think about making that connection come alive for you, and that’s the reason I focus on it and I wrote my book based on that.
The gut-brain axis
Ari: Beautiful. Yes, I definitely want to dig more into the gut-brain axis. I’ve heard this figure many times before about 90%, 95% of the serotonin that’s produced in our body is produced in our gut rather than our brain. Oftentimes this is communicated in a way that implies that therefore all of that serotonin is modulating our happiness. We have this narrative that’s been inculcated into the population for many decades now, that serotonin is what controls our happiness or depression. Serotonin deficiency equals depression, and if we are depressed, what that means is we have a chemical imbalance that we need to correct with these SSRIs, these specific serotonin reuptake inhibitors.
That’s the popular narrative that’s been around a long time. More recently, to add one more layer to this, there was a paper that recent systematic review that just came out by Moncrieff et Al, and showed that the data really does not support the serotonin deficiency imbalance model of depression. What are your thoughts on, I know there’s a lot in there and we can go into this piece by piece, but maybe starting with this piece of what is actually the role of serotonin, whether produced in the gut or the brain? What’s the nature of this relationship of serotonin to happiness and depression in your opinion.
Dr. Naidoo: In my opinion, I think that there are a lot of things that we need to be super careful about because science, and especially nutritional science is ever-evolving. I’m aware of the study and I think it’s great that someone brought this information forward. I want to just be clear though, that anyone listening to this shouldn’t, just stop taking their medications without speaking to their doctor because that can be hugely dangerous and have side effects. That being said, I think in my opinion, the way that we diagnose individuals based on the DSM-5-TR is flawed. There’s a checklist and humans do not fall into checklists, especially the emotional well-being. Someone might have PTSD and a touch of depression, someone might have anxiety and ADHD. People just simply don’t fall into one category. That has been a respected way that all of us have been trained, and I still use it when it’s necessary, and I use it as a framework. We have an issue with diagnostic categories. Then we have an issue, which is something we touched on already, that the system is dedicated towards, yes, therapy is a very important part of treatment, but it’s medication driven. Some of that is actually related to how insurance reimbursement happens. A psychiatrist in hospitals, for the most part in the United States, psychiatrists are expected in a clinical setting to prescribe a medication as part of their visit. They often not called on their therapy training to do that and part of that is related to how reimbursement happens. If you choose not to prescribe a medication, you may not actually at times be able to follow that patient long-term because they get a visit with the psychiatrist. That in itself is flawed because we are trained to do more than just prescribe medication, but that is the system in itself. Nutrition doesn’t even enter the conversation. For the most part. The other piece about it is that serotonin dopamine, [unintelligible 00:16:08] all of these different chemicals are involved. We know that it’s not just one theory, it’s not just one hypothesis, it’s not just one substance. We also know that there are many factors that impact mood, anxiety where serotonin has been implicated. I think that this is super helpful information for us to have. In fact, this year there were two things that were pretty huge in mental health that were unearthed. One was the Moncrieff paper, I believe it was from the British Medical Journal. The other was that some of the findings in the initial core research around Alzheimer’s disorder and how the images were done were found to be fraudulent. Billions of dollars of research were done on what we think was [unintelligible 00:17:02] data and has led us in the direction around the hypothesis of how we are treating, how we are trying to figure out, how we are trying to find a cure. Those are two very big things and-
Ari: I actually don’t know the part about Alzheimer’s, was it that the images were focused on these beta-amyloid plaques or something to that effect?
Dr. Naidoo: Correct. They were focused on proving a set of this hypothesis and the paper was, I believe, more than 15 years ago. I forget the details, Ari, of how it came to light, but it’s written about all over in the popular press, and it’s been published in a journal that someone re-examines– An expert reexamined these images and these images were tainted and found to be tweaked in a way that seemed to imply a certain outcome. Then that outcome was what everyone based their research grants on because it was now a proven hypothesis, let’s call it.
I feel that just taking those two things and the work that I do into account, I realize in a very humble way, we really don’t know the answers. When you ask me about serotonin, what I can say is it’s involved. I have seen people improve their symptoms, like the patient I mentioned on a small dose of Prozac can feel better. How much of that was the therapeutic relationship, his changes to his lifestyle and nutrition the actual medication? It’s really not clear. I’m not trying to avoid answering the question.
I’m saying that it’s multifactorial and that this is where an integration of research and clinical skills and being able to actually talk to a patient is hugely important. A lot of really brilliant people put out tons of data on nutritional psychiatry or nutrition or mental health and never see a patient, and I think there’s an issue with that. In integrating it, I will tell you that people have done well on good nutritional and lifestyle measures because I practice a method that is really holistic, integrated, and functional. It’s not just one thing, but nutrition is a pillar.
I can also say that the integration of actually speaking to someone and tracking symptoms is hugely important. When you realize that someone can be depressed due to a life event, a huge loss. It may not be the loss of a loved one. It could actually be the loss of a job. It could be the loss of an identity. It could be so many different things. You also realize that someone with a head injury can suffer from depression or anxiety or other symptoms in mental health. There’s a whole subspecialty of psychiatry that deals with that. When you put this together, I think the best we can do is assess someone clinically, do the best we can to offer them a really thorough evaluation of what’s going on, and then test to see what could work for them. I don’t always use medication and someone who is able to function, I might use lifestyle measures first but I’m a trained psychiatrist and I therefore feel comfortable at least being able to assess someone’s safety. That is one of the most important things in mental health is if someone is safe, they’re not suicidal, they are not so severely depressed. You can use other methods alongside that, but sometimes in the emergency room or the clinic or the acute care clinic, you see someone who’s actively either manic, psychotic has lost touch with reality, or depressed. Very long answer, but I’m open to conversation about it, but I’m hoping you see what I’m trying to say about the breadth of the number of things going on.
Mental health issues and neurotransmitters
Ari: Yes, absolutely. A couple more questions related to neurotransmitters. This might be hard to answer, but to what extent do you think mental health issues can be explained by neurotransmitter imbalances in the brain versus other mechanisms?
Dr. Naidoo: I think it’s one of many different things, and I don’t think that all of it is actually fully known. I think they play a role. Do I think they’re the only thing? No. I think that they do impact mood, they do impact symptoms and we need to include them in the conversation but we may not need to rely on them as much as we did. Now, with that being said, that’s where speaking to a trained psychiatrist or a clinician who can evaluate your symptoms and decide if you need a medication becomes important. Medications are not always needed. Here’s the other thing, there are probably mechanism we don’t know yet that we are still researching. One of the exciting areas of research is really finding solutions through food, psychobiotics, and or through nutrients.
Can these actually be taken by individuals to feel emotionally better and to offset symptoms, but be in the form of a food or nutrient, and by manipulation of the gut microbiome, the gut microbes? I think that as those types of solutions are added to say the buffet of solutions that we have, I think that becomes important too so that we don’t just have what I feel like mental health relies on, which is pulling out a prescription pad and giving you a medication when you leave your doctor’s office because it doesn’t always work. I think we also know from research that, for example, in anxiety, it’s been shown that only 7% of people actually get better. For the large part, most individuals may not have a full treatment of their symptoms, may still be suffering and some are not touched by the medication at all.
Ari: Got you. As far as the gut-brain access is concerned and I know you’ve mentioned some of these in passing, but what would you say are the two or three key pathways to understand about that relationship between what’s going on in the gut and the brain to understand how the gut health affects brain health?
Dr. Naidoo: Sure. I think understanding firstly that connection and how food is broken down and a healthy food versus a less healthy food and what that impact is. The second is the actual gut environment. Now, those gut microbes perform many functions for us. They are helping with hormone production, vitamins, sleep, and circadian rhythm, which is our internal body clock. They’re helping with our immunity. 70% of the immune system is in the gut. Super important at a time like now and beyond. They’re doing lots of things plus impacting mental health. As they’re acting one of the ways that they act is they interact with food. We need to understand that they are producing byproducts, they’re interacting that gut environment. They are impacting inflammation or fighting off inflammation. They are functioning as well.
Then the third component to realize is in this environment there’s a very delicate single-cell layer that is the lining of the gut. That lining is easily damaged. When you are producing more toxic substances, that lining gets damaged and these cells have something called tight junctions. When those are pretty easily damaged, there’s leakage and you get conditions like leaky gut or intestinal permeability, and where these toxic substances then enter the circulatory system. You start to realize the gut and brain are connected. Then if there’s leakage this is all going to reach and go back to other parts of the body. It’s also going to go back to the brain.
This is where neuroinflammation gets set up and neuroinflammation one of the other mechanisms by which we are considering in this whole emerging field becomes important. There’s some really top researchers in cognitive health and Alzheimer’s, like my colleague Dr. Rudy Tanzi at Mass General. One of the things he really firmly believes is that neuroinflammation can be reduced in its early stages by how you eat, your lifestyle measures, a plant-rich diet, anti-inflammatory foods, fiber-rich foods. One of the ways that you can actually lower that inflammation in your brain simply by how you eat.
Neurotransmitter production in the gut and mental health
Ari: Excellent. What about production of vitamins and neurotransmitters in the gut? We mentioned serotonin already, but I know GABA is another neurotransmitter that’s produced in the gut. Last I looked into this maybe a year or two ago, it seemed that there was some controversy around the role of GABA in the gut, and some theories were suggesting maybe it travels through the vagus up into the brain. Other theories were saying that maybe it just signals the vagus detects the presence of GABA in the gut and then signals something to the brain. It modulates brain expression just via nerve signals. What would you say overall about the importance of vitamin and neurotransmitter production in the gut related to mental health?
Dr. Naidoo: I think it’s hugely important. I think that there’s always updates through research and how we are thinking. In my more than 20 years experience of doing this work, one of the things that I feel is that, say we know that they’re different ways that GABA interacts. We know that GABA is important. We know that serotonin is important. We now know that the gut microbiome is important and we know that these gut microbes are effective. I want to use the example of omega-3 fatty acids here. Just take a second to do this. As someone practicing mental health, we often will lean on omega-3 fatty acids as a supplement, or in my case, I prefer to suggest food sources for individuals.
For the most part, this is one supplement that many psychiatrists actually do lean on. They will often include that in a treatment plan. We know that there’s a lot of good data on improvement of mood, help with cognition, help with anxiety, and others. It was a very big study published in December of last year by colleagues of mine who looked at a geriatric population of individuals and found that omega-3 did not help geriatric depression. Again, this was a well-done study well researched, and should it mean that I would never give that supplement or suggest that food to an elderly patient? No, because more and more we’re also moving towards highly personalized medicine, and the gut microbiome in each person is like a thumbprint. More and more we have theories, we have scientific theories, we have ongoing research, thank goodness we are learning all the time, but we also have the individual.
I think that’s what becomes important to integrate, that there’s ongoing research like you shared about GABA, but it’s usually important to understand that GABA plays a role environment production and hormone production and neurotransmitters. It may be different for each person. Now take vitamin D for example. We get 80% of our vitamin D by spending 10 minutes of time outdoors in actual daylight, not through window because of how vitamin D is produced. I think that understanding these little nuances knowing that vitamin B9 folate, you get a ton of it from leafy greens, low folate is associated with low mood. As you put together the facts that we’ve known or we learn from research with what is going on in the person’s body in a personalized way, and you understand that the gut is hugely important and integral to these different mechanisms, it becomes important. I also think the other thing is food impacts all of this, and that’s where I think food is a powerful tool to help all of us.
Nutrition and depression
Ari: Excellent. Getting into more practical stuff around specific mental health conditions and specific foods, what would you say are some of the biggest specific foods or nutritional factors that relate to one’s risk of depression?
Dr. Naidoo: The foods that you want to be careful about are very important because many people consume foods and they worry about their waistline or their weight gain. They don’t realize that these foods are actually impacting their mental health. The typical Western diet call the standard maken diet, a sad diet for a reason. It’s rich in sugar, hyper fructose corn syrup, processed ultra-processed foods, lots of stabilizers, food coloring, et cetera. They do cause weight gain, but they also have very devastating effect on our brain. A lot of foods that we consider so-called comfort foods are discomfort for the brain. A lot of foods that are treats, call treats by individuals actually mistreat the brain.
A lot of the things like artificial sweetness that disrupt many of the artificial sweetness that disrupted to the gut microbiome. The unhealthy fats, the hydrogenated fats, and the processed vegetable oils are just not great for us because they disrupted for the gut. They’re pro-inflammatory. They upset the omega-3 to omega-six ratio on the body.
Gut inflammation ultimately leads to brain inflammation and then become problematic because inflammation is seen as one of the underlying mechanisms for things like cognition, cognitive disorders, depression, anxiety, and more. When we break it down that way, we realize that there are foods that we want to cut back on and be careful about, but the foods that you can lean into one of the biggest foods is fiber.
It’s one of the nutrients that most Americans don’t consume. We tend to be worried about the grams of protein we are consuming, but we don’t consume nearly enough fiber. A big database study showed that I think one or two out of every 10 Americans eats enough fiber, yet fiber, which we get from plants, fruit, beans, not seeds, legumes, and whole grains actually nurture those gut microbes and feed them.
They need fiber in order to function. Any fiber-rich food is something that you can lean on. Prebiotics, probiotics, and fermented foods another huge group that actually can help offset mood symptoms. A study that looked at the use of a probiotic supplement versus Prozac showed that the supplement did better. Even eating a probiotic rich diet can help you. Fermented foods, a huge study from a research group out of Stanford, a highly respected group, looked at fermented foods and was published in summer of 2021. This showed that actually eating fermented foods and adding this to your diet can reduce the amount of inflammation. Hugely helpful, that group of foods. Omega-3 fatty acids, like we mentioned which you can get from fatty fish, wild-caught salmon, and other types of fatty fish.
You also can get plant-based sources from things like flax seeds, sea algae, and more. The plant-based sources do have the short-chain. Omega-3 is less efficiently transmitted to the brain, let’s say, but still worth including in your diet. Those are just some of the foods to think about. Then one of the ones I always like to mention, which I think are the hidden gems in our kitchen cabinet are spices.
Saffron and turmeric have been shown to be extremely helpful in terms of mood. Depression, definitely something to consider, and for [unintelligible 00:34:45] is add a pinch of black pepper?
Ari: Yes, saffron has some amazing research on it. I’ve been pretty blown away by some of the research on that related to mental health. However, it seems like almost all the studies on it come out of Iran. Iran is also one of the world’s biggest exporters-
Dr. Naidoo: Producers.
Ari: -of saffron. You wonder about the conflicts of interest that might be present there. I would love to see some studies on saffron that are done in other countries, but certainly from the research that’s there, it seems like a pretty amazing-
Dr. Naidoo: Certainly, a good bunch of them do come from Iran. The saffron supplements and the reason I mentioned this is it’s one of the times when a supplement may be helpful to someone. We do all have nutritional gaps. None of us eats a perfect diet. I say this because when you consume food, you just don’t use enough saffron. A supplement becomes important. I’ve definitely had people feel better when they use a saffron supplement because high doses of saffron are used. As with all research, it’s always important for those of you reviewing the research and looking at the different studies to check that the authors don’t have conflicts. That may not be a conflict that they needed to actually disclose in a paper because maybe they’re not manufacturing the saffron.
It’s a good point that much of the- a very large production of saffron or growth of saffron happens there.
Artificial sweeteners impact on health
Ari: What are your thoughts on artificial sweeteners? Do you feel they’re safe? Are they safe in general? Are they a risk for mental health or brain health in particular?
Dr. Naidoo: They, unfortunately, don’t do well in mental health for the most part, the older sweetness. There’s some newer ones that are showing some- I would say some better signs in the research. We don’t have all the mental health data on them yet. For the most part, if you had drinking a diet soda and you have anxiety that could be very problematic for you.
Artificial sweetness can offset symptoms and I’ve seen that happen. One clinical example is someone who was trying to actually give up soda, move to diet soda, and became more anxious. Even though the sugar-laden soda, the 20 grams of sugar in a– I think it was a 12 to 16-ounce bottle or maybe a 20-ounce bottle of soda wasn’t great for the brain either.
The artificial sweetener unfortunately set up the anxiety. Some of the newer sweeteners, one of them is [unintelligible 00:37:38] have a better relationship with insulin. If my patients come in and they just have to have something sweet and anything in moderation, little bit of stevia, a little bit of [unintelligible 00:37:53] little bit of maybe allulose they even newer ones coming out on the market that I’ve heard about through my work with the World Economic Forum.
What I can say is be careful with sweetners, use them in moderation. Really try to move away from things like diet sodas, read to see what sweeteners’s in them. One caveat is Stevia can set off anxiety in people and studies have shown this. If you do suffer from anxiety, be are a little bit careful with Stevia, because although it’s natural for some reason, it doesn’t always do well in people with anxiety.
Ari: Interesting. What about anxiety? Is it the same as far as and you just mentioned one thing with sweeteners there, but is it the same as the list with depression as far as the foods and the nutritional factors that affect that or are there some key differences?
Dr. Naidoo: There are some key differences because there are slight nuances with every one of the mental health conditions. With anxiety, one of the foods that you can lean into is tryptophan which is a precursor of serotonin but tryptophan actually has been shown to help anxiety. In some countries, like Canada, it’s a supplement that needs to be prescribed.
You can get tryptophan from things like chickpeas. You can get it from certainly certain types of poultry. Then there are vitamins that have been shown to be helpful and minerals. The reason I mentioned the minerals is magnesium is often overlooked, but magnesium can be significantly helpful for anxiety, as well as potassium and selenium, you get enough selenium from one or two Brazil nuts a day that you can eat.
That’s always a good one to lean into. Then there are some herbs that people often brush aside as unimportant, that lavender, passion plant and camomile can act actually help people with anxiety. Then vitamins that can lean into are vitamin D. We mentioned sunlight, tendons of outdoor time, vitamins B one, B six A, C, and E. The foods and what I did in my book, Aria, is in the final chapter share recipes, but for these different foods and these different vitamins, I list the vitamin in the type of foods. People have a checklist that they can go to because it’s hard to remember everything.
Your Brain on Food book
Ari: I’m curious in the book, which I highly recommend, I enjoyed thoroughly you emphasize a lot on gut health feeding the microbiome, and on the importance of fiber and plant foods with regards to that. I’m curious if you have any thoughts on the carnivore diet trend that’s happening in recent years.
Dr. Naidoo: I try my best to remain diet agnostic because although I happen to have been raised vegetarian just because of religious reasons in my family. I cook anything as a chef and I have no formal objection to anyone who eats whatever they eat but my position in nutritional psychiatry is it is related to your mental well-being. The balance of whatever you’re eating with the moderation around the unhealthy foods becomes important.
I think diets that choose and leave our entire food groups are problematic and I think finding some moderate balance of how you eat becomes important. How I evaluate someone who comes in is based on what they’re eating and tweaking that diet, I don’t necessarily say to people, you have to become accountable or you have to give up this food group.
The nuances in mental health is that mental health is so closely intricately related to metabolic health now and medications that are prescribed for certain mental health conditions actually impact your metabolic health. Things like insulin resistance, gaining weight, become hugely important and we can’t ignore them. For that reason, if someone is eating fruit, I’ll suggest that they eat lower glycemic fruit like berries.
If they are struggling with their weight, either they’ve had depression and they just have not been active or maybe they have side effects of a medication, like my patient I’d mentioned, it wasn’t a side effect. I will be cautious about working with them around TCR, Therapeutic Carbohydrate Reduction, being careful about which carbohydrates you consume but what I don’t want them to do is give up an entire food group if they don’t need to.
Some people cannot eat gluten because they have celiac disease. Some people are like myself vegetarian because of their spiritual background. Others feel very strongly about being plant-based. That’s really their prerogative but whoever it is, if I’m there to help their mental health symptoms, I want to tweak it. I feel the canivore diet is a little extreme and I think the same goes for any extreme diet. I would want an individual who came in with that diet really appreciate some balance that I want to provide through my consultation.
Ari: Are there any groups of whole Foods that you consider problematic? Obviously, there are all sorts of dietary belief systems. Dietary cult who have spent many years demonizing pretty much every conceivable food there is demonizing either red meat and encouraging people to go vegan and demonizing milk or demonizing eggs or demonizing–
Now we have people demonizing fruit, people demonizing lectin-containing foods like lentils and people demonizing cruciferous vegetables because they have potentially goitrogenic compounds in them. People now demonizing just greens and vegetables claiming that they have plant toxins in them that are trying to get you and are bad for you.
I think the only thing left is water that’s safe to consume.
I’m curious if from your vantage point there– Oh, and I forgot grains, I should definitely mention grains and gluten, certainly lots of demonization of that. From your vantage point, are any of these claims valid or are there any specific groups of whole foods understanding processed foods are obviously very problematic, but in terms of whole foods, are there any groups that you are concerned about?
Dr. Naidoo: In different mental health conditions, certain foods that may be problematic for others can be problematic. Gluten, for example, in anxiety, I’ve seen individuals have increased anxiety and what I would do is be very careful to do short elimination and see if their symptoms are improved, and sometimes that works, sometimes it doesn’t.
It may not be the substance it’s related to and there’s these individuals who don’t have celiac disease. I use that by way of example to say, Aria, that it’s often the quality of food, the source of the food, and how much you consume of the food. I’m of the belief that most people– Let me frame it this way. Many Americans eat the standard American diet.
How can we move from that type of eating to a healthier form of eating? It doesn’t start with demonizing food groups because then people go to the supermarket and they are literally afraid of what they can buy. Can I buy an egg? Children drink milk? Should I eat the vegetable? Should I never eat red meat? Whatever it might be.
Ari: It creates stress and nocebo effects as well.
Dr. Naidoo: This is so true and I see it all the time. People can become orthorexic which is becoming so careful because they want to eat a healthy diet, that they’re only drinking water. When it comes to, for example, in 2020 there was a very important study by [unintelligible 00:46:42] colleagues on really revisiting saturated fats. It really helped me moving from that paper to how I think about it. I think about it differently. I think that some red meat of the right quality is okay for you. You don’t have to give it up completely. You don’t have to eat it once a week. You can eat in moderation, but it’s less of an issue than we initially thought. That being said, let’s look at the foods you mentioned.
If you’re eating dairy, one of the things with dairy is much of the world is lactose intolerant and don’t realize it, but if you are consuming dairy, try to get and access is an issue. These foods are sometimes more expensive. Grass fed dairy is a better option for you. [unintelligible 00:47:34] is a fermented food, but if you can get a good quality one or find a way to make it, if you’re interested, that may be an option for you.
If you’re eating eggs omega-3 rich eggs that are pastured may be a better option for you. Again, I say that, but not everyone may afford the high prices on these. Wild salmon is a better option. Try caned because it’s sometimes much more expensive to get wild salmon in a supermarket. Lentils and grains and beans are usually important for fiber if you can tolerate them, there are ways to reduce lectins, the phytates in them simple cooking methods. I suggest those to people.
I don’t ask them to exclude the entire food group unless they’ve had a problem. With all of these different, let’s say ideas that come about, it’s not that there isn’t some research behind some of what people are saying, I think the messaging is the problem because I think when you use fear-mongering methods or fear-based tactics, then I see the impact in my clinic all the time.
People are like I said, just scared to buy any food and they’re wondering what’s left to eat. Balance of moderation, the source of your foods, the quality, the portion size, all of that becomes important. If you can use regenerative farming, for example, that’s a good option. If you can eat meats that are wild. Some meats are naturally wild because they’re not farmed, you can try that. They’re just ways to think about it and self-consume foods that you may want to eat and that doesn’t have to be demonized.
Ari: Are there any hidden trigger foods that people think are good for them, but are actually harming them?
Dr. Naidoo: I think that I’m going to use a condition here to explain this and the reason I’m going to share a little bit on this is because generally, we think of some of these foods as no problem with them, things like tomatoes, for example, are generally rich in lycopene, super healthy, and actually helpful, but in conditions like PTSD and I’ve seen this in OCD as well, foods that have glutamates that are even natural glutamates in tomato sauce, in miso, which I would otherwise recommend, which is fermented soybean paste. Just two examples as well as tomatoes themselves can be problematic for people, and I’ve seen that happen.
You may not think that this is an unhealthy food, but you have a certain cluster of symptoms, and I’ve seen an uptick symptoms in this way. I might go back and say, “Look, are these foods that you’re consuming without realizing it.”
How caffeine and alcohol consumption affect mental health
Ari: Got you. How does caffeine and coffee consumption as well as alcohol consumption fit into your paradigm of nutrition in mental health?
Dr. Naidoo: Alcohol can be a problem in terms of if someone has a substance abuse problem. As a psychiatrist, I have to make sure and evaluate that they’re not overly consuming alcohol, which can be problematic in that way, but if they’re having a glass of wine here and there and they are drinking alcohol, I always suggest a few things. In moderation, when I say in moderation, I usually ask people what they’re drinking because that gives me a guidance because moderation to one person can mean something else to someone else.
Just like a patient told me that pizza and coke was technically a vegetarian diet. The specifics become important. In moderation and clean cocktails. If you’re drinking a cocktail [unintelligible 00:52:00] sugar. There are ways to get around that. Staying away from the added fruit juices and added liqueurs. Cleaning up your cocktail will not just reduce the calories, it will reduce the sugar load on your body and that becomes important.
Drinking in moderation, clean cocktails, and context. For example, the Blue Zone study talks about Sardinians drinking red wine, one to two glasses with dinner, and this being a very big part of how they live, but they also eat with a sense of community, a sense of family happily enjoying their food, sometimes outdoors, sometimes indoors. All of that also matters. Alcohol, clean up your cocktails, drink in moderation if you consume alcohol.
Some positive effects, red wine has had [unintelligible 00:52:49] has had some good data behind it. It’s not entirely evil, but there are also people who say never ever drink alcohol because it’s a neurotoxin. My position is more people than not in the United States drink alcohol. I’m going to go with the fact that I’m trying to move people from the standard American diet to overall what we’re eating to a healthier diet than that.
If they’re consuming alcohol, I want them to have those tips with them. With coffee, caffeine is different from coffee. Sometimes the problems that people are experiencing, not with the caffeine content, but coffee on its own as a substance has a lot of plant polyphenols which are really good for your brain and your body. Again, with coffee, moderation. If it doesn’t work for you, don’t drink it. If it sets off your anxiety, avoid it. Drink it early in the day.
Some studies showed that consuming less than 400 milligrams in a day is helpful for most people, but again, I think we are so personalized now in the planning that we’re doing for nutrition that it could vary. Drink in moderation early in the day so it doesn’t impact your sleep. Again, like my patient I spoke to you about at the beginning, let’s not be adding a ton of stuff to it that only adds to the sugar load on your body so clean up your coffee like you clean up your cocktails.
Ari: Yes, absolutely. Out of all the different dietary patterns that are out there, everything from vegan to carnivore and all everything in between as far as Paleo Keto, Zone diet, South Beach diet, every conceivable permutation that’s been around Mediterranean, which of these diets would you personally consider to be the healthiest in terms of long term brain health, gut health, gut-brain connection, mental health? This whole picture. Which one of these dietary patterns if you could choose only one, would you say overall, understanding there’s individual variability, but as a generalization, this one I think is the best overall dietary pattern.
Dr. Naidoo: I would probably say if I had to pick one, the MIND diet, which has a lot of fact which is research backed by the late Martha Clare Morris and her group because it combines the benefits of the Mediterranean eating pattern as well. It doesn’t exclude the types of foods that people may be eating. They may be consuming poultry, seafood, red meat.
Now, usually, they talk about lean meats here, but what I would say is that with the recent research in the last few years around saturated fats, I don’t think we need to be demonizing red meat in the way that it might have been, but I think if you do consume it, consider the source and including your diet. I hate to actually pin it down to one because there are so many caveats.
I don’t necessarily– Let’s take the ketogenic diet for example. It started off with a long history of use for epilepsy, but it has been used in conditions in mental health and has been beneficial. Context matters because you cannot tell someone with a severe mental illness to follow a strict diet without having, say, family, a support system, a case manager, or other things that can support them eating that diet, especially if you want them to improve from it.
Context really matters because when I’ve treated severely mentally ill patients, it’s difficult enough to get them to take medication let alone change a diet. While all of these diets have a lot of either some clinical cases or evidence or data behind them, context matters. With every single one of them, there might be a nuance which is significant. For example, I mentioned fiber-rich foods are hugely important, and they are. Someone with IBS, IBC, SIBO, Crohn’s disease could have a great difficulty with fiber and might have to work with a functional gastroenterologist to figure out what they need to eat.
Ari: Got it? My last question to you is, are there any final thoughts you want to leave people with and then tell people where they can learn more from you and follow your work?
Dr. Naidoo: Thanks, Ari. Great question. I believe that you have the power at the end of your fork and if you truly embrace that and you think more deeply about it, you realize that you can truly impact your emotional health, your physical health, your metabolic health by how you eat. That power is very important and you can control it. You can actually get a free chapter of my book at the gut brain romance, gutbrainromance.com. Follow me on social media at D-R-U-M-A-N-A-I-D-O-O.
Check out the website, subscribe to my newsletter at umanaidoomd.com, and we’ll just love to hear from people. Thanks for a great conversation, Ari.
Ari: Thank you so much, Dr. Naidoo. It was an absolute pleasure, and to everyone listening, please go to Amazon, pick up a copy of her book This Is Your Brain on Food.
I personally enjoyed it tremendously, and I learned a lot from it. It’s packed with a lot of very valuable ideas and even lots of stuff that we didn’t have time to get into here. Dr. Naidoo, thank you so much. I look forward to hopefully speaking with you again.
Dr. Naidoo: Thanks so much, Ari. It was a pleasure.
Show Notes
Using nutrition to heal the body (01:21)
How nutrition ties into brain health (07:52)
The gut-brain axis (12:21)
Neurotransmitter production in the gut and mental health (26:22)
Nutrition and depression (30:30)
Artificial sweeteners impact on health (36:28)
Your Brain on Food book (40:34)
How caffeine and alcohol consumption affect mental health (50:54)
Links
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