How Does Nutrition Influence Mood? - with Dr. Uma Naidoo | The Empowering Neurologist EP. 103

Well, hi everyone. Welcome again to The Empowering Neurologist. I'm Dr. David Perlmutter. Several months ago, it seems like a long time ago, I had the opportunity to give a lecture along with Dr. Austin Perlmutter in New York. with— in a restaurant hosted by chef, award-winning Michelin-starred chef David Bouley. And David Bouley has described our guest today on The Empowering Neurologist, Dr. Uma Naidoo, and this is her book. We're going to talk about this in just a moment, called This Is Your Brain on Food. David Bouley has described her as the world's first triple threat in the food as medicine space. You know, we— a lot of us who are in integrative functional medicine consider ourselves to be in the food as medicine space because we talk about the healthful properties of being on a, on a good diet. Dr. Naidoo is a Harvard-trained psychiatrist. She's also a professional chef, graduating with a culinary degree with the most coveted award from a culinary school and as a nutrition specialist. Her niche is working with nutritional psychiatry. You know, that's a term we haven't heard a lot about, but we certainly will moving forward, especially today. So she's regarded nationally as well as internationally as a medical pioneer in this field. She, in her role as a clinical scientist, she has founded and directs the first in-hospital, hospital-based clinical services in nutritional psychiatry that— in the United States. She's the Director of Nutritional and Lifestyle Psychiatry at the very prestigious Massachusetts General Hospital and Director of Nutritional Psychiatry at MGH Academy while serving at the same time on the faculty at Harvard Medical School. She graduated from Harvard Longwood Psychiatry Residency Training Program in Boston during which she was the recipient of multiple awards, including the Junior Investigator Award from the American Psychiatric Association, Leadership Development for Physicians and Scientists Award from Harvard, as well as being the very first psychiatrist to be awarded the coveted Curtis Prout Scholar in Medical Education. The American Psychiatric Association has now asked her to author the first academic text in nutritional psychiatry. And as mentioned, she is the author of this new book, This Is Your Brain on Food. Just want to say that— think about it— that there will soon be an academic text championed by the American Psychiatric Association dealing with the role of nutrition in terms of relating to psychiatry. We're really, really moving forward. How exciting. So, Also exciting is the interview we'll do today, so let's jump right into it. Hello, Dr. Naidu. How are you doing?

I'm very well, thanks, Dr. Palmata. Thanks for having me.

Oh, I am absolutely delighted. You know, we've been— there's been a lot of literature. A lot of us have been working really hard in the area of nutrition and nutritional influences on preservation of cognition and actually even treating cognitive decline. time, when you look at the work of Dr. Bredesen, for example. But you have really hit the ball out of the park in really opening up our understanding of the powerful influence of nutrition as it relates to psychiatric situations. And I'm going to turn the tables on you right now because this is a question I get all the time, and I've probably answered it 100 times. Please. But what— here you are as a psychiatrist, but what caused you to suddenly maybe it wasn't sudden, realized that there was benefit in considering the foods that people were consuming as it relates to your discipline?

I think that's a great question, and thank you for asking me that. I think it really started as I was training in psychiatry, and I was learning the psychopharmacology of the medications I was starting to prescribe. I felt food had always mattered to me since childhood for other reasons, but I felt that a certain responsibility in terms of explaining lifestyle and physical health changes to my patients. So I grew up in thinking about the world and health in a very holistic way. And I felt that if I was going to prescribe a medication, my patients should know the side effects. And one story that always brings it to mind for me is sitting in my community clinic as a resident and a patient brought in their You know, we live in Boston, so we love Dunkin' Donuts coffee. And a patient brought in a 20-ounce size of coffee, and he at the same time was complaining about the weight he had gained on the medication I had prescribed, which was an SSRI. And I looked at the coffee and I said to him, that's a good-sized coffee. Do you get that every morning? And as the conversation went on further, we calculated that he put half a cup, a quarter cup of cream, between a quarter to half a cup of cream. in a 20-ounce size of coffee and about 8 teaspoons of sugar. And we broke that down and helped him to understand that just by making that tweak, he could not only save himself on some fat calories, but make healthier choices. And that was a pivotal moment for me that I still remember because I started to make that connection myself. And then I took it further from there.

I'm kind of envious that you had a pivotal moment. Because when I'm asked that question, I don't think I had a pivotal moment. So for you, it's this patient with the Dunkin' Donuts coffee and all the sugar, and that was sort of the epiphany for you.

It was. And honestly, at the time, I didn't realize that because what I began doing, it's almost as though hindsight taught me that, that it was that moment that I was like, oh. But what it did for me in that moment is it made me more curious. And we know that there's a very large gap in our education. and nutrition at medical school. So I wanted to read more and learn more and understand how to advise my patients. And that's really how it grew. Clearly I love food and I have a passion for that, but I also felt I needed to know a little bit more of the science behind it.

Well, your book, you begin by talking about something that many of our viewers at least have heard, and that is the connection between the gut and the brain. But you go so far as to care— we talk about the gut-brain connection or brain-gut connection from You call it a romance. Why do you call it— why do you embellish it so much?

I felt it was— I thought about that and I felt it was a really interesting way to introduce people to the idea. I know that people hear about the microbiome and the gut-brain connection or the brain-gut connection, but I also felt it was a way to share with them that just like a romance in real life, there are some good moments and there's some bad moments and sometimes in between. And in a very similar way, This relationship between our brain and our gut changes all the time, and for me, it brought it brought home the impetus and the importance of what they ate because truly things can change in a matter of a day. So what you put in your mouth every single day does make a difference, and we all slip up, and there's no perfect world, and we have a meal that we think oh I could have eaten healthier, but you can always self-correct at the next meal. So that that was why I chose. I chose that, chose that line.

So, um, I want to guess here that perhaps, correct me if I'm wrong, as it relates to, for example, mood disorders, that was there a degree of frustration in terms of not having really powerful tools from a pharmaceutical perspective?

You've hit the nail on the head. Um, I, Not only did I feel that we didn't have the absolutely— we didn't have the best medications, as much as they work, and I still prescribe medications even now, but I found that people would— not everyone would fit into a diagnostic category. And I definitely think that we know the DSM-5-TR is challenged. It's diagnostic criteria, and many people do not fit into those criteria. So that was one aspect of it. And the other aspect was even individuals who had access to care and were able to get a medication, many of them simply didn't get better. And for me, that felt— it made me even more sad and made me feel ineffective. And I thought, there's something I need to do about this. I need to figure out ways that— that there are lifestyle changes which I know are hugely important, but why aren't we having these conversations with our patients? We ask about smoking, we ask about all sorts of questions, you know, all sorts of important questions in the history, but why aren't we asking, what they're eating and what they're doing for movement or exercise or sleep, all of those components.

Well, I will say that in your book, it's not just your opinion. You know, you've used wonderful peer-reviewed medical citations throughout the book to justify the recommendations that you make, which I think— I don't want it to be lost, but you just added in other lifestyle issues like exercise. As it relates to anxiety, one of the interesting things, you know, we've been hearing about anti-anxiety foods, but you made it clear in your book that the research would indicate that while you can get tryptophan from various foods like dried fruit and turkey, etc., that the research really doesn't support those foods, but it really tends to more be supportive of taking tryptophan as a supplement as it relates to being beneficial towards treating anxiety. So how does that play out in terms of dietary recommendation?

So that's interesting because tryptophan is not only so important— there are 2 things that I discovered that were new information, new scientific information for me to integrate my understanding of tryptophan. One was that tryptophan on its own, in its in the form that it's, say, maybe eaten from, say, Thanksgiving turkey, does not necessarily enter the brain in that form. Secondly, it usually— actually, there are 3 things. The second thing is that it's also found in things like chickpeas, so they're a very rich source of tryptophan. And the third is that absorption into the brain is impacted by eating them with carbohydrates. So I make a little joke in the book talking about, so, you know, we may think it's just the turkey we eat at Thanksgiving, but it actually might be the mashed potatoes that make the difference. And what the study showed was that because tryptophan is such a big player in terms of the serotonin pathway synthesis and the major neurochemicals, it interacts in that way. So, you know, I think there are certain instances in situations such as anxiety where we think about supplementing what we would like people to eat in foods like zinc. You may get a ton of zinc From oysters, but not everyone eats oysters, and the plant sources of zinc are much smaller. So, you know, you— it's almost like you have to tweak it in a very personalized way for every single patient.

Well, I think, you know, that's why they call them supplements, because if you are able to track down foods that are high in one thing or another, maybe that's good enough. Let's explore just a little bit deeper the role of serotonin and anxiety and depression. And how inflammation that we might experience in our bodies from gut permeability, from eating perhaps allergenic foods, and/or— and other sources like glycation of our proteins from having a high blood sugar— how might inflammation be something, A, that can influence these mood disorders, and B, something that we could then target in order to experience some improvement?

The best way I could probably describe it is that a client that I saw who was referred to me for severe panic. And as I took a history, his primary care physician asked him to speak with me. As I took, you know, lengthy history, I uncovered that the most uncomfortable symptom for him was his irritable bowel symptoms. And so as we sort of unpacked the information, it turned out that he had changed his diet He was a young father, and he and his wife were enjoying their first child, but it had become stressful. His sleep had changed. He was more stressed. He had to work more because his wife took a little bit of time off. And all of these things changed his diet because fast foods became more accessible. You know, store-bought processed foods were easier. The vending machine at work became accessible when he had forgotten to pack lunch or a snack. And his diet had changed over a period of about 6 months. And as he noticed that, he also noticed that he suddenly had these symptoms that his primary care doctor was calling irritable bowel that he had not had before. We made the connection slowly between the significant change in his diet from usually eating home-cooked meals and a pretty healthy, well-rounded diet, not that Not the typical SAD diet, as we call it, a standard American diet, but he had been a relatively healthy eater. And all of this had flipped over on itself. And as we explained it to him, and I like to use this example, as he was eating poorer nutrients in the food, they were impacting the lining of his gut. And 90% or more of the serotonin receptors are found in the gut. So inevitably what was happening is as his gut was being impacted, and the term leaky gut was something I explained to him, then the bidirectional communication between the gut and the brain through the vagus nerve was impacted. Serotonin was impacted directly from that, and the inflammation that was being created by these processed and ultra-processed foods that he was now eating was literally damaging this really thin film, this layer in the gut. And I usually will, from my culinary background, I'll say to someone, you know, have you ever seen a sausage being rolled? Well, the lining for the sausage is really as thin as some of the lining is in the gut. So it's delicate. That's a way to convey that it's delicate. And the serotonin levels are impacted. And what happened was that he then developed significant anxiety to the point that he had what we thought was a full-blown panic attack. But when we looked at the root cause, it had been this dietary change that led to inflammation in his gut, impacted serotonin, became intestinal permeability, or as it's called, leaky gut, and then impacted inflammation in his brain, thereby impacting his neurochemicals.

Well, I would say to our viewers, keep in mind that when you— if you are visiting an integrative/functional medicine practitioner. Oftentimes these days, there are tests available that can determine gut permeability and levels of inflammation that really can give you a powerful sense that this might be the location where we need to pay attention because— Yeah. In your book, for example, you talk about ways of healing that gut using things like fermented foods and higher fiber. At the same time, restricting various foods that can be damaging to the gut lining and altering the gut bacteria, such as that would have otherwise increased inflammation being so detrimental. You, in that chapter, focused a bit on magnesium, and we've talked about this on the program quite extensively, how pervasive magnesium Magnesium deficiency or inadequacy really is not just in America but in developed countries around the world reflecting the lower levels of magnesium, for example, in the soil that grows our crops. So how do you go about identifying low magnesium? What might it correlate with in terms of clinical manifestations? And how do you fix it?

That's a great— that's an interesting question and it's a really good one because I think about it a lot. You know, by one of my mentors and who helped guide me in this area, that, you know, it's not a dangerous supplement to take, even though I truly, truly want my patients to be eating foods that have those nutrients in them and minerals. It's one of the few that if you come in super anxious and you really are opposed to taking a medication in any way, you know, I'm not sure that it necessarily SSI would be the most helpful. Also, it would take 2 to 3 weeks to actually work. It's not a bad choice to make. Now, you could do it through food as well, and we actually try to do both. But if you wanted to take a little bit of supplementation to start, that would be okay. I prefer, though, depending on the level of distress of the patient, to start with food choices and really have them start increasing incorporating, you know, folates and nuts and different complete whole foods that would boost their magnesium levels anyway. And if it's someone who has mild to moderate anxiety, you can quite easily do that. And usually in my office, they're presenting with, you know, either panic, anxiety, feeling as though things are changing in their body and they are not Usually an anxious person, something at work that normally wouldn't faze them is throwing them over the edge. And usually it's very specific to anxiety. It's not necessarily mood symptoms, although we very frequently, because of the location of the serotonin, often very frequently see anxiety and depression run together.

Well, I think, you know, you brought up something very interesting. A couple things I just want to emphasize. First, you said when, you know, people are losing control that might provoke anxiety. And I think, you know, the nature of our world these days being so unpredictable, we do have a sense that we have less control over our destiny than we might have had. And I think, you know, that might certainly be anxiety-provoking for a lot of people. And the other thing— 2 things you mentioned were, first, the great safety profile in terms of magnesium. I think, as you, you know, if people take too much magnesium, Maybe they'll get diarrhea, and maybe there are other things at very high levels, but it's a very safe supplement. And I would just say that for patients, if you want to get a good sense of your magnesium level, there's a test called a red blood cell magnesium level, or also called erythrocyte red cell— erythrocyte magnesium level that looks at the magnesium level within the red blood cell. than simply having the serum magnesium level. And as you just mentioned, my gosh, what a— I don't think it was your first recommendation. Your first recommendation I heard was exercise. So, uh, gosh, that's got to be, I think, on the top of the list. Beyond that, you then talk in your book about the value of vitamin D. And can we explore that a little bit too?

Sure. So, you know, vitamin D, uh, It's kind of— in mental health, I think there's certainly some good— there's really some good evidence around anxiety and depression. And I do think that it's, again, when it comes to things that we can easily obtain through food or through sunlight, or it's a relatively straightforward recommendation and feels easy but powerful to a patient, I feel that they can so, you know, So as you indicated in you and Austin's book, Dr. Perlmutter, you know, it's not— we have to think about why people don't necessarily take recommendations. So when I can find something that's easy, powerful, inexpensive to do, I would make that recommendation. I still do try to go back to food sources. And I think that, you know, whether it's zinc or magnesium and vitamin D, I I will put together a plan with someone based on whether we check their actual level for magnesium or try to supplement it initially. Ultimately, what I want to do is really move towards a good, healthy food plan that's rich in the same things our mom told us, our grandmother told us, you know, eat your fruits and vegetables, eat the whole foods. And one of my favorites is, you know, Eat the orange instead of a glass of orange juice because it turns out that an orange has— I think I calculated this a few weeks ago— about 3 times the amount of fiber and about 6— the orange juice from the store has 6 times the amount of sugar. So, you know, which would you choose? And certainly fewer calories in the actual orange. So all of those sort of go together as part and parcel of some recommendations.

Yeah, a 12-ounce glass of orange juice has 34 to 36 grams of sugar, which equals basically a Coke. So whenever I say it, people say, yeah, but what about all the vitamin C I'm getting? I mean, as if that's an offset.

And that's such a great point because people just don't— they look at that and they think, well, you know, for example, even with oatmeal, well, you know, if you put a ton of sugar, honey, and it's totally processed, You know, it takes away some of the good benefits. So it's kind of breaking it down that can be useful. And that's where, you know, little things like 4 grams— food labels are in grams, and we actually cook and bake in ounces and pounds. So just, you know, debunking that and saying 4 grams of sugar is 1 teaspoon. Then if you're having a little yogurt that's 4 to 6 ounces and it has 24 grams of sugar, Would you really be putting 6 to 8 teaspoons in plain yogurt? And I think that that just helps people make it more practical and makes it easy, but it also makes them feel more in control because food is something that we can all, you know, take hold of. It's something you can, rather than wait for medication to work, you know, you might actually be able to leave speaking with one of us and be able to start implementing those changes immediately.

It's always about making recommendations that are easy for a patient to follow. As it relates to vitamin D, I always say my first recommendation is that you take off all your clothes and run around naked outside for 15 minutes every day, even if you live in a big urban environment. Maybe that might not be something you can do. Okay. Well, if you can't do that, then why don't we just start you with a vitamin D supplement? Yeah. D supplement,

which is like, especially, especially in the Northeast. And one of the things that is interesting is if you're sitting at a window and getting the vitamin D, it doesn't work. You really do have to be outside. So you're absolutely right. You know, in my neighborhood, you might have to keep your clothes on, but it's a funny recommendation. I love it.

It's funny. I actually was on a national news program. We were right off of Times Square at the network, and we were talking about vitamin D because there was a recommendation that we need to actually get less vitamin D that had come out that day, and they asked me to come on and explain it, and that taking 2,000 units of vitamin D would be toxic. I explained to the woman who was interviewing me, I said, let's suppose that you took off all your clothes right now and walked downstairs into Times Square. On live television, it was— I know the people in the control room had their finger on the button. I said, let's just do it. And I explained how much vitamin D you would manufacture, and therefore you'd get a so-called, by the new definition, a toxic dosage based on being outside for 15 minutes. No, obviously that's not going to happen. In the anxiety chapter, you talk about, of all things, fermented foods.

Mm-hmm.

Why might that be a good choice?

So the fermented foods, things like unflavored, unsweetened kefir, which is a soured yogurt, or sauerkraut, or kimchi, the Korean pickle, or miso, all of these, or kombucha, which is something that people quite enjoy these days. The fermented foods really help. They help our gut bacteria. And, you know, Just like fiber helps the healthy bacteria grow, the fermented foods really kind of balance out feeding and supporting the balance of the good bacteria in the gut. So, you know, I'll say to patients, it's the good guys and the bad guys, and it's a battle all the time, every day. There are actually more bugs in your gut than there are human cells. Sometimes that's a little scary to explain, but I stick with, you know, you really need to take care of this. Those foods actually support a healthy microbiome. So if you're starting to— for example, I find it, like we talked about magnesium a few minutes ago, I find it an easy recommendation to talk to people about taking probiotics and fermented foods through food because it's something, again, you can leave the office and go to the supermarket and try out a kefir or try out something that's different that you may not have done before. And you can start to impact change. And so again, it comes down to really supporting the microbiome in a positive way. And when it comes to things like pickles or sauerkraut, we just— with all of those, including kimchi, you just have to watch the sugar content as well.

I'd like to move on, if we could, to— you brought up something in the book I thought was really interesting, and it was in the context of PTSD, which we Certainly something that a lot of people are talking about. We did a program several weeks ago looking at the use of hallucinogens, for example, as an adjunctive treatment for PTSD. Having said that, you correlate or bring to our attention the idea that there may be some relationship with the various sources of glutamate that are around us. And how did that idea kind of evolve, and where are we in terms of the understanding of the concerns over glutamate as it relates to PTSD, but also kind of other aspects of brain functionality as well?

Sure. So it really, for me, evolved. It wasn't something that I went into the research understanding, but was uncovered as I, you know, reviewed all of the science around not only the disorder, but what were the nutrition— what was the nutrition saying and what did we discover? You know, I think you will agree with me on this one, David, that, you know, the science of nutrition is changing all the time. Like you mentioned, the vitamin D study. And on one day you might be asked by the media about something and the next day it's uncovered. We've had that happen with omega-3 fatty acids. even though clinically we have pretty good response with them. You bet. Exactly. I recommend it because again, it doesn't harm a patient. Glutamates, I understood this through the research. Where I'm at with that is we just try to make sure that people understand the things that they should avoid. That's why in each chapter we break down foods to embrace and foods to avoid. That's a way of putting it together. I would like people to be able to read a little bit about the science and how we got to those points. I do also think that the research is still emerging. And so I feel pretty confident that we can make these recommendations. But at the same time, I'm very open to being wrong. And as understanding that things evolve and research comes out all the time, it's about adjusting those recommendations as we move forward.

But at the very least, you can, at the Chinese restaurants, ask for no MSG.

Exactly. That's, that's a very straightforward and simple thing to do. And, um, and, and I recommend it. Absolutely.

Um, I will say that I was very happy to hear what you just said, and that is, I'm open to being wrong. That's a great place to be. That's a place of real security with, you know, what your mission in life is and, and recognize that you're going to be wrong. Uh, and you know, it's okay to move forward and make progress. I find that the longer I do what I do, the more people will find things that I've said 2 decades ago when I would say, for example, we should be on a very low-fat diet, and then say, yeah, but you just told us this. Well, yeah, but the science has changed. Exactly. I mean, especially, for example, as it relates to simple carbohydrates versus fat in the diet, I think we're all at a place recognizing how important Fat is for the brain structurally and functionally. So you begin right in the beginning of the book talking about things like the Mediterranean diet, and you focus on the importance of getting adequate amounts of omega-3s. How is that important?

So omega-3s are, you know, so firstly, I've had good clinical experience with individuals who either eat tons of omega-3s through salmon, other sources of seafood, or have come to me because they read about it and they can obtain it as an over-the-counter supplement and they felt better taking it. So I think that it's a great adjunctive treatment when you're working with someone with depression, but I also again go back to food sources. I've also found there was a really interesting study on a small group of medical students done years ago that actually showed they used the supplement and they showed that they also had low levels of anxiety. So I feel that it's sort of a 2-for-1 medication if someone's going to use it. Of course, I mean supplement, but it helps both symptoms and it can be so hugely impactful. And I then try to break down both in the chapter but also in the recipes just ways that people can incorporate omega-3s through simple foods that they can eat. Because I do feel that, you know, studies like NHANES and others have also shown us that when you prepare your food at home, you actually consume fewer calories. And when you— even if you're not following any kind of special diet or trying to lose weight, you still consume fewer calories when you eat at home. So I'm not saying we have to do that all the time. I think COVID has sort of changed that for us a little bit, but I am saying that, you know, there's simple things you can do that you may not have realized were possible, and incorporating those foods into your daily diet can be very easy to do, especially for omega-3s.

You know, part of our outgoing messaging in these times has been that now is not the time to cash in on the diet and just You know, give it up and eat whatever you want. It's actually the last thing you would want to do. We've been talking about it in terms of having a robust immune system. Yes. Not only being able to deal with the virus at time of contact, in other words, in terms of a healthy innate immune system, but in terms of how you then respond to the virus in terms of limiting inflammation, hopefully, Reducing risk of cytokine amplification, et cetera, by again, having those types of foods on board. For example, you mentioned the omega-3s as one technique to limit inflammation, and certainly lots of anti-inflammatory foods on board versus refined carbohydrates and ultra-processed foods. Absolutely. But you're telling us as well, during the time of this COVID-19, In fact, pandemic. And hopefully, you know, this— by the time some people see this for the second time, we will be through it. But that said, that it plays such an important role while we're highly stressed, while we're challenged day in and day out, that the food choices that we make now, from your perspective, seem to matter more than ever.

They absolutely are. You've just again nailed that. David, because right now everyone is struggling in some form or the other. I've had moments where things felt so stressful that, you know, something, you know, ordering pizza or finding something that was just a quick fix, that was a comfort food, is so much easier. But again, you know, it's about how do I course correct and how do I share that with my patients? Because the problem is that You know, it's a journey. It's a— this attaining better health, improving how you feel emotionally, is a journey. Many people know the connections from wonderful doctors like yourself about how our bodies and minds are affected by nutrition and so many other things. I think the thing that people don't understand is that food actually does impact your mood. Food actually impacts anxiety. And so if we're making poor choices every day during this, during lockdown or during the pandemic, those are going to carry forward. It's not just the weight. In fact, it might be difficult to shed those pounds, but the problem with reversing the inflammation, a leaky gut, the impact on your stress level, your depression, anxiety, and even symptoms of PTSD, poor sleep, all of that will linger. So it's almost as though you're just doing yourself a disservice. I mean, one of the things that— I think it was Express Scripts, one of the companies— looked at the level of prescriptions that are going on, and they are heightened for anxiety medications during COVID to the point that there are certain doses of sertraline which are in shortage. So I think that, you know, I feel that the one thing we can all do is that we can eat differently. And on a day that, you know, you do choose an unhealthy food, you know, the very next day try to bring back those healthy habits. If not, over time the impact is going to be far more severe, not only in the inflammation and the immunity, but also just your overall health, but your— the impact on your brain.

In our book Brainwash, we actually talked about how Making bad food choices, for example, or deciding that you stay up too late, maybe not exercising, all the things that increase inflammation, for example, ultimately work as a disservice because they tend to lead us to more impulsivity. They tend to lock us more into amygdala-based behavior as opposed to leveraging the input from the prefrontal cortex, and as such, we make further bad decisions that tend to lead us to make further bad decisions. So it becomes— people have a tendency to get locked in and sort of cash in their chips. Right. But I think that what you're telling us today is that these are off-ramps from that highway, and that we could just embrace the notion of changing what we eat based on what you've been describing. That it can really lead us to manifesting other improvements. In focusing on our food choices, in the OCD section of your book, you mentioned something called orthorexia. Yes. I'm not certain that all of our viewers have heard that term. I think it's a very valuable thing to understand for those of us who want to make good food choices. Let's explore what that means, orthorexia, and perhaps how pervasive you see it becoming.

You know, I shared that in the book because I also wanted people to know that I want to be, you know, completely transparent. I don't always have success with patients, and the times that I don't have success are often in the field, in the area of orthorexia, where someone has healthy habits and they come in seeking my expertise around how to tweak those healthy habits and feel or be even better. Is there one more food group they should cut out? Should they restrict a certain type of calorie? Should they, you know, change up the exercise that their trainer is helping them with? And what I have found is that there's a certain rigidity with which some of these individuals are thinking about food. It's not flexible. And it's not adaptable. So, you know, you mentioned how we're— you mentioned how many people have, you know, have shared that they're struggling with what they're eating during the pandemic and during lockdown. In a similar way, these individuals are making healthy choices but almost overshooting that, and trying to help them find a balance that is healthy for their bodies and their mind is That's very much what I find I get resistance with. So I might share the information with them, but get a lot of individuals saying back to me, no, but that doesn't make sense, because— and they're usually really smart, wonderful people, because they know the research and they're reading, and they really are trying very hard, except that they're not— they're being so rigid that they're not adapting what they need to do to feel better. And at times like that, I haven't had as many, I wouldn't say no success, but I haven't had success sometimes with individuals who are struggling in that way because I don't want to discourage them being healthy, but I also want to say you don't have to exclude one more food group because actually it's, unless you have an allergy or an intolerance, you should be eating a whole foods healthy diet and being careful about the types of, say, you know, the processed foods and the sources of your food, organic food, you know. If you're going to use oil, be very careful about the choices you make. You know that we offer some guidelines about around that.

So, so maybe a little orthorexia is not so necessarily bad. You're saying people should be much more aware in comparison to the average, you know, or you called it earlier the SAD standard American diet.

American diet.

We really should be paying more attention. It might be looked upon in some circles as extreme. But at the end of the book, you talk about ketogenic diet in the context of bipolar disorder and also, I think, in the context of schizophrenia.

Mm-hmm.

Our viewers are dialed in on ketogenic diet. We've interviewed people around the world over the past several years talking about ketogenic diet. Just did another interview with Dr. Matt Phillips talking about fasting and ketogenic diet in neurological issues. But as it relates to bipolar disorder and even schizophrenia, What is the literature telling us in terms of the effectiveness of going keto as an adjunct to dealing with these issues?

Well, firstly, I think it should really only be done in close collaboration with your psychiatrist, because usually individuals with those disorders might actually need to take a medication in order to reach a more stable point if they've had a manic episode or been acutely psychotic. or hospitalized. So, you know, I would just say that they need to have the conversation with their psychiatrist directly, but also in the short term, certainly there's been some success with use of the keto diet in terms of balancing emotion, in some instances cutting down on the level of medications, but again, this brings me to what I feel is a very important point that I do try to convey, and I hope I did in the book, which is I still prescribe medications. There are instances where individuals, you know, in Boston at Mass General, we work in the acute psychiatric service, and the call that you don't want to hear— one of our largest bridges in Boston is the Tobin Bridge. You never want to be the resident on call when you have someone on the Tobin Bridge. You know, that is not the type of individual who's going to benefit immediately from a food intervention or nutritional intervention because they're either acutely suicidal or they're manic and they think that they want to fly and that they can fly, all of which, you know, I've seen and treated. And so in instances like that, I say that, you know, that the diet, the keto diet, can be helpful for certain symptoms once you're stabilized and you've been working with a psychiatrist for some time and he or she can work with you on interventions and monitor you carefully. So if there's a resurgence of symptoms or it becomes somewhat unhealthy nutritionally for your body, that they can step in and say, well, let's tweak this right now. And some of that information in the mental health realm is still preliminary. There's certainly been studies, but it's still, I consider to be early on.

Well, I'm probably a lot older than you. I'm sure that I am. And, you know, I think as a comment, to be supportive of medication in the treatment of schizophrenia, you know, when I was coming up, it was all about phenothiazine-type drugs and the side effects. As a neurologist, you know, how often were we consulted to deal with the side effects of phenothiazines, of the extrapyramidal issues, et cetera? Yes. So the, you know, the newer generation of antipsychotic medications have really I think perhaps our viewers might be surprised to hear me say it, but they've been a godsend in terms of treating schizophrenia. Yes, a ketogenic diet is something you might think about. And certainly, there's been quite a bit of literature on, for example, a gluten-free diet as it relates to schizophrenia as well. But I think, again, these should be looked upon, I would say, my opinion, and I think yours, as adjuncts for this.

I agree.

Potentially serious issue that might be the reason you get a call that somebody's up on a bridge, for example.

Exactly.

It's a very real and life-threatening condition. Well, I want to thank you for spending time with our viewers today, with everybody, and with me. I thought it would be fair and reasonable to just let everybody know that before we started recording, you and I had a bit of a heart-to-heart. That these are challenging times for everyone. And, you know, while we're all doing the best we can in terms of, you know, looking at the foods we're eating, trying to get exercise, getting out of doors, meditating, paying attention to our sleep, that still each and every one of us, I think, has a moment when you feel the challenge that things are different and disruptive and we can't predict tomorrow and it's anxiety-producing. And, you know, I was— it was great having never met you but meeting you now virtually, have a moment of heart-to-heart that, you know, we shared that. And I think it's great to be transparent for everybody out there who's watching this broadcast that, you know, no one gets a free ticket on this one.

Exactly. No, I thank you for inviting me. I enjoyed speaking with you so much. But also, I appreciated that moment as well, because it's good to check in with each other and check in with ourselves sometimes. It's not an easy time, and I would be surprised if someone came out saying, I'm on top of the world. Not because you wouldn't have some moments like that, and you should, but these are challenging times, and the uncertainty is probably what my patients are struggling with the most.

Well, great, and best of luck with your book. I took it apart, as you can see. Thank you. And, and thanks for spending time with us today.

Thank you so much.

Okay, bye for now.

Bye-bye.

Well, again, thanks to Dr. Naidoo for telling us about her wonderful book and joining us today. We really have a lot to learn moving forward about the influence of food well beyond cognitive function, something we've been talking about for a few years, but entering the realm of psychiatry, looking at things like PTSD, OCD, all the initials, right? Anxiety, depression, mood disorders. What a fascinating world it is becoming, offering us so many more approaches to dealing with these often very challenging issues. Thanks for joining us. We're going to be back soon. Bye for now. Bye.