Brain Food: The Top Foods for Mental Wellness

Coming up on this episode of the Doctor's Pharmacy.

You find three times the vitamin E in grass finished beef as you find in grain finished beef. It's also a great source of a compound called creatine, which supports brain energy metabolism. So people who don't regularly consume creatine, which is found naturally in beef, fish.

And you give them supplemental creatine, you see an improvement in their cognitive function.

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Now let's get back to this week's episode of the Doctor's Pharmacy.

Hey everyone, Dr. Mark here.

Brain disorders for so long have been made to feel out of our control, but there's so much we can do to prevent and reverse the range of signs and symptoms that steal our brains, our bodies, and our health as we age. Now, one very potent way of supporting our brain is through food. A diet rich in healthy fats like omega-3s, quality protein, and anti-inflammatory spices will do the trick. In today's episode, we feature three clips from the Doctor's Pharmacy about how food that we ingest at least three times a day can have a massive effect on our brain health. Max Lugavere takes us through all of the healthiest brain foods. And I forewarn you about the foods you shouldn't eat, encourage you to eat the ones you should, and remind you that you can't forget hydration. And finally, I talk with Dr. Uma Naidoo about how food can impact the microbiome, which has a direct effect on brain conditions like anxiety and depression.

So let's jump right in. I looked through the medical literature and I determined the foods that were going to be the most accessible, the most available to people, that are listening to this and watching this that are going to serve a neuroprotective effect foods that are literally superfoods for the brain. And I coined the term genius foods, which is not a scientific term, but it's the term that I've applied to the foods that are going to give your brain the most bang for its buck with regard to neuroprotection, with regard to promoting neuroplasticity by providing important builder block molecules like the coosa hexanoic acid or DHA fat. which we know is one of the most important and yet under consumed structural building blocks of the brain. And so we can look to certain foods like avocados, for example. Avocados at this point are pretty widely available and avocados are a fruit that provide the highest concentration of fat protecting antioxidants of any other fruit or vegetable.

Wow. Yeah.

This is of relevance to the brain because the brain is made of fat, right? Dr. Hyman, the brain is made of fat, but not just any fat. It's made of a type of fat that is most prone to oxidation, most vulnerable to what's called oxidative stress. And so when you eat an avocado, which is rich in vitamin E, a fat soluble antioxidant, it literally is one of the most powerful brain anti-aging foods that you can consume. It's also loaded with fiber, which makes it satiating and it helps support gut bacteria, which is promotive of a healthy gut microbiome. It contains potassium, which we know is really important for helping maintain a healthy level of blood pressure. And it also contains compounds called carotenoids, which we know protect neural tissue both in our eyes and in our brain. This is one of the reasons why avocados and dark leafy greens are protective against age related macular degeneration. They contain these carotenoids, which we now know also protect brain health. So that's one of my favorite foods, avocados.

Yeah, the thing, my problem with that is it often comes in the form of guacamole. Unless you order the vegetable sticks instead of the chips, it's a danger zone for me because I can, I just kind of like, those chips are, I don't like crack. I don't know why, but if anybody has had those corn chip thing, it's.

Like, I can't eat them because I just can't stop. Yeah, I'm the same way. I think it's better to, for me, well, it's that slogan, once you pop, you can't stop. We know now, thanks to scientific research, that that's a slogan with scientific backing at this point. That is a truism at this point, right? Because foods like tortilla chips are hyper palatable. They combine salt, fat, flour, and they're so calorie dense that it would have actually been a life-saving food potentially for a hunter-gatherer, right?

Well, that's why I actually am afraid of Mexican restaurants now. I'm like, I'm gonna, and then someone orders, I don't order that, I usually don't order the chips and guacamole.

Then someone's like, bring the chips. I'm like, oh no, I'm the same way.

I'm the same way.

You want to be a crack addict? I'm crack. Yeah. I mean, the thing is we feel as though we, I feel like there's this innate sense that we should be able to moderate our consumption of those foods, right? That's part of having a healthy relationship with food. However, I think what most people fail to realize and what's certainly not acknowledged by even our most esteemed healthcare professionals and those in the nutritional orthodoxy, it's that these foods are not designed to be consumed in moderation. They're hyperpalatable, and by the time you've filled yourself up on them, you've already overconsumed them. Unfortunately, people tend to experience a sense of moral failure when they're not able to stop eating the chips, right?

Yeah.

At a reasonable level of consumption, but that's because your brain has been honed by millennia where food scarcity was a real problem. We didn't have food security the way that we have now for the vast majority of our evolution. So, as I mentioned, those chips, as calorie dense as they are, would have been an amazing food for a hunter-gatherer who didn't have access to Grubhub on their phones or a supermarket on every corner.

And that's why it's easy to eat an entire bag of corn chips, but no one's gonna be binging on 12 avocados, right?

There you go. Because avocados are, they're satiating in a way that, in a way that ultra processed foods simply aren't. Another example of a, of a brain food.

Before you, before you jump on the next example, I just wanna highlight what you just said because there's been an elegant study done by Dave, by Kevin Hall looking at feeding people an unlimited amount of ultra processed food or nourishing and they let them eat whatever they want. And they tracked over a few weeks, they tracked their, their consumption and their, and their actual weight gain. And they found that the ultra processed food group essentially ate about 500 calories more a day than the people eating whole foods. And they gained obviously more weight. So, you know, it really speaks to this whole idea that, that there's some nutritional intelligence that we have. that causes us to seek nutrients in our diet. The problem is when we don't find them, we keep eating more. It's like looking for love in all the wrong places, you know? And we, we end up just over consuming because we're not getting the nutrients we need. And we see this, like with kids, for example, we've talked about this in the podcast who are iron deficient, they'll eat dirt. They'll eat dirt because dirt has iron. So in animal studies, and we've had Fred Provenza on the podcast. There's an innate nutritional wisdom where they're sampling maybe up to 50 to 100 different plants to get the medicinal properties of each of these plants to heal their body, to make it work properly, and they know when to stop. We don't, we don't have that nutritional intelligence anymore. And there was a study done decades ago, I think in the 20s maybe of orphans. And I've talked about this in the podcast too, but the orphans were led to eat whatever they want, brain, kidney, liver, , weird vegetables, kind of they give them an array of foods that were nutritionally dense that you think kids wouldn't eat, right? Like kids gonna eat liver on their own or kidney. Uh, and then they, then they, then they kind of track what they did. And these kids were far at the end of the study were far more healthy and far more robust because they chose all this variety of weird foods that actually their body's own nutritional intelligence told them to eat. But we lose that as we get older because our brain chemistry, metabolism, immune system, microbiome, all of it's been high, hormones have been hijacked by the food industry deliberately. So when you, when you have that deliberate usurping of your own kind of internal guidance system and wisdom about what to eat, we end up in this chaotic state of constantly searching for ingredients and nutrients and compounds that we're needing to survive. we can't get from the foods, we just keep eating more and more and more. That's really the problem.

Yeah, that's the movement towards what's been called intuitive eating. That's why I think that that's such a short-sighted and not very evidence-based initiative. Because when I sample the pint of ice cream that's sitting in my freezer right now, intuitively what my body wants is to eat the whole pint.

Oh, yeah.

So, so I, I agree with you that we need to get back to, we need to get back to foods that are, that are less industrially processed. And you bring up an interesting point. I mean, the, the over, the, the tendency to over consume ultra processed foods. I think it's really important for people to know the three things that make a food satiating.

Yeah.

Um, because then they can use this as a tool in their own lives. The first thing that makes a food satiating is its protein content. So there's actually the protein leverage hypothesis, which stipulates that our hunger mechanisms are driven in large part by our necessity for protein, which is an essential nutrient, right? And not just any type of protein, high quality protein. And the protein leverage hypothesis, I mean, people should remember that protein can be used powerfully to leverage as a way to kill hunger. And unfortunately, ultra processed foods are depletive of protein, in part because protein is the most expensive macronutrient. So typically with ultra processed foods, what you get is just carbs and fat, some combination of energy rich carbs and fat, right? And so protein, protein is crucially important. One of the major factors that makes a food satiating. The second aspect would be its fiber content because fiber mechanically stretches out the stomach. It's not an essential nutrient, but it does draw water, it does absorb water. And so it stretches out the stomach, which turns off the release of the hormone ghrelin, which is the hunger hormone. Usually, ultra-processed foods are depleted of fiber, right? It's one of the reasons why your average American today consumes between six to 10 grams of fiber every day, whereas one of our hunter-gatherer ancestors probably consumed about 150 grams a day.

Yeah, that reminds me of that study by Dennis Burkert where he looked at hunter-gatherers who'd moved to the city and became urbanized in Africa compared to their hunter-gatherer neighbors. And the hunter-gatherers had stool weights of four of two pounds and the city dwellers had stool weights of four ounces. So their poop was just a little hard poop. And the reason is all the fiber and the tubers and the nutrient dense food. So you said fiber is not an essential nutrient. It, it isn't for us, but it's essential for the microbiome. Yes. Our microbiome is essential for us to stay healthy.

So in a sense, it is really an essential nutrient. It is, yeah, through, through the, through the lens of, of the microbiome. Absolutely. It is. And it certainly makes life better. Studies show that people who consume more fiber have reduced inflammation. They live longer. So it's definitely, I would call it a conditionally essential nutrient.

Absolutely.

That we definitely want to look to consume more of. And then the third factor that makes a food satiating is its water content. Because when water ceased to be available for hunter-gatherer, the second best place that they would look to get their to meet their requirements for hydration would be food, right? Food is actually a viable source of water and shelf stable, ultra processed foods are depleted of water because water impedes a food's shelf stability because it allows mold to grow. And so these are the three factors that are all but missing in ultra processed foods and always very present in minimally processed whole foods. So, , definitely worth, worth seeking out, you know, any of those nutrients, ideally.

On a daily basis. Didn't you, didn't you miss the most.

Satiating nutrient of all in our conversation? Fat. Fat is, is satiating. Yeah, it slows, it slows the absorption of food. It re, it slows gastric emptying. Um, so that's why, well, most, most high protein foods are gonna come with a, are gonna have a fat source, right? Grass fed beef, for example, is a good source of helpful Fat, wild fatty fish, great source of fat. And so fat is fat basically, here's the, here's what fat does. Fat prolongs the satiety effect. The protein fiber, very, very satiating, but fat prolongs that effect so that you're not hungry 30 minutes later. So it's definitely good to, to look and find healthful sources of fat.

And by the way, the thing that makes you hungry is sugar. is, is basically when you, when you eat a lot of carbs and sugar, you just get hungrier and hungrier because you produce more insulin, which triggers all these secondary downstream biochemical challenges, changes that actually lead to increased hunger. So the more you carbs you eat, the more you want to eat. And the less you eat, the less you want to eat. I mean, you know that from your own experience. So do I. It's like, wow, God, that bagel doesn't look like food to me anymore. Or that muffin doesn't look like food or cookie. Why would I ever eat a cookie? It's not that you're depriving yourself, it just stops looking appealing.

Yeah, you're absolutely right. Dr. Hyman, there was this really fascinating study that I'm sure you're familiar with. You might have even talked about it on your podcast, but they basically took, scientists took two porridges. They were controlled for carbohydrate content and calorie content. It was just two wheat porridges that were identical in terms of their overall nutrition facts, but the difference was the degree of so one was a more coarsely ground porridge and the other was a more finely ground porridge. And it's the finely ground porridge that sent subjects blood sugar through the roof and led to a higher release of insulin. But what was most interesting about that study was that in the post-absorptive state, so after they consumed the more finely ground porridge, the finely ground porridge sent their blood sugar below baseline, which the more coarsely ground porridge didn't do. When your blood sugar goes below baseline, what that is is reactive hypoglycemia. And that can trigger in people that are susceptible to anxiety, it can trigger anxiety, it can increase hunger, that sensation of hanger. And that was, the capacity for the food to do that was driven purely by the degree of processing that the food had undergone. The more finely ground porridge was more akin to a sugar, right? Because it was just so easy for the subject's bodies to assimilate. whereas the more coarsely ground, the less processed version of the porridge actually brought subjects' blood sugar back down to baseline really smoothly and evenly. So that's why you definitely want to avoid added sugar to the best of your ability and also reach for foods that are less processed because this is not about calories, this is not about carbohydrate content. This was purely about the degree of processing that that food is undergone.

So it's, it's a great point.

Yeah.

I mean, you know, yeah, I mean, it goes without saying, people listening to the podcast understand by now that, you know, the ultra processed food is the number one killer on the planet. Like if you wanna do one thing to improve the quality of your health is never eat ultra processed food. And what is ultra processed food is basically anything that comes from a factory unless you recognize the ingredients. And then, and always the rule is if you, if you can basically cover the front of the package and just read the ingredient list and know what it is, It's probably okay to eat, right? If it says tomatoes, water and salt or sardines, olive oil and salt, you know what's in the can. But if it's got 45 ingredients, most of which you can't pronounce or in Latin, and you have no idea what it is, they can't tell if it's.

A corn dog or a Pop-Tart from the label, then you shouldn't eat it. Absolutely.

Real foods don't have extensive ingredients lists. They are the ingredients.

They are the ingredients.

Exactly. Exactly. Like an avocado doesn't have a nutrition.

Facts label or an ingredient list. It's an avocado. no, it should have.

It should have an ingredient list of phytochemicals so people can see what they're actually getting. It should.

You're right. But I mean, the, the, and the biggest irony is that they don't make health claims either, like avocados, grass-fed beef, wild salmon, eggs. The, you know, they don't, they don't make health claims. It's the, it's the ultra processed foods, the kinds of foods that have ads on TV.

Right. Those are the ones that are making.

All the health claims, and yet those are the worst foods for you.

It's generally true.

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Just go to symbiotica.com slash Hyman and use the code Hyman. That's symbiotica C-Y-M-B-I-O-T-I-K-A dot com forward slash Hyman and use the code Hyman for 20% off plus free shipping. Yeah. So we've got, we've got a really beautiful insight here, which is one, that we should be eating phytonutrient dense food. We're gonna talk about some more genius foods, but two, the quality of our food and the ability to understand what makes us feel satisfied really are key principles. So protein, fiber, water, fat are kind of the secrets to keeping your metabolism healthy. And you said that, you know, there's, there's no biological requirement for grains. It's even a step further. I would say there's no actual biological requirement for carbohydrates. There's no, there's no essential carbohydrates. So there's essential fatty acids, essential amino acids, but there's no essential carbohydrates. So you literally don't have to eat any carbohydrates. But with that said, I often also say that carbohydrates are the single most important food for long term health and longevity. And what I mean by that is that vegetables are carbohydrates. And they, they do contain some protein and sometimes fat depending on the vegetable, but essentially they're phytochemically rich food. So phytochemical richness is such a key principle that most of us don't pay attention to. And, and when you talk about a genius food, you're often talking about the phytochemical richness of the food. so tell us some more about other genius foods that we should be focused on, particularly in terms of the brain. Yeah.

So, I mean, phytochemicals are, are abundant in avocados, dark leafy greens. But because we already talked about avocados, I feel like it's, we should ping pong and talk about a good protein source, like a grass finished beef, I think, is a powerful brain food for people. It's, it's actually one of the more controversial recommendations, but when you look at, at grass-fed and finished beef. It's a great source of vitamin E, which I talked about as being a powerful fat protecting antioxidant. You find three times the vitamin E in grass finished beef as you find in grain finished beef. It's also a great source of a compound called creatine, which supports brain energy metabolism. So people who don't regularly consume creatine, which is found naturally in beef, fish, and you give them supplemental creatine, you see an improvement in their cognitive function. So we know that dietary creatine plays an important role in good brain health and good brain function. Our brain's level of creatine tends to decline with age and is also apparently depleted in carriers of the APOE4 allele, which is the most well-defined Alzheimer's risk gene. So I'm a big advocate of, in general, foods that contain creatine naturally. Grass-fed beef is a viable source.

So, so, so let's pause there for a minute because, you know, I, I agree with you. I'm just, just putting it out there. I think there's so much confusion about meat. And as we were joking before the podcast, it's not the cow, it's the how. Can you, can you break down for us the conversation that, that is raging today, which is that one, meat, if we eat it, is going to cause heart attacks, cancer and death and shorten your life. and two, that it's the worst possible thing we can do for the planet. And it's obviously very inhumane. So how do we, how do we, how do we tackle those three arguments against meat? Because you just said something that was really important, which is that meat is an essential part of our diet for keeping us healthy, particularly our brain health and our muscle health and so many other things in our immune system. How do you navigate this land minefield of meat eating and veganism?

Yeah, it's a great question. And it's a question that requires a nuanced answer. But the reality is that we have no good evidence to say that beef is unhealthy, right? We have lots of evidence to the contrary. We have mechanistic plausibility suggesting that beef provides very important nutrients, nutrients that in particular tend to be under consumed today. like vitamin B12, zinc. The problem is that much of our nutritional recommendations come from their origins are what's called nutritional epidemiology, which is one of the primary tools used in nutrition science because getting people to adhere to various diets as part of clinical trials is just not feasible for the human animal, right? So that's not a tool that's very viable with regard to nutrition science. So instead what we look at is nutritional epidemiology, observational studies. we look at populations, we see what they eat, and then we associate those observations with their health outcomes. And the problem with meat is that it's mired by the observations associated with meat consumption is mired by what's called healthy user bias. So people who consume more meat tend to smoke more, they tend to be more sedentary. And this is true with all meat, but it's certainly true and especially true rather with processed meat consumption. so processed meat consumption, if you would imagine what processed meat, the form that processed meat takes in the standard American diet, it's hot dogs, it's chicken nuggets, it's Subway sandwich. That's processed meat, right? So you take a meal- what is.

There 38 different ingredients in a chicken nugget or something? Yeah. Most of which are not chicken.

And people are consuming these food products, right? These food-like products with an abundance of white refined flour with a soft drink, with a large fries. They're doing unhealthy things in their lives, generally speaking, because I mean, somebody who's eating fast food on a regular basis, I mean, is probably not adhering to the most optimized lifestyle, right? So, that's observationally, that's what we tend to see. But now, observational research is getting better and better and better, and we're able to control for those different variables. and what you see is that when people consume meat and overall diet quality is high, meat consumption is not associated with any of those bad things, heart disease, cancer, diabetes, nothing like that. And that makes perfect sense because meat is a pristine source of protein, an abundance of micronutrients which we know support metabolic health, which only 1 in 10% of the US population has metabolic health, right? Because nine in 10 have some degree of metabolic illness. And, and I'll just, you know, to cap it, there's no, there has been no randomized control trial to show us that red meat consumption is, is, is causally related to any negative health outcome. Again, the opposite is true.

So, I mean, the only, the only mechanistic thing that's been looked at is TMAO, which is looking at a metabolite that comes from eating certain compounds in meat that are produced by certain bacteria in the gut that's going to be linked to increased risk of heart attack on a mechanistic level. What do you think of that data?

TMAO is also abundant in fish and fish consumption is associated with better cardiovascular health and certainly better neurological health. So we can't, we can't just isolate these mechanisms and then make these leaps in terms of our assumptions about those foods.

Well, at Cleveland Clinic, when they did this study, it was fascinating because they looked at what happened, you know, when they, you know, fed vegans meat, like nothing happened because their microbiome was already pre-built up with, with healthy microbiome because they're eating a lot of plant foods and rich plant rich foods and fiber, which is good. And, and also he found that if you drink wine and have false vinegar and olive oil, you actually mitigate the effects of meat on TMAO production. because of all the various kinds of phytochemicals in there. Also, if you marinate meat, it actually decreases some of the compounds that can happen when you grill it, although grilling isn't probably a good idea in general around meat. Slow cooking is better. And also, sort of the data really ignore some of the, the sort of the conversations ignore some of the data that really is, is contrary to what we're hearing around the badness of meat. For example, there was a large study looking at 11, 000 people, half of who are vegetarians, half meat eaters who all shopped at health food stores. So if you're shopping at a health food store, you're more health conscious. You probably have better health habits. You also, you know, are eating more plant foods. And within a plant rich diet, meat actually isn't harmful. And they found that the risk of death for both groups was reduced in half. The PURE study also was done that looked at large meat consumption, animal protein, and it was the carbohydrates that really were driving so much of the, of the problem. And so the problem with these observational studies is they're one, they're, they're not causative in terms of their conclusions. And it's, in, in, they're often confounded by a lot of problems that, that make it look like there's a problem, but there isn't. And in these studies, you know, we, we've had probably studies before, like the nurses health study that showed that all women who took hormones, Premarin, had reduced heart attacks and strokes and didn't have an increased risk of cancer. and when they actually did a randomized controlled trial, the Women's Health Initiative, which was a billion dollar study over a hundred thousand women, they found that gosh, it was the opposite. That actually the hormones were killing women. They were causing cancer, heart attacks, strokes, and all the earlier data from the observational study was completely overturned. So I think we have to be really cautious. They can often point to problems, but the, the, the, the effect size has to be big. For example, smoking. the effect size for smoking and lung cancer was a hazard ratio of 20 to 1, which means a 2,000% increase. When we talk about changes in meat, you're talking about for colon cancer, for example, you're talking about with processed meat only, you're talking about a 1% absolute increase in risk. 1% and if you go from five to six, you go, oh, that's a 20% increased risk. Sounds bad, but 20% is meaningless unless the hazard ratio is at least to two, you know, two, which is basically 200% increase, is pretty much garbage and I wouldn't pay attention to it.

Yeah, it's relative, it's relative versus absolute risk. And you see these studies or you see, you see the headlines all the time that egg consumption is associated with a 14% increased risk of cancer, for example. And so that, and that, that makes, that puts people on high alert about egg consumption. But as you mentioned, I mean, that, that leads to such a tiny increased risk of absolute in terms of their, with regard to their absolute risk that we almost can't take it seriously, right? Because nutrition, because the tools of nutrition science aren't foolproof, right? We use food frequency questionnaires, which are not the most reliable way to ascertain this kind of data to begin with. So it's very tenuous at best, and that's why I think it makes more sense to integrate a food that we know that our ancestors have been consuming since we've had ancestors, right? Since the dawn of humanity, humans have been omnivorous. And also, I would add that beef consumption, the dreaded beef consumption, has actually declined in the United States over the past 40, 50 years.

And yet chicken consumption's gone up, which may be worse for you actually. Yeah, I mean, it's- Factory farmed chicken was high in Omega-6s. It's full of antibiotics, it's full of.

Arsenic, it's not health food. Yeah, and most people consume it as fried chicken, right? Chicken dishes, which who knows what constitutes a chicken dish, but rates of obesity, rates of type 2 diabetes, rates of.

Alzheimer's disease, keep climbing. One of the best ways to access brain health is through our diet, both what we eat and what we don't eat. Let's start with the don'ts. the most dangerous thing for your brain is sugar and starch. Those cause inflammation in the brain. They cause dementia, they cause depression, they cause behavior issues. They're really nasty for the brain.

So it doesn't mean you can't ever.

Eat them, but think about those things as recreational drugs, as I've said. So starch and sugar. The third thing you really want to get rid of is bad fats. So trans fats are very dangerous. They're still in our food supply, even though they've been regulated as not safe to eat. They're still out there. and a lot of refined processed oils. So those would be the things that I would avoid, number one. And of course, processed food. That just kind of goes without saying. 10% of our calories come from soybean oil. It's increased a thousand percent in our diet. Didn't even exist as a real food in our diet until probably 1900, early 1900s. So we really entered an era where we are eating a diet that is so different than we have for almost all of our human evolution. and those fats tend to drive inflammation. They're easily oxidized, they go rancid, they're made with extraction processes that have hexane, and they're, they're often causing significant inflammation and damage in the body. Unless you know what's in it, like, I mean, if you have to have a list of ingredients, probably. I mean, yes, there's some packaged food that's fine, but if you have to know what it's in it. So if it says some big chemical words, you don't can't recognize it, or you've got 14, 000 things on the label. probably not what you should be eating anyway. Most people don't know this, but your brain is mostly fat. You know, we really are all fat heads. And about 60% of our brain is made of fat. And most of that is what we call DHA or docosa hexanoic acid. Sounds like a big chemical name, but essentially it's fish oil. Comes from algae, too. You can get it from algae. So if you're plant-based you can get it from algae. But it is the main ingredient for a healthy brain. And so we need to be eating fatty fish that's low in mercury, we need to be eating algae, we need to be doing things that actually help boost our DHA levels. The second thing is good fats in general, because our brain actually responds really well to fat. MCT oil, for example, is the derivative of coconut oil that's really great for the brain's energy system and can help improve cognitive function. It also improves athletic performance. The third category of foods we should be focused on are phytochemicals. There's 25,000 compounds in plants, maybe more, The Rockefeller Foundation is now doing the periodic table of phytochemicals. They're spending hundreds of millions of dollars to map out the medicinal properties in these foods, but it's really easy when you think about it. Just eat the rainbow. If it's colorful and it's not Skittles, it's okay to eat. So all the dark colored vegetables, greens, blues, purples, reds, yellows, those foods that contain these pigments are full of these phytochemicals. And they're really extraordinarily helpful in regulating brain function in so many different ways. You know, one of the things that often people forget about is the bottom of the matrix in functional medicine, which is the sort of the map we use to figure out what's out of balance for people. And hydration is really, really important because most of us walk around dehydrated. Most of us don't drink enough water. We have other fluids like sodas and juices and coffees and teas. but we don't really have enough water. And often when we do, we're not getting intracellular hydration, which is so critical. So not only in your bloodstream, but inside your cells, which is what makes you feel good. So it gives you energy and performance. So my favorite athletic performer is Tom Brady, and he never drinks water without electrolytes. Maybe that explains his seven Super Bowl rings. I don't know, but I agree. I, I've. using electrolytes in your water is so important and not the kind with tons of sugar and all kinds of weird stuff. My favorite one, I have no affiliation with this brand, it's called Light Show, L-Y-T-E Show, but it's simply liquid drops you can put in a glass of water and every time I drink, I try to add those in and there's a portable container you can take your little drops with you.

So intracellular hydration is really, really important and it's important for your cognitive function, it's important for energy, it's important for everything. Examples are things like anxiety and I will speak about that because it's one of the my clients are coming in most commonly with right now, the uncertainty, the fear, loss of jobs, quarantine, you know, restrictions changing and going back the next day is really creating an immense amount of anxiety. And what the studies have shown is that there's certain things that, so the way that I look at it is the things that you, in terms of food that you need to embrace and the things that you need to avoid. And the things foods that seem to worsen anxiety include foods with gluten in them. And it's not necessarily people who have celiac disease or non-celiac gluten sensitivity, but there seems to be a correlation in the studies around the level of anxiety and eating and consuming gluten. So things that are positive are the use of things like turmeric with black pepper.

What makes the gluten become a problem? What is the mechanism? Has anybody figured that out?

So we think that from what the studies have shown that it's that there's some sort of disruption that occurs in the microbiome that leads to dysbiosis in individuals who have anxiety. So I've had patients who can tolerate gluten, but if I were to give a general recommendation to someone based on what we've learned, we try to have them avoided. With the turmeric and black pepper, we know that curcumin and turmeric is activated by the piperine in black pepper and it actually increases the absorption by a significant percent. And a study also showed that where Omega-3s are involved, that can enhance the absorption. So this combination and the work that's been done on Omega-3s in both anxiety and depression, for example, There was a study of medical students done that looked at treatment of anxiety using omega-3s. And we've heard about omega-3s and people know about using it for mood, but it targets anxiety as well. And the combination of turmeric black pepper as well as omega-3s. And I'm talking mostly about food sources of omega-3s. Some people do take supplements and it's perfectly fine. actually is quite powerful for lowering anxiety levels. So those right there are things, you know, that people should move toward.

There's also some so maybe like sardine curry with a little black pepper.

Exactly, exactly, you know, or, you know, some sort of like really fancy glaze that you put on on seven, you know, and it could be oven roasted, it could be baked and, you know, using all the healthy oils and to make a life better, you know, as well as some other things. So that's, you know, those would be a good way to go. With, you know, the status of depression, there's been trials that were done using folate and mevalonate decades ago by some of my mentors at Mass General, but, you know, adding them in as leafy greens are thought to be helpful. And so there's a real logical way in which adding, you know, simple recommendations that we make about fruits and vegetables, adding that fiber back into your diet actually drives down any type of inflammation in the gut. And therefore, with the gut-brain connection, lowers any type of potential neuroinflammation. The thing that many, many people, and I think I'm more aware of these types of things now, is that serotonin, the happy hormone, 90% or more of the serotonin receptors are in the gut. So it really does make a difference what you eat because if you're eating poorly, those serotonin receptors are going to be affected. And the passage of serotonin in a healthy way back and forth, it all depends on what's being transported via the vagus nerve to the brain. And by eating the poor foods and creating dysbiosis in your gut, you're driving the mechanism in the wrong direction for you.

So one of the things you said, which I want to back up on, which is so important, you kind of glossed over it, which is this whole idea of neuroinflammation. Now, when your joint hurts, you get arthritis, it's inflammation in the joint, it hurts. If you have a sore throat, is inflammation in your throat, it hurts. If your brain's inflamed, it doesn't hurt, but it shows up as depression, anxiety, ADD, dementia, OCd, whatever, right? Autism, these are all inflammatory diseases of the brain. And what you're saying is that a lot of the source of the inflammation comes from imbalances in the microbiome, in the bacteria in the gut, which you call dysbiosis, which is the difference between symbiosis, which is a nice balance with your gut flora, which is dysbiosis, which is really bad bugs that are growing that drive inflammation. and when you're eating different foods, you're feeding different bugs. And that may be how the mechanism of this works with mental health. Is that what you're saying?

Exactly. So, a few different things. And thank you for backing up on the neuroinformation because it is such an important point. I'll give you an example of a patient. So, a gastroenterologist referred me a patient who is having severe panic for the first time at a stage in life that you wouldn't expect someone to develop anxiety and panic disorders going by the DSM-5 TR criteria. And as I took a history and spent time with him, it turns out that his actual, even though he was presenting with the panic to me, what was distressing him was his irritable bowel. He was very uncomfortable. He had developed these symptoms over time. And as we took, you know, found out more information, he had moved to a new job, highly stressed, eating very few meals at home, eating either in the afternoon from the vending machine, eating lunch out, getting takeout, and getting fast food on the way home. From being a relatively healthy weight and from being someone who was eating, I would say probably three, from what I remember, three to five meals at home in the evenings, his diet had changed over the period of 18 months. He developed discomfort in his bowel. you know, had bouts of diarrhea and constipation, but he presented to me with panic. And rather than do that, as we tried to figure out the details and placed him on the proper diet, these symptoms, it took time, but these symptoms abated over time. So much so that he didn't need clonazepam or Xanax or alprazolam for his symptoms of panic.

So you're saying you fixed his gut. and that fixes anxiety and his panic attacks. Exactly. But you and I went to medical school. We're old enough that we went to medical school and we were taught that there's something called functional bowel disease or irritable bowel syndrome, which we had a pejorative way of talking about as a supratentorial phenomena, which in English means it's all in your head. But maybe it's actually something else. Maybe it's an infrared diaphragmatic phenomena, meaning it's below your diaphragm. or in your stomach. And yet, as psychiatrist, how much did you learn about the gut? Zero, right?

Exactly. As well as nutrition. These are not things that where we've made the connections yet. There are treatments for depression like vagal nerve stimulation. There are things that actively target the vagus nerve that will help to treat depression. So, we sort of know some of the science around it, but we haven't put this in. but goes back to something you said at the beginning, Mark. You know, going back to my story of the Dunkin Donuts coffee from there, I just began to have more of an open mind around these questions. And I don't, I didn't know when I tried to help him evolve and change his diet that it would work. Part of it was trying to see if it, if it would.

Yeah.

And this was also someone who had developed these symptoms, also the context of that poor diet. He had not early on in his life, you know, for want of a better name for the syndromes that that was what his gastroenterologist called it. But as that evolved and he ate healthy and it did take time, it seemed like he encouraged the better bacteria to grow and some of that really kicked in. So I do feel that that root cause part of it may take time, but we just have to figure out where it is.

Well, this whole gut connection is so fascinating because what you're saying is the type of food we eat changes the type of bacteria. How does it do that? And why is it important that we focus on that?

Sure. So, you know, if you take a typical, you know, the standard American diet that unfortunately is the diet used as the point of comparison in a lot of nutrition studies, you know, it's generally here are some fun facts. A lot of fast food french fries have sugar in them. We know that you're gluten-free.

And gluten.

And gluten.

I don't even know the story, but I had this patient who was like, went to get some french fries at a fast food place. It's like, you know, I want to make sure the french fries don't have any wheat in them. And they're like, oh, no, no, they don't have any wheat.

We just dip them in gluten and then we fry them. There you go. So, since it's absolutely true, they have a lot of stuff that we don't realize is in them because you're just thinking it's a potato. But no, it's, it's It's very far from that, and it's made through a whole process of extrusion to make it a truly processed food. But the point being that it's a simple thing, and you think, oh, I'll just get some dinner on the way home, as that particular patient was doing. But there's so many added, just bad ingredients in foods that you don't realize. So you're familiar with sort of the added sugars and savory foods, salad dressings, ketchup, fruited yogurts and stuff. That's just one element of it. then there's the added gluten in people who are gluten sensitive. Then, you know, it's the, the, the unhealthy fats that you don't realize are there. You know, the last time I checked, there was 61 other names for sugar.

I think there's 250.

I'm sure there are. By now, I'm sure there are. And, and so, so I, I will, you know, teach people to just think about four grams of sugars, one teaspoon. Look at the food label, see what's in it, because any of those poor foods that are, you know, the foods to avoid are the things that are going to disrupt those gut bacteria. So basically the imbalance is going to be the bad bacteria having a party and the good guys are, you know, not doing well because they're being overrun. And that imbalance is what leads to the leaky gut or the intestinal permeability. And, you know, that's when it really starts to back up and also then causing your inflammation.

Well, you know, this is music to my ears because 20 years ago, I remember having conversations with Physicians talking about intestinal permeability and dysbiosis and leaky gut and they just. And gluten. And they just looked at me like I was from Mars, like I was some kind of quack. They didn't know what he was talking about. I'm like, I, you know, all I know is what I'm seeing. And I see when patients change their diet, when we fix their gut, they.

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