Can you beat depression with food? with Dr. Drew Ramsey

Welcome to the Doctor's Pharmacy. That's F-A-R-M-A-C-Y, a place for conversations that matter. And we're gonna talk about something that matters today, which is mental health with Dr. Drew Ramsey. And Drew is quite an extraordinary doctor. He's not the usual guy. He's a farmer, he's a writer, he's a psychiatrist. And he's breaking ground on talking about issues that nobody really talks about, which is mental health and food. You talk about it, Mark.

I do talk about it. What are the original guys talking about?

I was the accidental psychiatrist. You're the intentional psychiatrist. Now, Drew, a little background on Drew. He's a leading innovator in mental health. He combines clinical excellence, nutritional interventions and creative media to share a different way of thinking about the brain and the mood and our mental health. He's an assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons, and he's an active clinical practice in New York City. So Columbia's no slouchy place. That's pretty good. His work and writing have been featured in the New York Times, Wall Street Journal, Huffington Post, Lancet, Psychiatry, NPR, which named him a kale evangelist. Not only do you recommend kale, but you grow kale, which we'll get into. And he's been on the Today Show, he's been on BBC, he's done some TEDx talks, author of three books, Eat Complete, the 21 Nutrients that Fuel Brain Power, Boost Weight Loss, and transform your health. Another book called 50 Shades of Kale, which sounds kind of racy. The Happiness Diet, which I want to eat. And his new course, E-Course, Eat to Beat Depression, helps people maximize their brain health with every single bite. And he goes between New York City, which is kind of the epitome of urban life, to one of the most rural places in America, rural Indiana, where he lives with his wife and children and parents on his 127-acre organic farm. farm, which is amazing. So that's pretty powerful. Now, welcome, Drew.

Thank you, Mark. It's a real pleasure to be here with you. So it's fun for me to be here with you. Back when I was a little baby psychiatrist, I had this idea for a book and I was thinking, God, I just finished residency. We didn't really talk about food. Is there anybody thinking about this? And there was nobody except you. And I got that book. I remember still reading, I remember I was on the plane, I just started cranking through it. And so thank you. I'm here in part because of you.

Well, I wrote that book. It was for consumers or people who are interested in their health. But actually, it was also written with a subtext for doctors. Because a lot of stuff I don't think a person would understand, like methylation and sulfation and fancy biochemistry. But I felt like it was important to get it out there because when I started practicing functional medicine, I would take care of people's physical health. and improve their gut function, improve their immune system, optimize their nutritional status, and help them balance their hormones and all these really simple things. Well, simple through functional medicine lens, not what typical doctors do. And what happened was that people's mental health got better, their brains got better. And it was, at first it was kind of confusing to me because I was like, wow, how did this happen? Because there's this thing called the blood-brain barrier. And what happens in your body stays in your body. It's like Las Vegas, but doesn't turn out that that's the truth anymore. and that's really, I jokingly call myself the accident psychiatrist. People with bipolar disease and OCD and ADD and depression, anxiety, all these problems get better. Not only that, but things like Parkinson's and dementia would also get better. And I was like, well, what's going on here? So I began to really look at the data, and this was 10 years ago, and there was quite a bit even back then. But now I look back and it's like, wow, those were things that were really in the infancy. Nobody was talking about it. And you start to talk about this, but there aren't many psychiatrists around who are talking about gut flora and mood.

Or the immune system. That's changing. That's one of the exciting things happening now is as food is medicine is becoming more of something that gets embraced and gets understood is really critical, especially to prevention. I think we're just seeing more, people talk about the microbiome. There's a randomized clinical trial for straight up clinical depression last fall using a probiotic. We have two randomized clinical trials looking at the Mediterranean style diet to treat clinical depression. It's an exciting time right now.

And they showed benefit.

They showed tremendous benefit. I mean, it shows so much benefit. I mean, you know, if you fail antidepressant treatment right now, you get one of the treatment protocols we get put on something like Abilify and an atypical antipsychotic, augmentation strategy, that's your evidence-based protocol. That's a nasty drug. That's what they use to treat schizophrenia. And then it crossed over. I like Abilify for what we call it ego glue. I mean, when you need it, Abilify could be a good medicine, but what's interesting is the number needed to treat to get that right. and find that right patient it works for is about 10. With the Mediterranean style diet, what the trial showed is the number to get that right for it to help one person was four. And you know, compare that, you know.

So that means you treat 10 people.

To bilify nothing, one person gets better.

One person gets better. With food, you treat four people with.

Food and one person's better.

It's a much better drug than the drug.

I mean, it tastes better, it has fewer side effects, and it's what, you know, it's what whether you need a bilify or not, the part that concerns me and concerns you, is nobody gets food to start with. Nobody gets much instruction around food when you get put on medications ranging from, hey, this is how long you're gonna be on it, or hey, there's a little weight gain, let's really dial in your diet. We don't mention food. And that's just, that's a huge, beyond the meds, it's just a huge blind spot both for health care in general, but really for mental health and that, Your brain consumes more food than any other organ in your body. Every other field of medicine, you go to a cardiologist. We might not agree with the advice that they give, but at least they talk to patients about food. Gastroenterology. They say eat better. Yeah, they say eat better. They say eat better. And so, yeah, they say eat better, eat more carbohydrates.

Whoops. It's true. I mean, at Cleveland Clinic, I joke about this, and the head of cardiology there doesn't agree with this, but on the floor, the, diet when you have a heart attack, the heart-healthy diet is a low-fat, high-carb diet.

Of course, my dad had Still today. Quadruple bypass in Southern Indiana, amazing small hospital because they really know how to do it well there. And you look at what they bring them right afterwards and it's like some hydrogenated soybean oil, you know, not butter, whip and a roll and some applesauce.

Yeah, pretty bad. Or pancakes and syrup.

Yeah, just burger and fries. Stimulate their appetite. Not what you would want for heart health.

No. So how did you, as a psychiatrist, trained in one of the top institutions in the world, somehow realize that food was relevant and that the stir we had about mental health wasn't the real story?

Well, I think it's, I'm a psychiatrist, so let's start with my parents. I grew up, my parents when I was six moved to really, really rural Indiana. I grew up in Crawford County, which is just... Were they hippies or something? They were part of that back to the land movement, that original, I mean, they still have their original Rodale copy of organic farming. And they got, you know, it's funny now to think back, we're in this time, there's so much fear and anxiety politically, and they were in a period like that where people wanted to get away from all of the technology. Yeah, they wanted to get away from the man and grow their own food and put up solar panels and Swim naked in their pond, you know, the things that folks did out in the country. And so I grew up out there.

I'm not the average farmer, I would just say.

Well, you and I maybe know some different farmers, but yeah, you get a farmer out on a moonlit night, you never know what happens, Mark.

Okay, all right.

So we were way out there in the middle of nowhere and we built our own house with some help and moved in and started growing a lot of our own food. My dad's a professor and my mom's a, educator and a librarian and settle into this community. And when you live on a farm like that, it just gets into you. It was interesting moving to the city where I just missed this whole amount of information of just the smell of the forest right now. How's this kind of sweet smell in the smalls, the leaves decay? It's true.

Every season has a smell.

Oh, so much smells that are just, you know, the way the forest just blesses you where you walk out. And I remember the first time we were harvesting our honey and my buddy Ian who We had a photographer shot 50 Shades of Jayde Kale, but he's my good friend. We grew up, right, he's on the farm down the road. And we were out, we said, let's take a break, let's go walk in the woods. We walk in the woods and there was this huge orange streak going down one of our little streams. And we got closer and it was this big chanterelle bloom. And we just go back with pounds and pounds of, you know, these like.

Really, yeah, really gourmet mushrooms that, you.

Know, here in the middle of nowhere, just kind of, they're just there. It costs like $30 a pound in New York City. Yeah, right, interesting. We got it like, and so, so I think probably my interest in food came from that. I've got a, my parents really, or my dad's always been a label reader and a really healthy guy and paid a lot of attention to what he eats, both my mom and dad have. And so, you know, as I went through medical school, went through training, it was interesting. During that period of my life, I was a vegetarian, low-fat vegetarian, following the.

Latest advice, a real healthy guy.

I was in on that, too. Yeah, I mean, it was, I think all of us were. I did exercising a lot and and eating lots of Snackwell cookies, and then trained in psychiatric Columbia. And, you know, I mean, that's a wonderful institution. The guy who wrote the DSM, Bob Spitzer, what taught me the mental status exam. I mean, it's just, it's a storied institution for mental health. And so it was wonderful to be there and have a foot in that, and then also have this other foot that for a long time felt separate. And that was my secret. I'm like from the middle of nowhere. A lot of people call us rednecks or country folk or whatever. And you couldn't really let that out. And then it's been really nice. That's like changed. I don't know exactly, maybe I got a little more confidence, but also I think as people got interested in food and started to respect farms and farmers, all of a sudden this wasn't like an asset. And so in fact, I could drive a tractor and split wood and grow kale and not just talk about food, but live the reality of trying to grow some of our own food, suddenly that was something that we could talk about. So that's been really nice for me. My analyst has been happy about that.

That's good. So let's get into the food thing. Because you've written a bunch of books about it. You just published an article in the World Journal of Psychiatry, which is an analysis of food and its impact on mental health, was sort of a meta-review of all the papers that were written about it. Come up with some very interesting conclusions looking at both nutrients and foods and how they impact health and mood. Is this something you learn at all in psychiatry now or is this just kind of still on the margin?

Well, I think we're learning now. So, for the past five years, we've had a food and mental health workshop at the American Psychiatric Association. Last year, David Boulet came. So, the chair of our scientific committee, Philip.

You know how we got into all this, right?

But I wouldn't doubt maybe you had something to do with it. Have you seen his fermentation workshop going on?

He's amazing.

He's a chef. He's one of the top chefs in New York. Well, and he's like, I would say he's like one-third chef, one-third magician, and one-third healer.

Because David is, Chef Boulay is a force to be reckoned with.

He closed his main restaurant, which had been the top restaurant in New York for decades, to start a food as medicine program. Yeah, and for research, he's been spending all this time in Japan researching fermentation. So I think that's a good example of, People would say we don't talk a lot about food and we don't in our training programs yet. And that's in part because like all of medicine, there's this really slow translation. We have a huge problem and how do we innovate quickly? That we have a research finding and how do we quickly begin to adjust our clinical care model to reflect that research? Because that's what evidence-based medicine should be. So you'd think, wow, a couple of clinical trials, whole lot of correlational data saying food matters for depression. You think every center that's interested in treating depression would at least have a nutritionist there. and I think some do and we're seeing more- Thanks so much. Integration. Yeah, I've tried, you know, I've tried to- you-'re fighting a good fight. I've tried to still cheer, but you know, yeah, I'm inspired by places, you know, like Eskenazi Hospital has a kale farm on their roof. Yeah. That's a public hospital and talking about food and getting, you know, when I see places like that where they start following and they do an intervention and they see that there's 50 more percent plants being consumed by their staff. and they get excited about that. Like, that's progress. But you're right. It's not happening as much as it should, and, and that's why we're all talking about it.

But, you know, in psychiatry, they really, they go, oh, wait. We know that, you know, what your diet is has an impact on your mental health. Does there, like a, if you go to a psychiatrist, any psychiatrist in New.

York or, but they go, yeah, I think there is. Or I think it was, you know, I got, it's funny. I bumped into one of my buddies who's like a hardcore researcher, Alex dranovsky. This guy is like one of big giant brain MD PhDs, and I bumped them to him in the park, two or three years ago as this stuff started to get a little bigger. And I said, am I kind of nuts? Is this like, am I unsupported by science? And he just looked at me and he's like, Drew, the idea that people eating well is good for their brain? Yeah, I think we'd all agree with that. And so I think all psychiatrists would agree with it. I think some wouldn't feel as empowered as they should to say something. that some of it is complicated, some of it's cool biochem, but a lot of it eat more leafy greens, eat more rainbow vegetables, the kind of things we do in both eat complete and eat to beat depression of thinking in food categories and thinking in basics. Like this isn't rocket science. This is like get rid of refined processed foods, get rid of garbage, eat, you know, I quote you all the time with that eat the food that God made, not the food that man made. That's one of my, you know, and I don't, And with your psychiatric license or psychology license or your, you know, wherever you are in the mental health care system, to just encourage patients, as we do with so many other lifestyle.

Factors, give them that nudge. Sleep, stress, exercise. Exactly.

I mean, exercise, they say, works better than antidepressants for exercise. Exercise beats Zoloft at 18 months. And it's one of those things that I think so strange. I love, I prescribe a lot of Zoloft and I find it to be a helpful medicine for some people, the right people. But, The thing that we don't do is we don't say, Look, I'm also prescribing you exercise. I want to report next week. And that's that we're very good with psychotherapy and with psychopharmacology and with helping people change behavior, but it's not been something that we have done enough with. Like, okay, the most important behaviors that we really change are exercise, food, sleep hygiene, and to really make psychotherapy active in the way that like, all right, I definitely want to talk about your mom. Really interesting. I want to talk about your dreams. Super interesting. I want to talk about all your intimate issues.

Interesting.

But I want to make sure that this week we're thinking about something that we've learned and making a change, that kind of coaching model of I have a coach in my office and I'm like a little jealous because her patients, you know, they get like we talked about four things in here are your goals. And I was like looking at my patients thinking, man, they're gonna go jealous. You leave my office with like some deep thoughts. But really activating and making active, we call active psychotherapy, making psychotherapy an active engaged process. Now, just tell me more about that. Right. And that's- How that made you feel.

Yeah.

I mean, there's a time for that in a sense. We call it, and good psychotherapists understand what's called surface to depth. And surface is, there's time to get action oriented, there's time to really support someone. And depth is when, you know, it's time to get into that really the nitty-gritty But where, what I've been struck by as a psychotherapist, because I spend, gosh, 20 hours a week at least doing psychotherapy, is that knowledge of our deep self, we really have to help patients translate that into action and behavior. Action and behavior, right? A knowledge of your unconscious mind, in my opinion, absolutely critical to your mental health. I've been in psychoanalysis for 20 years. Yeah, I've been in psycho, I started in psychoanalysis when I moved to New York. So I'm like a farm boy and There I'm in psychoanalysis. I've done a little psychotherapy when I was in med school. And I would say that is actually my secret power. I'm well analyzed. And when I think about- and is.

That translating to behavior change for you?

It does. It translates to a lot of behavior change. It really translated to a lot of behavior change in my sense of how we as men in the world need to think about our behavior. I think it's changed a lot in terms of my, I'm an only child in terms of thinking about what that means in terms of how I think about peers and how I kind of think about siblings in a certain way. So, so I find it to be a really powerful, supportive and nuanced idea, you know, knowing ourselves in that way. But it's got to be like, well, I always say it's hard.

It's hard to be, you know, not be depressed if your thyroid's not working or your vitamin D is low.

It's impossible. It's impossible not to be.

I mean, that's the thing that I think so often. So I was saying, you know, that all that stuff's that's good. You can work on your beliefs, on your past history, your lineage, all those things really are great, but it's so much easier if you're not struggling against the physiological.

You actually can't do that system. I would argue that you can't engage in your mental health if you are nutritionally depleted, if you have really awful sleep hygiene, if you, I mean, you can engage, but you're not, you know, if you're in a bad mood and irritable or have low energy because your thyroid is off or your B12 is low, we're going to spend a lot of time talking and theorizing why that might be when actually there is no psychological reason for it. Your cells are thirsty and hungry. And that's when you look at the nutritional insufficiency rates in America, right? What's a critical brain nutrient? Zinc. 48% of Americans don't eat enough every day. Vitamin E, probably one of the most important fat-soluble vitamins. 96% of Americans don't meet the recommended daily allowance. It's just like whole grains. Yeah, you know this. I mean, it's just like what- Magnesium, 48%.

Fish oil, omega-3 is right plus- We.

Don'T even have a recommended daily allowance of long chain omega-3 fats, unlike every other developed country in the world. And so we don't even have a nutritional deficiency rate because we don't have a standard. It's really, it's alarming, especially when increasingly people are distracted, people are pulled into all kinds of strange ideas and diets about nutrition. People are pulled away from farms. I mean, I've seen stats like 70 to 80% of all food consumed soon is going to be prepared by somebody else. And I think something about you and I as physicians is that we both have chef's knives and we- Chef's knives. Yeah, well, you know, you prescribe it, you cook it, you grow it, and that's how you know it. And that's how you, you know, that is really in my mind walking the talk.

And so let's back up here a minute. So if someone's listening and they have depression, anxiety, mental health issues, what are the ways of eating that actually cause a problem? And then we'll get into what are the ways of eating that actually can fix the problem.

Yeah, that's such a great question. Let's start with the problem at the end of your fork before we tell you the solution. And the problem at the end of your fork, a lot of people know those words that, you know, everybody knows I'm about to say sugar. Everybody knows I'm about to say trans fats. Everybody knows I'm about to say processed foods. and so the surprise. It causes everything.

Cancer, diabetes, Alzheimer's, and depression.

And I think what's really been striking to me as a psychiatrist interested in behavioral change and as an eater and as a parent, how do you change those from being concepts to being behavioral and action-oriented items in your own life? And so what's causing the problem very simply is not getting enough of the right nutrients. And I would argue for a lot of Americans, missing a set of nutrients. Americans are not getting phytonutrients because they're not eating plants. Americans are not getting seafood because they eat 14 pounds per year, period. And it's fish sticks. It's not the seafood that we would want them to eat. This is not shrimp ceviche and wild salmon. And they also, there's I think a problem that isn't just around the food choice but is around I would say the missing spirituality of food. And that people have, we've lost our soul about food and when you tell people to eat well, there's a notion that, well, that costs too much or it takes too much time or I don't know how to do it. And I think those are our missing lies.

Yes.

And I think it's just, I mean, my mama taught me how to cook and she's taught me that recipes start with olive oil or butter, garlic and onions.

Pretty much.

And then you add in, what are you putting some vegetables in that and you're good, right? You put in some meat in that, you're good. and so-- Pretty much how I cook.

Yeah.

I mean, I think-- and what I'm shocked by things like when we make our lentil soup at home, we make a lentils, carrot, celery, and that's it. We put it in a crock pot. And I love serving that dish to people who are like, Wow, what's in here?

Right.

It's like, It's lentil soup. Yeah, carrot, celery, a little pinch of sea salt. So anyway, those are what's on the end of the fork that's causing the problem is first of all, people aren't eating with the fork. People aren't taking a deep breath and engaging their digestive system and people aren't in any way offering up gratitude or thanks for the most people. Some of you all are out there doing that. But the number of times as we did when we were we had that wonderful dinner with well and good and we sat there and I'm sitting there next to Gabby Bernstein and I'm thinking like I've been out in the Midwest like you don't eat until you say grace. And I said, let's have a moment and everybody's ready to give thanks and bow their heads for a moment. She said such a wonderful grace store food for us. So those kind of things. It's not just that that garbage is on the, you know, it's not even in your fork, it's in the package that you're eating, or that it's on the go. It's that we've lost that notion of where it comes from and valuing that and honoring that. And we're doing a better job as, you know, honoring the farmers who grow it, you know, who are, you know, these silent heroes, you know, talking about a health care crisis. I mean, talk about physician suicide. I mean, the biggest threat to farmers right now is farmer suicide. I mean, we're just losing dozens of farmers a day. It's the number actually came out, there was a little confusion, like what's the top risk group for suicide? Was it farmers or doctors? And I was like, you know, either way, it's just awful.

So is there data, science, proving that sugar and processed foods cause mental illness?

Well, let's talk about the data set that there is. The big data set and there's controversy about this data set is correlational data. And the controversy is that's really misguided us with a lot of nutritional policy per smart folks looking at that. I really like the writing of Gary Taubes and Peter Attia who kind of look at the science behind correlational studies and have some serious questions. But if we're going to think about that data as being useful, that data is very clear. When you eat more processed foods, which means simple sugars, trans fats, and a lot of simple carbs in all those ways that it's not just sugar folks, it's like, you know, fructose syrup and I love corn syrup solids.

Right, now they changed the name of.

High fructose corn syrup. Right, it sounds like a corn corn kind of like corn syrup. Corn syrup, you know, like maple syrup. And so those are the things that certainly we want folks to avoid. And what does the data say? If you eat highly processed foods, you have 50 to 100% increased risk of clinical depression. If you eat high glycemic index foods, there's a great study that came out, a colleague at Columbia looking at high glycemic index foods, so those are foods that just spike your blood sugar more, those have a significant increased risk, individuals have an increased risk of depression, the Women's Health Initiative, so big, big study of women ages 45 plus. And so there's that correlational data and it's just consistent when you look at the meta analyses of it, it's consistent that the food that we've created in the last 100 years leads to an increased risk or increased risk in that population of depression, same data for ADHD, not as much data for anxiety disorders, which is interesting, but certainly feels true to me clinically. Then we move on to randomized controlled trials. And the reason this is of interest is on the molecular side, like in the mouse models, you know this. I mean, not having enough nutrients and putting lots and lots of fuel in any sort of mouse look like. What does mouse look like? Yeah. I mean, what does mouse look like? I mean, it's very clear what depressed mice look like, because you stick them in little cages and they don't try and you put them into swim, it's a forced swim test. And when mice are depressed, they don't fight to get out, they just stop swimming. They drown? We don't let them drown, but they would drown if you didn't fish them out. Whereas non-depressed mice, they're fighting to get out. That's what a depressed mouse looks like. So the randomized controlled trials that came out recently are exciting because we can say it makes common sense. We can say on a molecular level it makes lots and lots of sense. We can say it makes sense in the correlational data, but you and I know, Mark, medicine's not going to change until we have randomized clinical trials. And that's where folks like Felice Jacka and Michael Berk and the Food and Mood Centre in Australia, they're really, I would say, the leaders in this where they've completed a number of trials. Natalie Parletta is also not part of that group, but they're part of the leaders in this. And now they're putting down numerous randomized trials and creating resources for patients with mental health concerns like depression to make sure food's part of the equation. And their data looks quite strong. And what I love about this is when the data comes out, it's funny, one of the big leaders in psychiatry, won't mention him by name, but been very critical, it gets really crit, it's funny, there's a big post about how in some, you know, one of these health medicine review websites about, you know, how bad the trial was or how small it was.

It's like fighting, and I have- Everybody's.

Always criticizing each other about the study. And I was like, so when we don't have data, you say there's no data. And then when people do a really good trial, you wanna pick it apart. And there's some feeling that it's almost like folks have really- People don't like paradigm shifts. Well, I mean, is this how bad it's gotten, Marc, that we're at a paradigm shift? We're suggesting that our patients, our neighbors, our families eat well for things like when they're thinking about their brain and their mood and their dementia risk and their depression. We've gotten so far down the rabbit hole of medicine that that's a paradigm shift. Yeah. Like, that's crazy.

It is absolutely nuts. And there's, you're right, there's so much data.

Like, you might be aware of Hibben's work, which was from the NIH show, Captain Joe. Captain Joe Hibben is like, he's a pretty cool guy. He's the leader of the, what he calls himself the, he is the servant.

He'S the Surgeon General's, he's a soldier in the Surgeon General's Army. There you go. And he did these amazing studies looking at the rise of omega-3. Omega-3, I mean, the rise of omega-6 fats refined oils and decrease in omega-3 fats leading to violence, homicide, suicide, and that changed behavior. And I remember once coming back from, you know, somewhere and I had a letter on my desk in my office and it was from a prisoner who wrote me a letter, read my book, Ultra Metabolism way back when and said, you know, I was a violent criminal in my life and I realized, you know, that when I changed my diet after reading this book, in prison. I don't know how he did that, that he realized he was a very different person. And they've done prison studies where they feed prisoners healthy diets and they reduce violent crime by 56% if you give them a multivitamin. It reduces crime by 80%.

In prisons. Yeah, you can see the notion that we don't approach that. What is criminal activity violence? Some of it's stuff we don't understand. Some of it's certainly horrible character pathology, but some of it When we think that this is a population that in general does not have good nourishment, in general does not learn a lot of mental health skills, there's a way that some of what's going on there is certainly just a result of a broken system of mental health care. And I would say a broken system of our culture. I've been inspired this month by the Benjamin Rush biography. And the reason is that I didn't know anything about Benjamin Rush. And Benjamin Rush, as one of our youngest founding fathers. He is the second youngest signer of the Declaration of Independence and I think the only physician signer. And he is our original American physician. They called him the American Hippocrates back in the day. And he's also our original psychiatrist. And he founded the first mental hospital and he helped us found this country on a very, very simple principle, which is that when we think about mental illness, we can't put people in asylums and say that they don't have spirituality or they're sinners or they're bad people. that we as physicians are going to treat them as patients and we are going to care for them. And that has just inspired me to really think about what's happening in our country and how bad our mental health has gotten and how we all know about it and we're just finally starting to talk about it. But we were founded as a place where we should have freedom to talk about this. I'll get you a copy of the Benjamin Rush book.

Yeah, it's fantastic.

Every doctor should read it.

So, Drew, you wrote this paper was published September 2018 in the psychiatric journal and it was really quite detailed in terms of its analysis of the types of foods and nutrients. So help us take this home. What are the things that you learned from there that are the most important nutrients we need and what are the most important foods to help us get those nutrients and just in general to help us for mental illness?

And so the simple, the paper is called antidepressants foods and folks can check it out. And it's an open source article. And I did this with my colleague, Dr. Laura Lachance, and quite simply, it's arithmetic. It's bean counting. And we went through all of the literature, looking at all of the essential nutrients, vitamins and minerals, and did a literature search to say, well, which of these have significant evidence that they can help prevent depression and that they can be used to treat depression? And there are 12 that we found. And I bet you could name all 12, Mark. They're the 12 we respect, omega-3 fats and zinc and B12, vitamin E, magnesium, and then iron. And so then we looked at just as simple what a nutrient profiling system is, is it just tries, it's just a system for looking at what foods have the most of those nutrients per calorie. And then what a good nutrient profiling system does, and Dr. LaChance and I really wanted to create a good one because oddly there are, I think, 27 nutrient profiling systems in the world that have been created. Some People have seen ones like the Andy or Nuval, you know how many have been about mental health? None. None. And so what we, a good nutrient trophic line system does looks at food categories. So we're not saying kale, kale, kale, kale. People say, well, I don't like kale. Can't eat too much of it. You're going to hypothyroidism. Exactly. Oh, no, it's toxic now. How is toxic more? But what we say is leafy greens. And so what we did is we scored, we looked at all of the top foods for these nutrients, scored them and then created a list. of the top plant and animal foods. And so, first of all, they're the foods that top the list, which I just think are interesting. Oysters, clams and mussels are in the top five on the animal side. And the reason we did animal foods is that no nutrient profiling system usually has any meat or any animals in it because it's all based on calories usually and plants always have fewer calories. But most people eat meat or seafood, so we wanted to give folks a list of which had the most nutrients.

And why would this shellfish, the top ones?

Top ones? Because think about oysters, why do they top the list? You got 10 to 15 calories per oyster. So, let's just say six oysters, 60 calories. And, for those 60 calories, you're getting 768 milligrams of long-chain omega-3 fats. You're getting 340% of your vitamin B12. You're getting, gosh, at least a third of your iron. You're getting 500% of your daily need of zinc. I mean, on and on and on, you're getting in some vitamin C in oysters. Okay, let's go get some oysters. Yeah, exactly. All that for 60 calories. And, that's just, and on the other side, looking at plants, things like watercress top the list. And, why just watercress? Lots of nutrients, no calories or very few calories. And, so that's a great example of nutrient density, those foods. And, so the food categories that people should be looking for are things like leafy greens, the rainbow vegetables, more seafood.

And, if you're eating meat and red meat, to look more towards wild red meats or grass-fed red meats. So, this is fascinating. So, the diet that prevents cancer, heart disease, dementia, depression, and fixes most chronic illness is the same diet.

It's really, well, it's where we got off in medicine. We kind of separated out mental health and brain health from the rest. Like you're saying, somehow the blood-brain barrier was like, Thou shall not pass. We didn't think that sure those same all those same activities that we think about in terms of our general health and the foods we want people to eat and the things we want people to do, move their bodies, connect, be part of their community. Yeah, that's key to your brain health and your mental health. Yeah.

And the trouble with our food supply is that it's often depleted. Even if you're eating the best foods, you have an organic farm, the soil matters.

It really does.

What's in the food.

Yeah.

And if you're growing in depleted soils, which most of our soils are more like dust and dirt.

Well, they're just like chemicals and chemicals out. I mean, it's really, you know, if you, if you, if you grow live, you know, if you, if you live by the food you grow, you don't, you know, you don't do it the way that a lot of food is grown. And even, you know, even organic food, it's funny, as you drive through the produce belt and I encourage people to do this and you look out, you know, you'll see organic stuff out there. Yeah. but it doesn't look like a, it doesn't look like a healthy farm somehow. It's got a lot of food on it, but it doesn't smell right. The people working it, they, they, I don't know, they don't seem happy in a certain way.

The, the, it's this because of their big monocrop organic farm. Yeah.

Yeah. It's a big monoculture.

You look at a big, till the.

Soil, which should produce great soil. They, they, there's a ton of tillage, there's a ton of diesel spent, there's a ton of compaction. Yeah. And, and it's a real I think it's a challenge right now.

Industrial organic is what Michael Pollan calls it.

It is, and in a lot of ways, you know, that's been a huge victory because we have a conversation about organic, right?

It's better than- and organic was just found to reduce cancer by 25% in people who had it.

This French study, right? I mean, so there's, you know, there's something there. So it's a step in the right direction, but when you think about where I'm from and you drive around, Our soil is pretty rough in Crawford County, but boy, you want to... I would say that a lot of places, Mark, where we live, if you take a lot of Americans, they wouldn't know they were in America because it's just that whole central notion, that Central America or middle American notion of a small farm and what that looks like and how that functions. Some cows, couple pigs, not a monoculture, a nice garden, for all your food and for sharing with your neighbors, that has died in a way. And I think- the Wendell Berry calls.

It the unsettling of America.

Yeah, and I think that maybe dead is not, that's on life support and maybe we're seeing a shift now.

It seems like it's coming back. There's more smallholder farms.

I hope so. I mean, it's definitely coming back. You see it on the coasts and you see it around urban centers. but there's still a lot of places that don't, you know, where it's not happening and that kind of combo of, you know, I would say agritourism and interest in food, but also just interest in farms. But I'm hopeful.

So my question was going down the path of, okay, if our, even organic isn't the best that it could be, if the foods have been bred in a way to create more starch, a lot of the phytochemicals have been bred out of it, the nutrients aren't there because of the soil, even if it's the best organic farm. And by the way, Dan Barber and Walter Robb, a former CEO of Whole Foods, have created a seed company to actually reinvent new seeds to breed them so they have flavor and they have nutrient density and they are phytochemical rich. It's a very different idea than breeding them for yield or for pest resistance or water. or drought, but they're doing all that too, but they're doing both. So, the question is, if that's true, then do we need supplements and do you use nutritional supplements in your practice to treat mood disorders?

So, I think even with the food we have today, you can still get all the nutrients you need. It's actually challenging if you look at all the recommended daily allowance and you think what you would need to eat to meet that, it's a little challenging. It requires some thinking about it. I always tell people, no, just eat nutrient-dense food, you'll be fine. But if you start scratching your head and adding up, it can be tough. Yeah.

I had a patient once who was like, I don't want to take supplements. So I literally looked every food up and I'm like, okay, selenium, it's in Brazil. So I have two Brazil nuts a day. I have 17 pumpkin seeds. I have, you know, two cups of, you know, broccoli or whatever it is.

And it was like, okay, fine. If you want to do that, go ahead. Let's check your nutrient levels. Well, I have that problem where I, I don't like the of turning a meal into a math equation. And so, I myself, I mean, I'm 44 and I stopped taking all supplements probably about maybe 10 or 15 years ago. I guess that's not entirely true. I'll take a little Omega-3 sometimes and certainly in my practice for non-seafood eaters or for individuals who are just kind of eating seafood every now and then, especially for individuals who don't want to try a medicine and they've never, even for individuals who do, I'll put them on a 1 to 2 gram milligram grams of fish oil. I mean, in the trials that Fish oil is very, in the science, in the studies of depression is one of these things that has statistical significance, but it's not able to show clinical significance in the meta-analyses that you get about a point reduction on a Hamilton D depression rating scale. That said, you can't take fish oil.

And be eating processed oils, which displaces it. You can't be eating piles of sugar. It's like, you know, and you wonder.

A lot of times. It's the way the studies are designed. Well, you wonder, one do they control for that? so we have all these SNPs now in the elongase genes in terms of how we process omega-3 fats.

Those are genetic variations.

Yeah, I mean there's that. There's also if you have somebody who's a seafood eater versus not.

But.

The bottom line is I think that there are certain supplements that should be tried, especially when people are struggling with traditional antidepressant response. A lot of people I'll see, they'll have been on a medicine, it works some, like with cheerfulness or with sleep. but they're not eating well and for whatever reason, they're not going to start eating well. So, that's a really good example of somebody who a multivitamin or something with zinc or magnesium, certainly anybody who's low. I mean, I always have that feeling like if you're low, I definitely like... Do you test your patients? Yeah, yeah. I don't do as extreme or not even extreme, maybe as thorough, but I certainly test everybody. I mean, I think what you were saying earlier, I think any mental health clinician who misses this is malpractice. If you miss a thyroid problem, a B12 deficiency, syphilis, I mean, there's a bunch of biological causes of depression. And I think you and I see that get missed sometimes where it's like, this is not even functional medicine. This is just basic medicine.

It's all good medicine. I mean, in my practice, I see the common deficiencies through testing are vitamin D, magnesium, omega-3 fats, sometimes iron.

Yep.

And the B vitamins, particularly around homocysteine and methylation issues, which is this cycle of folate B12 and B6. And so I find that giving people a multi and fish oil and vitamin D and maybe a little magnesium usually has enormous impact.

And, well, you think it's that even if you're going to get them to change their food right away, there's some, you know, that takes a little bit.

In, in, even with changing the food, I, I feel, I feel like we're so depleted, it's just.

Yeah, well it's hard and it's also it's really hard when you're depressed. So I think what it also gives people something to do. Yeah, because you do. I mean, depression causes a lot of carbohydrate craving and a lot of, you know, we call it comfort food for a reason because we eat it when we want to be comforted. I mean, I know when I'm in that bad spot, man, I'm a mac and cheese guy. It gives you a little serotonin. Yeah, don't give me any talk about carbs. I need like my comfort food. But it's, I think it's something else. The other one that's, I think, exciting is the L-methylfolate.

It's just exciting in the idea that- which is actually a prescription drug for depression.

Well, it's called Depakote, but it's like- yeah, it's a B vitamin that gets you served by, am I allowed to say that? It's a B vitamin that gets you served by Big Pharma is the way I think about it, which is you.

Have L-methylfolate, which is folate that has.

A methyl group added onto it. And instead of that being five bucks, it's 200 bucks. Yeah, but you can get it for five bucks. You can get it for- But the idea that we're just now, 'cause this is gonna be the next frontier mark, as you know, which is we're gonna start really getting into precision psychiatry. I mean, that's my most, my favorite new center at Columbia is the Center for Precision Psychiatry. There is that? There's a Center for Precision Psychiatry, there's a Center for Practice Innovation, there's a Center for Women's Mental Health. I mean, there's gonna be, there's a new center for media and mental health that's coming online, and precision psychiatry is just that, which is, there's no, I mean, one of the things I think is interesting is there's nobody that's more critical of psychiatry than our, like than ourselves. Because nobody sits with the- and sees the failure. Well, nobody sits with it like, you know, until you sit with getting an antidepressant prescription wrong and then getting it right and knowing that somebody suffered because you didn't make the right choice. When you sit with that, you want to get it right more than anybody else because that's your job. And so it's an exciting time between the new knowledge of the microbiome, the psychiatric genetics, which it's not there yet, but man, it's getting close. We're, I hope, going to see the tide turn on our mental health epidemic. We are going to see the tide turn on our mental health epidemic mark.

Yeah. We won't rest until it does, deal? No, no, we can. No, it's, I mean, it's the food stupid, as you know, to paraphrase a former president. But it's like, people don't get how.

Powerful it is and how impactful and how quick it works. How do you get people to see it though? Because I feel like, When we tell people, Hey, eat right, feel right, they get that. When we say, you know, feel good. You know what I do?

I think often incrementalism doesn't work because people don't see a change. So, people are eating a crappy diet, I say, just stop the soda, but they're eating like garbage. They're not gonna feel better. So, I put people usually for, I said 10 days, you can do anything. So, I put them on a basically elimination diet. I call it the 10-day detox diet for 10 days. And, they can experience without me telling them the changes that happen in their body, in their brain, in their mood, their energy, their sleep. And it's quick. So usually you can get people to do anything for 10 days and then they go, oh, okay.

Well, they have to, I mean, I think any good behavioral change, it's like we can't tell you. You can't read about it. The study's not gonna help. The sound bite, the science, you have to experience it working. as soon as you experience that, that extra energy, that better, what I find the better sleep quality, where I'm expecting to hear more mood, more energy, people are like, you know, Doc, I'm really sleeping better. And all those ways that, you know, that then makes nothing affects mood, I would say, like sleep. So it's, yeah, it's amazing.

Well, if you were able to change psychiatry and you had sort of an autocratic you know, wand that you could wave.

And I got to be the emperor of psychiatry. Yeah.

I mean, would you throw out the DSM-5? Would you say every psychiatrist needs to.

Get trained in functional medicine, nutrition and... Well, I do a few things. One is I'd want America to really meet psychiatry. Because I think so often when they think about psychiatrists, they think about Freud, they think about some old white guy with a beard, and they don't think about, like, our current president, Altha Stewart. first African-American female president of the American Psychiatric Association. Or they don't think about my colleague, Christina Mangurian, who's she was like one of these stellar. She's my medical student. Now she's the vice chair for health, equality and diversity at UCSF. And so these are women who are leading psychiatry and we are diverse and we are desperate to find, well, we're desperate for a few things. When we're desperate to better, we have a lot of solutions. We have, for example, I just, you know, the number one way to treat schizophrenia or to keep people with schizophrenia really well, it's not an antipsychotic. That helps for a lot of them with symptoms, but it's a job. And so there's a program spearheaded by the Office of Mental Health and Lloyd Sederer in New York and Columbia Center for Practice Innovation that looks at that and now makes sure that there are, I think there are 7,000 families in New York who are getting employment support.

When they have early So, basic simple things that are happening in medical care that are things that are happening outside the hospital.

Yeah, and so I would wanna see more programs like that. I think that there needs to be certainly training in, I would say not just nutrition, but also in lifestyle and lifestyle modification. I think that gets dumbed down in medicine in general, and we don't know how to do it. And I think a lot of times doctors don't think they should do it. and maybe that's true, maybe it's not.

But what doctors need to do.

Writing prescriptions is easy. Yeah, but even writing a prescription for food and exercise, some systems, that's all they're gonna do, but building out that capacity, I would want us to, I guess then, you wanna hear my number one change, I guess I've come upon this this week, as I've been really thinking about innovation in mental health. The number one change I wanna see is I want us to stop meeting patients when they're mentally ill. I want us to start meeting patients and helping them stay mentally well. because the most powerful tool that I have as a psychiatrist is the power of prevention. And no one comes to talk to me or think about talking to me or fights the stigma to talking to me until they're late in the game. And. And that's great. I'm gonna get them better. Wherever you. Wherever you meet me, I'm gonna help get you better. But I'm gonna help you get yourself better, actually, is the way to put it. But. But I hope that what changes and what is changing is that we start. having a language to talk about our mental health and recognize that we all have this. I think people think about folks like you and me, one of the things I love about you is you talk about being depressed and people think, oh, you're a brilliant, successful physician. You're an innovator. You don't have depression. And it's like, no, you do and you have. And that's what I hope is going to change. In terms of the field and the DSM, the diagnostics, I mean, there are smarter guys than me thinking about that. I think that's just Yeah, we're gonna have a reckoning that the way we've been doing it has been necessary without the DSM.

That's a way of labeling people based on symptoms or what mental illness they have. It doesn't tell you why.

It doesn't tell you why. It's a symptom-based diagnostic approach because it's hard. We don't know why. What I love is now, there's a big idea in psychiatry, not big idea, but a new idea. The inflammation has a lot to do with depression.

Yeah.

Now, that's been an idea in functional medicine and in wellness for 15 years. So, that's changing. And I think that we're gonna see more of an integrative model. The other thing is I would just hope that we come out of the shadows a little bit and that we're collaborating and integrating more and more, especially with wellness.

Yeah, I agree. I think rethinking mental health, and changing our meaning we attach to a lot of it, which isn't necessarily always psychological, often is, but it's not always. And how do we combine that with a psychological approach?

That's the original, you know, the original psychiatry, the model they teach us is the bio psychosocial model. And except they usually leave out the bio.

Well, you know, the bio is they leave out some of the biology.

Serotonin.

Well, let's give an antidepressant.

Like that's serotonin. Like the worst brand anything that for psychiatry. Why does serotonin get screwed up? Hundreds of molecules in the brain. Nobody even knows about BDNF. BDNF is the hormone that makes your brain grow. That's the one we care about. That's what food and exercise and psychotherapy.

All have in common. It hung up on serotonin. Well, Dr. Ramsey, it's been a pleasure having you on the Doctor's Pharmacy. You've all been listening to Dr. Drew Ramsey on the Doctor's Pharmacy, a place for conversations that matter. And if you love this podcast, please sign up for listening to it wherever you find your podcast, share with your friends and family on social media, and please leave a review. We'd love to hear from you. And if you want to know more about Dr. Ramsey, go to drueramseymd.com, learn about his work, his books, and check it out. See you next time on the Doctor's Pharmacy.