How Diet And Lifestyle Can Improve Mental Health And Cognition

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

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.

Hey everyone, it's Dr. Mark.

Now I know a lot of the.

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A treat, I'll grab some Hugh chocolate too, which I love. For my toiletries, bag, I'll bring some Schmidts deodorant, some all terrain herbal armor bug spray, a tin of raw elements SPF 30 natural sunscreen, and a bar of Dr. Bronner's peppermint castile soap. Thrive also carries so many other things that can make packing for a trip easier and I'm sure you'll find your own personal favorites. If you join Thrive Market today, you'll get $80 worth of free groceries. Just go to thrivemarket.com/hyman.

That's T-H-R-I-V-E-Market.com/hyman to get this amazing offer. Now let's get back to this week's episode of the Doctor's Pharmacy. hi, this is Lauren Feehan, one of the producers of the Doctor's Pharmacy podcast. We can't have a healthy, high functioning mind or body without a healthy, high functioning brain. And in a world where so many people feel unhappy or depressed, prioritizing time each day to care for our brains through our diet and lifestyle is more important than ever. In today's episode, we feature three conversations from the Doctor's Pharmacy on how our brain function impacts every aspect of our lives. and why we need to care for our brains now to feel better and live longer. Dr. Hyman speaks with Max Lugavere on the best foods for your brain and the ones to avoid, with Dr. Christopher Palmer on why optimal brain function depends on healthy mitochondria and metabolism, and with Dr. Daniel Amen on getting to know.

Your brain type to increase your happiness. Let's dive in. I coined the term genius foods, which is not a scientific term, but I love it. 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 DHA, 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 out of 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's a slogan with scientific backing at this point. That is a truism at this point, right? Because foods like tortilla chips are hyperpalatable. They combine salt, Fat, flour. Yeah. And they're, 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, that's why I actually.

Am afraid of Mexican restaurants now. I'm like, oh, Mexico, 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're like, you want a crack addict, some 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 over consumed 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, right? 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 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 whole foods. 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. 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 on 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 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? But kids gonna eat liver on their own or kidney. 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, a 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, but we can't get from the foods. We just keep eating more and more and more. That's, that's really the problem.

Yeah, that's the, the movement to, towards in what's been called intuitive eating. That's why I think that that's such a short-sighted and, 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, 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 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 Burk 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 isn't for us, but it's essential for the microbiome. Our microbiome is essential for us to stay healthy.

So in a sense, it is really an essential nutrient. It is, yeah, through the, through the lens of, of the microbiome. Absolutely. It is. And it, 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 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 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 seeking out any of those nutrients I did.

Didn't you miss the most satiating nutrient of all? which is fat.

Fat is satiating. Yeah, it slows, it slows the absorption of food. It, it slows gastric emptying. 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 healthful 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 processing. 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. And 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 hunger. And that was that 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 sent brought subjects blood sugar back down to baseline. really smoothly and, 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, that are less processed because this is not about calories. This is not about carbohydrate content. This was purely about the, the degree of processing that that food is undergone.

Yeah.

So it's, it's so 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 want to 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, 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, real foods don't have extensive ingredients lists. They are the ingredients. They are the ingredients. I say absolutely. 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, 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, that are making all the health claims and yet those are the worst foods for you. It's generally true. 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, it's even a step further. I would say there's no actual biological requirement for carbohydrates. 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 do contain some protein and sometimes fat, depending on the vegetable, but essentially they're phytochemically rich foods. So the phytochemical richness is such a key principle that most of us don't pay attention to. 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 grass-fed and finished beef, it's a, 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 and 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. We, 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, oh, wow. most well-defined Alzheimer's risk gene. So I'm a big advocate of, in general, foods that contain that contain creatine naturally. Grass-fed beef is a viable source.

There's a reason I'm 62 years old and healthier than ever, and it's because I put a lot of effort into optimizing my health. And I know that if you're listening to this podcast, optimizing your health is important to you, too. Like me, you're probably doing your best with your diet to get good nutrients into your body and limit the damage done by toxins. Now, one of the keys I found to eating the right things is monitoring your glucose intake. Poor glucose control is tied to all kinds of issues like weight gain, fatigue, diabetes, Alzheimer's, heart disease and stroke, just to name a few. But it can be hard to know exactly how much glucose you're getting in your diet and how your body responds to it. But I have found a solution that I'm excited about sharing with you. It's Levels Continuous Glucose Monitors. Now, I've been using Levels to track and understand my own unique metabolic data. I just stick the small glucose monitor onto my skin and the data starts transferring to my smartphone immediately. And it's helped me learn a lot about what foods work best to support my health and vitality based on my own physiology. In fact, I had one time where I thought, oh, I'm eating a really healthy meal and it was super delicious and it was really not too starchy or sugary, but I ate a ton of food. I way overate because my friend ordered so much of this delicious food and it was all farm raised and great and healthy. But eating a giant amount of food also spikes your blood sugar and your insulin levels. And we were both laughing because our levels monitors both showed levels of blood sugar over 150, which I'd never seen before. So I learned to moderate my food intake and not go overboard. Now, if you're interested in learning more about levels, go to levels.link/hymen. They've got a super well-researched in-depth blog that I recommend checking out if you wanna learn even more about topics like metabolic health, longevity, and nutrition.

We have had more than enough research, clinical trials, demonstrating that the ketogenic diet can stop seizures even when pills and surgery don't. We have more than enough evidence on this.

Yeah, it's the last resort is diet. After all the drugs and surgery don't work, then we try diet.

Yeah.

Then let's try diet. Even though it's- Because I mean diet could be dangerous.

You might, you know.

Yeah, they might end up losing weight. We wouldn't want that. So once I realized that, I started using this intervention in many other patients. And, you know, it was not across the board. It was not a miracle cure for everyone. I will fully state that and disclose that.

Yeah.

But it was dramatically effective and sometimes even more effective for other patients that I used it with. And I was putting what I always thought of as chronic mental disorders, schizophrenia, bipolar disorder and others, into full complete remission, sometimes getting people off all their meds, and they were remaining in remission for years. And I ended up getting connected with other patients who had found their way to this intervention either through other clinicians or on their own. And some of these patients The most striking case was somebody who had been in remission for, at the time, was about 12 years. And she was 70 years old. It suffered from schizophrenia for 53 years. And her schizophrenia went into full complete remission off all medications for 12 years. those things don't happen in psychiatry right now.

I mean, Chris, what you're saying is basically the world is not flat. You're like Christopher Columbus and everybody else is actually saying the world is flat because it looks flat. We have these diseases, they don't go away, they're chronic, there's no cure for them. And it's remarkable when you start to see it. In essence, it's like you're saying, well, it's like saying, well, I saw someone who's fully autistic and now they're not. That's the level of drama of this case. It's, it's, and I've seen the same thing over and over and over again for decades, because by doing functional medicine, you just get to the root cause. And, and the thing that you, you know, I want to drive home is that you really are dealing with some of the underlying biology of the inflammation in the brain. And whether it's autism or Alzheimer's or ADD or depression or schizophrenia, if you biopsy the brains, they're all inflamed. Now, the causes can be different. That's why the ketogenic might work for some, not others. Maybe another person might have another issue. They may have, for example, heavy metals or a toxin that's causing a problem. And if you don't deal with that, then maybe they tuna all day, every day in their tuna fish sandwiches. That's their diet at home. But, you know, we have to kind of get to the root cause. But when you start to sort of broaden your net and look at the, the, the overlying framework, you're really dealing with this, this brain inflammation. And what you're saying is so revolutionary because when you look at the economics and the disability of mental illness, it far surpasses any other illness, heart disease, cancer, diabetes, Alzheimer's. It is the single biggest cause of disability and costs. I think I read a study recently that $95 trillion are going to be spent over the next 35 years on chronic illness. And a lot of that, the majority of that is for the disability that goes associated with depression and mental illness. It's not necessarily being in the hospital and the loss of productivity to society. Like you said, this guy was just sitting at home, couldn't do anything. Now he's a productive member of society. What is the cost of that?

So let's talk about what it taught.

You about the biology of the brain because you were trained as a psychiatrist, you didn't learn much about that other than the neurochemistry of neurotransmitters and using psychiatric drugs which modulate neurotransmitters, which is good, but you probably didn't learn that much about how to address toxins or the gut microbiome or diet or, you know, nutritional deficiencies or hormonal imbalances or any of that. So, so how, how did you begin to unpack that? And, and what was the, what is the, the view that you have now that you wrote about in your book, Brain Energy, that talks about the biology of what goes wrong? Because once you understand that, then you have a roadmap in order, which allows you to actually create a treatment plan that can work and be reproducible.

Yes. And I think- and by the way.

Before I let you go on, I.

Just want to point out that the ketogenic diets also work in autism and Alzheimer's and in many, in epilepsy and I've seen this also in schizophrenic patients.

So it's really powerful.

It is. Yeah, I just want to highlight even though, you know, the disorders you just mentioned are all very serious disorders and I was talking about schizophrenia a little bit ago, I want to just highlight one of the things you said, depression is the leading cause of disability. So this, you know, most people think of depression as a fairly straightforward illness and we have tons of antidepressants and we've got psychotherapy and we've even got shock treatments and we've got so many treatments available. They have to be effective, right? Well, actually wrong. It, the majority of people with depression, bread and butter depression, are not getting better with our current treatments. And it's not because they're not getting treatment, it's because our treatments fail to work for far too many of them.

And.

So I think that it was really interesting because the way that I went about unpacking all of this, was, you know, I started with the neurology literature and because this is anti-seizure treatment and we use anti-seizure treatments in psychiatry every day in tens of millions of people. And so that was really low-hanging fruit and it was a great resource to tap into because we've got 100 years of clinical and neuroscience evidence on the ketogenic diet and what is it doing to the brain. And so, I could tap into that and lo and behold, sure enough, the ketogenic diet rebalances neurotransmitter imbalances. It decreases brain inflammation. It changes the gut microbiome in beneficial ways.

It.

Gets people off gluten.

Yes, it gets people off gluten. It gets people off lots of other toxic foods probably. It improves insulin signaling and insulin resistance in most people. And so it has a wide range of effects. But still, this is where the field of psychiatry is. It's like all of these different things. And so I went on a deeper search for how do these connect? Because at first I started off with a mission to how am I going to convince other mental health clinicians to use the ketogenic diet for serious mental disorders because nobody's going to believe this. They're just not going to believe it unless I can present a clear and plausible mechanism of action based on science. Nobody's going to buy this. And this miraculous treatment that I am seeing in front of my eyes is going to go wasted. And so I kind of felt like I'm an academic.

No, you might lose your job.

Yeah, I did worry about that many times.

You probably wouldn't go to jail like.

Galileo, but you might lose your job.

I worried about that. The good news now is that I have the full support and endorsement of McLean Hospital, actually.

Amazing.

They are very enthusiastic and supportive of this.

See, when I heard about what you're doing, I just said the happy dance.

I was like, and I've been telling everybody, I'm like, wow, finally somebody's getting it where it counts.

That's awesome. So the way that I ended up coming to the science is I ended up focusing on mitochondria and mitochondrial function and more broadly what we call metabolism. And so I came at the science from that perspective and ultimately viewing mental disorders as metabolic disorders of the brain. And that in order to understand metabolism, you have to understand mitochondria. But in fact, you have to understand everything that you have known about for decades, functional medicine, how it's all interconnected, how diet, toxins, hormones, the gut, stress, all of that come together to result in illness. So functional medicine has been doing this for decades. and yet I was holed up in my Harvard position and evidence-based medicine. And so we didn't learn a lot about functional medicine. And certainly functional medicine protocols are not being used in psychiatric hospitals for the most part around the world. Most psychiatric hospitals are not using these protocols. or this paradigm. And so, but at the end of the day, even looking at mental disorders as metabolic disorders, which revolve quite a bit around mitochondria and mitochondrial function, I ended up coming to the same conclusions that you did.

It's quite extraordinary. And, you know, I don't know if you're aware of this, but right at Harvard, there is Uma Naidoo who has a whole Department of Nutritional Psychiatry talking about the microbiome. and the brain. And there's another physician who's been on my podcast at Stanford. They have a department of metabolic Psychiatry. So it's starting to happen, and more and more psychiatrists are becoming aware of the data because there is data. There's a lot of literature now that supports this notion. So when I, when I look at sort of the mitochondria, it's really about, you know, metabolism and energy and, and, and it's, it's sort of, I'd like you to sort of unpack how that actually connects to psychiatric diseases. Because, you know, I first heard this concept when I talked to Martha Herbert, who's a psychiatrist, sort of neurologist, sorry, a neurologist. And I think she's also, psychiatry, I might be wrong, who, who was treating autism. And she was doing brain scans on these autistic kids. She saw their brains were swollen and inflamed on biopsies with these kids got killed in a car accident or something. And see, these brains are just full of inflammatory cells and the immune cells, the white blood cells called the glia. And she also called what they have a metabolic encephalopathy. She said that autism is not a brain disorder, it's a systemic disorder that affects the brain. And that's what I hear you saying, that psychiatric illness, for the most part, is a systemic disorder that affects the brain. And the causes can be many, like it could be with your diet, it could be your microbiome, but I was with the gentleman this weekend whose family was a Hungarian Jew whose family was killed in the Holocaust. He says, I know 150 members of my family were killed in the Holocaust. I know everybody's name. and I've lived in a constant state of trauma and stress my whole life. And, you know, I was like, wow, this is the epigenetics of this. And Scientific American just came out with a paper, not a paper, but an article, sort of documenting some of the research in New York after 9 11, where they saw women who were pregnant when 9 11 happened, their children were, were incredibly affected by the stress and Trauma that happened to the mothers when they were pregnant and was registered in Gene expression patterns and epigenetics and in cortisol levels and cortisol receptor function. And I was like, wow, this this data is really coming along in this. So there's a lot of things that can affect it, but often the psychiatric problems are so misdiagnosed and mistreated, honestly, and it creates so much suffering. And so what you're talking about is really a revolution.

It is. It certainly was for me, and it certainly is for psychiatrists that I speak with. I don't think they've really considered this. the reason that I am so passionate about mitochondria in particular is because.

They.

Actually are responsible for much more than just energy production. So most people know mitochondria as the powerhouse of the cell. And so they create ATP, which is our energy source. And there's no doubt they do that and they are instrumental in that role. And without that, we would not live. but they actually do so much more than that. So they are primary regulators of hormones, for instance, key hormones like cortisol, estrogen, testosterone, progesterone and others. That the production of those hormones actually begins inside mitochondria and as those hormones travel through the body and influence cells throughout your body, the primary influence ends up converging on mitochondria.

And.

So in many ways, the reason that I became ridiculously excited about this theory is because it is a way to connect all of the dots, the biopsychosocial models, of mental illness. It is a way to connect all of them. So mitochondria are instrumental in neurotransmitter function, neurotransmitter production, the release of neurotransmitters, the influence of neurotransmitters. They play a significant and powerful role in inflammation. But inflammation in turn affects mitochondria. and so it all, at least in my mind, once I started diving deeper, I was kind of flooded with all these questions. But wait, this can't, it can't be this simple. Like this, this is too simple. There's no way that this complex issue and the complexity of Psychiatry and the brain, there's no way. It can end up being this simple. And for the last five years, I have tormented myself in some ways with questions like, if this is really true, then this should be true, or that should be true, or this should be true. And at the end of the day, everything in my mind seems to converge on these issues.

Yeah, it's so true because I was.

Reflecting on a previous podcast who was a pediatric neurologist. trained at Harvard, Oxford. She works at University of San Diego now. And she, she did brain Imaging, functional MRI Imaging of the brain in autistic kids, and finally had energy problems that mitochondrial energy deficits were evident in the brain of autistic kids. And then by giving them mitochondrial nutrients, basically the co-factors and helpers that actually help you turn food and oxygen and energy, like CoQ10, for example. or in B vitamins and just some really simple things that are very inexpensive that these kids would literally get better from autism. That's not to say that all autism is just caused by these nutrition deficiencies or mitochondrial issues. It's, it's, but it's one of the things that we see. So there's a lot of people coming at this from a lot of different areas. You're in the psychiatric Lane, but, you know, the neurological Lane is seeing this, too. And so is pretty much every other, the other issue. I mean, whether it's your weight or whether it's heart disease or diabetes or Alzheimer's or Parkinson's. So many diseases are really related to mitochondrial dysfunction. So it's great. It's really amazing.

One of the big lessons I learned from imaging early on is that all psychiatric illnesses, all of them, are not single or simple disorders. They all have multiple types. Giving someone the diagnosis of depression, is exactly like giving them the diagnosis of chest pain. And nobody thinks about it like that, but it's absolutely true that nobody gets a diagnosis of chest pain. Why? Because it doesn't tell you what's causing it and it doesn't tell you what to do for it. I mean, you're not going to give everybody nitroglycerin. I mean, that would be stupid, right? But now we think of depression, oh, you're depressed. take Lexapro or you're depressed, take Luvox, which is really interesting. We may talk about that in the pandemic.

But yeah, it turned out to be a joke for COVID.

Yeah, it's really interesting. And I think I know why.

But.

ADD is not one thing. It's seven different things. One of my best-selling books of all time, Healing ADD, I talk about seven different types. And then when I was thinking about happiness, I'm like, the thing that makes spontaneous people happy, like scary movies and having an affair, jumping out of an airplane, the persistent person would actually, those things would make him or her miserable. And so it's really important to know your type. There are five primary types. So you balance. That means, you know, most any reasonable thing will make you happy. spontaneous, you need novelty or you're not happy, persistent, you need routine or you are not happy, sensitive, you need connection. They were damaged most in the pandemic with the isolation. And the cautious people, they need peace to make them happy. And so know your type. I have an online quiz called our brain health assessment, brainhealthassessment.com, you'll see which of the 16 types you have and then, well, what are the things more likely to make you happy? And all of these strategies have questions and for get your brain right, the question, the little tiny habit, I don't know if you know BJ Fogg, but I worked with him.

Yeah, yeah, yeah, yeah.

Six months on tiny habits. So we have 50 tiny brain habits. But the mother of all tiny habits for the brain is for strategy one, is this good for my brain or bad for it? So when you go to do something, you just ask yourself, is this good for my brain or bad for it? So when we were at Saddleback, our first fight with Pastor Warren was, you got to get rid of the donuts. Or it's good for your brain or bad for it. I mean, obviously it's bad for it. I don't know if you remember that.

I do. And the soda, the pancake breakfast, and.

The restaurant controls, and the whole thing. We had a work on offer.

They did good, though. I would say they, I was impressed at that scale of change that they did so quickly. It was very impressive.

It's amazing. And then the question for the second strategy, am I doing something today that makes me uniquely happy? So it's really diving into happiness is not the same thing for everybody. So don't say it's, novelty and gratitude and appreciation and fun and comedy, because it's different based on your type. Three, you'll appreciate is supplement your brain. We live in a society of deficiencies. And if you're nutrient deficient, especially serotonin, you know, most people don't know that birth control pills depletes serotonin. And I've seen this over and over in teenage girls. They go on birth control pills and now they're anxious or they're depressed and no one's thinking it's changing their neurotransmitters. And my favorite happy supplement is saffron. I've been following the science of saffron for 20 years. 24 randomized controlled trials against Prozac, Paxil, Zoloft, Miprime affects her equally effective. But rather than being anti sexual, you know, put someone on an SSRI and they have trouble having an orgasm or their libido goes down. Saffron is pro sexual and it makes them more interested. And there's studies showing that saffron helps with memory, even in people with mild cognitive impairment. So when the pandemic started, I just released a product I love called Happy Saffron. Saffron is a curcumin. And I'm like, right at the beginning of the pandemic, my dad died. I had to close our Manhattan clinic. I mean, it was a disaster. I'm like, I'm taking this. So this is the supplement. I take many of them, but that's my favorite one. And so I think we might agree probably everybody should take a really good multiple vitamin. Yeah, everybody should take an omega-3 fatty acid. You should optimize your vitamin D level, test it, odds are it's low, and then work to get it high normal because we're in a pandemic. And then it depends on your brain type. So our spontaneous people do better with stimulating supplements like rhodiola, our persistent people do better with serotonin boosting supplements like 5-HTP. the sensitive people do better with saffron or SAMe, and the cautious people do better with GABA, theanine, magnesium. I'm just a huge fan. And too often you see this is people go to their family doctor, their nurse practitioner, and they end up on a benzo. And it's like, no, no, no, that's like 20th on the list. Let's do meditation, diaphragmatic breathing, let's try Gavin magnesium. Please don't do that because why would you start something? Somebody can't stop. And I see them creating so many problems with inappropriate medication use.

Well, they don't even work that well. That's the thing. If you took Prozac and you're cured and you were happy, life was good. wonderful, but it just basically no better.

Than a placebo for mild or moderate depression.

So, you know, that's another problem.

Well, the pharmaceutical industry doesn't want to be in the order business. I mean, they consciously made the decision to be in the reorder business, that once you start something for a lot of psychiatric medications, they change your brain to need them. in order for you to feel normal. So many people are just wickedly afraid of going off antidepressants because of the withdrawal from them. And I'm not opposed to medication. I'm just opposed to that's like the first and only thing you do without getting someone's diet right, without getting their habits right.

Right.

Well, that's so true. I mean, you also talk about in the book, this whole idea of four circles of happiness. It's an exercise you do to make you happy.

What is that?

Well, when I was in medical school, actually, the first week, our Dean came in the classroom and he said, never think of patients as their diagnosis. Always think of them in four big circles. And it's just stuck with me. He went to the board and he drew the first Circle, which is the biological Circle. So, you know, as a doctor, you need all about their biology. And as a psychiatrist, for me, you know, our primary organ is the brain. So brain health, as we talked about. The second circle is the psychological circle, which involves development and how they think. And secret number five is master your mind and gain psychological distance from the noise in your head, which we'll talk about soon. super fun circle, but it's basically the psychological circle. And then he drew- One of the.

Things that you said is, don't believe every stupid thought you have.

And I didn't learn that till I was 28 years old in my psychiatric residency at the Walter Reed Army Medical Center. And I'm like, my eyes got really big because, you know, I've struggled with anxiety. And I'm like, why didn't they teach me that in third grade?

Right?

Just because I have a thought has nothing to do with whether or not it's true, whether or not it's helpful, whether or not I should attach to. And it's not the thoughts you have that make you suffer, it's the thoughts you attach to that make you suffer. And then he drew the third circle, which is the social circle. He said in the social circle, It's how are your how are your patients relationships and what's their social situation? And, you know, two years into this pandemic, the social situation for so many people has just been a disaster from the societal unrest, the political divide at Christmas. I have never seen family division like I have seen. And I'm saddened. by it. And I kept telling my patients over and over and over again, without connection, you have no influence. So you're a vaxxer, you're an anti-vaxxer, whatever. You know, people were like not getting together and angry at each other. And I'm like, if you don't stay connected, you have no influence on the other person. And then the last circle, which I just love so much, is the spiritual circle. It's, why do you care? You know, what is your deepest sense of meaning and purpose, your relationship with God, with the planet, with the past, with the future? And really talking about that with my patients. And I have to tell you, Mark, nine out of 10 patients, when I ask them what their goals are and why they think they're on the planet, they haven't thought about it. And I'm like, you know, a business is not going to go unless it has a mission statement and a purpose and a strategic plan. And so that's actually number seven of the happiness secrets is live each day based on clearly defined values, purpose and goals. And purposeful people are happier. But if you don't know, and there's a great exercise in the book on how to find your purpose that I love. And, you know, one of my favorite patients that came out last year that I've been her doctor for about 11 years is Miley Cyrus. And I love her so much. And she has just grown up so much in the last couple of years, and she's very purposeful. she knows what she's about and what she wants to accomplish. And her bad habits didn't fit. And ultimately, that's the question to ask for secret number seven, is does it fit? Does my behavior fit the goals I have for my life?

Interesting.

So, you've been doing this for a.

Long time, like 40 years, and you've looked at a bazillion brain scans. and you did what most psychiatrists never do, which is they look at the organ that they're treating. I want a concept. What did you learn through that detour that you took from traditional psychiatry? And what are the sort of big lessons that you got and that helped change the way you treat your patients?

I became a psychiatrist when I was in medical school. My first wife tried to kill herself. And I took her to see a wonderful psychiatrist. And I came to realize if he helped her, which he did, it wouldn't just help her, but ultimately it would help me. It would help our children and our grandchildren. And I became a psychiatrist because I loved it. But I joined the only medical specialty that never looks at the organ and treats. And I was an X-ray technician. in the Army before I went to medical school. And I'm like, well, of course you should look. How do you know unless you look? And when I got the opportunity to look, it literally changed everything. I realized that Psychiatry is broken, making diagnoses based on symptom clusters with no biological data. That's just insane that, you know, we're run by the pharmaceutical industry. That's not a good thing. because the motive isn't wellness, the motive is profit. And when I started looking at the brain, I'm like, oh, let's dump the term mental illness. I've always hated that term. And let's really focus on brain health. If I can get your brain right, the biological circle, your mind is going to be better. Now you got a program. your mind with your values, purpose, goals, not believing every stupid thing you think. But if the foundation of mental health is sick, you're not going to be okay. And that's where I learned, like Lyme disease can have a negative impact on your mind. COVID-19, what we know now is it activates the limbic or emotional brain. and 20% of people who have COVID will get a new mental health diagnosis within the first five months. Wow, that's just craziness. I learned that diet matters. Secret number four is only love food that loves you back. That you are in a relationship with food. And so many people are in an abusive relationship with food. When we were doing the Daniel Plan, one of the pastor's wives, you know, I scanned her brain and she's in my office and I was drinking tea and she said, Could you put the tea down? I'm like, no one had ever asked me that before. But, you know, I'm polite. And I put the tea down. She said, I didn't want you to spit it at me. and I'm like, I've never spit tea at anybody. She said, after you and Dr. Hyman lectured, I told my husband that I'd rather get Alzheimer's disease than give up sugar. I'm like, did you date the bad boys in high school? Because that's obviously a bad relationship with sugar.

The question then becomes, well, how do we improve our brain health to improve our mood?

So it's really three big strategies. You know, you and I both spend a lot of time trying to make things really simple for people. So the first one is brain Envy. You got to care about it. Nobody cares about their brain. Why you can't see it, right? You can see the wrinkles in your skin or the fat around your belly, and you can do something when you're unhappy with it. But because most people never look at their brain, they don't care about it. In 1991, I was 37. I'm a double board certified psychiatrist, board certified in general psychiatry, child and adolescent psychiatry, is the top neuroscience student in medical school. I didn't care one wit about my own brain because I'd never seen it. And when I saw it, I was sort of horrified because I played football in high school, had meningitis twice as a young soldier, and I had bad habits, like it's only sleeping four hours and I was I was eating fast food. I was overweight. I just didn't even think about it. And so I developed a concept the week before I scanned my mom, and she had a beautiful brain. And I developed a concept called brain envy. I always say Freud was wrong. Penis envy is not the cause of anybody's problem. I've not seen it one time in 40 years. It's brain envy. You gotta like love and care. for your brain. And that becomes easy to answer the question, is this good for my brain or bad for it? Which is why I'm not a fan of alcohol and I'm not a fan of marijuana. The second strategy is avoid things that hurt your brain and you just have to know the list. And, you know, whenever I post on alcohol or marijuana on TikTok, it goes crazy. You know, people just get so, oh my goodness, how can you say that? I wrote a blog last year called I Told youd so. And when I first met Tana, and you know Tana, when I first started dating her, she said, I'll never tell you I told you so. And she lied. It's her favorite thing to say. And I've been saying since I started looking at the brain that alcohol is not a health and then the American Cancer Society came out against any alcohol because any alcohol increases your risk of seven different kinds of cancer. Not to mention all you have to do is watch Netflix. The people who drink the most get into the most trouble. Alcohol is at the center of divorce, incarceration, conflict. For sure. And so many health problems. So you want to be happier, you want a healthier brain, kill the alcohol and other things that nobody knows, like general anesthesia can damage the brain. And like, I didn't know that. Nobody ever taught me that. But I had a patient who I had her scanned, and then after she had a knee replacement, she said, I think I have Alzheimer's disease. And her brain looked like she'd just been hit by a truck. And I'm like, I wonder if there's any literature on this. And there's a whole food fight in the literature among anesthesiologists on cognitive function after anesthesia. So, for example, people have coronary artery bypass surgery have significant increased risk of getting dementia. Now, it doesn't mean you don't have surgery or anesthesia. What it means is no. That's a potential her. And so you have to do things that help. Yeah, things that I didn't know, like playing football is a brain damage in sport. I mean, you'd think most thoughtful nine-year-olds would come to that conclusion.

No.

Obesity. I published three studies now. Last one on 35, 000 people. As your weight goes up, the actual physical size and function of your brain goes down, which should just scare the fat off anyone. And so.

Brain energy. Yes.

Big belly, small brain.

Well, and you've heard me say if you want to keep your brain healthy or rescue it, you have to prevent. or treat the 11 major risk factors that steal your mind. And I first learned this term from you, diabetes, where you're overweight and have high blood sugar. It's a disaster for the brain, because when you're overweight, it increases five of the 11 risk factors. You have lower blood flow to your brain, your brain looks older, so aging, It increases inflammation, it stores toxins and takes healthy testosterone and turns it into unhealthy cancer promoting forms of estrogen.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make.

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