The Science of Mood And Your Microbiome with Dr. Uma Naidoo

Coming up on this episode of the Doctor's Pharmacy. Things that seem to worsen anxiety include foods with gluten in them. And it's not necessarily people who have celiac disease or non-celiac gluten sensitivity, but there seems to be a correlation in the studies around the level of anxiety and eating and consuming gluten.

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I just stand in the relaxing red light for a few minutes a day, and my body really responds to getting a full dose of that healthy light. Plus, Juuve has the best customer service in the business, answering questions and helping you decide which Juuve device may be best for you. So to check out the Juuve product for yourself, head over to juuve.com/pharmacy. That's J-O-O-V-V.com/pharmacy with an F, F-A-R-M-A-C-Y. And once you're there, you'll see a special bonus the Juuve team is giving away to my listeners. Just use the code Pharmacy at checkout. Now let's get back to this week's episode. Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you want to know if your depression, anxiety, ADD and all kinds of other mood and mental issues may be related to what you're eating, you want to listen carefully to this podcast because it's with an extraordinary physician, A triple threat, as my friend David Boulet, the chef, says. Dr. Uma Naidoo, who's the world's first triple threat, as he said, in the food is medicine space. She's a Harvard-trained psychiatrist. She's a professional chef. I don't even, I can't tell you how jealous I am that you're a professional chef, really, and a nutrition specialist. It's incredible that you're doing the work you are doing and you're doing it at Harvard and you've created a work working program called Nutritional Psychiatry, which I've been waiting for for a long time. So thank you. And she's regarded nationally, internationally, as a medical pioneer in this newly recognized field of nutritional psychiatry. She's been featured in the Wall Street Journal, ABC News, Harvard Health Press, Goop, and lots of other places. She's really interested in the special impact of food on mood and under mental health conditions, particularly in the gut, how the gut and food and mood are all connected. As a clinical scientist, At Harvard, she's found and directs the first hospital-based clinical service in nutritional psychiatry in the United States. This is a huge advance in our thinking about the brain, mood, and food and how it all connects. She's the Director of Nutritional and Lifestyle Psychiatry at the Massachusetts General Hospital at Harvard, Director of Nutritional Psychiatry at the Massachusetts General Hospital Academy, and she's on the faculty of Harvard Medical School. Welcome, Uma. Can I call you a minute?

Of course you can. Thank you so much, Mark. Thanks for the invitation.

Of course. And she's the author of a great new book that's coming up called this Is yous Brain on Food. In her book, she shows the cutting edge science that explains the ways in which food contributes to our mental health and how a sound diet can help treat, prevent, and reverse a wide range of psychological and cognitive health issues from ADD to anxiety, to depression, to OCD, and lots more. And I can't wait to talk to you about this because I've been waiting to find a legitimate psychiatrist who's been willing to talk about these issues in an intelligent way for the last 20 years. So I'm so excited to have this conversation with you. Thank you. Okay, well here's the deal. I wrote this book about 12 years ago called the UltraMind Solution. We were just chit chatting about it before the podcast. And I came upon this book by accident. So I was treating people's bodies. I was treating their gut and their microbiome. I was treating inflammation. I was treating their toxic burden. I was treating the nutritional deficiencies. I was doing all these things that I would do in the course of treating their physical ailments, whether it was autoimmune disease or diabetes or whatever it was. And I began to notice that they would say things like, Dr. Hyman, my depression is gone. My anxiety is gone. My OCD went away when you gave me these antibiotics to treat my overgrowth of bacteria in my gut. my memory is better, my brain fog is gone. And I was like, really? So, yeah, what's going on? I jokingly call myself the accident psychiatrist. And you've really been steeped in this world for a long time. And a lot of this has come from your own experience with your own health. And we all got into this that way. I mean, I got into it when I was sick and ended up really needing to focus on food as medicine. Same thing happened to you. So, you can talk about what happened with your breast cancer diagnosis and you talk about this in your book, this Is yous Brain on Food, and how you were making a cup of tea and you were thinking about how your life sort of completely was upside down and you were kind of nervous and scared and this light bulb went off. So, talk about that experience and how you ate and what happened and how you flipped the switch in your head to support your physical and mental health during that time.

Thanks for asking about that. It's an interesting thing because the one didn't inspire the other. I happen to be working and doing the things that I've been doing for a long time. It's only in the last, say, I would say five to seven years that we've started calling it nutritional psychiatry, but really have been doing this work since residency and had been offering advice to all of my patients and was feeling pretty healthy and well. And that was when I was diagnosed. I remember being in a, you know, I was in a fortunate position of being connected in a really great medical system. Mark, I'm sure you've had this type of experience when you've been ill. And literally in within seven days, including a weekend, I was diagnosed. And treatment began probably just about a day later than that. So it was very sudden and it was somewhat of a shock to me. And I remember None of my work that I was doing with my patients really kicking in for myself until this morning that I was going to my first chemotherapy. And there was natural anxiety. I was now facing the stuff that I'd learned about, had talked to other patients about, and now I was the patient. And there was a similar moment that happened. I was making myself a cup of green tea and the kettle shut off and I suddenly in this sort of, little bit of a state of shock, realized, you know, why am I not thinking about what I tell everyone else? Why am I not taking with me to my treatment day all the appropriate foods? And, you know, it really changed from there. From moving from state of shock, I really moved into the things that I knew had made a difference to my patients. And week after week, my oncologist as well as my fellow helping to take care of me would say, you know, we want to know what you're eating today and what did you bring in? And it was really the simple things. It was what I put in a smoothie. It was, you know, having the green tea. It was thinking about things that could combat nausea. And, you know, I was fortunate to, to really combat the anxiety that I was feeling, little things like adding turmeric to my smoothie with a pinch of black pepper and little things like that. And I truly learned to see the effectiveness through my own experience, but it was very unintentional. And so I figure out how to-.

I figure out how to- well, that's so great. So you've been down this road for a long time, then you had to practice on yourself. But what led you as a psychiatrist to start thinking about nutritional psychiatry? Because it seems like a big gap. Right?

Absolutely.

Most psychiatrists, you know, learn about this book called DSM-5, which is categorizing diseases and diagnoses based on symptoms. It has nothing to do with the cause. And you began to think about, gee, what is the cause? And explore the role of nutrition and later got into the role of the microbiome, which we're going to talk about. But how did you first go? The light bulb goes on and go, wait a minute. This is not what I learned in medical school. It's not what I learned in my.

Residency, but there's something here. It starts with a little younger life because I came from a family where food was, you know, source of nutrients, source of a lot of love, lots of cooks in the kitchen. And I brought that with me as I went into residency. And for me, cooking at the end of the day or making a meal was something where I was able to de-stress. It was a very mindful time and I didn't realize it until I put together the fact that I was enjoying getting home at the end of the day and actually cooking something. So that, you know, even from young on in my I was sort of interested in what people are eating and what types of food and what spices you use, et cetera. And where this sort of came, grew into an interest is I realized there was a real gap in my nutrition education. And I, as a resident, became very interested, you know, if I was going to prescribe, say, Zoloft, whatever it was, I wanted to know more about the side effects and how to counsel my patients. And I remember something I also wrote about in the book, which is, Patient came in and, you know, Dunkin Donuts is one of our most popular coffee shops in Boston. And he was complaining at the clinic and saying, I don't understand, you know, you put me on this medication and I gained all this weight, but he also came in with a 20 ounce Dunkin Donuts coffee. And really it was a sweetened one. A sweetened one. You know, and I broke, I sort of unpacked it from him and I said, well, how much of sugar and cream did you think it went in that? And we calculated it was more than a quarter cup of of cream, you know, as well as probably six to eight teaspoons of sugar. And from that moment, I think it was, it became something for me changed because I realized that what I went to intuitively was helping someone understand what I knew as a doctor I should be learning more about. And it led me to really study more about it and understand that if I was prescribing something, I really cared about the lifestyle changes that went with it. And I later came to understand that what I was really looking at was sort of the root cause in Psychiatry rather than putting someone into a of criteria because many of us know who practice that people just don't fall into those easily. And a lot of patients who come for nutritional psychiatry consultations and work, you know, they may not meet the criteria, but they want to find other ways to feel better. And, you know, that was the path that led me there.

Incredible. And you've gone so deep into that path. And I remember seeing the obvious cases in my own practice. This one guy came in once and he was a very overweight guy, big belly. He's like, Dr. Hyman, I get panic attacks every day at two o'clock. I was like, yeah, what happens? Well, I get short of breath and I start sweating. I feel anxious. I feel like I'm gonna die and everything's terrible and the world's closing in on me. And then what do you do? He says, well, I drink a can of Coke and it all goes away. And, you know, he was having hypoglycemia, which is low blood sugar, which was causing this fluctuating, spiking sugar. and adrenaline.

Dr. Right.

And I was like, well, and you start to pay attention to these stories and it's not the stories we link up in medical school, it's the stories that we pay attention to when we listen to our patients, which is really important and clearly that's what you've done. So how do you sort of go down the rabbit hole rather than saying, looking at antidepressant medication, which when you look at it, mental health is a big issue. We are seeing a mental health crisis in America. I recently wrote a book called Food Fix and then I was shocked to discover that the the biggest driver of costs in our healthcare system and in our society, when you look at both the direct and indirect costs, is not being overweight or diabetes, it's actually depression. Mental health issues are the biggest driver of years of quality of life loss.

Yes, and disability. Absolutely.

Disability. And she's like, well, wait a minute, this is a pandemic also, but really not talking about how to address it. And we think, oh, well, we'll take antidepressants. talk to us about how that approach has really not lived up to its promise. You know, in severe depression, it can be helpful for select patients, but for the most people who have it, it doesn't seem to be that effective. So can you talk about what the challenges are and how we need to think differently and connect diet and food?

Absolutely. So, you know, there's actually we're facing a Zoloft shortage at the moment. So, certainly, there's some shortage in certain dosages. and it's happened during this time because people have become so much more anxious and actually depressed. People were not feeling that way before. And I feel that what happens when we see people clinically is that, you know, we may prescribe, and I do prescribe medications, but some people come to me who want to try an alternate being. If they're not, you know, actively suicidal or manic, they're not experiencing the psychotic episode, it's perfectly reasonable to start with nutritional strategies. but what I find is in the medication population that I treat of patients, not everyone gets better. And I really push against having to add on a second medication if I don't need to, unless it's for a separate symptom completely, which almost never happens. So they don't get better. I always suggest that they be in other forms of therapy. So someone with anxiety should be using one of the apps that I would suggest. they use for anxiety and mindfulness. They should be doing and learning breathing exercises. They should be paying attention to exercise and sleep as well. So it's not just one component, but with the medication, they don't necessarily get better. And sometimes they develop side effects that put them off wanting to be fully adherent with the medication. And they get disheartened. And it's unclear, you know, whether they get disheartened maybe some of the weight gain happens or they're just not feeling good. And I think that there's something, you know, we need to look at the cycle.

So you're depressed, the medication doesn't work.

And then you gain weight and then you're even more depressed. Exactly. So, you know, it's sort of this cycle that they get into and they don't necessarily fit into, you know, criteria. So I do think that we need to re-examine that in a more global way, but that's where these alternate strategies can be very useful for someone who's invested in really trying to unpack for themselves what might be the problem and work in a consistent way who wants to embrace a healthier diet and healthier foods to feel better. And I think that's where this could be a very useful tool for people.

So how do you drive into the nutritional strategies? You see a patient comes in with a mental health issue, whether it's ADD or anxiety or depression, depression or OCD. Where do you start? What do you eat? What do you tell people to eat.

To fix that, to work on those issues? It's so I, you know, and more and more as I've studied the microbiome and the gut-brain connection, I move from more General when I first started my, my clinic for more generalized suggestions based on, you know, someone's individually telling me what their diet is and essentially what they're doing to a very highly personalized plan. And some of that based on some fascinating research that has come up around things like yo-yo dieting that has shown that in some animal studies that, and the science was very nicely done, that there's almost a, there's almost, for one of a better word, like a fat memory in mice that were overweight that was recorded in the microbiome. So it has taught me, that each person is so different and that I have to think about them more in terms of what they're eating, what their symptoms are, what their makeup might be. And so I, you know, first obtain a proper history, ask them what they think they should be eating and what they are eating. And often in that history taking, I'll uncover something that is a startling, most often something starting that they didn't realize. And I've talked about some of those examples in the book where they may be eating something that they perceive to be somewhat healthy, part of a diet, part of a cultural diet, whatever it is, and they actually either packing in sugar that they didn't know about, something that is obviously driving the gut in the wrong direction or driving dysbiosis. So what's an example of that? Sure. So for example, I had, and I speak about her in the book, I had a patient patient who was pregnant and had a healthy pregnancy and was eating a lot of her favorite spice, which is a Korean spice called Gochujang. But when you get the store-bought version, there's a very high, some sort of preservatives, but there's a very high sugar level in that. And she was just adding this to her healthy foods, her vegetables and her lean proteins and stuff, but she was a larger amount of it because she sort of was craving it during the pregnancy. And so some of what we had to do is really peel back on that and figure out other ways we could do that. Either we created a source that, you know, worked on a little recipe that would give her the flavors for that, but take away the unhealthy ingredients. So, you know, it's sometimes it's little things like that.

That's amazing. All right, so talk about how specifically the studies recently have shown that diet can have a profound impact on our mental health. Things like ADD, depression, anxiety, sleep issues, dementia, OCD. I mean, we don't think of, for example, OCD is being diet related or ADD is being diet related. But how are these linkages being discovered in the science now? Because I've been witnessing them for decades as a clinician and I've been waiting for the science to catch up and it's kind of catching up. So, what have you found? You're at the you know, Harvard Medical School, this is not some fringe idea. This is now mainstream. So talk about what these studies show and how we can learn about how these things are all connected.

Sure. So, you know, the basis of how I describe a lot of it is around the gut microbiome and how, and I'm sure your audience is very familiar with just how information gets formed and things like that. The way that it works with examples of things like this big anxiety. And I will speak about that because it's one of my clients are coming in most commonly with right now, the uncertainty, the fear, loss of jobs, quarantine, you know, restrictions changing and going back the next day is really creating an immense amount of anxiety. And what the studies have shown is that there's certain things that so the way that I look at it is the things that you in terms of food that you need to embrace and the things that you need to avoid. And the things that seem to worsen anxiety include foods with gluten in them. And it's not necessarily people who have celiac disease or non-celiac gluten sensitivity, but there seems to be a correlation in the studies around the level of anxiety and eating and consuming gluten.

So.

Things that are positive are the use of things like turmeric with black pepper.

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

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

So maybe like sardine curry with a little black pepper.

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

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

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

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

Zero, right? Exactly. As well as nutrition. These are not things that we've made the connections yet. There are treatments for depression like vagal nerve stimulation. There are things that actively target the vagus nerve that will help to treat depression. We sort of know some of the science around it, but we haven't put this in. And some of it goes back to something you said at the beginning, Mark. You know, going back to my story of the Dunkin Donuts coffee, from there I just began to have more of an open mind around these questions. And I didn't know when I tried to help him evolve and change his diet that it would work. Part of it was trying to see if it would. And this was also someone who had developed these symptoms also the context of that poor diet. He had not early on in his life, you know, for want of a better name for the syndromes, that that was what his gastroenterologist called it. But as that evolved and, and he ate healthier and it did take time, it seemed like he encouraged the better bacteria to grow and, you know, some of that really kicked in. So, so I do feel that that root cause part of it may take time, but we just have to figure out where it is.

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

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

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

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

I think there's 250.

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

My ears because 20 years ago, I remember having conversations with physicians talking about intestinal permeability and dysbiosis and leaky gut and they just, and gluten, and they just looked at me like I was from Mars, like I was some kind of quack. They didn't know what he was talking about. I'm like, all I know is what I'm seeing. And I see when patients change their diet, when we fix their gut, they get better from all sorts of things. and your work is so important because we've had on the podcast a psychiatrist who's talked about metabolic psychiatry, which is a role of sugar and insulin. But you're taking all this down into the gut. And, there's an incredible bunch of studies that were looked at by psychiatrist Stephanie Chung and her colleagues that looked at gut health and depression. And, they found that people with major depressive disorder had about 50 different types of species in their gut microbiome that were different from the control groups. that didn't have depression. And a lot of recent research shows that these bacterial species are associated with high quality of life are often depleted in people who are depressed. And bacteria that cause inflammation are found in a lot higher numbers in people who have depression. So can you talk about what these studies showed and the connection between this inflammation and depression? Because, I mean, I, I saw a study recently that just made me crazy, which was using TNF alpha blockers for depression. which are these powerful drugs that cost 50,000 a year they use for autoimmune disease to shut off inflammation. Why not deal with the source, which is the gut? So talk about what these studies show and how this connection exists between inflammation and depression.

So the more that we learn about the gut, the more that we realize there might actually be certain specific bacteria that are involved with the positive drive of depression versus the negative drive. I want to actually mention the study. And the reason I'm talking about it is that it's linked to this in the sense of how people don't realize the impact of certain gut bacteria and a food mechanism that can help you. A study that looked at yo-yo dieting, and this becomes significant because my patients who come in who've gained the weight from, say, a medication don't know how to get off it and they might start to lose weight and then they gain it back. And sort of Yo-yo piece of dieting has also happened with, say, reality TV shows, and people don't realize that they could actually be a mechanism in the gut. The study that was done and published in Cell sometime this year showed that in particular lean mice and mice that had gained weight, they identified that certain gut bacteria were driving this and there was almost for want of a more elegant word, like a fat memory coded in the bacteria in the gut. Then they found that if they fed back proper and certain antioxidants, that the inflammation caused by this gut memory improved. And I think that what is so cool about this is it's one of those studies that directly showed a mechanism where antioxidants worked in a positive way. And I think that for me, it goes back to the Stephanie Chung study and those that have shown the multiple bacterial species, a quality of life factor, a lowering of depression. And, you know, I think I appreciate what you've been saying all throughout this conversation, Mark, because going into this, you know, I think that I didn't, when I said at the beginning, you know, the illness that I had didn't lead to the book. It was because I wasn't sure that there was a book. I had been doing the work. But it was some of the work that got more publicity that led to my writing the book, because I knew the science was there and what this did for me is it pushed me to look at, like you were saying, you know, 700 references condensed to over 550 because there was science behind it. And sometimes, you know, we get pushed to the side as complementary alternative or soft science, but there's real data behind it. And I think that the more we can explain that to people and have them try things that, you know, it's not going to harm someone unless you have an allergy to try a different diet and to use these mechanisms to feel better. And we can be highly specific in some of these situations.

Yeah, exactly. And what you're saying is so, when you said it was so important because, you know, if you're looking at trying a drug that's very expensive or that has potential risky side effects, the bar is a lot higher than saying, why don't you stop eating sugar and gluten and eat some vegetables and fiber and fix your gut? And the evidence is there. We may not have large randomized trials, but we, we have a lot of evidence, like you said, and, and the The kinds of studies that are done now are just so compelling and so beautifully done. I remember one of the studies I looked at was the SMILES trial, which looked at just swapping out people's normal processed food diet with more whole foods. It was as good as any antidepressant, right?

Exactly. It was as good as an antidepressant. They added in counseling and coaching. You followed this diet, and then they also had someone check in with you. and ask you some questions and see how you're doing. So, you know, a lot of, say, weight loss programs have built in coaching now because there's this almost contact part and accountability part that is very helpful to people. There is a great trial done by my colleagues in Australia. And I think that, you know, one of the things that we're trying to do more of is really larger human trials. The difficulty is that how to capture some of the actual food that people eat becomes a little bit of a challenge. And so, you know, I think that we're-- Because we're not lab rats. You can't just lock us away and.

Feed us the same diet. Feed us the same diet.

Exactly.

Free living humans are hard to study.

It's hard to study. It's different if you're prescribing, you know, if you're doing a pharmaceutical trial. And, you know, there's also a lot of a lot more funding that goes to pharmaceutical and very little incentive that goes to nutritional science and nutrition epidemiology studies. There's definitely a difference. And so, you know, I do think that with the studies we've looked at, even if the numbers are smaller, we've looked at the science and tried to pull out for people facts that will be digestible to them that they can actually take home and say, well, I can try to do that. And at the end of the day, you know, I think we can always find a study that's pro one thing on the same day, a study that's against the same thing. It's how we interpret it for people and show them the balance of what has worked. And that's where clinical, you know, like you said, with so many patients that you've treated, that's where the clinical piece also becomes so important.

Yeah, it's so interesting. One of the things that you sort of write about and talk about is the role of the amygdala, which is our fight or flight reactive part of our brain that is what gets us into trouble if we're not able to manage that fight or flight response. And what seems to be going on today in our society, and I'm just literally thinking of this hypothesis now in my head, is increasing division, conflict, divisiveness, reacting out of fear, anxiety and our society seems to be falling apart based on this incredible increase in this kind of behavior, which I've never seen before in my life. I mean, there's always difference of opinion and so forth, but this is just very different. And I'm wondering if it correlates with the increases in processed food in our diet, changes in our gut microbiome over the last 50 years, the changes in, for example, glyphosate, which is over the last few years has a powerful gut microbiome destroying absolutely. Properties, which is basically weed killer that they use on 70 of our crops. So I can go on antibiotics. I mean, there's so many things that are gut busting things. Do you think there's a correlation between the microbiome and the amygdala? And do you think it's related to this change in our diet? And do you think it's connected to.

All the changes we're seeing in our society and this incredible conflict? I just, I just can't help but wonder if that's true. I, you know, I, I like, and I, I think this is a worthy hypothesis. to think more about. Certainly the rates of depression and anxiety, substance use and possible abuse of partners or people in the home increased during COVID A very short survey was done during March by the American Psychiatric Association and we haven't yet collected enough data to comment on the rates of increase of mental illness. However, separate to that, the overarching increase of disability, as you were speaking about early on in our conversation, has increased. And, you know, what has changed in the world? Well, what has changed in our lives and in the world is how we eat. That has been significantly different. Our dinner plate size from the 1920s and '30s has changed from nine inches to about 12 inches. And if you have, you know, family who come to visit you from overseas, they'll want to share the appetizer or share the main course because the portion sizes here are very different. So if you think about how our food is evolved, then you know, you talk about the high fat and the low fat issue. You talk about, you know, the use of glycolate in our crops. All of that combined with high fructose corn syrup, everything that has happened, yes, our diets have changed. I sincerely think that how we eat, not to be too cliched, but it really does impact how we feel. And I think the level of irritability, anxiety, agitation, depression, has, whether it's diagnosed or not, whether it's treated or not, has increased in society. It's almost as though people are just more on edge. And how can it not be linked to our brain and how we for sure.

I remember talking to Bruce Ames, who's one of the leading sort of scientists in the world, incredible guy, probably in his late 80s now. And he was doing studies of high fructose corn syrup on the gut, and he had this finding, which was striking, which is, you know, typically when you get fructose and fruit, it's, it's, it's a, our sugar and fruit is, is combined with glucose. Right. So when you just have pure fructose, which is rarely found in nature, which is found in high fructose corn syrup. It's free fructose, which is very different than what you find in fruit. It actually requires energy to be absorbed by the gut and uses up ATP, which is the energy modules. And he said, because of the increased volume of high fructose corn syrup, it literally is punching holes in the gut because the tight junctions, which are keeping the gut from being leaky can't stay together because it's an energy dependent process that gets interrupted because all the ATP, the energy that's used to keep the gut lining together gets used to help absorb the fructose. I don't know that's true, but it was a fascinating theory. And I was like, it makes sense because it's about 15% of our sugars and our calories is high fructose corn.

I mean, corn syrup, which is terrible. And it's in everything. It's in everything that you don't even realize. that's where I think I really feel that it has to be part of it. I don't think it's the only thing, but I don't mean to seem like I have blinkers on, but I do think that even diagnoses in childhood disorders has increased. So all of that has to make a difference as well as the facts around childhood obesity and things like that.

Let's talk about the childhood mental health issues. I grew up 60 years ago and there was that one kid in the class who was kind of a troublemaker and nobody else was pretty okay. Now you go to schools and the school nurse is like a pharmacist. She's dispensing all these psychiatric medications, antidepressants, ADD medications to kids. One in 10 kids is on ADD medication. I mean, you look at the kids' illnesses. It's not allergies or eczema anymore. It's depression and obesity are the kids' main chronic illnesses. It's frightening. And so how would you say this ADD crisis, which is exploding, is connected to diet? And how do you tend to treat these patients?

So I see I'm an adult psychiatrist, but what I know about these disorders.

Is that- A lot of adults have ADHD too.

Exactly, so I do, as I said, I do deal with that. However, one of the interesting studies showed us that we've always thought, well, sugar drives the agitation and the almost hyperactivity. There were significant studies that showed that that wasn't the cause. And I found that really fascinating because I had always thought that to me that was a clear link.

I mean, just go to a birthday party when kids are eating cake and ice cream.

Exactly. So it seems sort of counterintuitive. But, you know, I think it starts at exactly where we've been going in this conversation. It starts with what they're eating, what's happening in schools. You know, when the funding to school lunches are changed, there are industries that then moving vending machines to schools. And so kids who want a snack and where the lunches have changed are naturally driven to, well, I'm going to get a candy bar, get a bag of chips, or whatever it is. So there are things that have happened in society separate to the processes of high fructose corn syrup and all of that, and the added sugar, then the food labeling laws and the pushback from industry around the food labeling laws where they're wanting to show large labels, the quantity of added sugar, so people became more aware. if we take it to the children in our society, you know, they've basically grown up with all of this. So unless they've, if they've grown up eating the regular diet that most people eat in this country, they have therefore eaten, you know, glycosylates, they've eaten, you know, all of these processed ingredients, all of this added sugar, and how could they not be obese? So how, you know, it's almost, it's a setup sadly it's a setup for failure. There isn't anyone to blame about it. It's that how do we change that? How do we truly have them eat in a different way? I have a member of the newest member of my extended family, his parents basically decided that he shouldn't initially eat sugar until maybe he went to his first birthday party or something like that. And he eats fruit. he loves berries and you know he if you gave him an ice cream he would probably eat it because he's little but he doesn't really know that taste and it begs the question if you if you know we all have these different taste receptors and things but if you not if you haven't grown up with that super sweet taste that we have in all of our foods if you're not avoiding them then what do you do? You know and I'm really curious to see how he grows because he eats he loves fresh fruit, he loves whole foods. And it's just, again, it's because his parents have done this. So, you know, it's a big question. It's a bigger question than I have the answers to.

I mean, I just remember a kid I had with ADD. It was just so striking, and I've talked about it before, but it really got me thinking about this more specifically and actually inspired me to write this book, the UltraMind Solution. He was 12 years old. His mother brought him in because he had severe ADD and ADHD. He was so disruptive, he got kicked out of kindergarten. He was on Ritalin for years and struggled, really struggled to focus, pay attention, and had all these other problems. He had irritable bowel, he had stomach cramps, he had eczema, he had allergies. he had headaches, he had insomnia, he had muscle cramps. He had this whole list of symptoms that were unrelated to his brain dysfunction, right? According to his psychiatrist.

Right.

And I'm like, well, I don't know if I can help his ADD, but let's see if we can, you know, his guts a mess. He's, I mean, his diet, he, I don't think he ever ate a vegetable in his life. He lived on junk food. He ate processed food. He ate foods with trans fats and high fructose corn syrup. And I, you know, based on his symptoms, I projected he was going to be deficient in Omega-3 fats, deficient in vitamin D, deficient in zinc, deficient in magnesium, deficient in B6, deficient in folate. I mean, he was just deficient in everything. And his gut was a mess. And I'm like, well, let's just. Let's just see if we can heal his gut, get him off the bad stuff. Wow. Put him on good stuff. I gave him a whole foods diet, got rid of processed food, got him off gluten and dairy because he had all these inflammatory issues that often can be related to those foods. And, he did have some antibodies to glide and they weren't off the chart celiac, but he definitely had some reactions. Yeah. And, I gave him a basic multi and fish oil and vitamin D and a little magnesium because he had a lot of magnesium deficiency symptoms, which can cause anxiety, which he had. I mean, you know, we waited, you know, two months, he came back and his mother had brought his handwriting before and after, like he was treated. And before his handwriting was illegible. We call it dysgraphia. It's just illegible handwriting. It's common in these kids. These kids have bad penmanship, dyslexia, dysgraphia. Two months later, his handwriting was perfect. Wow. I was like, what happened here? And not only was his handwriting perfect, but all the other symptoms went away. His behavioral issues went away. His ADD went away. allergies, as eczema, zero about everything went away. And I was like, wait a minute, the brain suddenly went from this synchronous, chaotic, incoherent thing to this coherent, focused, synchronous functioning. And I was like, wow, if that's true, then this. And I'm on to something. And then I began to really pay attention. And so for story after story like this in adults and kids and. I think we don't really tend to focus on these approaches. It's not that we can't use medication. Yes, sometimes we need medication. Some people really need it and absolutely it's life saving for people. But do one out of every 10 kids need to be on medication? Exactly. Is that our birthright? Is that are we all genetically defective that we have to have ADHD? No, we have nature deficit disorder. We have too much Technology. We don't have enough good food.

We don't have to, you know, all- Exactly. And I love what you said about, you know, he probably never ate a vegetable in his life. And that's what happens in, you know, in, in, in with the school lunches and all of that stuff. And then you start to introduce better Foods, whole Foods, healthy whole grains, everything, depending on what they eat and depending on the specific diet. And, you know, you see the improvements. And I've certainly seen that in adult patients. who over time, you know, are able to focus better, able to manage their work better, you know, they feeling that, you know, they'll actually physically feel better. And there's almost a calming of the gut. It, you know, it really is almost like the gut is soothed. And through that, as do the transmission of the neuro chemicals and things all start working in the right way and they start to feel better.

Well, it's so true. You know, in your book, you talk about these five things that are, I think, central concepts that are so important. And I'd love you to just share a little bit about each. We touched on neuroinflammation, talking about neuro oxidative stress, neuroplasticity, emotional immunity, and the gut-brain axis and how to support that. I mean, these are really radical ideas that we never learned in medical school, but that now seemingly are what our understanding of the brain is and how we need to approach not just psychiatric disorders, but all neurological issues.

Absolutely. So, you know, we've talked a lot about the gut-brain axis and what I say to people is, you know, I may sound like your mom, but, you know, I'm telling you to eat more vegetables, eat more food. Why? Because you get the fiber from those, from the nuts, seeds, legumes, and beans, and that will help your healthy gut. That is also linked to the antioxidant foods that are rich in your diet. So, you know, when we say eat the rainbow, we are asking you to do that because of polyphenols, carotenoids, flavonoids, all of the great colors and nutrients in those foods. Again, that antioxidant load works as antioxidants against the radical oxygen species that can form during inflammation. And so you get the calming down again by eating these antioxidant foods. And so, you know, those they all, to me, all these different pieces work together, but we tend to discuss them separately as we go through it with neuroplasticity. We've understood that the brain can change. And so We understand that, you know, there are these really cool things like BDNF, which is a neurotropic factor in the brain that can actually help the growth of new cells.

It's like miracle growth for the brain. It makes new connections. Yeah, exactly.

It's like miracle growth for me. It makes new connections. And we didn't, you know, for a long time, we didn't know that this could happen. So again, I bring it back to what you eat and what's happening to your gut because you can positively affect those growth factors or negatively. You can have the miracle grow work for you or you can have work against you. And then the way that I think about the emotional immunity part is that there's a ton of evidence in a field called psychoneuroimmunology where they look at the different hormones, they look at the brain chemicals, they look at immunology. The way I bring this back to depression and anxiety in the main, I would say the more common mental health conditions is that there's a huge amount of your immune system housed in the gut. So again, the food gets to your gut and if it's the right food, you thrive. If it's the wrong food, you don't thrive and you lead to the dysbiosis, the leaky gut and all of those symptoms. That also then drives your depression, it drives your anxiety all in the wrong direction. And so, you know, we try to We sort of try to just unpack these ideas, but I feel and I hope that what people will take away from it is there are these mechanisms we know about and we understand, but that you can use food in a way to implement this. It will not cure everything. It is not necessarily the first line in this first line of treatment in severe illness where you might need a medication initially. But I have used it adjunctively with even very sick patients to help heal them as they either come off medication or get into more stable phase.

Amazing. So you find you need less medication using this approach as a psychiatrist?

Over time, not in every single case, but over time, if people come to me on medications and if they're doing much better and they're in a safe situation and we they're being monitored and can report their symptoms. We can certainly tape down the medications, absolutely. But it doesn't become a replacement. Some people do have a recurrence and we need to step in and figure that out.

Well, you know, it's amazing to me as you're talking about these concepts of the gut immune system and dysbiosis and the microbiome and nutrition and leaky gut and you're at Harvard. How are your colleagues responding to this? Do they think, oh, there's my crazy friend Uma over there who's doing her thing? Well, she's nice, we'll just ignore her, but let's do the real medicine over here. What are they saying about you?

It's interesting, you know, because I think that I had the opportunity to start this clinical service because I had mentors who encouraged me to do it and saw the different pieces that I was trying to put together. And, you know, the chair of my department is someone who did a lot of these studies in Folate most initially. So I think that I think that I think I'll know when the book comes out as to who fully agrees and who disagrees.

But they know you're working on these issues, right? They know your stuff.

I mean, people have been very supportive sending me referrals and that type of thing. And I don't want to, you know, don't want to imply like it's it's the most and largest growing service. But I think what you highlighted is some of these ideas start small in the sense that they're in larger institutions, but if someone's paying attention, we have the ability to grow them and have people come to us and have the ability to help more people. So, you know, I use the word earlier that, you know, sometimes it's thought of as a soft science and this and that, but not this evidence. And this this book really pushed me to dive deeper into what's out there and what are the studies saying. And, you know, make a choice for yourself when you read it. We do not necessarily say give up a certain food or eliminate a certain food or go on a specific diet. And the reason for that is, as a psychiatrist, I have to meet someone when they come into my office, meaning figuratively, you know, they tell me that they only eat red meat. I've got to find a way to work with them. If someone comes in and says that they're vegan, the other end of the spectrum, I've got to find a way to work with them with their independent and individual diet, irrespective of what I eat. It's really about trying to personalize that plan. And I think that more and more I'm getting a lot of referrals from my primary care colleagues and lifestyle medicine colleagues, you know, my own department sends me patients. So it's growing steadily and I'm happy about that.

Well, that's great news. I'm so excited. I'm so excited about your book, which everybody should get a copy of. It's called this Is yous Brain on Food: An Indispensable Guide to the Surprising Foods that Fight Depression, Anxiety, PTSD, OCD, ADHD, and More. And, you can find it everywhere you get your books.

And, you're also working on enhanced nutrition information for your recipes. Can you talk about that? Yes. So, I have a amazing research on my team who has studied both nutrition, nutritional science and metabolics. And what he's done is created an app that is, you know, he is still developing, but what it will do is take our recipes and break them down into the, literally the combination of what the breakdown of polyunsaturated fatty acids, fatty acids are compared to the monounsaturated fatty acids. So taking it to a much deeper level than you would normally do when you use a recipe. And I think that in this, if individuals want to sort of follow recipes from this book or in the future follow programs that are looking at nutritional elements that could be helpful to them.

You know what I'd recommend also is it's going to be a lot of work. But, you know, I don't know if you know about this, but the The Rockefeller Foundation is working on the periodic table of phytochemicals.

Oh, that is fantastic.

There's 25,000 phytochemicals in plant foods. I did not know that. And they're characterizing all of these phytochemicals. And, you know, when you were talking about the role of antioxidants in the gut and modulating inflammation, the polyphenols, these colorful compounds in plant, colorful plant foods actually feed different bacteria. so it's not just their antioxidant effect. It's actually how you literally feed the bugs in your gut. So it's not just pre and probiotic foods. It's not just fruits and vegetables. It's all these other compounds that we're just learning about. So maybe one day we'll be able to have an app that actually tracks all these. Tracks all of that. Yeah. And you know, well, these ones are super great for the brain. These are going to come to my gut inflammation.

These are going to feed these 50 good bacteria over here that improve the quality of my life. That would be really pretty amazing, wouldn't it? That would be awesome. I did not know that. about the Rockefeller Center. I'm going to look into that because it's so exciting to know that stuff like that is going on. But, you know, I think the more information people can have when they're trying out a recipe or trying out a food beyond, you know, the calories and the stuff that we've known for a while would be super helpful to them, especially if they're trying to, you know, eat the healthy fats and stuff.

Well, thank you for your work. Keep it up. We need to know more and more about the gut and the brain and food, mood and all the connections there. And everybody should definitely pick up a copy of this Is yous Brain On Food, an indispensable guide to surprising foods that fight depression, anxiety, PTSD, OCD, ADD, and more. That's a long title, but you should get the book and it's going to be fantastic. I really wish you a lot of luck. And if you've enjoyed this podcast, please share with your friends and family on social media. Leave a comment. We'd love to hear from you.

Subscribe wherever you get your podcasts. And we'll see you next time.

On the Doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called It's my weekly newsletter and in it I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health and I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S. and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, longer. Now back to this week's episode.

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