Feed Your Mental Health: Drew Ramsey (Transcript)

Here, I’ll demonstrate. Radical truth.

I’m a 45-year-old physician. I’m married. I have two wonderful children. I’m confused about what to do. We moved in with my parents in the poorest county in Indiana, like in the same house. I live with my parents. Radical truth. We have a mental health epidemic on our hands.

Prioritizing Mental Health

The radical truth is I think that none of us really prioritize our mental health as the most important aspect of our health, that that’s really what we should be thinking about. So often we think about mental health in terms of mental illness. You’ve heard that statistic, one in five people have a mental illness.

You should be aware of it. These people over here, you folks with depression, anxiety, panic disorder, OCD, dementia, addiction, those folks. That’s not working for me anymore.

I wonder what happens if we really change this narrative. What if we stop thinking about mental illness? It doesn’t work for me because if I go back in my family tree just a little bit, I see all those illnesses, depression, anxiety, suicide, addiction, dementia.

Mental Health Version 2.0

So I don’t think it’s one in five of us. I think that makes my family just like your family. And if five out of five of us are working on our mental health, I think that’s how we take on the mental health epidemic.

And that’s my request of you today, to think about that mental health version 2.0 of you. Like what would that look like? We think about building our physical health.

There’s so much that we can do. I was in the gym this morning getting ready, building my physical health. What about if you’re going to build your mental health?

What if instead of catering between mental illness and mental health, we really think what is that next version? Like what would Dr. Drew Ramsey mental health edition 2.0 look like? He’s emotionally resilient. He’s optimistic. He has amazing sleep hygiene.

Building Mental Health

That would be great. What would that take for you? What are the things that you can do every day to improve your mental health? And more importantly in some ways, what are the things that you’re doing every day, at every meal, to take away some of your mental health?

Instead of having a brain that is vibrant and growing as all brains can be, you have a brain that is shrinking, that is not filtering the world as a joyful and happy place. Let me tell you, this couch has taught me so much for my patients. People think that I treat mental illness, but I think I build mental health.

Let me tell you about a young man who graced my couch recently. We’ll call him Pete. Pete’s a college freshman, and he’s struggling with his mental health.

Pete’s Struggles

College is not working out the way that he thought it would. He feels kind of foggy in class. He falls asleep. He can’t sleep very well at night. Maybe it’s the Netflix. Maybe it’s the video games.

We’re not so sure. He is having some dark thoughts that he’s not ever had before, and he’s a little tearful sometimes. He’s having a hard time going out because he feels anxious.

What would you do for Pete? It’s really easy to give people advice about their mental health. Like, Pete, cheer up. Go out. Join some clubs. Talk to some girls.

Nutritional Psychiatry

It’s a college. There’s a new field in mental health called nutritional psychiatry, and it’s based on a lot of data that looks kind of like this. Researchers in Spain followed 10,094 university students over four and a half years. And at the beginning of the study, they looked at their diet and ranked it.

How close did they follow the Mediterranean diet? You know, that great diet that’s good for everything with olive oil, fresh fruits and veggies, lots of nuts, some seafood? Over four and a half years, the students who adhered most closely to a Mediterranean diet, just actually in the top half, they had a 42% to 50% decreased risk of getting depressed.

Just think about it. Think about that was just half true, just 25% lower risk of getting depressed. And what about for patients like Pete who are already struggling with their mood? I mean, that’s a correlational study. You’ve all heard that, like, correlations don’t equal causation.

Treating Depression with Food

Well, a randomized clinical trial, the first ever that used food to treat clinical depression was just published January 31, 2017. Researchers took individuals who were struggling with their mental health, already had depression and were in treatment, and they added on the Mediterranean diet. That sounds kind of nice.

They had seven sessions, and what they found is over 12 weeks, 33% of those people went into full remission from their depression. They were already in treatment like a lot of people were, but they weren’t getting all the way better. It got me wondering in my clinical practice, like, what should I be telling Pete? I mean, make no mistake about it.

I’m a full, card-carrying psychiatrist. I prescribe meds. I find them helpful and effective to lots of people. I do lots of psychotherapy. I like to talk about your mom a lot. I think it’s fascinating.

Nutrients Correlated with Depression

Hi, Mom. We can talk about my mom later if I get back on the couch. But I wonder what foods scientifically could I prescribe or think about prescribing to Pete. So a colleague, Dr. Laura Lachance, and I looked at all the scientific literature.

We looked at all of the vitamins and minerals and tried to figure out which are most correlated to depression. We found there were 12. And then we got this question, this key of nutritional psychiatry, that if you’re going to count calories, you should only do it for one reason, and that’s to figure out what’s called the nutrient density. It’s a key part of nutritional psychiatry.

We want you eating more brain nutrients and focused on that instead of calorie counting because it’s like a can of Coke, 140 calories. Kale salad, 140 calories. Not that hard. We found that there were a set of foods, and it taught me a lot about how I prescribe food.

Brain-Boosting Food Categories

There were a set of food categories that have the most of these nutrients that are correlated with brain health, things that you read about, the long chain omega-3 fats and B12, vitamin B9, folate, magnesium. And they divided into these categories that led to a little rhyme that I shared with Pete. Seafood, greens, nuts and beans, and a little dark chocolate.

Pete was like, what’s at the top of that antidepressant food scale, Doc? I was like, oysters and watercress, Pete. And he didn’t really think those sounded like the most delicious foods. That’s why we think about food categories.

It’s these food categories of seafood where you find these fatty fish. Women in college who eat two servings of seafood a week have a 25% lower risk of getting depressed. Women who eat more fish during pregnancy are six times less likely to get depressed in the postpartum period.

The Brain Food Box Study

Researchers took this kind of data and they decided, you know, let’s do something, let’s keep struggling, let’s put Pete in a little study. It’s really interesting, just published about three weeks ago. Researchers in Australia took 100 students with depression and with bad food habits and they gave them a box.

They’re like, hey, Pete, what’s up? Here’s a little box of brain food, bro. Pete’s like, well, it’s in the box. You open it up and it’s like olive oil and nuts and these little factors of the Mediterranean diet.

And then they asked Pete to watch a video. Pete likes watching videos, so that worked. 13-minute video where they recommended brain foods, eating more vegetables, eating seafood three times a week, eating three tablespoons of those nuts every day. What they found is over three weeks, the students who got this intervention, their stress, depression, and anxiety scores dropped by about 30%.

Western Diet and Brain Shrinkage

And that drop stayed for the next three months compared to the students who didn’t get anything. Changing diet seems to profoundly influence our brain. And maybe it seems like a simple statement, but it’s something that we often don’t connect, that when we think about how to feed your mental health, when we think about mental health version 2.0, maybe it’s the farm boy in me, but I want a foundation to be built out of whole, real foods.

It’s very, very clear that when we eat a Western diet, your brain shrinks. From age 60 to 70, actually, you lose about the size of my pinky in terms of brain cells. Now, that’s a lot of brain cells. I think you want that for your mental health.

Setting Mental Health Goals with Food

There are so many goals that you can set for yourself, that mental health 2.0 edition, but I hope these foods are part of it. I said to Pete, Pete, maybe not oysters, but are there any seafoods that you might eat? I asked some of the 8th graders this earlier, and they’re like, shrimp.

I said, great, good place to start. Shrimp, not the most amazing source of omega-3 fats, but a way to begin developing that palate. Because it doesn’t work, I found, in mental health just to give you all a list of foods. Like, eat the wild salmon, eat the blueberries, kale.

That doesn’t help. What helps is really encouraging you to find a joyful place with food, and to think about these food categories. Seafood, greens, nuts and beans, and a little dark chocolate.

The Power of Greens and “Brain Bows”

Now, leafy greens, that might sound hard, but they’re such a wonderful, nutrient-dense food. Think about all the calories you get in a few ounces of something like kale, or arugula, or Brussels sprouts. They should be a foundational piece of your diet.

Now, not in my seafood, greens, nuts and beans, and a little dark chocolate, that I hope you will take into your mental health journey, is a very other important factor, a simple test when you look at your plate. Do you see colors on there? Do you see a rainbow of colors?

Pete was like, rainbow of colors from my brain? I was like, right, Pete? He’s like, you should call those brain bows, Doc. I was like, brain bows? I was like, Pete, you’re starting to get it, bro.

Seafood Consumption in the U.S.

Brain bows. So, seafood, Pete, what are you going to do? Fish tacos, maybe a little ceviche, right? It’s one of those things that’s so hard for Americans.

We eat about 14 pounds of seafood a year. And not folks like me and Pete. I grew up in the Midwest. Fish meant fish sticks. I didn’t fish until I was 30.

Yeah, fish sticks, like, ooh. But again, that challenge to yourself, building more mental health, it’s not like you’re going to wake up tomorrow and there’s a better version of you. But little steps at mealtimes to cut out these foods, the foods that I think we all know now, are really, really bad for your health.

Nuts, Beans, and the Microbiome

But the part that hasn’t really made the news is how bad they are for your brain. And again, that’s your miracle. I mean, that’s the most important asset you have by far. Now, why nuts and beans?

Well, nuts are a great snack, first of all. And also, nuts contain a very special scientific fact about them. There’s a molecule in your brain called BDNF, brain-derived neurotrophic factor. And besides building better brain cells out of all this great nutrient-dense food, we also want to get your brain into grow mode.

And BDNF is responsible for that. There’s only one study that’s ever been published looking at BDNF levels in relationship to food. And they found when they added nuts onto a Mediterranean diet, there’s actually a protection against getting severely low levels of BDNF, that factor that seems to help your brain grow and repair. It actually even spawns the birth of new brain cells.

The Gut-Brain Connection

I’m 45. That sounds amazing to me, more brain cells. And why beans? Well, the forefront of science and brain health is that a lot is going on down here that affects your brain.

We call it the microbiome, all the bugs in your gut. It’s surprising because in medicine we’ve been killing bacteria for hundreds of years. Now we want you to eat it.

Trillions of bacteria, billions and billions of bugs down here. And the type of food you eat directly impacts what lives down there. Now why is that important to our mental health? We’ve heard this buzzword, inflammation.

Inflammation and Mental Health

It’s like circling around, like, oh, chronic disease is caused by inflammation, heart disease, diabetes. And it turns out depression and dementia are related to inflammation too. Where’s this inflammation come from?

Well, the largest part of your immune system is actually your gut. And when we eat a more plant-based diet, when we eat more of these rainbow, brainbow vegetables, we have a diverse microbiome that looks like it supports your mental health. Your gut is in constant contact with your brain.

And in fact, over the last year, there have now for the first time been studies published looking at the microbiome of individuals with depression and anxiety, seeing it’s a little bit different. For the first time ever, clinical trials using probiotics to try and do things like prevent people with bipolar mania getting re-hospitalized.

Food as Part of Mental Health Care

Now, I don’t want you to leave here with any confusion. So often nutritional psychiatry gets used as this idea that like, gosh, if you just take a little apple cider vinegar in the morning, you won’t ever get bipolar disorder. Or if you just eat a little bit more kale.

And my patients and I and you, we all deserve better than that. That’s a stigmatizing attitude that makes some notion that whatever your journey is, if it’s medication, psychotherapy, wherever it takes you, meditation, that as you build Mental Health 2.0, one thing is so clear that food needs to be part of it.

Conclusion: Pete 2.0 and Prioritizing Mental Health

Now, there’s a little time in session where it gets tough, our last minute. There’s so much more to talk about with your mental health. I hope it’s really clear to you that there is a substantial amount of data that gives you control, that gives you something that you can do every day, three times a day, four times a day if you snack on nuts, that you can just move that ball a little bit down farther field towards Mental Health 2.0 version of you.

Now, you might wonder what happened. You know, Pete. Pete 2.0, what would that look like? Radical truth. I’m Pete. And I worked really, really hard to build my mental health, to take care of the mental health of my family and my patients. And I want to make sure from this moment on that you think about prioritizing and taking care of your mental health. And I hope you will feed your mental health. Thank you.

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