Food as medicine for mental health with Dr Adrian Lopresti and Dr Uma Naidoo

Food as medicine for mental health with Dr Adrian Lopresti and Dr Uma Naidoo

Internationally recognised nutritional psychiatrist and professional chef, Dr Uma Naidoo joins fx Medicine ambassador Dr Adrian Lopresti to deep dive into the world of nutritional psychiatry.

Together they explore the concept of food as medicine for the management of mood disorders and cognitive decline conditions.

Dr Naidoo unpacks the concept of the gut-brain axis, and how neurotransmitter production and cross-talk with the gut microbiome affects mood, and how we can influence this through dietary interventions.

Dr Naidoo shares her clinical insights to support the implementation of sustainable, positive change for our patients using food as medicine to influence behaviour change and compliance to achieve beneficial mental health outcomes.

This podcast is full of practical tips and insights into various nutrients that have been evidenced to positively lower neuroinflammation associated in mood and cognitive decline disorders, and to encourage the concept of mindful eating to support sustainable long-term outcomes for our patients.

Covered in this episode

(00:26) Welcoming Uma Naidoo
(05:32) Dr Naidoo’s approach to Nutritional psychiatry
(07:49) Food’s impact on mood and the gut/brain connection
(10:40) Serotonin and neurotransmitters role in the gut
(13:08) How dietary interventions impact mood
(16:06) Mindful eating
(19:21) Food and dietary recommendations for mood disorders
(25:10) Dietary interventions for mood disorders
(30:05) Dietary interventions for cognitive decline
(33:32) Nutritional supplementation in mood disorders
(34:44) Clinical pearls to maintain dietary changes
(41:09) Thanking Dr Naidoo and closing remarks

Key takeaways

The gut and brain are connected anatomically by the vagus nerve, which acts as a bi-directional messaging system, allowing the two organs to communication with each other continuously.
Highly processed foods create biproducts which can be toxic to the gut microbiome, leading to intestinal permeability, which may influence inflammation, often related to mood disorders such as anxiety.
90-90% of serotonin is produced in the gut, with 90-95% of serotonin receptors found in the gut. Use of selective serotonin reuptake inhibitors (SSRIs) often produces gastrointestinal side effects due to this.
Nutritional Psychiatry principles involve a push towards consuming whole foods to lower inflammation.
Fermented foods lower gut and systemic inflammation.
Phytonutrients found in plant foods help to nurture commensal gut bacteria.
Eating breakfast, consuming a small amount of caffeine, and including polyphenols such as cherries, eggplant, and green tea may improve focus in patients with ADHD.
The standard Western Diet is pro-inflammatory, contributing to mental health disorders and cognitive decline.
Omega 3s including olive oil and fatty fish such as salmon and anchovies (as well as sea-algae) have been found to be antioxidant and protective against inflammation.
Herbs and spices such as turmeric with black pepper, cinnamon, saffron, rosemary, ginger, and sage have demonstrated positive effects on cognition.
Foods that contain luteolin including peppermint, sage, thyme, celery seeds, parsley, and artichoke may improve brain fog.

Resources discussed and further reading

Transcript

Adrian: Hi, and welcome to fx Medicine, where we bring you the latest in evidence-based, integrative, functional, and complementary medicine. fx Medicine acknowledges the traditional custodians of country throughout Australia, where we live and work, and the connections to land, sea, and community. We pay our respect to the elders past and present and extend that respect to all Aboriginal and Torres Strait Islander people today. With us today is Dr. Uma Naidoo, a nutritional psychiatrist and director of nutritional and lifestyle psychiatry at Massachusetts General Hospital.

Dr. Naidoo has studied nutrition and has also graduated from the Cambridge School of Culinary Arts as a professional chef. In fact, she was awarded her culinary school's most coveted award, the M.F.K. Fisher Award for Innovation. Dr. Naidoo is regarded nationally and internationally as a net pioneer in the field of nutritional psychiatry, and is the author of the national bestselling book, This Is Your Brain on Food. It's my great pleasure to welcome Dr. Naidoo on fx Medicine, where we will discuss the crucial role that diet plays on a range of mental health conditions and strategies practitioners can use to help support their clients.

All right. Welcome to fx Medicine, Uma. Thanks for being with us today.

Uma: Thanks so much for inviting me, Adrian. It's great to talk with you.

Adrian: It's great to have a chat. I certainly wanted to really talk to you a bit about, obviously, the work that you do. And I know that you are a psychiatrist and using food as a treatment is not typical in psychiatry. So, I suppose you've been asked this question 1,000 times. How did you become interested in the relationship between food and mental health, given that you're a psychiatrist?

Uma: Part of it stems from my childhood, just being brought up in a family that was a lot of food, love, science, good eating, good nutrition, about that integration. So, food's always an important part of my life, as was science. Many physicians in my family, so a lot of discussion of science. I think the interesting thing is that when I went to medical school, I noticed there was not too much we were learning about nutrition. And even when I started residency in psychiatry, a patient very early on kind of accused me of causing him to gain weight because he'd had the side effects of Prozac, which is fluoxetine. And it wasn't actually caused by the medication because I had just started it a week before.

And it was an interesting moment early on in my career because I found myself looking at what he was drinking, which was in the Boston area, one of our favourite types of coffee is called Dunkin Donuts, and they serve them often in very large 20-ounce cups.

Adrian: Yes.

Uma: And he had this very large coffee in his hand. And I said to him, "What did you put in your coffee today?" And he said, "Well, I did this and I did that." And I calculated it for him using the computer and showed him how he was consuming a quarter cup of processed, ultra-processed creamer, laden with sugar, and then eight teaspoons of sugar on top of that, and how these were just empty calories before he had even eaten his breakfast.

His eyes lit up. It's almost as though a light bulb went off. And that really changed the nature of the conversation and our ongoing therapeutic relationship because he saw something that he could immediately change because he learned something about what he was doing. And I saw firsthand the power of just interpreting simple nutritional information to someone. And I realised how powerful could this be if I dived deeper. And although I'm not much of a calorie counter, this just helped improve the point about empty calories.

So, I really went on to try to learn more, explore more. And that's when nutrition was really an important part of how I started to integrate my work in mental health.

Adrian: And did that occur early in your career working as a psychiatrist? Or were you working more as a traditional psychologist first and then became more interested in the dietary side of things?

Uma: I started off in traditional psychiatry because you have to go through the years of training. And it was actually during my years of training when this happened. I'd always cared about nutrition. But this just alerted me to how powerful it was. And at the same time, I was prescribing very potent medications and realising that these had metabolic side effects and problems and were causing weight gain in people. But I also realised pretty early on, no one was talking about this. Medical school, you learned, oh, this is a side effect of a medication. And then when you went to residency, you would've thought that we'd be taught more about that. So I realised it was a gap, and I just started to pursue more of it.

Adrian: Yes. Yeah. I must admit I had a similar experience. I'm a clinical psychologist, so I started as your traditional psychologist doing more talk therapy. The light bulb moment for me was when I was running a social skills group for children with ADHD and a child arrived with a Red Bull in his hand. And I thought, "This can't be right." This should be a major factor impacting on his behaviour. And then certainly that's when I became more and more interested in the role of nutrition. So, absolutely. So, do you still use psychiatric medications with your patients now or is it purely dietary side of things that you look at?

Uma: I am always able to prescribe medications, and on occasion I do. But my practice is really much more pivoted towards the clinic that I founded and I run at National Hospital in Boston at Harvard Medical School, which is in nutritional lifestyle and metabolic psychiatry. So, my referrals tend to be individuals who may have a prescriber, they may be seeing, say, a primary care doctor or the equivalent of a GP who may be prescribing medications. But these individuals are looking for these additional tools to help their mental well-being. So, now, I would say my referrals are much more specialised, but I certainly believe in the power of medications.

And to be honest, medications have saved the lives of many of my patients who were seriously ill and needed that to start their well-being journey with mental health problems.

Adrian: Obviously, many of your patients would be on medication, so you see that nutrition can be a good adjunct or even alternative for people presenting with depression and anxiety?

Uma: Yes. It's always a great adjunct. And also, it's something that people overlook. They think about food, nutrition, eating habits as something associated with just type 2 diabetes, with weight gain, or let's say a family history of hypertension, but they don't associate it with their brain health or their mental health.

Adrian: So, what about then...I suppose you've got a clientele then who are coming in knowing that you're doing nutrition and that that would be part of the intervention they're going to be offered by you. With somebody who's experiencing depression or anxiety, how does food affect mood? What's the biological mechanisms going on there?

Uma: Of course. It starts off with the newer science around the gut-brain connection, which really emerged in the last decade and a half to two decades. So, if you went to medical school in the 1990s or earlier, you were not learning about the gut microbiome. And the gut microbiome has... Well, Hippocrates really nodded to this connection eons ago, modern medical science and research had to catch up. Now, what we understand about the gut-brain connection is that the gut and brain do arise from the exact same cell line in the human embryo. They then divide apart to form two different organs, the gut and brain. Then the gut and brain remain connected anatomically by the 10th cranial nerve, which is a vagus nerve, which I like to call a two-way or bidirectional text messaging system.

And this allows for the transmission of chemical messages back and forth, up and down, all day and all night, so that these two organs are always in communication. Now, when your food enters the picture, food is being digested around the same time. And when the food reaches the gut area, it is interacting with the trillions of microbes in that environment. I like to say that on days that we're eating a healthy salad or healthier meals, the breakdown products with the interaction of the gut microbes are positive for the gut environment. These examples are short-chain fatty acids. On days that we're mostly eating a fast food item and fried foods and unhealthy foods and highly processed, ultra-processed foods or junk foods, the breakdown products are more toxic because the bad microbes really start to thrive. And the breakdown product of that interaction are more toxic to the gut lining.

The moment you start damaging the gut lining, you start to create or set up for not only inflammation or dysbiosis, but you start to damage the single-cell lining of the gut wall, and you start to develop conditions like leaky gut or intestinal permeability. And that's really where the problems start and this leakage starts, and you start to not only develop inflammation, but as I see individuals go down this path, it is often going to also see an uptick of mental health symptoms and uptick of anxiety or new onset of symptoms in mental health.

Adrian: Okay. So, through that leaky gut and then the inflammation that occurs, and then obviously, the gut-brain direction. What happened to serotonin? I know that originally that was theory posited when it comes to mood, was serotonin and neurotransmitters. And I know there's more recent evidence indicating that it's certainly not just serotonin. So, where do you see neurotransmitters and serotonin feeding into it all?

Uma: So, they are part of what happens in the gut environment because this is almost like we don't understand it fully. And what I mean by this is, we tend to think of serotonin as a neurotransmitter associated with the brain, and it certainly is. But 90 to 95% of serotonin is produced in the gut, as well as 90 to 95% of serotonin receptors are on the gut. So, for example, if someone is prescribed a medication like Prozac or Zoloft, which are fluoxetine or sertraline, a selective serotonin reuptake inhibitors, some of the first side effects are gastrointestinal. And that makes sense because they have receptors in that area.

And so, the serotonin is interacting in the same environment with the gut microbes, with the food. It's all occurring in the same place. And we know the serotonin is not the only mechanism or the only answer. But we know this from newer research that's been done and published last year in the British Medical Journal, but we also know that there are other neurotransmitters involved, dopamine, GABA and others. So, I like people to think about it as a complex system, a system of neurotransmission and neurotransmitters that's interacting with the gut microbes, that's interacting with the gut-brain connection. And that ultimately, this is more of a symphony that is occurring in the body, and the gut-brain connection starts to unfold or explain that food-mood connection.

And I think that's usually a factor that people, once they start to understand that, it starts to make a little bit more sense.

Adrian: So, does dopamine and GABA also get produced in the gut?

Uma: They are involved in that environment. All of these neurotransmitters are also involved in the brain, but what I'm trying to point out is that it's more complex than either one neurotransmitter or one factor happening.

Adrian: Okay. So, when we think about food and when you are giving food and people are eating a specific diet or they're having a fatty meal or a meal with lots of processed foods, can that immediately affect their mood? How quickly does dietary interventions work with your patients?

Uma: This is highly unique because even in the work that I've done in my clinic all the time, the nutritional psychiatry treatment plans have become highly specific or personalised. Because really, our gut microbiomes are unique. It's very different in each one of us. And for that reason, each person does respond differently. The range of responses that I tend to experience with my patients, when someone makes a healthy habit change and has been, say, having symptoms of depression or mood symptoms, they can start to feel uplifted or start to feel better, or even start to notice they're sleeping better within about a week. And other people may take slightly longer if they're consistent, say up to three weeks.

But if someone is really starting to make dietary changes and almost clean up the way that they're eating just by moving to healthier whole foods, and including the nutrients, the micro, macronutrients that really boost and help mental wellbeing, they start to feel better within that first week to 10 days. It's not fully cured. It's not a sprint, it's really a marathon. And it takes time and consistency for all of the symptoms to lift or for them to feel completely better or much better. So, part of it involves patient's guidance, counseling, the correct dietary patterns that they should be following, the correct foods, a whole plan that helps set them up for success.

Adrian: So, if somebody is coming in with depression and anxiety, ADHD and you provide advice about diets and the foods that they need to eat, do they have to be 100% perfect with regards to what they eat, or is it just a gradual change that occurs? How do you work with such patients?

Uma: Yes. I try as much as possible to have a plan that is really very inclusive for people. Meaning that when people are given rigid rules like eat this, not that, which tends to be the mentality in the United States, they tend to fail. And people can only sustain giving up an entire food group. It's very different if you have an allergy or food intolerance. But if you are asked to give up an entire food group and you're used to having it every day, it's hard to sustain that habit. So, I often start with something simple that the person is willing to work on, and really build up that plan from there, allowing them for flexibility.

Uma: So, I have six pillars of nutritional psychiatry. One of them is the 80-20 rule where balancing consistency is key. 80% of the time, you're trying to clean up your diet, you're trying to eat more healthy, whole foods. But 20% of the time you may be traveling, running through an airport, you may not find the healthiest food option, and that's okay. The idea is to correct at the next meal, the next day, to pick up those habits again and remain on track as best you can.

Adrian: Yeah. I suppose that as people work and feel better, their moods will guide what they should or shouldn't eat, I suppose. That if they know that they're going to eat a particular food and the next day they're going to feel awful, then that feedback will hopefully then guide their actions. So, hopefully, that's what happens over time.

Uma: That's absolutely interesting what you're saying because the psychology of eating, mindful eating, and even mindfulness, all of these things really play into this integrative approach that I use. When someone in that first week, say, gives up a food that has been, in my opinion, and based on my evaluation, causing them troubles, causing them to have more anxiety or worsening mood, the moment an individual, could be longer than the first week, starts to feel better, they want to do more of whatever it is that is helping them feel better. And where we've instituted these nutritional psychiatry changes, they really start to be driven by wanting to feel emotionally better.

And they will come back months later and tell me, "I've been doing well. And last night was a family birthday, and I had X, Y, and Z at this birthday party, and I immediately noticed not feeling good. I didn't sleep well, I felt anxious, I didn't feel good. I had brain fog the next day." They start to notice these changes in their body and how their brain is functioning. So, it does become something they can observe over time and really, really helps to drive positive behaviour.

Adrian: Yeah. I know that certainly with some of my patients in the past, sometimes if they're a little bit reluctant, I get them to engage in some behavioural experiments whereby if they're reluctant giving up a particular food, we might then try a week where they consume that food regularly, and we'll monitor their mood, get them to do some mood diaries every day and see how that changes. And then the following week, we remove that food or group of foods from the diet, and then do another behavioural experiment where we just measure their moods over time. And that feedback then also can provide them with useful information, and hopefully motivate them to continue on the right path.

Uma: Exactly. And that's some of the work that we do as well. And it's very powerful to share those results with the patient and try and prove to them exactly what they're experiencing and show to them on a scale or a test that you can administer.

Adrian: So, what are the foods? When somebody's coming in with, let's say, for example, with anxiety or depression, what kind of foods or diet are you suggesting?

Uma: Well, first and foremost, we start off with wanting to really help improve their diet away from what is the traditional standard-making diet called sad for a reason or the Western diet, which is really high in refined sugars, processed, ultra-processed junk foods, and fast foods, and fewer whole healthy foods. So it's the principle of eat the orange and skip the store-bought orange juice because the store-bought orange juice in the U.S. has a ton of added sugar and all the fibre removed. But when you eat the orange, you can absorb and eat all the nutrients, fibre, and everything that's in the orange itself. So, it's a principle of moving towards whole foods.

So, I like to counsel people around, firstly, getting a full dietary assessment and a full psychiatric evaluation, and then asking them about one habit. And especially with COVID, almost every one of us has picked up a habit that we are not happy with, for example, around food. Not everyone, but a lot of people. And they'll say, "Well, I began eating ice cream during COVID, and that's what I have every single night with my family. So that's something that's been bothering me. I know it's not great." So, we might start there. And a couple of things that we do are not only that they start to cut back on it, we try to give them a healthy recipe that they can make, say, making ice cream from fruit and having a flavour that they like chocolate, because they could cacao from unprocessed cocoa powder that would really make it delicious and something they could still enjoy.

So, it's starting to cut back on the food and starting to replace it with a healthier version. And then we go into different categories or groups of foods. So, for example, people hear the word prebiotic and they think they have to buy a supplement, but actually, there are lots of everyday prebiotic foods like garlic, leeks, onions, jicama, bananas, and more that they can start consuming. They can also start to consume fermented foods. Fermented foods in a very big research study published in Cell in August of 2021 by a research group at Stanford, showed that eating fermented foods actually helps to lower inflammation in the body.

So, this is important because just adding fermented foods to your diet can help you fend off that inflammation that we talked about at the beginning of this conversation. And then it's the different colours of fruits and vegetables, which give the biodiversity, the fibre, the phytonutrients to feed and nurture those gut microbes. So, there's that group that you can add in. Then there's omega-3 fatty acids from fatty seafood like salmon or anchovies or plant-based sources, chia seeds, flax seeds, or sea-algae. And one of my other favourite groups as well is spices. So, I work with people down different food groups and have them start eating different components of these to really put together the ideal nutritional psychiatry plate that works for them, that are foods that consistently want to eat. One of my favourite things with spices is because they're so easy to not only flavour food, but have so many brain benefits as well.

Adrian: So, Uma, with regards to those foods, obviously there's some people who enjoy cooking and have a good background with regards to cooking, others who haven't had any experience and don't enjoy cooking. What are you doing there? Do you have...are giving people recipes? Are they attending cooking classes? How are you working with people in that area?

Uma: It all depends on the situation. Actually, one of my patients was featured with me on a segment on television in Boston because she had been a high-functioning executive with anxiety and was someone who ran a family business and really wasn't cooking. So, we did a combination of watching and seeing what the medication was doing because her primary care doctor had started her medication. We adjusted those down as we started to make dietary interventions. I provided her with shopping lists so she could buy the groceries that we needed.

And we started to make some super simple recipes all from my book, This Is Your Brain on Food. And she began to actually enjoy cooking because the moment she felt she could accomplish even cooking a simple meal for her family, she got into it. And so, some situations are that way. Other situations, someone may not quite be ready to cook, but they're willing to have a friend or family member help them make something so that they start to eat healthy, and then I provide recipes. So, it really is a combination of different things based on what the individual need is.

Adrian: Okay. Okay. So, here are the foods that are really good, or that may potentially help improve your mental health. Let's then come up with a plan on how we can kind of incorporate that in the diet. That might be that they cook it themselves or you get other support systems in place to help them with that. That sounds great.

Uma: Yes.

Adrian: What about people... So, obviously, when it comes to mental health, you've got your different diagnostic criteria, you've got your major depressive disorder, you've got your different anxiety disorders, you've got ADHD. Obviously, I suspect you'll also be seeing people with bipolar disorder and schizophrenia. Now, does the dietary interventions change based upon the disorders? If somebody comes in with ADHD, for example, are there particular foods that you would recommend for them compared to somebody who comes in with say, depression?

Uma: Yes. So, in my book called, This Is Your Brain on Food, it's also called The Food Mood Connection in certain countries. Australia actually has both versions of the book. What I do is I break down the different mental health conditions, the most common ones, and say, you took ADHD, for example. It really is, I would say that a common thread is cleaning up the diet, meaning exactly what I spoke about, sort of finding those habits that someone may have picked up that we know are impacting them. But then there are specifics, for example, it was found in a research study that someone with ADHD, really to get their day started for the best focus, they should be eating breakfast.

And this is often a challenge in those who are prescribed medication for ADHD, which often suppress the appetite. So, that's important, just encouraging them to have a breakfast. And based on the research study that was done, they actually had created a protein bar. So, since the protein bar was created for this research study, what I did is took that and made it into a protein smoothie with the same ingredients that someone with ADHD or actually anyone who wants to try it, could use that as a way to start their day right. Because it's easier for someone on occasion drink something just to encourage them to have breakfast and to maybe help their focus.

Also, it was found that a certain level of caffeine, a small amount, could help ADHD. So, certainly, in adult patients who do consume coffee, that is one option. Polyphenols, foods rich in polyphenols, specifically various cherries, things like eggplant, green tea, these help focus. So, what I try to do and what I did with the research is honed in on the condition, review the research of the foods that you should embrace, and then the foods that you want to cut back on in certain conditions. So, that helps guide people.

And honestly, I found that during COVID, because my book was released during the pandemic, people used it as a guide to start some of these dietary changes on their own. And even today, it continues to be a way that they can use it as a guide while they're waiting for a therapy appointment or something like that.

Adrian: And I'd highly recommend the book. I think it's a great book. And yeah, certainly I like how you've broken it down in the different chapters.

Uma: So, it turns out that all these years in the clinic and then comes along the pandemic, now, anxiety was always the number one condition in mental health in the United States, but it's also not recognised as such because the symptoms are, people are able to function, they just feel incredibly anxious. So, some people actually during the pandemic, really were unable to function. Also, Adrian, what happened during the pandemic, it was the first time in my career of more than two decades, a medication called Zoloft, which is otherwise called sertraline went on shortage in the entire United States.

We were being contacted by pharmacies to say, "We don't have this medication in stock because about spring of 2020, there were so many new prescriptions for anxiety and mood disorders that we ran out of the medication." This continued throughout the pandemic in terms of just the levels of anxiety. Fortunately, we were able to get more medication for those who needed it, but what came to me throughout this time was that I was seeing anxiety across all age groups, all demographics, even if someone had problems with focus, even if they had problems with their mood, they were also just suffering with anxiety.

And so, I felt that it was important to review the research, share the clinical cases, and bring this forward in a book which is called Calm Your Mind with Food: A Revolutionary Guide to Improving Your Anxiety With Food.

I'm hoping it's going to be able to help more people, especially since anxiety, we know has increased so much after the pandemic.

Adrian: Now, just a question I have, one of the things I'm experiencing in clinic is also seeing a lot of people with mild cognitive impairment potentially turning into Alzheimer's disease. What do you recommend there? Is there any foods that people can eat or consume to possibly prevent Alzheimer's disease? Are there particular nutrients that you would recommend there?

Uma: Well, a lot of the research on the MIND diet by the late Martha Clare Morris and her research group, spoke to certainly a diet that can help with really almost improving or helping our cognition. We don't have a way that we can reverse Alzheimer's or reverse a cognitive deficit that has already occurred. But one of the takeaways that I really want people to understand about cognitive issues is that you can reverse early neuroinflammation in your brain simply by how you eat. I have this ongoing positive dialogue with a colleague of mine.

We talk about this all the time, where many of us may actually be walking around with early signs within our brain that if we continue to eat pro-inflammatory, highly processed, ultra-processed junk food sorts of diets, which are not healthy for us, we could just drive and worsen that neuroinflammation, but we could also really switch out our diets and start to reverse and calm down that neuroinflammation. So, that's something that's super powerful for people to understand. I'll also say that coffee in small amounts was found to be beneficial.

Olive oil was found to be protective because of the phytonutrients, the anti-inflammatory and antioxidant properties. Herbs and spices like turmeric with black pepper, cinnamon, saffron, rosemary, ginger and sage were all herbs and spices that were found to have a positive effect on cognition. My favourite being turmeric with the pinch of black pepper, where black pepper actually activates the curcumin in turmeric and makes it more close to 2000% more bioavailable to the brain and body. And then foods that actually contain luteolin, which is an antioxidant, and some of these foods are things like fresh peppermint, sage, thyme, celery seeds, parsley, artichoke, actually help to lift brain fog.

So, that is also something that I'm seeing a lot of in my clinic with either individual suffering with long COVID or long-haul of syndrome, or just the after-effects of having a COVID infection. And it can be super helpful for them to start to incorporate these types of foods in their diet as well. I'll just say, there was a very recent study published in the New England Journal of Medicine that looked at the Mediterranean diet. And some of the conclusions were that it was not particularly helpful for the entire group in terms of dementia. But I think it's not just as straightforward as that, it's a little bit more complex, but I think it's just important to know about that study as well.

Adrian: With food, obviously you're talking about providing dietary changes and recommendations regarding particular foods. Do you ever use supplements in supplement form with your patients, or is it purely around foods and ingesting it through food?

Uma: I used to think that we could always fix things only with the way that we eat, but I've grown to realise and really have understood through my patient care and my own experiences in life that none of us eat a perfect diet. So, there are often nutritional gaps we need to fill, and that's where supplements can be very helpful. I live in the northeast of the United States, and there are many people who are actually deficient in vitamin D because of the levels of sun.

And so, I think it's important to test and not guess, and speak to your clinician about something you may not be feeling well, you may be having some symptoms, and a clinician can easily do a blood test or check that out, and you can start taking supplements. You can do a combination of supplements as well as eating foods with those nutrients to help yourself feel better.

Adrian: I've done a lot of research on saffron and curcumin, and I've done some studies on bacopa and blueberries and grapes for mild cognitive impairment. So, I agree. I certainly the core needs to be food and what people ingest, but sometimes it's not always possible and supplementation can be useful. And I agree that diet needs to be the core, but sometimes like you said, vitamin D supplementation and I know that certainly omega-3s is really important, but then I have many people coming in who just dislike fish, for example. so sometimes omega-3s can be an option.

Uma: Right. And we know that the plant-based sources are not as well absorbed, although they can use them, though, they can take a vegan supplement. But you're absolutely right, not everyone wants to consume seafood for different reasons or likes seafood. So, we have to provide options for individuals so they feel they can try different things.

Adrian: So, if somebody's coming in and you are looking at incorporating dietary interventions, what tips or clinical pearls can you give practitioners to help them support their clients, help their clients incorporate changes and also maintain those changes as they go along? Are there particular tips that you can give practitioners?

Uma: Definitely. For one thing, Adrian, we designed the first course in nutritional psychiatry, which is an online asynchronous learning course at Mass General Hospital. And it's a way to engage clinicians from all over the world to really start to use these nutritional psychiatry interventions in their practice. We also have a course that I've co-developed with the Nutritious Life School and Keri Glassman, who is a nutritionist, and that is also available for people to take online to, again, learn the principles. The tips that I have for them are first and foremost, introduce the idea of food for mood or nutritional psychiatry to your patients.

While everyone is not a psychiatrist, you can certainly employ the principles behind nutritional psychiatry to counsel your patients, to offer them guidance, and definitely work in conjunction with their physician or their prescribers so that you can really provide a comprehensive treatment plan to them that can be useful. Quite often, like I said, people come in knowing that they maybe have absorbed or started some unhealthy habits that they want to change, that's often a good place to start working with them, to stay motivated to make that change.

So, I think there are many different ways that we can start to help people. That is one good way, introducing the topic, making them aware that the food they eat is such a powerful tool. So, really the food as medicine movement that they have the power at the end of their fork. And secondly, a simple thing is starting with something that they want to change to really have them almost get tapped in or encouraged by seeing the positive benefits of a habit change because then they want to do more and the process becomes much easier.

Adrian: That's great. Now, we can go forever. I know that we really only touched on a lot of the topics that you've covered in your book. And I know you've blogged regularly. Just recently I read one on Alzheimer's and the food for Alzheimer's that you've written too. So, I think there's so much there. And certainly, the research is increasing, the body of evidence linking food with mood is increasing.

We're seeing that what we eat can help also prevent the onset of depression. And the amazing research that's going on now with the gut-brain connection it's just... Was there much around when you started practicing with the gut-brain connection, if you think back to then, how much literature was there in that area when you started?

Uma: There really wasn't. There really wasn't. It was a very rudimentary understanding. And yet, between, I want to say between 2012 and 2017, there were about 12,000 journal articles published on the science of the gut-brain connection.

Adrian: Wow.

Uma: And so, it really emerged and continues. And I think it's one of the most exciting aspects of where we are going in nutritional psychiatry. There's so many exciting frontiers for the gut microbiome. Now, it's not the only mechanism, there's certainly other mechanisms that are being researched, but I feel the one that's most tangible, like if you ask me about helping clinicians in this area, part of the reason that it's explaining one of the mechanisms without brain connection is it's tangible to people if you break it down for them.

And everyone eats, we all eat several meals a day, and then they start to connect that it's really related as well to their brain, that that's the missing link. It can be very powerful.

Adrian: Yeah. Obviously, with the diet, there's, I suppose, positive side effects that accrue, you're going to not only feel better, but physically, there's going to be a whole range of improvements in symptoms. You may also have less headaches, your gastrointestinal symptoms are going to be improved. Your energy is going to be improved. You may even lose some weight. So, there's a whole bunch of positive side effects that accrue from this.

Uma: That's exactly right. People may do this for different reasons, but the moment that they say, "Lose a few pounds," they start to really realise they're feeling better and they're feeling better emotionally, but they're starting to feel physically better, physically stronger, and it starts to come together for them. So, for me, it's whatever that first positive impact is that really can help us along the continuum of helping people.

Adrian: All right. Uma, thank you very much for being with us today on this podcast. I certainly recommend anybody who hasn't read your books and it's certainly the upcoming book. I'm really looking forward to that, to really check that out. And you mentioned the courses that are available. I think that's really important for practitioners to be able to educate themselves, not only about the connection and the foods that people should eat, but also the behavioural changes, how can you support your clients to be able to make the changes, which I think is extremely important. So, thank you very much for joining us today and it's certainly been great talking to you.

Uma: It's been wonderful to talk to you. Thank you so much for your support. And I really appreciate you sharing my books and my courses with your audience. And hopefully, the idea is to spread the word and help more patients, but also help more clinicians learn about this kind of work.

Adrian: All right. Well, thank you everyone for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the fx Medicine website. I'm Dr. Adrian Lopresti, and thanks for joining us. We'll see you next time.

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