Coronavirus in Context: The Relationship Between Diet and Mental Health

[MUSIC PLAYING] Hi, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. We've talked a lot about weight gain on our show and the results of the poll conducted by WebMD. But living through this challenging time doesn't mean that you can't also eat healthy. In fact, eating better might actually help you deal with anxiety.

I recently had the opportunity to chat with Dr. Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University, about tips to eat healthier during the pandemic. In this episode, Dr. Ramsey talks about the relationship between diet and mental health as well as how to enjoy comfort foods that are delicious and nutritious. When people are anxious, often they'll turn to comfort foods.

Those foods are not fruits and vegetables. They tend to be chips, ice cream, foods that tend to have high sugar content. How do we address this issue of wanting to use food, perhaps to address some issues of anxiety?

The way that we do this in nutritional psychiatry and a lot of the focus of my work is, how do we upgrade that behavior to something that's good for the brain? So I li-- I eat emotionally, for sure. But I try to, when I'm wanting things like carbohydrates, to really think about how I can increase the nutrient density of that dish. You mention people craving ice cream. That's a fine choice sometimes-- it's easy, it's quick, it's satisfying.

But other nights, is it possible to just do a simple swap, like do some full-fat yogurt with some dark chocolate shavings, some berries, and some nuts, or have a cup of tea with honey. You know, it sounds silly as a replacement for dessert, but just to try it as an experiment. So those are the sorts of ways if you're craving comfort food. How about a kale mac and cheese? Mac and cheese is delicious. Kale--

Kale.

Kale mac and cheese is delicious and also quite nutritious.

Is it? Is it delicious?

Hey, bottom line is, increasing the nutrient density of your comfort foods is the way to win that, where you still get that satiation of soothing yourself with food. So I think we want to encourage that in patients and then help them increase the nutrient density. That-- that just needs more nutrients per calorie. Easy ways to do that are plants, bivalves, like mussels, clams, and oysters.

That's-- what we work for is kind of less shame and fear around eating for patients. We've really failed as a medical profession giving nutritional advice, and in my opinion, that we've really been centered around singular nutrients and fear-based messaging. And so we really try and promote a very joy-based message of, Mother Nature makes a lot of amazing food for you. It's all nutritious. Let's figure out how to help you really have a-- a diet that supports you, especially now during more quarantine, likely, that's happening or at least really restricted eating behaviors and shopping behaviors.

Are there a couple super foods that you recommend most people to start consuming, that maybe they're not? So for instance, I always talk to patients about blueberries. There's one superfood out there they should consume every day-- and I try to do it every day-- is a blueberry.

I love the blueberries, certainly those little anthocyanins in there. But that's really the only reason that blueberries are a brain food. They're a low glycemic inde-- index food. And then they got some press because they have anthocyanins. Lots of things have anthocyanins. And so blueberries are great, but what we do in nutritional psychiatry is we focus on food categories.

Food category so many Americans are missing when it comes to eating for the brain health is seafood. We eat about 14 pounds per person for-- per year. Americans tend not to-- we don't even have a recommended daily allowance in the US for long-chained omega-3 fats, things like the bivalves-- mussels, clams, and oysters. I love seeing those in patients' menus, really easy and delicious to cook at home. All of the benefits you get from seafood, you get from the bivalves.

We look for other food categories like leafy greens. And I talk a lot about kale. You don't ever have to eat kale. But those leafy greens are the most nutrient-dense food category. They're just water, minerals, vitamins, and phytonutrients.

I actually like kale.

OK, all right, OK.

--kale and [INAUDIBLE]. I'm not sure about the mussels and the clams, but-- but--

Well, you know--

--kale is OK.

They also can be simple, like small potatoes or small blue potatoes. Those anthocyanins you love in blueberries, they also come in blue potatoes, a nice resistant starch if you cool them, very calming, satiating, delicious comfort food that's also packed with potassium and folate and fiber. I also really love the fermented foods these days and pushing those in the sense of all the science coming out about how the microbiome affects energy metabolism, how it affects brain health and mental health.

Give us some examples of those fermented foods.

So fermented foods are things like kefir and yogurt, are probably the two most commonly consumed in America. But fermented foods are part of any culture. So kimchi, sauerkraut, natto, tofu, these-- these are all fermented foods that-- sourdough bread-- that-- that have some live bacteria in them. When we think about having a healthy, diverse microbiome, really, it's a two-step process for most Americans. They need-- most people, eating more fermented foods and eating more plants.

Is there any role for supplements in your diet?

You know, certainly supplements play a role, and I think a lot of people kind of push that, especially medicine as an insurance policy. And-- and I guess I've always taken a little contrarian stance on this. I don't think that we can medicate or supplement our way out of the health crisis and the mental health crisis that we have. I think that we have a tremendous problem in America and the types of ways-- and the foods that we eat and how we approach nutrition, wellness, and health.

And so certainly there are some supplements that play a role in mental health. We certainly use omega-3 fats sometimes to help augment in depression. There's not really a lot of data about any of these. For example, there's-- there's data about zinc. But instead of a zinc supplement, I'd love to get patients eating more papitas, more oysters, more food that contains zinc.

Real quickly, are you a believer in intermittent fasting?

I am. I like intermittent fasting. I like ketones, and I like the idea of ketosis. I think so often in dieting, nutrition, and medicine in America, we are a country of extremes. So to like ketones, intermittent fasting, mea-- means you're a, you know, ketogenic guy. I think it's very interesting--

Like that better than Mediterranean? All the data's on Mediterranean diet, Dr. Ramsey.

Well, I don't think data is what drives individual eating choice. And so as a clinician and nutritional psychiatrist, if I meet you, and you want to go carnivore, I-- I want to hear what that's about for you. If I meet you, and you are in the midst of a horrible depressive episode, and you're a vegan, I want to hear what that's about for you.

I don't want to come at this, let's get you on the Mediterranean diet because that's what all the data says. That-- I don't find that to be effective medicine s my patients. And I think it's where medicine really-- I hope we'll listen to some of what's coming out of how psychiatrists approach food and how we approach patients. We have a-- a different setting in the sense of, maybe having more time.

But we also have a stance that is maybe a bit less paternalistic. And so I want to think about for an individual, certainly, what elements of the Mediterranean diet translate to them? If somebody is using a lot of corn and soy oil, I'm going to want to hear about olive oil into their experience of it.

Well, well, OK, but then why do you like ketosis?

I like ketosis occasionally because one, it's a state that all traditional cultures have engaged in. When you look at the Mediterranean diet, I feel it's really missing from the data, is the Mediterranean lifestyle includes one to two months of fasting a year, that if you're a Greek orthodox, you're fasting a lot. You're either not eating dinner, or you're on a fast during the day, or you're cutting out certain foods.

You know, there's something about fasting states that is very spiritual, it's very deep, it's very centering. And there's a lot of interesting data about inner-- you know, when we are in ketosis, our brain metabolism shifts profoundly. Right now, if you're-- if you ate carbohydrates, your brain is running on carbs. Every neuron is firing on glucose. If you move into ketogenic states, where you're getting more ketosis, your brain starts to shift. And in ketogenic states, longer term, up to 75%, 80% of all brains fuel comes from--

Yeah, if they're done-- in fairness, if they're done correctly, you know, there-- there is some prescriptive nature of the ketogenic diet. So there-- there are some elements of that. And you know, there's-- I could argue there is the DASH diet as well, where there's very good--

There's so-- there's so many diets, right? There's the DASH diet, there's Mediterranean, there's paleo, there's Whole30. There was an amazing study about ketogenic diets, looking at three-year outcomes in diabetics and showing phenomenal numbers.

Well, I want to be fair to the other diets as well. I mean--

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And I-- and I think this is where the public and clinicians maybe shy away or get a little confused. And that's where nutritional psychiatry really helps us just get back to basics.

I might have to make some kale mac and cheese tonight. Thanks for watching Coronavirus in Context.

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