Depression, anxiety, low libido… your mood is directly related to what you eat. Nutritional psychiatrist (and chef) Uma Naidoo, MD, examines the “gut-brain romance” and explains the delicate balance between your diet and your mental health. If you haven’t given up junk food to lose weight or reduce the risk of diabetes, maybe you’ll do it to feel happier? Plus… what happens when you try too hard to eat healthy.
Phil Stieg: Hello, I’d like to introduce Dr. Uma Naidoo, director of the Nutritional and Metabolic Psychiatry Department at Massachusetts General Hospital. Good nutrition is about much more than weight loss, fitness or longevity. In her book, “This Is Your Brain on Food,” Dr. Naidoo clearly explains the gut brain relationship and provides straightforward diet recommendations. Dr. Naidoo, thank you for being with us today.
Uma Naidoo: Thanks for inviting me.
Phil Stieg: For those of us that this is all a new subject, can you really explain to us what the concept of nutritional psychiatry is?
Uma Naidoo: Yes. So nutritional psychiatry is the use of healthy whole foods and nutrients to improve our mental well being, based on the current scientific evidence, and it does not exclude the use of therapy or medications. In fact, it’s really meant to work in Symphony with one another. And I think that is very important for people to understand.
Phil Stieg: When you go out and give talks, is there a surprise reaction by the connection between food and mental health?
Uma Naidoo: I think the AHA for people is that food actually does impact your mental health because most people, especially in the United States, think about food in terms of waistline or type two diabetes or other things like that.
Phil Stieg: I think your book beautifully laid it out. You don’t have to read it from page one to page 200 and whatever. You can take chapters out depending upon where you are in the brain health spectrum. And I think that’s great. In your first chapter, I love the term “gut-brain romance”. For the lay person like me can you explain, what’s the process that’s going on in this romance?
Uma Naidoo: The “gut-brain romance” is interesting because the gut and brain Are kind of like a couple, and in a relationship, they’re good days and bad days. And that was why I used the words romances or not always romantic. But just this way, also, in relation to food, the gut and brain Originate from the exact same cells in the embryo. Then they divide apart to form the two organs, the gut and the brain. Then they are connected throughout life by the vagus nerve, which is the 10th cranial nerve, and acts like this connector, this two way Super Highway between the two organs.
Very simply, on a day that you eat a healthier meal, the breakdown products of digestion are healthy for the gut and the gut microbes, and they are healthy for the brain. On a day that you’re heading to the fast food restaurants the highly sugared, Highly processed, ultra processed junk foods and fast foods and other foods that are not healthy for our brain, their breakdown products are more toxic to the gut and the gut microbiome, and they start to set up for inflammation.
And those more toxic products are sort of a bad day in the romance because you start setting up inflammation, and what they start to do Is damage the layer that lines the gut. And ultimately, over time, if that’s the diet that you persist on eating, It leads to things like what is often called leaky gut or intestinal permeability. So that just sort of breaks down that there are the good days and the bad days in the romance.
Phil Stieg: It’s funny, because I know that when I’m cheating on my diet. There are certain restaurants that I can go to, and I know the next morning, I just wake up slow, And I don’t have the same energy levels. And it’s exactly that interaction that occurs very quickly and affects you.
Uma Naidoo: It’s true. And things like stress can actually start to evolve and change the microbes within 2 hours of that stress impacting you.
Phil Stieg: You state that your goal is to show us how we can integrate diet with better mental health. But you make the comment that what works for the group, which is the group studies and the scientific data that you provide, doesn’t necessarily mean that it’s going to work for Phil Stieg. And that’s an important comment. There’s a little bit of trial by error in this, correct?
Uma Naidoo: Yes, that is correct. And part of that is related to the uniqueness of the gut microbiome. We really are thinking and the science is showing us that it is incredibly unique, like a thumbprint for every one of us. I often will say every healthy food is not healthy for everyone because our body responds differently. And so you’re absolutely right. It is highly nuanced. And not everything in a group study is going to work for that individual.
Phil Stieg: Today, I wanted to focus on some of the more common things that I’m sure you, as a psychiatrist and many psychologists have to deal with. Obviously, the most common thing is depression. Clinically, what does that mean to you when you say somebody has the diagnosis of depression and then what are they doing from a diet standpoint that they should start avoiding?
Uma Naidoo: Very often with depression, some of the nuances are things that people don’t realize. They may be eating a sandwich for lunch and thinking that they’re getting a low-fat deli meat. But some of the more processed packaged meats and cheeses are loaded with nitrates and actually have been shown to worsen depression.
So it starts off by thinking about how a person is eating. They might have heard that yogurt was healthy, but they’re eating a fruited blueberry yogurt. And although blueberries on their own are healthy, the fruited yogurt in a half a cup serving could have 24 grams of sugar. So it’s very important for them to understand that they have options and that they can be better versions of what they’re eating. So they can have yogurt. Just have a plain yogurt, add the berries, but avoid those loaded sugars that are added into things like fruited yogurts. Sometimes people are really making an effort, but they don’t realize the big impact of the small things like those added refined sugars, which affect the body and the brain, most importantly.
Phil Stieg: So in depression, high carbohydrate, high sugar content is one of the major things that an individual should avoid?
Uma Naidoo: Correct. So I wouldn’t want them to avoid all carbohydrates. I’m really talking about highly processed, refined grains and things like processed sliced bread, tons of pasta. No one is saying don’t eat pasta, just eat it in moderation. Things like baked goods or daily donuts that have highly refined sugar. Simple carbohydrates. Lots of foods that have high fructose corn sugar syrup, but also artificial sweeteners. Aspartame is pretty harmful in depression, saccharin, sucralose, and even stevia. So these are things that someone has to be really careful of to cut back on.
Phil Stieg: Do you have any advice for individuals when they go to the grocery store, they always say avoid the aisle with the freezer in it. It’s really hard to find things that don’t have a lot of sugar and carbohydrates, even cereals. You think you’re doing the right thing and you’re not. Any advice?
Uma Naidoo: Firstly, I think we need to advocate for ourselves. We have to understand food labels a little bit. For example, I’ve seen many moms misunderstand the food label because of how a cereal is said to be whole grain or whole wheat. Actually, it’s the last ingredient, it’s the least amount, and it’s actually highly sugared. This trickery around food labels is something we need to take upon ourselves to understand a little bit by looking at the amount of sugar. Looking at the actual whole grains of fiber in the content of the food.
The whole point about the produce section is that vegetables and fruit, as well as beans, nut seeds, legumes, all contain fiber. And we desperately need that not diet because some large database studies have shown that only one in ten Americans eat enough of their vegetables and fruit, and that’s our biggest source of fiber.
So lean into the colors, the textures, try out different flavors. And also the other thing you can do is think about if you don’t want to spend the time cleaning and prepping the vegetables, go to the frozen section. Buy frozen veggies, not frozen foods and frozen pizza, but frozen veggies are actually an economical way to get them. They will last longer and they’re flash frozen. So unless they have sauce or sodium or syrup, they’re actually pretty healthy.
Phil Stieg: There’s a spectrum, I’m sure, between clinical depression, where you feel that you need to provide medication, but also appropriate depression. I lose a loved one. And I know that I feel just kind of down because something bad happened. Can I go eat something? And what are those things that I should look for to eat to help me feel less depressed?
Uma Naidoo: So like I said, one of the things we want to think about is we want to take away a habit that you might have been leaning on when you weren’t feeling good. Maybe it was a tub of ice cream in the evening. Maybe it was having too many glasses of wine in the evening. Stop there and then start to add in foods like those rich, colorful vegetables. Things like leafy greens actually are rich in folate. Low folate levels are associated with depression. Things like omega three fatty acids. So fatty fish like salmon, wild sockeye salmon, anchovies, sardines, but also walnuts, flax seeds have omega threes, the short chain omega threes in them.
Phil Stieg: Can you do it from the nutrition segment to the drugstore? Go buy omega three, go buy folate. And it’s not as pleasant. But can you do it that way?
Uma Naidoo: So it’s not ideal. I’m much more of a food first person. Let me explain why. When you eat the spinach, the arugula, the leafy greens, you’re also getting the other nutrients and you’re getting the fiber. Fiber is important for our gut. Remember the “gut-brain romance”? It’s the good food that helps along that romance.
So there is a place for supplements. For example, saffron has a good amount of evidence of helping depression, but we can’t eat enough of it. The clinical trials used much higher doses of saffron because they used a supplement. That’s an example of where a supplement could be helpful. But for the most part, a lot of the other foods I would suggest trying first. But if you say you don’t like seafood and you don’t eat it for that reason, you can always look at getting a supplement because it’s certainly going to be helpful.
Phil Stieg: I live in New York. Anxiety levels are always high, even on a good day. What’s going on with anxiety, number one? And number two, what can we eat to reduce our anxiety levels, or at least not to enhance the external causes of anxiety?
Uma Naidoo: For one thing, I think that anxiety – it’s an emotion, it’s a feeling. It’s certainly a clinical diagnosis and all of that. But a lot of people in these times may not meet the criteria called for anxiety. But are just feeling very unsettled, worried, concerned. I think that again, we start with things like caffeine. Are you drinking too many cups of coffee a day? Are you leaning into diet soda because the artificial sweeteners are disrupting your gut and are probably driving your anxiety. Are you including fiber rich foods in your diet? This is where you can really help yourself. Fiber rich foods break down slowly in the body. So beans, legumes, lentils, broccoli, Brussels sprouts, any one of those. But high fiber foods will help you keep your blood sugar on an even keel and keep you on an even keel.
Fermented foods. Great idea to add fermented foods in your diet because things like kombucha, miso, tempeh, and sauerkraut can actually help with inflammation in the gut. And a very important study from an important research group at Stanford showed the fact that eating fermented foods lowers inflammation. So fermented foods are another one.
And then spices, spices like turmeric with a pinch of black pepper will really help you with anxiety over time if you just slowly incorporate just a little bit into your diet every single day. Quarter teaspoon of turmeric with a pinch of black pepper to make it more bioactive, bioavailable to your body will help you over time and add it to a super smoothie or a tea if you don’t cook.
Phil Stieg: For me, spices make me anxious, so I stay away from them. You’re a psychiatrist, and I think that I wouldn’t want to lead the listeners down the pathway that I’m depressed or I’ve got an anxiety disorder, I’m going to cure myself with a diet. For you, when do you start with medication? What’s that dividing line between being symptomatic to the point they need medication versus when you say, I think we can fix this with diet?
Uma Naidoo: That’s a very important question because as I mentioned, I still prescribe medications. And when someone is acutely ill, suicidal, severely depressed, unable to get out of bed or losing touch with reality, this is a time where they might need an emergency hospitalization and really active treatment. It’s really individuals who are coping, who are functioning but not feeling as well as they could be. Talking about brain fog. They’re still able to get to work, whether it’s virtual or in person, but they are struggling to get the task done. So they’re getting by, but they wish they could be more effective. That’s a great example of someone who might be able to use dietary interventions immediately.
Sometimes we start with a combination of medications. They may be on medication. And over time, as the dietary changes kick in and they’re feeling better, we might be able to work with their prescriber to lower the medication or just that. And that happens quite a lot as well. So sometimes it’s a combination, sometimes it’s dietary interventions only. But much of that depends on the clinical evaluation that they are otherwise safe, that they are functioning okay and can tolerate working on these dietary changes. In other words, they have to have the energy to implement the changes.
Phil Stieg: Throughout the book, you list what’s bad for you food wise and what’s good for you for each one of the disorders that you focus on. And it seemed to me that in every chapter you always said the bad thing was the American diet.
Uma Naidoo: So the Western diet or the standard American diet is really high in the wrong types of fats: trans fats that go into shelf-stable baked goods and cookies and breads that are shelf stable, highly refined flours. Remember, you don’t have to give these up immediately. You may not have to give them up at all, but you want to eat them in moderation. You don’t want to lean on those packaged processed foods as the main source of your nutrition.
Things like added and refined sugar are found in most foods, often in savory foods. So ketchup, salad dressing, pasta sauces that are store-bought often have a ton of sugar. Don’t realize that’s where we have to be savvy about food labels. Artificial sweetness in those diet sodas or foods labeled as sugar free or low sugar are important because they can worsen our symptoms, especially in mental health. And then processed, refined vegetable oil, soy, corn, those types of things are really often used in fast food restaurants and certain restaurants because they are more cost effective. But they are pro inflammatory to the gut and we want to be careful around them
Interstitial theme music
Narrator: These days, between the highly detailed packaged food labels to the calorie counts in restaurant menus, we have many tools that can help us be careful about what we eat. But is there such a thing as being too careful?
(restaurant sounds)
Researchers are starting to pay attention to an emerging eating disorder called “orthorexia nervosa – an unhealthy focus on healthy eating. It can have the opposite of its intended effect, leading to malnutrition and dangerous weight loss instead of improved health.
(restaurant patron: “Excuse me waiter, is your egg salad option guaranteed to be completely vegetarian?”)
Narrator: Unlike the better-known eating disorder “anorexia nervosa” (where sufferers try to limit all foods), orthorexia is an overwhelming obsession with eating only “good” “healthy” and “pure” foods. When the health and purity of someone’s food becomes the only topic of conversation – an obsession, even – that’s when orthorexia may be suspected.
Although it’s not an officially designated mental health diagnosis, experts are still debating the diagnostic criteria. Orthorexia may be experienced at one time or another by nearly 5% of American adults.
Therapists who study this strange phenomenon have described not only malnutrition and other physical effects but also emotional consequences and distress when someone can’t live up to the self-imposed purity ideals.
They also note that while those with anorexia usually hide their eating issues, people with orthorexia tend to be open about them. They may even try to recruit others to their way of eating.
(restaurant patron “…and then, as soon as I decided to do only green vegetables and almond milk, I could immediately feel the toxins leaving my body… “)
Narrator: Orthorexia may start as a healthy concern for one’s diet, but can spiral down in a pattern of obsessive thoughts and destructive behaviors. Orthorexia can often lead to social isolation, as fewer people can share the sufferer’s increasingly restricted palate.
(restaurant patron: “You know, there’s nothing on this menu I can eat– I guess I’ll just have to go home…”)
(restaurant sounds fade out)
(closing theme music)
Narrator: Treatment for orthorexia is a slow, gradual process of re-introducing foods that had been a cause of fear and anxiety. Patients eventually learn that one need not obsess over a meal to enjoy it.
Interstitial theme music fade out
Phil Stieg: Throughout the book, I was impressed with just the undertone that basically the individual has to be proactive. This stuff doesn’t just happen on its own and the brain needs energy, so it’s going to want to eat and feed the body and feed itself. But give us advice on how, or what measures you take and recommend to your patients on being proactive regarding a healthy diet.
Uma Naidoo: What I find in all honesty, is that people come to me because they want to tweak something in their diets. They come to me for nutritional psychiatry advice. So that is an advantage to me because they come in with some motivation or some awareness that there’s an issue. But then I ask them to start with one thing that they want to change, that they’ve identified as a problem and that they want to change because what I find is that that usually works the best and that the moment they start to feel better changing or tweaking that one habit. Sometimes it’s a matter of days before I get an email. I’m sleeping better, I have more energy today. I’m not saying that everything happens that fast, but some of it is a psychological viewpoint. You’re really working to almost improve your own health, and that is motivating to you.
What I do find is when a person starts to feel better, they want to do more, they want to do so much more. And that is often a path that we go down together. And they feel motivated because they just started to lose weight or they can concentrate better at work or they’re sleeping better.
Phil Stieg: Can you maybe highlight an example of where you met a patient, recommended a diet change, and all of a sudden, their life was transformed?
Uma Naidoo: Well, it happened earlier in my career that kind of pushed me in this direction. A patient kind of came and yelled at me and I was a very timid resident at the time. And he said, you prescribed Prozac and you caused me to gain weight. I knew from looking at the chart, looking at the medical record that it wasn’t me. And we had his baseline weight, but he also was carrying this very large 20 ounce cup of Dunkin Donuts coffee, which everyone drinks in Boston.
And I said “well, what did you put in your coffee today”? And so he told me, and it ended up being a quarter or more of a cup of processed creamer and about eight teaspoons of sugar. So I sat down at the computer and we calculated the number of calories consumed. Now, I don’t feel calorie counting is the be all and end all of nutritional science, but it’s one aspect. And I proved to him that he was consuming so many empty calories, the sugar, the processed creamer, that his eyes lit up. And that really was my AHA moment, because he felt, you’re telling me something that I can change. I’m drinking this seamlessly every day, but also mindlessly and just consuming all these empty calories then that’s even before I have my breakfast.
So when we worked together, they ended up being a really good, effective and therapeutic relationship, stopped yelling, and started working with me much more effectively. We cleaned up little things in his diet, starting off right there with a cup of coffee. He lost weight over time – it was gradual. We didn’t need to increase his dose of Prozac. He was able to stay in a pretty low dose. He felt a lot better when he lost the weight. The medications kicked in and his dietary changes kicked in. And I realized the power of working with someone when they feel that they can advocate for their own help and make the changes.
Phil Stieg: Let’s maybe wrap this up with a little bit of talk about the ever-present subject of libido. I thought it was good that you dispelled many of the facts about aphrodisiacs, like oysters, you’ve ruined Valentine’s business with strawberries. In Italy, they always talk about sea urchins. And then there’s rhinoceros tusk. What can you tell us a little bit about some of the things going around about aphrodisiacs?
Uma Naidoo: It’s interesting because foods that boost oxytocin – oxytocin is sort of that “hugging hormone” – include foods that actually could be on a Valentine’s Day list, like dark chocolate. (But it’s the extra dark chocolate. It’s not the candy bars we’re used to.) Some magnesium and essential acids are found in certain foods, like certain meats, certain vegetables, etc.
And then nuts are a good one because pistachios, almonds and walnuts have some good evidence behind them and they can be added to foods that you enjoy. I actually put together an avocado chocolate mousse, which, because avocados show good evidence, the nuts are great to add in, and you can make it with dark chocolate. So there’s a good one for you.
Phil Stieg: If you eat that, will it put you in the mood, or do you have to sort of be in the mood and you eat it and it makes you feel more … passionate.
Uma Naidoo: Sure. So with all of these things, it’s not necessarily that immediate effect, like a Tylenol when you have a headache, it’s going to be longer term.
What made me really write this chapter is that so many individuals struggle with the side effects of selective serotonin reuptake inhibitors. So what are other ways we can help them? And so if we be helping them really improve their diet and include these foods and maybe include them on the night out of the cooking dinner at home, but have awareness of them as they are also cutting back on things which could dampen their sex drive for their libido.
Phil Stieg: You mentioned the side effects of the serotonin re-uptake inhibitors. It’s commonly used for depression, but then it also has a diminishing effect on your libido. I’m a little bit surprised that the percentage of patients that don’t respond to the serotonin drugs is about 30%.
Uma Naidoo: It’s pretty high.
Phil Stieg: And if it’s that high, what else, then what are we talking about? Sleep, exercise, meditation?
Uma Naidoo: And nutrition. So there’s a bunch of individuals who are suffering out there, and medications are simply not helping them. Access to care is limited. We know we simply are short on prescribers, short on therapists. it becomes a holistic approach. What can you do with exercise to boost how you feel? Can you use a mindfulness practice? Can you make sure that you’re hydrating? Dehydration? I’ve seen patients present with panic due to dehydration. Can you think about ways that you can build in meditation, movement, dance, spending time in nature actually helps with mood, lowers anxiety, helps people feel centered. It’s not just one organ or one system. It’s really about the whole body. But nutrition is a big pillar of that because like I said, you can’t out-supplement a bad diet. You can’t out exercise a bad diet. You can’t just say, hey, I’m going to head to the fast-food restaurant every day, but I’m going to be exercising and doing meditation practice. It kind of works altogether.
Phil Stieg: In your life as a physician, did you ever encounter any surprise foods that you found to be either really good for you or bad for you?
Uma Naidoo: I’ll tell you that culturally, my grandmother would give me a little drink made with ginger and, say, tumeric and some form of milk when I was a kid, if I had a cold and she’d always have a remedy for something, and I loved her dearly, so I would always drink it or eat it or whatever it was. But I didn’t really pay attention to it. I didn’t think it was serious. I just thought of spices in terms of flavoring food. And when I really dipped into the science behind the different spices and what we know about things like rosemary, parsley, Mexican oregano, thyme, and everything out there, I was fascinated to understand that there was so much more behind all of this and the nutrients in food themselves. So that was fun for me.
Phil Stieg: We talked a little bit about the goals of your book, but did you do it because you think that the medical profession and the lay society needs more education and greater awareness on the importance of food for your brain?
Uma Naidoo: That’s a great question because I felt that nutritional psychiatry fills this gap in our understanding around the power of food and our brain. And I felt that people needed to know that it’s not just soft science, it’s emerging evidence that my book is heavily researched for that reason. Although it’s written as a nonfiction trade book, there are over 550 references to show people and guide them through the fact that if they’re reading something, there’s scientific evidence behind it that they can look up, they can interpret, they can read, as we know, as physicians can always be an argument made back and forth about any particular fact based on emerging evidence. But I also felt like this food is a medicine idea and concept needed to be brought forth into the world, and that people needed to understand the power at the end of their fork that they could use to feel better.
Phil Stieg: Uma, it’s been a delightful time sitting here talking with you and gaining a greater understanding in a rather straightforward way about how we can make our brains better. Your book, “Your Brain on Food,” is well written, easy to read. I recommend it to everybody listening. And besides that, it’s a free recipe book. So thank you so much for providing the book for us and spending time with us.
Uma Naidoo: Thank you so much Dr. Stieg, I enjoyed being here and I appreciate it.