By: Alexis Zinkerman
I wanted to find out more about this new terminology going around the internet called nutrition psychiatry. I interviewed Dr. Drew Ramsey who can be found at drewramseymd.com. Dr. Ramsey is a psychiatrist, author, farmer, and founder of the Brain Food Clinic in New York City. I asked him about foods we should eat to heavy metals in our diets to gut microbes. Here’s our conversation:
AZ: Tell me about the history of nutrition psychiatry. What studies instigated the movement?
Dr. Ramsey: Nutrition and psychiatry have always been strongly linked. We think of it as a new movement, but beginning with the first description of vitamins, we’ve known that mental health and brain health are dependent on proper nutrition. Over the past twenty years there has been increasing interest in how dietary patterns effect risk of mental illnesses. That is refreshing as a single nutrient focus, say B12 or omega-3s effect dementia and depression, is less applicable to the general population. Dozens of correlation studies have demonstrated as correlation of dietary patterns and the risk of depression and dementia. 2017 was an important time year as the first clinical trials using a Mediterranean style diet to augment the treatment of clinical depression. Both trials were positive showing for the first time that changing diet can improve outcome in clinical depression. I’d encourage people interested in the subject to check out the SMILES and HELFIMED trials.
AZ: What foods should people on psychiatric medications be eating for optimal health?
Dr. Ramsey: When I launched our ecourse Eat To Beat Depression and published Eat Complete, I noticed it was difficult to have a conversation about mental health and nutrition without invoking medications. I want to talk zucchini and suddenly its a statement about Zoloft! Well, I don’t think the presence or absence of psychiatric medications should influence diet very much. Some folks need meds (Yes I prescribe). Others don’t. Yet, every brain needs brainfood. If you are concerned about your mental health, and really we all should be thinking about our brain health when making food choices, you should be choosing nutrient dense foods that have the highest concentration of nutrients that are key for brain health, such as long-chained omega-3 fats, B-vitamins, and phytonutrients.
The big emphasis for many of our patients is getting them into a joyful stance with food and increasing the nutrient density of their diet, meaning more nutrients and fewer calories. We work in small goals to increase awareness, improve food planning and acquisition, and help people with small achievable goals.
AZ: Can the right foods better a person's mental health?
Dr. Ramsey: Yes certainly. Take the average American’s diet. The top source of calories are added sugars and added fats. These contain none of the nutrients the brain needs. No long-chained omega-3 fats. No B-vitamins. No minerals like zinc and magnesium. Then, consider all the interesting new science abou the microbiome. Gut flora is increasingly seen as influencing brain health. It’s one of the ironic challenges of nutritional psychiatry. We all know that when we eat well, we feel better. But people don’t connect mental health with food in the way they connect heart health or obesity with food choices.
AZ: Tell me about what you do at the Brain Food Clinic with patients.
Dr. Ramsey: We are a general psychiatric clinic in New York City with a side of avocado. We add a nutritional assessment and Brain Food prescription in with our mental health evaluation and treatment. Samatha, our clinical coordinator is a therapist, health coach and chef, and so we bring a diverse nutritional viewpoint to the table. Our technique uses the principles of motivational interviewing, basically meeting people were they are and helping them move to the next stage of change. We think about food categories instead of singular foods, and try to help people eat robustly from high yield food groups like leafy greens and seafood.
AZ: What are foods to stay away from and why?
Dr. Ramsey: Don’t eat fake food, stuff made for the shelf, not for your health. Highly processed foods have a big list of ingredients. Bad choice. Carrots, mussels, kale have no ingredient list. Avoiding processed foods means avoiding added vegetable fats and added sugars, plus, garbage fats like trans-fats are only found in processed foods. Fake foods are basically lying to your brain and over time really misalign your palette and food habits.
AZ: Why are unhealthy foods promoted so heavily in our society?
Dr. Ramsey: Profit. Unhealthy foods are cheap to make. The bottom line is huge for vertically integrated food companies. Unhealthy foods are designed to be habit forming, from researching the crunch to which colors motivate kids to nag their parents for more, the food industry can be avoided with a simple step. Don’t buy the food they make. The cost savings long-term is enormous - you won’t get the diseases of western civilization. But long-term health benefits are are tough sell compared with the taste of sugar and slick marketing.
AZ:Why is heavy metal overload in the body bad?
Dr. Ramsey: Heavy metals are like lead and mercury are toxic for the body, so we have biological systems to excrete them. Metal overload is relatively rare, but can happen, for example if a young child is eating tuna daily. The problem mostly is that inaccurate fears of mercury means most women don’t eat much fish. Researchers estimate that costs us about 9 verbal IQ points overall and the the EPA and FDA have drafted a statement to encourage pregnant women to eat 2-3 servings of fish per week. Heavy metals are a lot like gluten - for a small number of patients these factors are critical to their health. But for most people, these aren’t a factor in their health. For so many, all the “toxins” become the focus of an eater and food becomes something to fear. Enter the “detox” diets which are bogus and we end up with eater confusion. I created National Kale Day, and one year after we partnered with the Los Angeles Public School system to serve kale for the first time, a rumor about the toxins in kale went viral. Suddenly, the message was, “Yes, you thought it was a superfood, but actually it is toxic.” As a doctor and a farmer, this kind of thing really frustrates me. Folks are hung up about mercury in seafood, but that’s a minuscule risk compared with the “toxins” in highly processed foods and fast food.
AZ: How does the gut make us feel mentally better? How should we feed our gut?
Dr. Ramsey: Plants and fermented foods make a healthy gut. There is so much hype about the microbiome right now and a lot of distraction information, like the big focus on gluten. Most people have unhealthy guts from a life of simple carbs, few plants in their diet, and too much alcohol. I recently asked several fo the top microbiome researchers what I should be doing differently as a clinician - should I be prescribing more pro-biotics or elimination diets? They all said no. There is nothing magic. People should eat more fibrous plants and promote a diverse gut flora via fermented foods like kefir, sauerkraut, and kimchi. You really can’t have an optimally health brain with without a healthy gut.
Part Two is an interview with Peri Gershoni, RDN, BSc, at Psynergy in California with healthy recipes to try.