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Episode 12: Your Brain on Food with Uma Naidoo, MD.
87 Plays4 years ago
We are honored to be joined by psychiatrist Uma Naidoo, a trained chef and leader in the field of nutritional psychiatry. Here, she graciously talks about some of the most important parts of the mind-gut connection.
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Transcript
Introduction and Overview
00:00:05
Speaker
No one is talking about the connection between how we eat and how we feel emotionally. Thank you for joining us on Doorknob Comments, a podcast that we created to discuss all things involving mental health. We take the view that psychiatry is not just about the absence of illness, but rather the positive qualities, presence of health and strong relationships and all the wonderful things that make life worth living. I'm Dr. Farah White. And I'm Dr. Grant Brenner.
Interview with Uma Naidu
00:00:29
Speaker
We had the opportunity to interview Uma, who does some really interesting work in the field of nutritional psychiatry, and that's a pretty rapidly emerging field. Uma is great. I know we know her from GAP, from the Group for Advancement of Psychiatry, and she happens to be married to a good friend and colleague, Srini Pillay. And she's a very, I'd say, understated person. And I was really amazed to find out the work that she's been doing with nutritional psychiatry,
00:00:59
Speaker
her own story as a cancer survivor and the fact that she's a professionally trained chef. And I had a chance to review her book and it was incredible and I just wanted to share her knowledge and wisdom with our listeners.
00:01:14
Speaker
Yeah, I agree. I really love the book. And Grant, I'm so grateful to you for bringing her in. The format of this episode is a little bit different because it was put together from a webinar. So I think it's really linear and organized. And I think people enjoy it, I hope. Yeah, there's a lot of information in it. And we've tried to make sure that's accessible. I definitely think people would benefit from getting a copy of her book, which
00:01:40
Speaker
One of the things I love about it is that there's there's a bunch of recipes at the end. Yeah, I know that was really fun. And they're not too complicated, which I appreciate it. So, okay, I hope everyone enjoys Dr. Naidu welcome.
Uma Naidu's Work and Roles
00:01:53
Speaker
She is Michelin star chef David Boulet described as the world's first triple threat in the food as medicine space.
00:02:00
Speaker
She is a Harvard-trained psychiatrist, professional chef, and nutrition specialist. Her niche work is in nutritional psychiatry, and she has regarded both nationally and internationally as a medical pioneer in this more newly recognized field of nutritional psychiatry.
00:02:17
Speaker
In her role as clinical scientist, Dr. Naidu founded and directs the first hospital-based clinical service in nutritional psychiatry in the US. She is director of the nutritional and lifestyle psychiatry service at Massachusetts General Hospital and director of nutritional psychiatry at the Massachusetts General Hospital Academy and serves on faculty at Harvard Medical School.
00:02:38
Speaker
Her recently published book, This Is Your Brain on Food is excellent. Starts out with a personal story, goes through the basics of nutritional psychiatry with chapters on specific conditions, and it ends with a wonderful section with her favorite personal recipes.
Understanding the Gut-Brain Connection
00:02:55
Speaker
Dr. White, would you like to say a few words? I absolutely loved your book. I think not only fascinating to read about, but just beautifully, beautifully written with a lovely warm tone. Not surprising.
00:03:26
Speaker
you know, what we should do for high cholesterol level. But no one is talking about the connection between how we eat and how we feel emotionally. And I think that that has emerged in terms of the area of research around the gut microbiome. The gut and the brain, even though they're far apart in the body, are actually inextricably linked from when we were formed. So the neural crest cells in embryology
00:03:31
Speaker
Thank you so much. I appreciate that.
00:03:51
Speaker
actually divide and form both the gut and the brain, and then these organs are connected by the 10th cranial nerve. So there's this real connection that is anatomical, physiological, biochemical. And I feel like that's important for people to understand, but it also goes hand in hand with understanding that serotonin, as we like to, in a fun way, call it the happiness hormone, 90% or more of the serotonin receptors are in the gut.
00:04:19
Speaker
So it makes sense that if someone is prescribed a selective serotonin reuptake inhibitors, such as fluoxetine or Prozac, also all after any one of the others, that they develop gastrointestinal side effects. I use that to help explain to the clients that I have that there's this real connection.
Diet's Impact on Emotional Health
00:04:35
Speaker
If the receptors are there and your food is being digested there as well, that there's this connection that happens. And I like to call the vagus nerve the two-way superhighway because there's this bidirectional communication that has been shown in studies and then
00:04:49
Speaker
understanding as I go through in certain sections of my book.
00:04:53
Speaker
the impact of what the gut bacteria do. Now, I say bacteria generically, but the truth is there are several different types of microbes within the gut, 39 trillion approximately, and they're not just bacteria, they're different things. We want to keep those microbes in working for us and not against us. And an easy way to think about that is that when you eat, you can make a choice on any given day to eat a healthier meal versus eat at a fast food restaurant.
00:05:22
Speaker
On that day, you can start to impact your gut bacteria in a positive way or in a negative way. You may not feel that immediately, but it starts to evolve. So it's a very dynamic system, and I think if it's one thing we need to understand, it's that how we eat does actually start to impact how we feel over process. So that is usually how I share my understanding of the gut-brain axis, and I think it's sometimes very useful for the clients I work with to understand it that way.
00:05:51
Speaker
Very interesting. And I think, you know, that's definitely not something that's well known yet. And hopefully your book will help get the word out. Absolutely right. I mean, I think that the research is ongoing. And I think that there's at least enough to share what we know.
00:06:07
Speaker
and also really pay attention to what I call body intelligence, because when individuals come in and share with me how they're feeling after they ate something, I always pay attention. I think the psychiatrists will always do, but I pay attention with the little kind of interest around, wow, why is that food making you feel that way and what's going on with it?
00:06:26
Speaker
We grow up hearing you are what you eat. And people really, I think, are disconnected in a lot of ways from our bodies, you know, and especially nowadays, right, during COVID and working from home and being in video all the time. It's very easy to become disconnected from a lot of things, including the fuel we put in our bodies and and even paying attention to how what we eat affects how we feel. I remember as I was a surgical resident for a couple of years and we would work
00:06:56
Speaker
two days straight, right? We didn't eat very well as surgical residents, but I would not even know if I was hungry. And to this day, it's the same. I could work all day long. I don't notice when I feel hungry. You really have to retrain your body to sense itself. How do you counsel clients on
Advice on Personalized Diet Changes
00:07:15
Speaker
that?
00:07:15
Speaker
You know, I think that so many individuals have to start at the basic pillars that I suggest. And one of them is really gut healing. It's as simple as that. It's adjusting, slowly adjusting your diet in the right direction. And number one, you know, psychologically speaking, people don't like to be told what to do.
00:07:33
Speaker
So I encourage people along a slow and steady plan asking them what they will buy into and what of sort of a buffet of options will help them decide what they can start today when they leave, you know, when they leave the consultation with me. It's really about something that has meaning to the individual that they really want to change because if not, they might come back a week or two weeks later and not have done anything and say, well, I try to cook a healthy meal and you know, that doesn't work, Dr. Naidu, it's just, you know,
00:08:02
Speaker
one healthy animal doesn't do it. So I think it's about engaging what someone will do. Really principles that we have studied, meeting someone where they're at, I have to be diagnostic. It really doesn't. If someone's on a carnivore diet or a paleo diet or a vegan diet, I have to figure out how to help them with their mental wellbeing. And it's not the conversation there, what they eat, what they like to change. Then I might have a suggestion about,
00:08:30
Speaker
maybe this would be better to change than that, but why don't we choose from these? In that way, a person starts to buy into the plan and want to change. And when they start to feel better or feel lighter emotionally, change starts to happen. One piece of advice that you gave that really stood out to me was the idea of just changing one thing at a time. And if you try to change something and it doesn't work, then to kind of redirect that energy and try something else.
00:08:58
Speaker
Absolutely, but it's sort of you tweak it as you go along. And honestly, from when I first started doing this type of work in a more focused way, the emergence of almost a more personalized nutritional psychiatry plan for people has happened because you have individuals reacting to even healthy foods. They start to eat healthy food and they don't feel good.
00:09:19
Speaker
So again, it has to be tweaked and adjusted all the time until some level of gut healing is obtained. And I always work in consultation when I can. I shouldn't say always, but it doesn't always happen. I really like to work in concert with other specialists. Many people get referred to me from gastroenterologists for psychiatric issues, but as we uncover things,
00:09:41
Speaker
there might be more going on related to dysbiosis or gut imbalance. And gut healing is one of the ways where we can start. And to speak to your point, Grant, some of that is almost retraining the body to sense hunger, to start healing in terms of feeding what the microbes in the gut love and what they feed on is fiber.
00:10:02
Speaker
It's not insignificant that you start talking about a healthy salad, leafy greens. People might roll their eyes, but there are actual bacteria that get activated in a good way from the folate and certain leafy greens. The fiber in certain fruit and vegetables, beans, nuts, seeds, legumes, healthy whole grains are what we need
00:10:20
Speaker
to have those microbes thrive. A happy gut is a happy mood, so those are some of the things we stop with. People are aware of the importance of probiotics with fibers. I've seen some really interesting research, and you mentioned it in your book, about when people switch to indigenous diets, their gut microbiome flourishes.
00:10:42
Speaker
And their whole mentality changes as well. And it's interesting, you know, some of the studies almost assign a certain amount of so-called memory in those microbes. It's really interesting. There's a real synergy, like you're saying, that inside of our bodies live these billions of organisms and they depend on us because we are their world. But we also depend on them because they change
00:11:06
Speaker
What are some of the things that you could mention for listeners that the gut microbiology affects directly? I think the best way to explain it through food, and by the way, the other important thing for us to remember, especially the time like now, what we're facing, a very large amount of the immune system is housed in the gut. That's another reason that our food impacts our immune system.
00:11:30
Speaker
Food and the immune system are related in many ways, but it's one of the ways. So I think that's important for people to understand as well. Let's, for example, take what happens when digestion happens. You start eating, you know, the food starts to get broken down, different enzymes get involved, it reaches your gut. If that's a fast food meal, plating with a certain level of vegetable, processed vegetable oils,
00:11:51
Speaker
Sort of, I would say, unhealthy fats and processing added sugars. It turns out that fast food French fries have added sugar in them to make them hyper palatable, which is why you can't put them down and you always have to upsize. When these foods reach your gut, the balance of the bacteria start to change because those foods feed the bad guys in the gut. The bad microbes start to thrive and really overthrow
00:12:15
Speaker
good microbes. And that's when you start to have inflammation in the gut set up. Now, it doesn't happen immediately. The effect starts to happen immediately. You don't feel it immediately. It really gets set up over time and gut inflammation, things like intestinal permeability or a leaky gut, when the tight junctions, you know, basically start to leak what is in the gut. And that's really when
00:12:39
Speaker
people can, of course, we focus on the mental health aspects, but people can have skin rashes, they can have gut issues that they can't quite understand. So it's really a way to think about what you want those microbes to be doing is forming the good short-chain fatty acids, because when they set up
00:13:00
Speaker
those reactions. And when they start to form those substances, they are working for you. And ultimately, what you want to prevent is gut dysbiosis or the imbalance happening with the bad microbes overthrowing the good ones, setting up gut inflammation, which ultimately one of the ways that neuro information gets set up and potentially
00:13:21
Speaker
worsening of mental health symptoms. Yeah, there's a lot of research on how inflammation is not great for the brain. What are some foods that people can eat that will help with depression and anxiety and how do they help?
Foods to Avoid for Mental Health
00:13:35
Speaker
One of the things I like people to know is that they're foods that we need to know to avoid when we have certain conditions. It turns out that processed meats have an ingredient called nitrates, which are used in how these processed meats are made.
00:13:50
Speaker
With nightweets, it turns out drive depression. So staying away from those or switching out, you know, say a lunch meat or a snack that you're having at home is maybe a good idea and a place to start. I can't say enough about sugar. I know that I'm speaking to a very highly educated audience, but there's actual, there are actual studies that link added sugars. So I'm not necessarily speaking to sugars and food, which are a healthy ingredient that, you know, healthy food that you should be eating.
00:14:17
Speaker
in appropriate quantities and portion control. But the added sugars are linked to depression and they drive anxiety in the wrong direction. Another one to avoid artificial sweetness. There's certain artificial sweeteners, unfortunately, including stevia, which I know many people turn to as a more natural alternative. And most of the time, I think in appropriate quantities, it's fine, but it worsens anxiety. So
00:14:40
Speaker
it's something to be careful of there as well. In terms of foods you can add and enjoy, just starting to incorporate tree and probiotic foods in your diet, and I'll go through more later, starting to embrace the color of the rainbow. Why? Because the polyphenols in a colorful plate of food, you know, think red peppers, bell peppers, zucchini, cucumbers, leafy greens, all sorts of things, the colors actually represent the phytonutrients that they contain.
00:15:05
Speaker
So whether it's the carotenoids from carrots that bring back healthy nutrients. And here's something that's important is you can eat them, but you actually need your gut bacteria to help really make the antioxidants more available to your brain.
00:15:23
Speaker
And that's something that's helpful for people to know. Prebiotics, probiotics, really eating healthy servings of fruit and vegetables every day, going to more specifics around that later.
Beneficial Foods and Spices for Mental Health
00:15:35
Speaker
And then, you know, including healthy spices, thinking about what the healthy fat should be, a serving of avocado, olive oil are good choices to use for cooking.
00:15:45
Speaker
and really breaking it down that way. And then there are spices that hit the high notes with good depression. For example, one is saffron and the other is turmeric with a pinch of black pepper. And I say that because turmeric is worth having and adding to your diet because it has so many positive effects, especially in mental wellbeing, both anxiety and depression, just to start amongst others.
00:16:10
Speaker
It's easy to add in, easy to obtain in most supermarket aisles these days, including organic versions. And most of us keep black pepper at home. So a quarter teaspoon of turmeric with a pinch of black pepper. The piperine activates the curcumin, which is the active ingredient in turmeric. That's an easy thing for someone to do. So say you don't cook with it, put it in that super smoothie or tea, and you can try that whenever you can get it if it's something you'd like to.
00:16:39
Speaker
But that's worth incorporating, then including some B vitamin rich foods and stuff like that, which happens once. I know there's a lot of research on turmeric. And you mentioned in your book that in some of the studies, people take up to 1,000 or 2,000 milligrams a day, which I think a lot of people would be looking for a nutritional supplement. And you point out that you have to take it with black pepper, piperine, otherwise the gut can't absorb it.
00:17:07
Speaker
It's quite interesting. I think you also mentioned in your book that saffron costs more than gold by weight. Is that still true? I know gold has been up recently. It's true. I haven't looked up the markets today, but it's just these tiny threads that are so delicately obtained from the focus of a plant.
00:17:30
Speaker
you need a very little when you when you cook so think you know paella or um indian briani or risotto but here's the thing i think it's one of the few times when although you know i i like to talk mostly about whole foods and whole healthy foods
00:17:46
Speaker
It's a supplement that you might want to speak to your doctor about because saffron has a significant amount of evidence related to depression. And I'd love for you to cook with it, but you're not going to reach the levels that you need for it to be effective that way. I also feel with food, the more you can add it, the better. So why not do both?
00:18:04
Speaker
Excellent, thank you. I'd love to hear about the relationship that people have with food in their gut, but I'd like to ask questions. Is there any research you know of related to intermittent fasting, such as a 16 to 8 schedule and depression, or how fasting affects the microbiome?
Intermittent Fasting and Mood: An Uncertain Impact
00:18:22
Speaker
So I feel like we don't know enough about this yet. I think that if you're working with a practitioner and they feel like you are using a diet that is helping you, you could assess to see through body intelligence how you're feeling emotionally. I don't think that the research from what I understand and have read is quite there yet.
00:18:43
Speaker
Many people are embracing different types of fasting, fasting, mimicking diets, intermittent fasting, and things like that. I think that it's very reasonable to discuss that with your physician, but I don't know of the impact yet on mood. Thank you for this insightful presentation. You mentioned supplements like saffron, turmeric, cumin, and folate. Could you share some thoughts on ashkawanja and adaptogens?
00:19:06
Speaker
Sure. So, you know, I know that ashwagandha has been used in traditional Ayurvedic medicine. It's thought to really help with anxiety. If it's something that, you know, why do I say speak to your physician and not just being boring about it? Because there are things like grapefruit juice that help, you know, why wouldn't you think of that as a healthy ingredient? But many people on this call will know that the interaction with liver enzymes
00:19:32
Speaker
make that something we need to be thoughtful about. So when I say ashwagandha or adaptogens, speak to your physician, see what his or her input is around what you're eating and how you can incorporate them. Mostly I try to find food sources and that's what I mostly share in my book. Are there any fruits and vegetables to avoid? The next question. I think that's a great question. So I treated someone, began working with someone I should say a few months ago,
00:20:00
Speaker
and the adult patient brought in her teenage daughter. And they happened, they came to the console together and they both had the opposite reaction to the same healthy ingredients, speaking to the mostly unique microbiome. And therefore what I would say is that pay attention to your body intelligence. If you don't respond well to a certain food, pay attention to that. It may not be for you.
00:20:28
Speaker
The other thing that I like to guide people around is the glycemic index, which I outlined in the book. And the reason I say that is that food are healthy. Having them as inappropriate servings a few times a day is a good idea. But if you're struggling with your weight or side effects of a medication where you might have gained weight or that type of thing, you want to stick with lower glycemic foods, such as the dairy family,
00:20:53
Speaker
blueberries, raspberries, blackberries, that type of thing, because they're lower in glycemic. Watermelon is a delicious food, but it's also higher on the glycemic index. So I'm not saying you should stay away from it forever, but I'm saying balance that up in terms of when you eat it and try to split up your servings during the day when you eat fruity. And in terms of vegetables, it's always the greens, the sulfurophanes that you get from things like cauliflower and broccoli and Brussels sprouts and those types of vegetables
00:21:22
Speaker
And peppers, red bell peppers are one of the highest in vitamin C, it turns out. So always a good choice. And make it the more colorful, the better. I would say pay attention to the glycemic index. And when we say vegetables, obviously potatoes are very low on that list. And sweet potatoes are up there as a complex carbohydrate. But again, I would embrace other vegetables first.
00:21:47
Speaker
Very good, very good. The last question is, and then we'll have some more resources to share where people can go, is are there any specific advice for people suffering from OCD and or hoarding? Now, I see chapter seven in your book is obsessive compulsive disorder, NAC, glycine, and the dangers of orthorexia nervosa. But any quick advice for people? And then I'd say go go by Dr. Naidu's book and read that chapter.
00:22:14
Speaker
Thank you. So, you know, I think that it's it's it's pretty much planning some things to embrace and avoid and
00:22:23
Speaker
I think that while everyone's condition is unique and it depends on the severity of OCD, sometimes treatment for OCD can be quite lengthy and it depends on how severe it is, how they coping, what their level of functioning is. But there are certainly foods that you can use to help and foods that you should avoid for that condition. And we go into a significant amount of, I'm just aware of the time, a significant amount of detail on that.
00:22:53
Speaker
There was just one last question about how long people can expect it to take, you know, before they see some changes. Sure. I think that's a great question. You know, I've had people within three days, two weeks start to feel better. And it's tough to know is that the actual food versus embracing a healthy habit change
00:23:13
Speaker
feeling good about making that move in their life? Or is it the actual food? So I've had people really start to feel better within about three days of embracing a healthier diet for up to three weeks. I think that if you're really starting to build a plan where you embrace healthy eating habits along the way, I would say at least three weeks to a month to really start to see good effects. And, you know, consistency is key.
00:23:38
Speaker
Okay, great. Well, thank you so, so much for being here. We're so grateful for you to share your time and expertise, but where can we find you online? Thanks. Please, please follow us on social. We're always trying to put out information and share fun facts.
Conclusion and Resources
00:23:55
Speaker
It's at Dr. Uma Nailu, which is at DR.
00:23:58
Speaker
U-M-A-N-A-I-D-O-O. And my website where you can get the book and find other fun stuff is umanaidumd.com. U-M-A-N-A-I-D-O-O-M-D.com. And if you are interested in the book, it's available in different formats, audio, Kindle, or major retailers. Eat well and be well. Thank you.
00:24:23
Speaker
One disclaimer, this podcast is for general informational purposes only and does not constitute the practice of psychiatry or any type of medicine. It's not a substitute for professional and individual treatment services and no doctor-patient relationship is formed. If you feel that you may be in crisis, please don't delay in securing mental health treatment.