Your Brain On Food: Dr. Uma Naidoo On The Intersection Of Nutrition & Mental Health

Dr. Uma Naidoo is a nutritional psychiatrist, professional chef, and nutrition specialist. This conversation explores the intersection between food and mood, with Dr. Naidoo sharing her expertise on how what we eat impacts our mental well-being. We discuss the gut-brain connection, foods that fight anxiety and depression, practical nutrition tips, and much more. Throughout the conversation, Dr. Naidoo provides actionable advice and fascinating insights into the world of nutritional psychiatry. Dr. Naidoo is a true pioneer in this field. This conversation is a must-listen for anyone interested in using food as medicine for the mind. Enjoy! Show notes + MORE Watch on YouTube Newsletter Sign-Up Today’s Sponsors: Bon Charge: Use code RICHROLL to save 15% OFF 👉boncharge.com On: Enter RichRoll10 at the checkout to get 10% OFF your first order 👉on.com/richroll Peak Design: Save 20% OFF 👉PeakDesign.com/RICHROLL Brain.fm: Get 30 days FREE 👉brain.fm/richroll Birch: Unlock 20% off ALL mattresses and 2 free eco-rest pillows 👉BirchLiving.com/richroll AG1: Get a FREE 1-year supply of Vitamin D3+K2 AND 5 free AG1 Travel Packs 👉drinkAG1.com/richroll Squarespace: Save 10% off your first purchase of a website or domain 👉Squarespace.com/RichRoll Check out all of the amazing discounts from our Sponsors 👉 richroll.com/sponsors Find out more about Voicing Change Media at voicingchange.media and follow us @voicingchange Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Rich Roll?

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• 0:44Rich Roll?

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• 1:05Speaker 01

  Lifestyle and nutrition is the one remediable factor across all chronic diseases. We know this. If we worked towards improving our dietary and lifestyle factors, we could improve our ability to fend off cognitive changes over time. Every food has some super-powerful effects. The antidote to the standard American diet is don't reach out for the store-bought orange juice, which has no fiber and added sugar, but just eat the orange. One of the most powerful factors is how we eat. How can we integrate food into how we are offering solutions for people?

• 1:43Rich Roll?

  Hey, everybody. Welcome to the podcast. My guest today is Dr. Uma Naidoo. Uma is a board-certified nutritional psychiatrist on faculty at Harvard Medical School. She's also an award-winning professional chef and the founder and director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital, which is a very cool, first-of-its-kind program that integrates mental health care with nutritional science. Uma is also the author of the international bestseller, This Is Your Brain on Food, and her latest, Calm Your Mind with Food, is a primer on the nexus between diet and anxiety.

• 2:25Rich Roll?

  This conversation focuses on the relationship between what we eat and how we feel, and how dietary changes can actually aid in reclaiming control over our mental well-being. Specific topics include the gut-brain axis, the neuroscience of mood, and the influence of diet on neurotransmitter production. We also discuss the nature of anxiety, specific foods to calm the mind and promote brain health, and many other topics. In light of the increasing escalating rates of anxiety, depression, and other debilitating mental health disorders, Dr. Naidoo's work is not only salient but empowering. So, let's do it.

• 3:08Rich Roll?

  This is me and Dr. Uma Naidoo.

• 3:14Rich Roll?

  Well, Dr. Naidoo, it's a pleasure to meet you. Thank you for doing this.

• 3:17Speaker 01

  Thanks so much for inviting me, Rich. I'm excited to talk with you.

• 3:20Rich Roll?

  You're a very interesting figure. You are a trained chef and nutrition specialist, and also a pioneer of something called nutritional psychiatry, which I admit, I had never heard of before. Can you explain what this area of expertise is precisely, and how you kind of came into this field?

• 3:40Speaker 01

  That's a great question. Thank you. I like to explain nutritional psychiatry as the use of healthy whole foods and nutrients to improve your mental well-being. And it does not exclude the use of medications, which may be very necessary in some cases, and the always-important psychotherapies that are available to people. I came into this area mostly because, as I grew up, I spent a lot of time with my grandparents during the day, my maternal grandparents. My mom was in medical school. And I would watch my grandmother, you know, and help her pick fresh vegetables from the garden. Prepare meals, I'd help her, I'd eat meals with my grandparents. And for fun, they'd teach me yoga and meditation.

• 4:22Speaker 01

  So I recognized when I went to medical school, and then even more so in residency, that no one was talking about food and nutrition. Yet I was being taught to prescribe some heavy hitting medications. While they were life-saving to some people, we also knew that they were creating side effects.

• 4:41Rich Roll?

  Mm-hmm.

• 4:42Speaker 01

  But no one was talking about that. And we were discussing side effects, but we're not addressing lifestyle factors.

• 4:48Rich Roll?

  Mm-hmm.

• 4:49Speaker 01

  And a patient early on sort of took me on, was upset with me. And I knew that he'd only been on the medication a week. So I had not caused him to gain weight. But this really opened my eyes to the power of interpreting information that someone can use in real life. A lifestyle factor, a lifestyle change, what you put in your coffee, literally, can make a difference if someone knows that. So he was putting a quarter cup of processed cream and eight teaspoons of sugar before he even ate breakfast. And he had struggled with his weight for a while. And that made me want to pursue this more. Work was done, research was ongoing. Um, and really it evolved and is still a very nascent field, which is probably why you haven't heard about it.

• 5:32Rich Roll?

  Right, so you do your residency and then you go into this area of psychiatry. At what point do you decide, I'm gonna become a trained chef or I'm gonna dig deeper and get credentialed in nutrition science?

• 5:46Speaker 01

  As I recognized the gaps, I began, I graduated residency. And I was exploring food, learning to cook on my own, really enjoying it and decided, especially when I understood, uh, the kicker for me was my food hero was Julia Chalmers.

• 6:03Rich Roll?

  Hmm.

• 6:03Speaker 01

  And I would watch as I was studying, uh, earlier on. And when I realized, reading some of her books, that this was her second career, she was known.

• 6:13Rich Roll?

  It was late in life.

• 6:14Speaker 01

  That's right, it was late in life. I thought, well, why not me? You know, I love this, can't I do this? And it took a lot of hard work rearranging my schedule. But when I could rearrange it in a way that my patient care was covered, I helped my colleagues, they helped me, and I was able to go to school, I decided to do it. And probably was some of the best years of my life.

• 6:34Rich Roll?

  Did you pioneer this department at Mass General? And, you know, how did you get buy-in from these large institutions, Mass General and Harvard University?

• 6:44Speaker 01

  I mostly got buy-in because the direct mentors who saw what I was doing, and I spoke to and were really supervising me. Throughout, you know, throughout your career, you're always either supervisor, you have mentors. I had, I was very fortunate to have that. And I sort of explained, look, this is what I'm doing, this is what I'm reading in the literature, this is what is coming forward, I'm talking more to my patients about this, why can't we do it? Can we find a way to appropriately bill for it? Can, because hospitals care about that. But why can't we include this? We're a cutting-edge institution, why not? And I was fortunate that I had had them support me, meaning there wasn't resistance to doing. They were like, we know what you're doing, you can start this, why don't you

• 7:27Speaker 01

  go ahead and start, you know, evaluating patients in this way? And it took off from there. And while it's a slow and it's a small and very dedicated, almost tertiary care service, because it's referral-based, it's now pivoted with the release of my books because what I recognize, which is that people reach out to me literally from all over the world, and they'll need this kind of help as an additional tool. No one has said, stop your medications or stop therapy, but it is an additional tool to support their mental well-being. And I know that that lies in creating more educational resources.

• 8:03Rich Roll?

  Right.

• 8:04Speaker 01

  And I've been dedicating a lot of time to that.

• 8:05Rich Roll?

  Yeah, to that point, you know, sort of well understood that nutrition education really isn't a significant component in the medical school education canon. My sense is that that is changing, albeit slowly. Has your work in this department percolated down into what students are exposed to during medical school? Or what is the kind of current state of affairs there?

• 8:27Speaker 01

  So it certainly has helped with our students at Harvard at the medical school. I am part of the Division of Nutrition. We have special interest groups. Colleagues of mine have started a culinary medicine curriculum. We actually have dedicated meetings where students are brought in and are part of it. We're also about to publish a textbook for medical students. I've written two chapters in that on my areas of expertise, and we come together, all specialties. So doctors and clinicians and dieticians on this committee are from different specialties. And this book will be coming out later this year, and it'll be available to all medical students. So it's really to do what we can in a small and steady way to bring it forward.

• 9:10Speaker 01

  I don't think, though, that it's trickled into mainstream psychiatry. There's a lot of interest in lifestyle medicine, lifestyle psychiatry, and nutrition. And I think through those mechanisms and with sort of trusted colleagues, we're really trying to bring it forward in the academic system.

• 9:27Rich Roll?

  Yeah, I suspect some resistance from, you know, the conventional institutions of psychiatry. I mean, you're not without your critics, of course. You know, we can get into that if you like. But I think it is encouraging that, yeah, a textbook and, you know, the receptivity of students in these institutions is a signifier of change.

• 9:47Speaker 01

  And then at Mass General, we Designed and created the first online training asynchronous training for clinicians. That's CME credited, so you know, doctors and other clinicians care about getting their credits for their licensing, which we understand is important. So that's been in existence now for a few years.

• 10:06Rich Roll?

  Yeah. Well, the fundamental premise of kind of the umbrella, you know, 10,000 foot view on your work is quite literally that food is medicine in a general sense, this Hippocratic, you know, kind of trope. But in your case, I think of it more as precision medicine directed at targeted outcomes, based on another thing Hippocrates said, which is bad digestion is the root of all evil and death sits in the bowels, which you quote in your book. So it's all about this relationship between the microbiome, gut health, and other physiological processes in the body, most specifically how they impact

• 10:48Rich Roll?

  the brain and mental health. So maybe we can begin to unpack that by starting with the gut-brain axis and kind of explain what that is and, you know, this relationship between food and brain health.

• 11:02Speaker 01

  There are several mechanisms, but I feel one that is easily, more easily understood, where this is a nascent field in mental wellbeing, is around that gut-brain axis, because the gut and brain first and foremost originate from the exact same cells in the human embryo. They divide apart, they form these two organs and then remain connected by the vagus nerve, the ten cranial nerve. But there's more to the story, because in addition to being this bidirectional messaging system between these organ systems, the neurotransmitters and the actual receptors for these, about 90 to 95% are in the gut. And even though

• 11:44Speaker 01

  there isn't all, just a complete conversion into the brain and they're also located elsewhere, it's important to understand that where the food is being digested and interacting with the trillions of microbes is also where and in the same location as these receptors. And the neurotransmitters. I like to remind people that when you take a headache pill, you know, I'll ask the silly question, and when you take a headache pill, you often, you're experiencing the pain in your neural tissue, in your head. Maybe it's frontal, maybe it's inside, whatever you describe it as. But you're actually swallowing something, you're ingesting something, and it's working in a different part of your body. So why don't we think about food that way? It's more complex, there are many more breakdown

• 12:27Speaker 01

  reactions occurring and all sorts of things physiologically, all of which I know that you know, but it's that similar principle. When food is broken down, it's not as much of an immediate reaction, like solving that headache after you take a pill. But it's the breakdown products that then can either be harmful or helpful to the gut microbes and the gut environment. And it's the less healthy, more harmful, toxic byproducts of digestion that start to damage the single cell lining and over time, you know, cause inflammation, dysbiosis, and an environment that can lead to, from skin conditions to an uptick of anxiety, to many different things.

• 13:05Rich Roll?

  So we have this relationship between the gut and the brain. It's bidirectional, meaning that the brain impacts the gut, the gut impacts the brain. The gut communicates with the brain in two ways, via the nervous system, the vagus nerve, as you mentioned, but also through our circulatory system. So essentially, we eat food, gut bacteria metabolizes it. This creates metabolites that then travel through the bloodstream to the brain, where they're assembled into these neurotransmitters, which are chemicals that carry messages between your nerve cells and in turn, perform a variety of functions, including the regulation of mood. And this is where the whole world of kind of mental health

• 13:50Rich Roll?

  and the relationship between what you eat, what you're putting in your body and the nature of your microbial kind of ecosystem has an impact, not just on physiological processes that we're unaware of, but actually translate into how we feel and, you know, behave in the world, which is kind of a fascinating thing.

• 14:11Speaker 01

  It is fascinating and I'm glad you feel that way because it certainly fascinates me, but it is not always easily understood and it is not something that modern medicine, as much as we've come a long way, focuses on because food is usually seen as firstly, nutrition is seen as a side by activity that you get referred to someone, maybe it's a dietitian, maybe it's a nutritionist, that you have sort of side counselling. You know, it really needs to be integrated and in certain specialties, it's more integrated with the primary medical team. And certainly that's what I've seen, but most people really think about nutrition when it comes to medical conditions or as we should be in the United

• 14:56Speaker 01

  States in relation to our weight, but not in terms of brain health.

• 15:00Rich Roll?

  Sure. And then in terms of mental health generally, redress of mental health issues is generally focused on talk therapy, pharma interventions, SSRIs and the like, modest lifestyle suggestions, although perhaps that's not a primary thing or maybe not as much of a priority as it should be, socialization, sleep, exercise, things like that. But really nothing about this role that nutrition may play as both a contributing factor to mental unwellness or as this intervention that you speak of to actually treat mental health symptomology.

• 15:36Speaker 01

  This is true. Alongside the ACLM, the Lifestyle Medicine Group, actually, many clinicians can study lifestyle medicine. There's also this developing area of lifestyle psychiatry and what I love about that is that it integrates and you can integrate pillars of nutrition, you can integrate pillars of metabolism into this. And one of the things we're also starting off, we already have developed education for clinicians outside the hospital. And now we are, we've had, since 2017, I've lectured to our residents, our trainees at the hospital, in their third year of residency about nutritional psychiatry.

• 16:17Speaker 01

  So they have some awareness, but now there's more interest from our trainees and so we're developing the first elective at the hospital, where part of their fourth year of training as they graduate at the end of that year, will be seeing these consultations, being supervised and a whole curriculum that we're putting together. So I feel like those are Slow and steady changes that will take time, but it's hopeful.

• 16:43Rich Roll?

  Yeah, it's a fascinating area. This idea that what we eat in turn impacts like how we feel, like our mental health, not just how we feel physically in our bodies, but our kind of outlook on life and our general disposition. But I suppose to kind of understand the impact of diet on our brains, we have to understand how diet impacts the balance of neurotransmitters, right? Because those are the kind of active catalysts that we're speaking about here. So maybe just walk us through like the nature of these neurotransmitters. There's a bunch of them, GABA, serotonin, dopamine, acetylcholine, et cetera. How do they function to modulate our mental outlook on life?

• 17:27Speaker 01

  So it's interesting because mental health diagnosis based on the DSM-5 TR is certainly flawed because it doesn't really offer more than diagnostic classifications, which have been helpful to help mental health clinicians put this in order. I say that because we've also then through pharma depended heavily on the serotonin hypothesis, which was upended by a research group in London, really saying that it's not the whole picture. And while that doesn't and should never mean, oh, stop your medications and, you know, come off the SSRI, it did provide a different way to think about this.

• 18:12Speaker 01

  And so serotonin being the leading neurotransmitter, really, in my opinion, through where most of the medications have focused. I think it's not that it's not a mechanism, but it's not the only thing. One of the things that I like to think about is how a precursor to serotonin, something like a food. Either turkey or chickpeas actually have the precursor.

• 18:42Rich Roll?

  The tryptophan in the form of tryptophan.

• 18:45Speaker 01

  Exactly, in the form of tryptophan that then has to undergo an infraction to cross the blood brain barrier and then be converted. So it's it's cool to know these things and to understand how food can interact with these neurotransmitters. The other thing that was has been very cool to understand through research is that there are different bacterial groups within now we know the we know that the trillions of microbes are bacteria, archaea, protozoa, fungi, many different things, but mostly we study the bacteria. But now there are different bacterial groups associated with different neurotransmitters. That's also has kind of led to us understanding a little better how these mechanisms can happen.

• 19:28Rich Roll?

  It would stand to reason then that a very targeted prebiotic or probiotic oriented around that specific strain of microorganism that is a precursor to the neurotransmitter that you're trying to improve or optimize could be an interesting intervention, but short of that, foods being the precursors to the precursors.

• 19:51Speaker 01

  Exactly, I think of it that way, and I also think that in addition to prebiotics, probiotics, and that whole emerging area, there's also psychobiotics and where I think some of the research will go over time in being able to create interventions through food and maybe supplements that actually have an impact on mental well being that are not in the form of the traditional medications we're used to prescribing.

• 20:16Rich Roll?

  Explain what that means, psychobiotic.

• 20:18Speaker 01

  It's also part of a field of research where it's using food and nutrients to impact the microbes, impact the neurotransmitter levels instead of using a medication. I think it's kind of cool because I think it will over time offer us more solutions that are really based in an integrated and holistic approach to care rather than the first line being the, you know, an SSRI or certain medication, not that those are not needed, but they're not necessarily needed in every case.

• 20:52Rich Roll?

  Walk me through a hypothetical patient intake. Somebody comes into your clinic. Perhaps they're subsisting on primarily the standard American diet. They're depressed, they're anxious, they have a high-stress job, maybe not entirely sedentary, but not exercising enough, suboptimal sleep, et cetera. How do you begin to unpack what's actually causal versus correlative in terms of their mental health and tailor a bespoke intervention around diet and lifestyle that could be beneficial for that person?

• 21:30Speaker 01

  So the way that my clinic is set up is, and was set up before moving more to educational objectives, has always been as a tertiary care center. So I'm getting referrals from within my hospital system, which is pretty large, different specialists, knowing that we provide this service and saying, and sometimes, interestingly, Richard, it might be a patient who's read the book or something like that and thinks, something is wrong here and I want to speak to this doctor, and it's kind of cool. So what I'm trying to say by using that term is they often come in with an identified problem. This is not necessarily a physician saying to their patient, "You must talk to this psychiatrist." Very often, it's a very specific problem that they're trying, and I'll give you an

• 22:14Speaker 01

  example, that they're trying to heal or get help with. An older patient who was referred by an infectious disease specialist had been in and out of the hospital due to multiple chest infections. And every time that she got sick, she needed bouts of antibiotics. So she had read something in, I think, the local newspaper, and she decided that her gut was disrupted, and took this conversation to her doctor and then got a referral to see me. And I always remember this because one of the things she said is, "I know that I need these life-saving antifungals, antimicrobial treatments." And she was so sick with these infections, she needed to be admitted to the hospital each time.

• 22:57Speaker 01

  She came to see me between one of these episodes. But... She knew something was wrong and what I had to do was walk through a full-length history. But what I uncovered in that, and I obviously spent a good amount of time on the eating pattern and nutrition. And I usually ask people to track just three days on their own. They can do it on their phone. We can provide them a form if they need to, but to track what they've eaten. Because often, if you ask them longer than that, they don't remember. I usually often want them to use their phone because it's with them and they'll type something in. You know, food frequency questioners are not a great idea and a lot of the research is based on them. So I like to track in that way. Sometimes it's a nutrition app if they're working with on. And that gives me a snapshot into what they're eating.

• 23:42Speaker 01

  Interestingly, in her case, and I'll use this example, you uncover one thing that is, it could be part of the standard American diet. That's usually an easy one, right? Because you can start to work on cutting back on the foods that we know are not as healthy. But with her, she was actually, I was kind of wondering, you know, she's eating healthy foods with rich in omega-3. She's eating lots of salads. She's paying attention to vegetables. She's really doing a good job. And then she said, "I have a sweet tooth, but I've really done better with that." And I said, "Well, tell me more about that." It wasn't just that she liked sugar. That's a common problem. Her grandkids lived in New York and she would see them on the weekends. They'd all get together and when she saw them, she would bake up a storm on a Friday.

• 24:26Speaker 01

  And from cookies to cake, whatever it was that they liked, the particular treats of the week. And she'd always keep a few for herself. And that ended up being a good amount of cookie or cakes or candy that she was baking, baking from scratch. Just through a very different way, we found that that was the issue because she was consuming, although she was eating a healthy diet the rest of the week, she was walking, she did yoga, she was active despite her illnesses. She was consuming all of this stuff as part of, you know, loving them and wanting to prepare treats they liked. And it's a great example. I use it because it became the thing from which we work and reverse engineer a plan. So it's how do we start?

• 25:10Speaker 01

  Once you identify at least one thing that's

• 25:14Speaker 01

  Upsetting that person's metabolism, they're causing some dysbiosis, causing some inflammation in their body. You have a place to work, work backwards, work with their, in her case, with her infectious disease doctor to see what tests, you know, were needed. And then kind of work out a plan that she was willing to eat. It included some things around sleep, she was not sleeping well, some other lifestyle factors, sense of community. She was, had become a little bit lonely and isolated since her husband had passed away. So a few factors like that, all of which were important.

• 25:48Rich Roll?

  Right, but fundamentally eliminating the sugar binges.

• 25:52Speaker 01

  That was where it started, but it took a while to find what that was.

• 25:55Rich Roll?

  In the context of a holistic kind of prescription. Yeah, interesting. You mentioned that serotonin is not the full picture, but it is key to maintain a healthy serotonin balance and

• 26:08Speaker 01

  Yes.

• 26:09Rich Roll?

  If you are down or depressed or have anxiety, perhaps elevating serotonin through dietary choice has shown, in your book, you talk about this, some efficacy in terms of boosting mood and alleviating anxiety and depression and regulating sleep and appetite and the like. So what would that look like if someone's like, well, I'd like to elevate my sero... First of all, how do you know if your serotonin levels are low? And in the event that they are low, what are the specific dietary interventions to amplify or boost that?

• 26:44Speaker 01

  So the way that you'd know your serotonin is low is no different from evaluating you for taking an SSRI, right? Because it's not as though we're going in and getting a blood test. And I think when I commented earlier that the DSM-5 TR is not the whole picture either. It's because mental health psychiatry, we don't have invasive tests, we can't do a brain biopsy, we have a limited number of things that we can do to diagnose people. And the reason that I feel the DSM-5 TR doesn't capture everything is very often A person doesn't just have a little bit of depression. Often depression and anxiety live together.

• 27:24Speaker 01

  They may have PTSD and anxiety, or they might have focus issues and trauma. It could be many different things. So categories of things have helped the system move it forward, but they don't capture everything. In a similar way, I don't necessarily know if I'm evaluating you for medication and I'm checking that symptom checklist in the hospital and going through the multiple sort of mood scales and anxiety scales that we are trained to do. And in evaluation, you know, am I dealing with this? But we tend to go to an SSRI as a way to help you on anxiolytic or something else. Food is not that different.

• 28:03Speaker 01

  I don't always know that that is low, but I can take from the history, from understanding their lifestyle, from understanding poor sleep, you know, maybe it was eating differently during the pandemic, picking up an unhealthy habit that's sustained itself beyond the pandemic. A lot of that has gotten, you know, people into great difficulties. There's 25% more anxiety since the pandemic worldwide. And that was published in The Lancet. So we know these things. Very similarly, a comprehensive diet to then help the individual kind of improve. And then what I do is track a lot of the symptoms through scales, through report, through

• 28:45Speaker 01

  things like sleep, even appetite, things like brain fog. A lot of those are just built into the system of how we track them.

• 28:52Rich Roll?

  Hmm, yeah, I saw some alarming statistics. 26% of Americans struggle with diagnosable mental illness. 29% will experience a depression diagnosis in their lifetime. I mean, it's basically one, you know, one out of three. Thirty-one percent of people have a chance of experiencing anxiety. Like, these are epidemics and they don't happen in a vacuum. They're, you know, cofactorial, obviously.

• 29:19Speaker 01

  Correct.

• 29:19Rich Roll?

  You know, before we dig any deeper into this, maybe it would be worthy to kind of define what anxiety is, what depression is, how these things differ. Because They don't stem from one thing. They're biological, psychological, and social.

• 29:34Speaker 01

  They are. Environmental, genetics, so there are multiple factors. Depression is primarily a mood disorder where, you know, you are just not feeling yourself. You are not sleeping well, perhaps. Your family is essentially telling you, your friends are telling you, you know, you don't go out with us anymore. You're staying at home sleeping. You're not making it even onto your Zoom meetings. You're not making it into work. You might lose weight or you might gain weight because atypical depression can be slightly different. And people have an increased appetite often, and more often we see sort of a loss of weight or loss of appetite, just a loss of libidinal energy, just across the board, someone who's struggling that way.

• 30:19Speaker 01

  But usually, my clinical experience leads with that mood and affective disorder. Interestingly, with anxiety, because they do often kind of travel together with anxiety, sometimes I think the biggest thing is people don't realize that they have anxiety. And it may be presenting as poor sleep, you know, in the afternoon, not being able to focus. And they think, well, I have a problem with attention. But when you dig deeper, ask the questions, evaluate more, and start to treat, even if it is with a medication, in fact, they realize that they karma with the medication. That's if the medication works, and they frequently don't work. So we do need more solutions. So it isn't that different.

• 31:05Speaker 01

  And then, of course, the set criteria that we go through from DSM five to R.

• 31:09Rich Roll?

  If you have a patient that is diagnosed with anxiety or depression, and they are a good candidate for a nutritional intervention, what does a typical diet plan look like? What are the foods that you're looking to, you know, increase in this person's rotation that might ameliorate some of the symptomology?

• 31:31Speaker 01

  So with anxiety, the way I think about it is I have an acronym, Calm Foods, and I also think about it in terms of Uh finding out what they like to eat, um what is their level of cooking expertise? Or can they get help with that? Can they buy partly prepared foods and put together a meal based on really simple? And I speak about it in terms of an anti-anxiety eating plate. And what I do is I've created kind of a protocol that then go they can go through with different foods. And the foods listed there have the nutrients which really target anxiety. Things like cruciferous vegetables that are higher in sulforaphanes.

• 32:12Speaker 01

  And then there are little trips and hacks, uh tricks I should say, and hacks around how you prepare these foods to really make sure they're nutrient dense. With things like broccoli, for example, research has shown, uh that was published in a journal of agriculture, that if you especially chop the broccoli fine, let it rest for about ninety minutes, it actually has a higher level of sulforaphane. So I give my patients tips like, you know, prepare the night before. Let it sit out, put it in the fridge and then cook it up the next day. Or when you do your meal prep day, we try to make it as easy as possible for people. So that's that's just one thing. So the protocol walks through recipes that are linked, that you can pretty much go make that recipe that are meant to be simple and follow this eating plan for week one.

• 32:55Speaker 01

  The way that those are targeted on a plate is I want people to lean into plants. Like the Blue Zones calls it in Powerline, the Plant Slant. I want them to focus in on plants because these are low calorie, high fiber, highly nutrient dense foods with multiple phytonutrients. I like to say instead of rainbow, you know, kaleidoscope of color because they're bringing so many things to your brain and body. And then when you think about the rest of the plate, unlike the food pyramid that we learnt in school, you know, it's really reversed that. A small portion of some healthy healthy grain like chima. Um and then your healthy fat, this could be avocado, olive oil, and then a clean protein. Whatever that for me would be, you know, like a nicely flavored seared

• 33:39Speaker 01

  or um oven baked piece of tofu or legumes and lentils. For someone else it could be chicken or or beef or whatever is their choice. So when they think about it visually, it's really largely vegetables. And these other three components, then of course they always should be hydrating with with things like water or kind of a calming tea.

• 34:00Rich Roll?

  You mentioned the kaleidoscope, which is basically a way of saying increasing the diversity of plant foods on your plate, which is one of these six pillars that you have to calm the mind. So maybe walk us through what those six pillars are.

• 34:15Speaker 01

  Sure. So one of the pillars is eat whole, be whole, the antidote to the standard American diet, which is don't reach out for the store-bought orange juice, which has no fiber and added sugar. But just eat the orange, just eat the orange. So whether that's an apple or an orange, eat the whole food more times that you can. The idea there is to encourage people to really move away from the processed, ultra-processed version of things. Whenever there's a so-called better food or new food that is, comes into vogue, take cauliflower, for example, it turns into cauliflower pizza crust. Now, nothing wrong with that. If you're making it at home, or you have a sense of what's in that, there are healthier versions, but it's still processed in some way, right? So just eat, eat, when

• 34:59Speaker 01

  you can, eat the whole food. Another one is magnify micronutrients, which comes back to that kaleidoscope of colors. One of the things that the World Health Organization has told us is that 30% of people worldwide, especially women in children, are deficient in iron, and often goes undiagnosed. So magnifying micronutrients, things like magnesium, many Americans are short on magnesium, becomes important. And so that just is really a reminder to include these when you can through foods. Another one is, you know, exclude the anxiety triggering foods. And this is not a surprise, but again, people don't always associate ultra-processed foods with causing anxiety, or certain junk foods or fast foods, or

• 35:44Speaker 01

  highly sugared foods or sodas. That connection is often not made, and very often it, someone will say, "Well, but I feel good when I eat that donut, you know, why shouldn't I eat it?" It's the long-term effect. It's that in that short term, you may actually feel. Really nice, but very often, if you've, you know, if you've eaten one donut, 10 minutes later, you need a second or third. So these are not sustainable options, especially if you're metabolic health. So another one is consistency and balance. And what I mean by this is 80% of the time, I want this to feel comfortable for people to do and not be about food rules and make people feel uncomfortable because, you know, they took their child to a birthday party and cupcakes were served.

• 36:28Speaker 01

  These things happen, this is life. But 80% of the time, if you are mostly trying to follow this, it's an opportunity to course correct on those unhealthy foods you may have started eating or you may be concerned about. Another one is prioritizing healthy fats and it's where we get the fats from, right? It's, you know, avocados, it's extra virgin olive oil, it's nuts and seeds. These are highly nutrient-dense foods, which are bringing in the healthy fats to our body, but also to our brain. When we talk about omega-3s, the short chain omegas ALA from things like nuts and seeds, the little things like the fact that turmeric actually activates and can help the conversion.

• 37:10Speaker 01

  So this is why my cheer puddings often have turmeric in them. You know, it's to help that absorption if you're obtaining your omega-3s from nuts and seeds. So little things like that are meant to really help people and focus in on these pillars.

• 37:41Rich Roll?

  These pillars, which you describe as a protocol for calming the mind, are basically just good advice for how you're going to guide your nutritional priorities going forward for all aspects of health, of course. Like, some of them are very straightforward, probably not new information for, you know, many of the people who are listening to this.

• 38:03Rich Roll?

  But I'm interested, you know, you mentioned anxiety-producing foods. We all know, you talked about the donut, but like, we all know what it's like to...

• 38:12Rich Roll?

  gorge on processed foods and then it tastes really good. Well, you're doing it and then you feel lousy and you're lethargic and you have brain fog and you feel terrible afterwards. But what is going on physiologically when you eat foods that are ultra-processed that has a direct correlation or relationship with enhancing anxiety or some of these negative mental health indicia?

• 38:37Speaker 01

  So I think you raise a good point. I think that there's a lot of these foods that we want to eat for our overall health. But here's the thing, most people are not, right? Because a very large percentage of Americans have struggles with mental health, the statistics you just quoted, and are not really familiar that food can be a way that they can not only maybe clean up insulin resistance and other things, but also improve mental wellbeing. So it becomes powerful in that way because it's an additional tool that someone can use. Often as a side effect, some of my patients lose weight. And it's again, because they're moving towards healthier principles.

• 39:19Speaker 01

  Mechanisms that causes include inflammation, dysbiosis, which is that again, that disruption of the negative and the healthy and unhealthy microbes in the gut. Also, setting off metabolism because of how we're eating. So when you are leaning into ultra-processed foods, you may in fact develop leptin resistance. So the leptin receptors no longer work effectively. They essentially start not telling you what they should, which is, you know, you've eaten a plate of food and you fall. It's time to get up from the table. They malfunction and you lose a sense of satiety and satisfaction when you eat. That can lead to metabolic health

• 40:02Speaker 01

  factors. In fact, most of your metabolism gets set off. And yet, studies have shown you can actually walk yourself back from leptin resistance by adjusting your diet through lifestyle and healthier foods. But what that sets off is very high levels of anxiety.

• 40:20Rich Roll?

  Because you're metabolically dysregulated, your de facto neurotransmitter

• 40:28Rich Roll?

  Disregulated as well, right? So the signaling to the brain gets screwed up in some way.

• 40:32Speaker 01

  Gets disrupted. And one of the interesting things that happens is that the actual receptors malfunction in leptin. So you get a high level of leptin, but they're not reaching the receptors. Your anxiety gets set off. And it's really all, I think you might have probably also heard that some people use the term, you know, type 3 diabetes for conditions like Alzheimer's because there's really this through line of not only metabolic health problems, but also inflammation that is underlying so many different conditions. So these become mechanistic ways of how we are understanding things right now. And they also then provide intervention points to walk ourselves back from some of these symptoms.

• 41:17Rich Roll?

  Well, let's talk a little bit about inflammation. There is this connection as well between the immune system and mental health. The immune system, the majority of which resides in your gut microbiome, and this growing awareness that chronic inflammation is incident to all of these chronic lifestyle ailments that most people are dying from or suffering from. So define inflammation and the differences between acute and chronic and why it's important to understand this and the impact that it's having.

• 41:54Speaker 01

  So interestingly, you know, the type of inflammation that that comes into play and is so important for healing is, you know, you're running a marathon, you fall off and trip and you scrape your knee. Well, inflammation needs to help you heal that wound, help the pain and, you know, create new skin on that scraped wound. And that is incredibly important just for normal functioning. When we're talking about this in nutritional lifestyle and metabolic psychiatry, we are talking about the chronic insidious inflammation that gets set up through how your lifestyle factors are working. So poor sleep can be one of them, but also through how you're eating and what you're eating.

• 42:36Speaker 01

  And very simply, you know, if you are consuming, if you're kind of tapping into the six pillars we spoke about, and you're trying to adjust your diet towards healthier norms, the breakdown products are actually good and positive, and really the gut microbes are making short-chain fatty acids, which we need. And the short-chain fatty acids in the gut microbiome help create balance, because gut microbiome is almost like its own, it isn't an organ yet, but you know, it's performing so many functions, it's helping with sleep and circadian rhythm, which is our internal body clock, vitamin production, hormone production, immunity, mental health, so many things and more. So, when you are

• 43:18Speaker 01

  healthy in that area, and you are eating in a way that is keeping that balance okay, short-chain fatty acids are helping us, as are the breakdown products of the foods that we're eating, the interaction of the plant polyphenols with the microbes, all lead to healthy substances. But if you're tapping into the ultra-processed foods, there are microbes that are unhealthy, that that live there as well, and their breakdown products are toxic, toxic polysaccharides, which start to circulate, create inflammation in that environment, and ultimately lead to piercing and penetrating the single-cell lining of the gut, then the derelict layer, and then you enter the circulatory system. So, you're

• 44:02Speaker 01

  out there, you're going to reach the brain, and you know, this this process of inflammation gets set up. And again, you can walk yourself back from that, and one of the most powerful ways are lifestyle and nutrition factors.

• 44:16Rich Roll?

  So when you're eating these ultra-processed foods, and you're seeding your gut with a certain type of microorganism that is, you know, metabolically producing

• 44:29Rich Roll?

  Quote-unquote toxins. The immune system is triggered to respond. It rushes in and produces inflammation. How does it do that? Is it like increasing blood flow to the area? Like, how does that translate into a less-than-optimal kind of cellular lining to your gut? Is it like a T-cell response? Like, what is happening specifically? Like, I'm still trying to, like, I understand you break a bone, you cut, you know, you get swelling. Your immune system is responding to repair the damaged area. We talk about inflammation all the time. Still not quite clear on like what that looks like in its chronic form.

• 45:10Speaker 01

  Yeah. So you get, you know, inflammatory cytokines being produced. You get these toxic breakdown products from food that are going to pierce that cell lining of the gut. And they all sort of interact in this environment to flip the balance of healthy microbes and healthy breakdown products in concert with everything else in that environment to really set up for things like inflammatory markers that have been found. There are certain things you can look for. They're not traditionally done and they're not something that a routine blood test for sure because in hospital-based systems, a lot of that is dictated by insurance.

• 45:52Speaker 01

  But that can actually show up as inflammatory factors and inflammatory markers. So it's linked in that way.

• 45:59Rich Roll?

  In turn, what's happening in the brain as a result of chronic inflammation? And how is that translating into anxiety, depression, or other indicia of mental health issues?

• 46:12Speaker 01

  So once these, let's just call them toxins, or these inflammatory substances reach the circulatory system, they're going to circulate throughout the body. And the brain is vulnerable. You know, they get through the blood-brain barrier and they start to impact neurons and ultimately lead to neuroinflammation, which is essentially brain inflammation. And, you know, one of the things that one of my mentors always talks about is if people understood, and I think it'll tie into what we're saying here. That many of us, just like people walk around with nascent cancer cells and nothing happens to them. You know, one person develops cancer, someone else does not.

• 46:55Speaker 01

  In a similar way, we also have some imperfect neurons in our brain and they could lead to cognitive impact and cognitive changes, and we know this. But one of the most powerful factors is neuroinflammation and how, one of the things that impacts neuroinflammation is how we eat. If we dealt and worked towards improving our neuroinflammation in the brain simply by dietary and lifestyle factors, we could actually fend off cognitive changes. This is a mentor who pretty much, I think, discovered the first Alzheimer's gene or something like that, but something important. So I always remember that because it was a really seminal moment in my understanding

• 47:37Speaker 01

  of what we can change in, in brain health in that way. And impact neuroinflammation, which if we start to work on, and food is a factor, lifestyle is, sleep is a factor, and lifestyle is a factor, that we can really improve our ability to fend off cognitive changes over time.

• 47:59Rich Roll?

  So then what do we know or not know in terms of the relationship between chronic inflammation or dietary choices and more longer-term brain deterioration, diseases, dementia, Alzheimer's and the like?

• 48:16Speaker 01

  What we know is that, that food and lifestyle, like I just said, are, are factors. I think that we're not at a point of finding that cure for Alzheimer's. We know that we can ameliorate a lot of things through things like the process of inflammation. We can improve things through certain, certain types of eating patterns. Certain people will use fasting, time-restricted eating.

• 48:44Speaker 01

  We can choose certain nutrients. We know that things like trimic with black pepper, blueberries, certain foods are targets for cognition. Beyond that, I think that there's a still, you know, we have a way to go with the research and I'm glad it's ongoing.

• 48:59Rich Roll?

  We had Dr. Sarkis Masmanian in here the other week. Are you familiar with his work at Caltech?

• 49:07Speaker 01

  Not all of it, but I know of the name.

• 49:09Rich Roll?

  Yeah, it's quite fascinating. I mean, he's looking at the relationship between the microbiome and neurological disorders, specifically Parkinson's and autism, and finding this connection between the nature of the gut ecology and the incidence or onset of these disorders. And there's still a long way to go to figure out what an intervention might be, or, you know, how to actually, you know, deal with it. And these are all studies that are done in mice, not in humans. So it's a leap, but I think it underscores this idea of just how powerful and significant the microbiome, and in particular, like the health of the microbiome, is in terms of all of these things that we think of as being

• 49:53Rich Roll?

  different or unrelated. Like, the human brain likes to categorize things, to separate them and put them into buckets. The brain and the body as two different entities and we treat them separately, when in truth, you know, we are holistic creatures and these things are not separated, they're interrelated in ways that are much more integrated than we would suspect or imagine.

• 50:15Speaker 01

  And I love what you're saying, because not only do I agree with it, but, you know, mental health is no longer an above-the-neck concept. We are understanding that it is so related to other parts of our body. Understanding that we are holistic beings and that one thing impacts another, I've become so critical with food being one of the pillars.

• 50:37Rich Roll?

  On this idea of the bidirectional relationship between gut and brain.

• 50:43Rich Roll?

  How does it work in reverse? We've been talking about how the microbiome can influence the brain. But how is our mental state influencing the gut? And maybe more specifically, how does anxiety affect metabolism? Because this is going not just from bottom to top, but top to bottom as well.

• 51:02Speaker 01

  So a few different ways that we know so far. The research is always evolving. So I always want to remain humble in that space, realizing that it changes. But this is what we know, and this is how I understand it so far. There are a few things. When we are anxious, we know that, say you have a bad day and you have an argument with someone, or whatever it might be, we know that actually those emotions are transmitted to the microbes and that they respond and they show changes and they evolve. Just like when you eat, whether it's healthy or unhealthy or less healthy, they are responding. You don't see the effect immediately. So we know this from the research that our emotions-

• 51:42Rich Roll?

  And is that from the vagus nerve? Sorry to interrupt.

• 51:45Speaker 01

  Yes.

• 51:46Rich Roll?

  How is that messaging-

• 51:47Speaker 01

  Yes.

• 51:48Rich Roll?

  -getting translated?

• 51:49Speaker 01

  One of the strongest pathways is through the vagus nerve. So whether it's neurotransmitter changes that are being transmitted down to the microbes, we know that our emotional health gets transmitted. When it comes to things like stress and anxiety, the other thing that gets set off is our levels of cortisol. And this is not something that we unfamiliar, but we know that something gets set off. And our metabolism changes. All of these things really start to drive anxiety. Like, we know in the brain that the amygdala and the hippocampus are related to the hot beds or the hot spots for anxiety.

• 52:30Speaker 01

  We understand that with so many people having some struggle with metabolic health, that this has impacted as well. So our mind state, so to speak, actually impacts the gut directly. One of the most direct mechanisms is through the vagus nerve. It becomes powerful because that's where alternate holistic and integrative practices like meditation and breathwork can be very powerful. Like, I always make sure that my patients learn a breathwork exercise. And research published in early 2020 that was looking at pranayama yoga, breathwork yoga, and cardiac disease. Secondarily showed that it improved depression and anxiety.

• 53:15Speaker 01

  So we know that there are ways that we can modulate this through these external factors and, you know, improve mood and certainly lower anxiety.

• 53:25Rich Roll?

  Hmm. And in turn, is there a sense or an understanding of how something like pranayama or another form of breathwork or yoga or, you know, anxiety ameliorating behavior in turn aids with metabolism or the nature of the gut microbiome? Does it work bidirectionally in that way as well?

• 53:50Speaker 01

  You know, I think that with metabolism, it's more complicated because you have the interplay with leptin, you have other factors going on, you have the potential of, you know, insulin resistance being impacted. So I don't necessarily think it's that exact same way. But we know that when our metabolism is set off and is sort of not in check, and we know many Americans are struggling with this, that our anxiety levels kind of pop up and we know that that's related in part to leptin resistance.

• 54:21Rich Roll?

  Hmm. Walk me through a day in the life of food for somebody who, I want to be very practical here, if somebody's listening to this and it's like, just tell me what I should not eat and eat, you know, like what does my breakfast look like tomorrow? What does my lunch and dinner look like? What should I be snacking on if I'm just looking to, you know, kind of care for myself a little bit better in terms of reducing anxiety or perhaps even taking the edge off some form of depressive condition?

• 54:52Speaker 01

  Sure. So some of the foods, and I'm going to go through different meals with you, but some of the foods I'm going to be leaning into ones we've spoken about, and then I'll try to pick up on certain metabolites and factors that are involved. So let's think about breakfast. You know, I think breakfast is a choice these days because some people choose to use intermittent fasting and time restricted eating. For mental health, we don't have long term studies on whether fasting or time restricted eating is improving mood. Anecdotally, my patients who do fast will notice that they have more energy and have a little bit more focus that they speak about.

• 55:32Speaker 01

  But they're also being monitored by a team of physicians. They're not just out there deciding how they should eat, a little bit more careful.

• 55:38Rich Roll?

  Is there a, an optimal windowing of time that you've noticed that works better than another?

• 55:44Speaker 01

  No, not, not really. I think it honestly, it comes back to personalization. It varies with people and we know that the windows are different in men and women. But there are a lot of patients, my patients who wake up and they're hungry and they may need to be taking other medications. So it's important for them to eat. So good choices are, I like things like cheer pudding, great source of ALA. Um, simple recipe with literally a plant based milk or milk of your choice, a drop of honey, and I do mean, you know, very little. Just for some sense of sweetness, or I prefer cinnamon, which is not only a spice that helps control of the sugar levels in your body, but it allows the sweetness. And I like nuts and seeds and berries on my cheer pudding.

• 56:29Speaker 01

  And it's very, it's sort of nutrient dense. It's fiber filled and protein rich, so you don't need a lot of it and you can make it ahead. I also like choices of a tofu scramble. So I add in spices, I add in lots of vegetables. If I'm making a large portion, I can save some for the next day as well. Um, so I, you know, use my tofu, I kind of chop it up or blitz it in a food processor. And I love to really pack that up with those vegetables that add in biodiversity. I'm always adding spinach or some green because the folate, one thing they have iron, we know that many people are iron deficient. But the folate is rich in vitamin B nine and low vitamin B nine is associated with low mood.

• 57:13Speaker 01

  So adding those in becomes important. I also like to use a different way of making an omelette. So I was raised vegetarian, so always like to have options for what different people eat. And so another thing is to use chickpea flour and to make sort of a chickpea scramble for which I have a recipe in the book. Another great way to add in. Spices, herbs, flavourings, all of which have powerful nutrients for your brain, but also vegetables and adding in your plant slant there. Snacks that I like are basically like a granola but made from raw nuts, some extra dark natural chocolate chips, there are vegan versions of this that I actually am really liking.

• 57:54Speaker 01

  And often, you know, coconut chips just for the crunch and it can actually be a really nice snack on the go, even if you're travelling, or some berries, or just a handful of nuts um on the go. And then lunch, I like to, some people want a heavier lunch and a light dinner and some people flip that. I like to think of a really large salad with lots of greens. Uh same nutrients we're talking about here, but remember we're also getting the fibre that really feeds the gut microbes, we're getting the biodiversity from that kaleidoscope of colour, bringing different nutrients to the gut. We talked about the plate variation. Proteins there could be a clean protein, so for someone it could be, you know, tofu,

• 58:37Speaker 01

  tempeh, um some, some legumes, lentils. For someone else it might be chicken and then uh I like avocado or olive oil. Sometimes the olive oil is just the dressing for that bowl. And one of my favourites, favourite grains, because I can uh make a, you know, a small amount ahead in the week, is something like quinoa, but I really use a lot of spices because it doesn't taste good on a roll, it's got to be flavoured up. And same, you can interchange the afternoon snacks. Also like to add calming teas into your day. So passion flower, lavender, chamomile tea, mint tea, just made with French mint leaves, um are great in the afternoon. And mint contains an antioxidant called luteolin which helps with brain fog. Often my patients will say, you know, I feel sluggish in the afternoon,

• 59:22Speaker 01

  I don't have enough energy, it's a great way to, and green tea does. Green tea is rich in, you know, L-theanine and E G C G and it also gives people a little bit more focus without the buzz from caffeine. And for dinner, you know, I go in the direction of always bringing in spices when I can. So I like cauliflower steaks and I'll make a tikka masala spice on that, use my air fryer, add in tons of veggies around that. Someone else in the family may eat a different protein, but lots of vegetables. I like a side salad or I like lots of side vegetables along with that. Some of my favorite choices are broccoli, you know, different colors of broccoli, like purple sprouting broccoli, the beautiful orange, you know, cauliflowers that we get, whatever

• 1:00:07Speaker 01

  it is that you like, green beans, you know, choose the vegetables that you love and add them in. Because not only are those satiating, they're flavorful and they're good for you. So, you know, that's sort of how I walk people through a day. And I have options for, you know, people who love dessert because you can make almost a chocolate pudding from using avocado and extra dark cacao.

• 1:00:31Rich Roll?

  Sure.

• 1:00:32Speaker 01

  You know, people do innovative things and so, you know, you don't have to exclude these things from your life. And there are things like extra dark natural chocolate, which I learnt in culinary school and I thought that, you know, clementines or oranges paired with extra dark chocolate was a flavor profile until I understood that extra dark chocolate is the highest source of plant-based iron. And since we know many people are anxious and many people are iron deficient, you need the vitamin C from, say, the clementine or the orange.

• 1:01:02Rich Roll?

  For the bioavailability.

• 1:01:03Speaker 01

  For the bioavailability. So it's a lovely pairing for, you know, people who want a nice snack and it's great for kids too.

• 1:01:08Rich Roll?

  Yeah. To your point about iron deficiency, obviously you want to be sourcing all of your nutrients from food, the matrix of the foods that you're intaking is the optimal way to source all of that. But if somebody is iron deficient or they do a blood panel and they realize, oh my goodness, my vitamin D is low or this is off and that's off.

• 1:01:27Speaker 01

  That's very important.

• 1:01:28Rich Roll?

  Where is your, your head in terms of supplementation?

• 1:01:31Speaker 01

  Yep.

• 1:01:32Rich Roll?

  Does that have its place? What does that look like? What are some of the more common supplements that you would recommend? Obviously it's going to be specific to that individual.

• 1:01:41Speaker 01

  Right.

• 1:01:42Rich Roll?

  But is there a tether or a relationship between certain supplements or deficiencies and? You know, mood disorders like anxiety or depression.

• 1:01:51Speaker 01

  I think that's an excellent point you made about iron deficiency because sometimes people are so iron deficient that they need iron supplements.

• 1:01:58Rich Roll?

  It takes a long time to deplete those stores and then in turn a long time to build them back up.

• 1:02:02Speaker 01

  Correct, so they might actually need to do both. They can always eat healthy and add in those iron-rich nutrients, but taking a supplement may be what their doctor recommends and they really should do it to get to that point where at a healthy level. They might be able to talk to their doctor about coming off that supplement, but when they've normalized, and that does take time. But generally, I'd really feel there's a place for supplements. The reason I feel that is many of us, including myself, don't eat a perfect diet. And supplements actually fill those nutritional gaps that we have. Some of the ones that are very related to mood and anxiety are things like vitamin D. I live in the northeast of the country. Many people are vitamin D deficient and should have a check.

• 1:02:45Speaker 01

  Yes, you can get, you know, eighty percent of your vitamin D by spending time in daylight. Not only making sure you're attending to your circadian rhythm, but also absorbing before you put on sunblock or sunscreen, absorbing some daylight. Doesn't work through a window, but low vitamin D is associated with high levels of anxiety and a low mood. Another one that I sort of favor is magnesium because so many Americans are magnesium deficient. And magnesium is involved in so many other biochemical reactions in the body.

• 1:03:16Rich Roll?

  There's also like seven different types of magnesium, right? So walk us through which type of magnesium you would recommend and the various applications or uses for those different forms of magnesium.

• 1:03:31Speaker 01

  So, let me explain my position here. So I feel like magnesium can do so much from helping constipation to helping anxiety that there's a very wide range of uses. So I want people to be aware that there are few that I talk about that will help with anxiety, but for the most part, they really should be speaking to their doctors about it because magnesium does so much. And with any of these... Supplements, there should always be a way in which you're following the recommendations, right, of the dose, because people think, well, let me improve this by having a ton of the supplement can be unsafe. So the other ones that I love.

• 1:04:12Rich Roll?

  And also, sorry, I keep interrupting you.

• 1:04:14Speaker 01

  Oh, no, no, no.

• 1:04:15Rich Roll?

  But like, I think it's important to point out that, again, you know, these things are operating in the context of a holistic system. And I think our brains are like, well, if I take this, this happens. But if you're taking a bunch of different supplements, like, how are those all interacting with each other?

• 1:04:29Speaker 01

  Right.

• 1:04:29Rich Roll?

  How are they interacting with the foods that you're eating? And it becomes very complicated very quickly, right? So the solution isn't just a sort of binary, you know, X does Y. You have to really take into consideration, you know, multivariate factors.

• 1:04:48Speaker 01

  I agree with you. And I think I was more answering your specific question around which supplements impact mental health and specifically mood and anxiety, but completely. One of the things that, you know, kind of led from my early days of spending time with my grandparents is this holistic and integrated approach. So how's someone sleeping? You know, what are they doing for hydration? Being dehydrated can actually precipitate anxiety sometimes. And people sometimes wake up just because we've slept overnight with dehydration. And just having a glass of water at their bed stand is important. So it is always an integrated and holistic approach with these different factors. And it's individual to that person. I've had a patient who came in with a

• 1:05:33Speaker 01

  biological relative who had an opposite reaction to the same healthy food. And, you know, I think to myself how incredibly personalized our approaches need to be. So all of these things are hugely important. And what works for your supplementation may not work for me. Some general guidelines, you know, test, don't guess. So let's make sure we know what supplement you need and how you can replenish it. Involve a provider because they might guide you or maybe you have a different system where you get your blood test. There's so many different ways to access care these days. Maybe you do it that way, but usually there's a nurse, there's a practitioner, there's a telehealth visit involved and then assess what needs to be replenished.

• 1:06:16Speaker 01

  If you have vitamin B12, I grew up vegetarian, so I would get with pediatric or adult visits, get a vitamin B12 test and see if I needed to get that. But you know, there are options now, like nutritional yeast, which I use in many of my recipes. So there are ways to get other supplements and just check.

• 1:06:36Rich Roll?

  A lot of, a lot of foods like the plant milks, et cetera, are fortified with B12. Do you have a sense or a preference around the type of B12? And this is for the plant-based people. Methylated, methicabalamin, cabalamin. Like there are different forms and there seems to be some confusion about which one people should be opting for.

• 1:06:59Speaker 01

  So it's interesting because my understanding is that the oral supplementation may not be as effective. You might need to take, take it as a shot, as an IM injection. So speaking to your provider about that is important in terms of supplementing it. And the one that I tend to lean towards is methylcabalamin.

• 1:07:35Rich Roll?

  You mentioned calming teas, which made me think of the role of adaptogens. You talk about ashwagandha. What is an adaptogen? And how are these working in concert with everything else and impacting our, our mental health?

• 1:07:53Speaker 01

  So, you know, interestingly, ashwagandha is sort of a, a root that was used and doesn't, does not taste good, tastes very bitter, which is why a supplement is a good idea. It was used in ancient diabetic medicine for, for eons and for different conditions. But it has actually ended up having a good number of human trials helping anxiety. So I've really come to embrace it as more than just my cultural roots, but something that can help individuals who are looking for. A few solutions that are not a prescription medication. You know, what an adaptogen does is uses the mechanisms of your bodily systems to actually improve a certain condition.

• 1:08:36Speaker 01

  And in this case, with ashwagandha, we know that people actually have some relief over time for anxiety. So it's a good supplement to consider. Saffron is an herb that I love to, you know, a spice I love to cook with. It's expensive and you don't use a lot of it, yet saffron has a number of trials showing that it helps with a mood and helps with anxiety. Saffron is another one that I like to suggest as a supplement. And anecdotally, individuals have told me on podcasts and other places that, you know, it's something they've given their children because it's something they've found to be safe, they've spoken to pediatrician, they don't want their child to take a prescription medication.

• 1:09:19Speaker 01

  So it's just an interesting thing to consider.

• 1:09:22Rich Roll?

  What are your thoughts on so-called like quote unquote, "super foods"? Not in the sense that they are panaceas, I think they get perhaps too much attention. They're sort of the cherry on top of the sundae, that and the sundae being like the pillars that you already referenced. Like they're great as long as you're doing all these other things. But there are benefits to incorporating things like turmeric or moringa, things like this that perhaps are a little bit more exotic for most people, but have, you know, a wide-ranging array of like positive benefits on the body. Turmeric, of course, being a powerful anti-inflammatory.

• 1:10:03Speaker 01

  Yeah. Often I might be asked by media around, you know, what is a certain superfood? And I have to tell you, I try to-

• 1:10:10Rich Roll?

  Food is food, right?

• 1:10:11Speaker 01

  Exactly, exactly. I try to say like-

• 1:10:13Rich Roll?

  These things are getting a lot of attention?

• 1:10:14Speaker 01

  All foods are super. Exactly. It's like the food of the day, the food of the week.

• 1:10:17Rich Roll?

  Well, it's a lot sexier than a whole grain. I mean, let's face it.

• 1:10:20Speaker 01

  It's like, you know, eat your kina, no, not really, I want a superfood berry or whatever it is. So I try to, you know, push back if I'm asked that because I feel as though it's so important, you know, we talked about biodiversity of the different foods, the colors, the kaleidoscope, the nutrients in these foods. It's really- Every food has some super powerful effects. It's what you choose, it's the sourcing, it's the portion. You know, rather than people counting calories, for example. I'd rather they have a bowl of broccoli as their side dish. Because we know that that is rich in sulforaphanes. We know that this is gonna have positive effects. So I try to step back from that a little bit. And if someone says, well, is blueberries a superfood?

• 1:11:03Speaker 01

  Well, blueberries are fantastic, one of my favorite. But the other berries are great, too. Maybe you have access to black raspberries. Maybe you have access to other delicious berries. But these are all going to be good for you. I just don't want you to go, you know, get a, I was gonna say a lollipop version of them. You know, because that's not, that's not the idea. I think that's where marketing food companies and the whole, something you're very familiar with is just, it's leading people astray from the healthy, obvious choices that the pillars may talk about. And may actually helping people go back to what probably the way our grandparents or great grandparents were eating.

• 1:11:46Rich Roll?

  Beyond anxiety and depression, there's a whole litany of other mental health considerations. What is your sense of the impact of dietary choices and ancillary lifestyle choices on things like OCD or ADHD or something I personally suffer from, which is seasonal affect disorder? I get very down, you know, when the days are short and it's cold and dark out.

• 1:12:15Speaker 01

  Yeah, it's a very real thing. The, so OCD has some interesting factors. In my book, This Is Your Brain on Food, I go through the different conditions and nuances. So in OCD, glutamates, actually in some healthy foods, like different types of soy sauce, certain mushrooms and things like that can actually offset symptoms of OCD.

• 1:12:38Speaker 01

  And what is helpful for people to know if they're struggling with these symptoms is to work with a clinician to figure out excluding even those tomatoes, you know, some of those foods that are relatively healthy, or miso, actually, for example, that they might want to cut back on to help. A study done in children with ADHD showed that omitting breakfast actually was not helpful because it worsened their symptoms and was harder for them to maintain focus throughout the day.

• 1:13:07Rich Roll?

  Hmm.

• 1:13:08Speaker 01

  And this is interesting because if they prescribe medications, there's a lot of, you know, medications that are being prescribed to children with ADHD and focus and attention, they suppress appetite.

• 1:13:19Rich Roll?

  Yeah, it's, yeah, you don't want to eat.

• 1:13:20Speaker 01

  You don't want to eat breakfast.

• 1:13:21Rich Roll?

  Their stimulants, basically.

• 1:13:22Speaker 01

  Exactly. So you don't want to eat breakfast. So little nuances like that, that I think help guide in the different conditions. And that, you know, food, food can just be a tool, not the only tool, but a tool that people can use to bolster how they're feeling emotionally. You know, things like light boxes, things like having that access to sunlight becomes hugely important. And especially, you know, in different parts of the country, seasonal affective disorder is huge, again, related to sometimes the level of sunlight as well.

• 1:13:57Rich Roll?

  If I want to enhance my focus and my cognition, I want to sit across from you for a couple hours and be completely dialed in, present, paying attention, alert. What are some of the foods I want to avoid? What are some of the foods that are going to possibly enhance that?

• 1:14:15Speaker 01

  So let's, let's get rid of the ones we want to cut back on and just be more...

• 1:14:20Rich Roll?

  I'm not going to eat a pizza, you know, my eyes will swell up. I don't have celiac, but I can tell you, like, I feel like my head grows two sizes after I eat something, you know, like refined grains.

• 1:14:30Speaker 01

  Refined grains, yeah.

• 1:14:31Rich Roll?

  Or sugar and crash and all that.

• 1:14:33Speaker 01

  Right.

• 1:14:34Rich Roll?

  Of course, there's the obvious sort of thing.

• 1:14:35Speaker 01

  Exactly.

• 1:14:36Rich Roll?

  I don't want to do.

• 1:14:37Speaker 01

  I'll tell you the, the one that's, um, so, you know, we know sugar's obvious, we know sodas and things like that. But people, I can't underscore this enough, that, that people don't realize that...

• 1:14:51Speaker 01

  An ultra-processed packaged and a processed food just has a ton of, it's the color of the diet of food stabilizers, a study done in mice, published in a reputable journal in 2022, I think it was March, looked at the gut microbiome, given what our conversation earlier, and a food thickener called CMC, carboxymethylcellulose, and showed that in these animals, when they were fed this, it actually led to actually no production of short-chain fatty acids in their gut microbiome. And this is frequently used in our foods to thicken things. If you read the labels, you might see it.

• 1:15:36Speaker 01

  So it's, it's, yes, it was an animal study, but a lot of our research in medicine starts with animals. You know, aspirin did, many medications did. So all I'm saying is that I think, you know, we're starting to find this connection. So let's underscore ultra-processed foods because they actually are very damaging. And it's not that we can avoid them, but let's be mindful about the choices we make around that. The seed oils, the issue with seed oils is more that our standard American diet that many people are eating is, kind of flips the ratio of omega six and omega three in the favor of omega six, which can be pro-inflammatory. We need some omega sixes and we should be eating them, but that ratio becomes important and that's where we go wrong. And they're not official sweeteners.

• 1:16:20Speaker 01

  So the old artificial sweeteners are problematic to the gut microbiome. They trick our systems, our bodies, into thinking that sugar's, you know, going to reach us. And that is one of the reasons that people using a lot of artificial sweeteners, say diet sodas or foods that they're eating, can actually develop cravings and eat more and may gain weight. So just something to watch for.

• 1:16:43Rich Roll?

  That is a controversial. Take though, is it not, there are other people who who say otherwise when it comes to artificial sweeteners.

• 1:16:50Speaker 01

  I think people have varied number of opinions. I'm not saying that I'm 100% perfect or right, but I am saying that's my understanding of the science. And I think the new sweetness, which actually have been shown to, right now, the research is not showing anything bad, but a lot of stuff that's in diets, sodas and things like that can be problematic, certainly to the gut microbiome and to these signal signals in in the body. So but, you know, the things that we can be dialing into, one of the things that's sort of a hidden pharmacy in our kitchens is is our spices. You know, they can be bought in small quantities. If you can get organic, those are obviously a better choice.

• 1:17:31Speaker 01

  But the the power of the plant polyphenols and things like turmeric that you mentioned, capsaicin from chili peppers, the luteolin from mint, all of these things actually help not only flavor foods, they can flavor your tea, they can flavor your food, but they also enhance your meal with, you know, note little calories, because if they're just a pure spice, you're adding flavor without at sometimes needing to add less of something sweet because of the cinnamon. And then, you know, leaning into the berries, the nuts, the seeds, you know, microciferous vegetables are some of my favorites, your leafy greens, are just some components of how I think, well, how am I going to stock my fridge this week, and then your choices of protein.

• 1:18:13Rich Roll?

  Is there something specific I should be thinking about, though, if my focus really is to improve focus, like, what are the key foods that are gonna do the best job at elevating my ability to, like I said, be present, stay focused, concentrate?

• 1:18:31Speaker 01

  Sorry, you did, I said vitamin C is one of the important nutrients with focus, and omega threes is another one. So those two definitely showed up in terms of helping, probably one of the mechanisms is the anti-inflammatory effect, again, but it's becomes important because, and then, sorry, green tea, EGC, G and L D N, super helpful for people with kind of focus and.

• 1:18:56Rich Roll?

  Oh, that's good to know. I don't drink enough green tea.

• 1:19:01Rich Roll?

  What are your thoughts on caffeine? There's two sort of things, two threads to pull on here, I think.

• 1:19:07Speaker 01

  Yeah, so I'll tell you what I think. Caffeine is part of coffee, but coffee on its own has a lot of plant polyphenols that can even help, you know, organ systems like the liver. And this has been outlined by one of my colleagues who's a hepatologist at Harvard. And really feels like coffee, and I've read the books, he probably drinks more coffee than I want him to, but drinks a lot of coffee, is okay. It's the caffeine that often sets off some issues, especially in conditions like anxiety. So my guidance is around coffee is when you can get clean sources of coffee. What you put into it becomes important because going back to the start of our conversation,

• 1:19:50Speaker 01

  my patient was putting a quarter cup of processed cream and it sugars. That's, you know, that's setting it off in a different way. So I'm a fan of coffee for anxiety, have it early in the day if you tolerate it. If you drink a sip of coffee and you get jittery, it's not for you. That's, you know, paying attention to body intelligence. I have noticed in myself that more than two cups, you know, early in the day, what I can tolerate. I forgot this recently before a television interview and it was around the holidays and I had family over and we were drinking coffee with, you know, the early afternoon. And I literally went to the interview very jittery and I thought, I should know better. So, you know, you know that about yourself.

• 1:20:33Rich Roll?

  Yeah, of course. Also as a sleep dysregulator, I mean, it has a, like a seven hour half-life, right?

• 1:20:40Speaker 01

  Exactly.

• 1:20:40Rich Roll?

  So if your sleep disrupted in any way and you're not getting your, your, you know, solid eight hours and getting, you know, the restorative sleep that you need due to some level of caffeine consumption, then you're going to be de facto dysregulated in every other way. And that's going to affect your mood and everything.

• 1:21:00Speaker 01

  That's.

• 1:21:00Rich Roll?

  The downstream impact of that is.

• 1:21:02Speaker 01

  Sleep and mood and anxiety and all of that is huge impact.

• 1:21:06Rich Roll?

  Metabolic regulation and.

• 1:21:08Speaker 01

  Correct, because sleep impacts that as well. So my kind of, for what I say to people is 12, I'm guiding someone in a plan. I'll usually say 12 noon, but usually that gets pushed about 1:00 or 2:00 PM. But I like to create that cut off certainly for myself and I think it works for most people that because if they're having an early dinner, that hopefully gets the caffeine metabolized and it's not impacting their sleep. So I like them to have it if they can tolerate it for the other benefits of coffee and pay attention to what they add to it.

• 1:21:40Rich Roll?

  Alcohol.

• 1:21:41Speaker 01

  Alcohol, the other hot topic. So my position on alcohol is we know the negative impacts of it. We know that it can be neurotoxic. We know that it can be hugely problematic. But I also, in mental health, feel strongly that I need to address more of the people that I'm treating. And it's harder for me to say to people, I want you to just stop drinking this entirely. Can I say to them, let's work on this plan that is improving different elements of your health overall to improve your mental wellbeing? And can we start cutting back on this? Because one of the things that happened in the pandemic is many, not many, but some people got into a little bit of difficulty with that because

• 1:22:25Speaker 01

  people were at home. And I evaluated someone in a telehealth visit once who I was sort of surprised and I had to ask her, you know, as part of this initial evaluation, are you drinking wine? Because it looked like a wine glass and it looked like wine. I thought maybe it's ginger ale, but I'm not sure. And I asked and it was. And she had gotten to this state of such extreme anxiety on her own during the pandemic that in order and my meeting with her was like a 12 noon meeting. It was her first meeting of the day, that she couldn't get on to her first meeting without a glass of wine. And she was kind of all siloed on her own, struggling with, you know, what had become this devastating

• 1:23:07Speaker 01

  anxiety. And so people got into different types of issues around that. So only in moderation, you know, if people are advising you that something is a mess, pay attention, you might need help. And if it's not for you, please don't start drinking alcohol because I'm not saying there are some great benefits for you. I'm mostly trying to address that. Many people, they're not. I think. More people than not may consume alcohol in my practice. And if they do, how can I work with them to feel better?

• 1:23:42Rich Roll?

  I would just tell them to cut it out.

• 1:23:44Speaker 01

  I know, it's just not easy.

• 1:23:45Rich Roll?

  I mean, look.

• 1:23:45Speaker 01

  Just like with ultra-processed, I can't say to people, just cut it out.

• 1:23:48Rich Roll?

  Yeah, I mean, just give them the hard facts, Uma, come on. I understand if somebody's in a high-stress situation or they're experiencing anxiety, it's like, I want to have a drink, it takes the edge off. It ameliorates that anxiety. But what it also does is set in motion a chain of events that are going to make your sleep less stressful. Like, it's ultimately going to exacerbate the anxiety that you're looking to treat. And similarly, you know, with excessive or chronic use, in the same way that marijuana operates, like, a lot of people use that to calm themselves. But ultimately, it ends up being a situation where their anxiety is way worse and then

• 1:24:30Rich Roll?

  they're dependent upon it because without it, the anxiety spikes. But in truth, it's the causative impact of a lot of that experience.

• 1:24:40Speaker 01

  I respect what you're saying. I also want you to know that the studies in alcohol are quite mixed. And I'm not saying that I agree with them. But I am saying that I have to offer, just like I was raised vegetarian and really never ate meat growing up, I have to be flexible with someone in mental health because they may come in with a different diet. But I will tell you that, you know, there is a sober curious movement that I'm really behind in terms of helping my patients. And there is education that is provided to people. But just like you mentioned marijuana, you know, I'm very mixed about the psychedelic movement. So what are we doing in the big picture of things? And I'm not saying one is right or wrong, but where are we headed with this?

• 1:25:23Speaker 01

  You know, what is that big picture view of?

• 1:25:26Rich Roll?

  Yeah.

• 1:25:26Speaker 01

  How do we help our integrated?

• 1:25:28Rich Roll?

  I'm sure you have people come in and they, they say, well, I heard, I heard this about ketamine therapy or psilocybin, et cetera. Certainly, as you know, like, there is some really interesting research coming out about this. And there's no question that it's helping certain people in certain situations, veterans with PTSD, et cetera. But I do think that there is still some.

• 1:25:53Rich Roll?

  Misunderstanding around how powerful these

• 1:25:57Speaker 01

  I agree.

• 1:25:57Rich Roll?

  These compounds are and our relationship with them feels a little bit too casual. And I think it's human for us to think, well, I just need to, if I do that thing, it'll solve my problem.

• 1:26:08Speaker 01

  Right. I think the search for that solution is always the case. And I agree with you. I think that it's honestly in brain science, I think, I think it's too soon for us to know definitively. And I am very cautious, you know, and I'm not trained in ketamine therapy. And I'm, as a reason, I didn't go in that direction in my career. I'm not saying you're wrong. It might be for a person in guided treatment with the right clinician, but I don't think it's, it's the be all solution. And neither psychedelics.

• 1:26:40Rich Roll?

  You mentioned the importance of like working with people and meeting them where they're at. In your experience with all the people that you've seen and that you work with, what is the differentiator between the person who can take the counsel that you're providing and put it into action and make those changes and experience the results and sustain them over time versus another person who sits across from you and you tell them what to do and they just can't quite do it?

• 1:27:15Speaker 01

  I think of that first hook, that first, and I mean positive hook to get them started as a positive gateway effect. So, meaning that if I can identify in that, and it's a critical part of that evaluation, one thing that's bothering them that we can change because if someone is sleeping better within the first week, has more focus or energy, these are powerful. And someone who's struggling with anxiety or a mood condition, that for me is one very huge factor.

• 1:27:49Speaker 01

  The times that I've really run into, honestly, for one of, I'm trying to say this in a nicer way, but people who don't make it, they don't get behind the plan, they can't get behind the plan. It's often a condition that I see a lot in my practice called orthorexia. And it's not identified by NADA, which is the National Eating Disorders Association, as an eating disorder, but it is a fixation on a certain healthy food, a healthy food group. And they really do struggle to work with me around, can we adapt this? Can we add this in? Can we take that out? Can we change? Because they tend to come back to, well, but this is what I've done.

• 1:28:28Speaker 01

  And I can't really explain to them that their overwrought anxiety might be related to the rigidity of holding on to those principles. So that's where I've had the most difficulty.

• 1:28:40Rich Roll?

  Which, of course, is rooted in a control issue that is driven by some kind of latent fear that they have. Right? I mean, as a psychiatrist, in thinking about the mechanics of trying to guide somebody through a lifestyle change, all these things come into play. Orthorexia, of course, but also, what is this person's sense of self? Are they insecure? Are they self-loathing? Do they have a muted capacity of what they're capable of? And trying to figure out how to, like, get in there so you can inspire and motivate and educate and guide them in a way that's going to work for them.

• 1:29:24Rich Roll?

  And it becomes very complicated. But I'm really fascinated with this difference between people who are like, oh, you told me to do that and I did it, and people who are like, yeah, I tried or it didn't work for me, or I couldn't do it. Or, you know, how do people change? Like, as a psychiatrist, what have you discovered or experienced in the treatment of, you know, as a clinician, that gets people over that hump and feeling empowered enough to, you know, make changes and sustain them?

• 1:29:54Speaker 01

  I think that's a great question. So just going back to the orthorexia, that's why a team is helpful, because having someone, you know, be the primary therapist, we train in therapy. But if I'm in this role, having them work with someone to work out the fears, the underlying issues may take time. And that becomes a key part of that almost treatment team approach. But It's, people get, you know, advice all the time. I'm a firm believer that people generally know what healthy foods versus unhealthy food groups are. But effecting change becomes extremely hard. Behavioral change is hard.

• 1:30:34Speaker 01

  And for me, it's trying to work using almost my skills training as a therapist and in psychiatry to find my way in to their psychological space in a safe way that I can help them to grab on to the one thing that they want to change. And sometimes it doesn't work initially. Sometimes someone struggles for a little bit, you know, I can't get that. And sometimes it involves other factors we need to put into place. Exact meal planning, assistance from a nutrition coach, having them, in addition to checking in with me, having them get help from a dietitian who works out the plan with them, helps them implement things. A family member who helps them shop, whatever it might be.

• 1:31:18Speaker 01

  It sometimes takes a while to get to that point. But when I mention that gateway effect, when they click with something that shows them, like the coffee or the gentleman at the beginning of our chat, it becomes the fulcrum of change because then they want to do more. I've learned in my practice-

• 1:31:38Rich Roll?

  Right, they have to have like a tactile experience where they do something and they experience that result-

• 1:31:43Speaker 01

  Some positive result.

• 1:31:44Rich Roll?

  And that sets in motion like a chain of events that engenders encouragement and motivation.

• 1:31:50Speaker 01

  And works towards that. You've highlighted a very important thing, which is behavioral change is really hard. So providing someone with just a plan is not enough. There has to be a relationship involved and a way to understand what's going on with them psychologically that they want to make a change. And so sometimes- Finding a way to understand what's bothering them. They've come to me for a reason, they've been referred. But what is bothering them about their eating?

• 1:32:18Rich Roll?

  Yeah. There is the individual who's like, oh, I read the book and I just went and did it all and changed my life. They don't need any accountability to anybody or any community aspect of it. And then there's the other person who has to have their hand held and, you know, walk through the tiniest of change and constant kind of accountability to a team of people. And those are very different individuals. I don't know what distinguishes them psychologically, but yeah, every person has their different levers, I suppose. And, you know, it's only a trained person who can divine what's gonna get that person to make changes. I suspect, though, overall, kind of on the James Clear Atomic Habits thing, it's like,

• 1:33:01Rich Roll?

  give them a tiny little thing that they can succeed at and let them experience what a win feels like and then that will embolden, you know?

• 1:33:08Speaker 01

  Right. And, you know, part of my, my method and my protocols were not the same when I first started because I, I had a different view. I thought it should always be food first and there wasn't a place for supplements and I'll readily admit that. And I also thought, well, I need to give them five steps to follow. And I learned the hard way clinically. Working with individuals, five is too many, you know? People need a supplement because they just may need to fill that nutritional gap to help them with what they're eating. And a lot of that was education for me in, in how to adapt, meeting someone where they're at and honing the method, you know? It's not perfect, it's always evolving.

• 1:33:51Rich Roll?

  Yeah, yeah, yeah. Also like the paradox of choice. If you're like, well, you can eat any one of these 10 things, like that's, that's like paralyzing, like just give me the thing to do.

• 1:33:58Speaker 01

  Just give me one thing.

• 1:33:59Rich Roll?

  And then on top of that, getting them to take ownership of it for themselves. Because I don't want to take responsibility, I want you, Uma, to, you do, you do it for me. This is why I'm here, I'm paying you. You're gonna fix this for me and I actually don't really have to shoulder that responsibility or do any kind of hard work because you're gonna fix it.

• 1:34:19Speaker 01

  Right. And honestly, that's where, that has been the power of the prescription, right? In the US medical system, it's been, you know, the urgency, the immediacy of coming, I need this fixed right now, you know, I need that SSR, I need that medication to help my anxiety. And it's a system that's failed us. So it's helped people. There's always a place for those medications, which can be life-saving, but it's not the whole picture. And so many people either suffer the side effects or don't recover in terms of anxiety from medication that we have to think more broadly about not only where the responsibility lies, but

• 1:35:01Speaker 01

  how do we help people be guided with changes. It's not easy.

• 1:35:06Rich Roll?

  You said something along the lines of if we're not looking at lifestyle factors, diet, sleep, exercise, et cetera, it's not in terms of like mental health outcomes, like it's not even worth having the, I'm misquoting you completely, but something along the lines of like, all the focus is on medication, pharma interventions, we're overlooking all these lifestyle things. What we really need to do is look at the lifestyle stuff first, because if we're not addressing that, none of the other stuff matters. I feel like that's a quote that got you in a little bit of trouble. It's a bold statement. Is that something

• 1:35:46Rich Roll?

  you stand by? Is it more nuanced than that? Like, what is the role of pharma interventions, psychiatric pharma interventions in the context of these lifestyle choices? My assumption is that these things need to be kind of handled in an integrative way together. But what is your, I mean, you touched on it earlier, but I just want to make sure I understand your perspective.

• 1:36:07Speaker 01

  Right. So let me reframe this. I feel that mental health is a very big topic, that's a very hot topic right now. And I feel that unless you've, you know, been on the front lines, kind of working with suicidal ideation and helping someone and working through those factors, that opinions about mental health are very different from clinical care and research. And I think one has to be cautious about that. So I would never, you know, say lifestyle factors first, you know, eat these foods. I think that they're all integrated. And what I do is sometimes individuals are referred to me who are already on a medication. And they may stay on that medication as we work on lifestyle choices.

• 1:36:52Speaker 01

  I still prescribe medications when needed, but I am more thoughtful. And my career trajectory has taught me to be more thoughtful about when that's a better choice than not.

• 1:37:01Rich Roll?

  Hmm.

• 1:37:02Speaker 01

  So they are meant to be a holistic and integrated approach. And we never think it's one or the other, or that we should push medications aside in favor because someone could be unable to get out of bed and so severely depressed or so warped with anxiety that they they can't make it out of bed to get to their first meeting or their shower. That's when, you know, acute conditions, where medications are absolutely needed. And so that food can't help, but it wouldn't be the first line. So it's always that integrated approach.

• 1:37:35Rich Roll?

  If somebody's listening to this, obviously, we're just touching the surface of what you address in in your books, which in addition to being, you know, canvassing everything that we spoke about and going more in depth on on all of the subject matter, also provide like recipes and, you know, all kinds of guides. But if somebody's looking for a little more handholding and they don't live in Massachusetts, like, is there like a directory of of of people who do what you do or something similar that people can find out more about this field and find a clinician who's kind of on your page that they can reach out to?

• 1:38:15Speaker 01

  I don't yet have that, but it's a plan for me to build that out. And I mentioned earlier, Rich, that, you know, I've pivoted from immediate direct clinical care to building out the resources because what the books brought forward is a need for this. And not just within the country, a need for it from other parts of the world as well. There are definitely doctors practicing and using these methods. I don't yet have that directory, but I'm planning to build one. And I'm sorry that those resources are not yet ready.

• 1:38:44Rich Roll?

  Okay, so, fair enough. But beyond your books, though, is there some place you can point people to where there's more? Available information and resources that they can edify themselves with?

• 1:38:56Speaker 01

  So, one of the things, I write extensively for media. If you Google nutritional psychiatry, it will come up with a few doctors do this sort of work. You might want to check within your state if there's anyone practicing this way. We are trying to build out resources through things like IFM, the Institute of Functional Medicine. There's some private entities. So there are ways that we are trying to improve the resources in this field. There also are courses that people can take if they're clinicians. Actually, coaches can take the course as well, so.

• 1:39:31Rich Roll?

  Where are those courses available?

• 1:39:32Speaker 01

  So, there's a course at Massachusetts General Hospital Online, the Psychiatry Academy. We have a course Cooking for Mental Health Clinicians. And we have a course on As a Nutritional Psychiatry Primer. There's a course on my website for just basically learning to get deeper into this knowledge. And, you know, it's a slow and steady.

• 1:39:55Rich Roll?

  Yeah, yeah.

• 1:39:55Speaker 01

  Slow and steady growth.

• 1:39:56Rich Roll?

  Those are for clinicians only, though, not?

• 1:39:58Speaker 01

  No, the one on my website is for anyone.

• 1:39:59Rich Roll?

  Oh, it is?

• 1:40:00Speaker 01

  It's actually intended for people who, it's almost like they want to get deeper than just the book.

• 1:40:05Rich Roll?

  If you were to wake up in a parallel universe and found yourself to be the Surgeon General of the United States, I always ask this type of question to the doctors. What is your initiative? Like, where are you placing your focus?

• 1:40:18Speaker 01

  The exact integration we just spoke about. Bringing food as medicine forward, but in a way that's integrated. So no one is saying you shouldn't take a medication or you shouldn't be using allopathic medicine primarily as what you're doing. But why not we integrate? Lifestyle and nutrition is the one remediable factor across all chronic diseases. We know this. This is not unknown to doctors and to clinicians, to all of us. So, integrate that. Make sure that as we are having a discussion with someone about their blood pressure, is it at a point where we can help them intervene with lifestyle measures? Can they come back three months later?

• 1:41:00Speaker 01

  And go through an exercise program and eat differently and lower their blood pressure before we prescribe that. What about statins, the same thing. What can we do as an integrated system, I'm not denying the use of medications, but bring that food is medicine movement more front and center, that also includes systems around hospital food, school foods, which California is definitely on the forefront of changing that, and I'm always impressed by that. But there are different things that would be linked to it, not just, you know, eat this versus that. It's building out the system, the ecosystem of integrating food as medicine at medical school levels, in schools, things like community gardens,

• 1:41:44Speaker 01

  learning or teaching kids to have a little garden in school that they could work on. Just understanding food from the ground up. So it would be a whole ecosystem, but it would be that primary motivation.

• 1:41:55Rich Roll?

  And given that you would be wielding great power, and on this subject of, you know, systemic overhaul, would there be certain policy initiatives, like I'm thinking about the, you know, hospital, insurance, industrial complex, some of the aspects of the great bureaucracy that are at odds with or are counterproductive in terms of the type of care that you would like to see people get?

• 1:42:23Speaker 01

  For one thing, you know, even at, I feel like with primary care visits, with certainly for mental health visits, there should be an integration of a food prescription. And by that, I don't mean this food is going to cure your depression. I do not mean that at all. But the integration of how can we integrate food into how we are offering solutions for people at a very basic level. So it doesn't, wouldn't work in the emergency room, but it would work in primary care and outpatient visits, lifestyle medicine doctors, lifestyle psychiatry, all of that. And I think having ways to make this part of the conversation, maybe it's educational materials, maybe it's video materials, maybe it's something you

• 1:43:07Speaker 01

  can access on your phone. It's helping people get to that point of why it makes a difference.

• 1:43:14Rich Roll?

  I have to let you go. We're almost out of time here, but. I want to end this with some real practical takeaways. Like, if there's one core precept, concept that you want people to take away from the work that you do, the message that you're putting out in your books and your writing, your talking, etc., you know, how would you distill that down into something that is going to lodge in people's brains and activate change?

• 1:43:42Speaker 01

  Start with one thing. Start with one thing that's bothering you about something you're eating or drinking. It could be the coffee. It could be diet soda. It could be ice cream. It could be whatever it is. Something probably bothers most of us. And it is the way, if you truly feel you're ready, to start. So pick one thing, start there, and work your way into a bigger plan once you start to experience the positive change of better sleep, feeling more focused, having more energy at work, whatever that might be in your life.

• 1:44:20Speaker 01

  I think is a good way to really dip your toe into this nutritional psychiatry lifestyle measure to see if you want to do more.

• 1:44:31Rich Roll?

  Hmm, beautifully put.

• 1:44:33Speaker 01

  Thank you.

• 1:44:34Rich Roll?

  I'm thinking if there is a question that can be coupled with that, like, what is a question that you want all of us to ask ourselves that would help us kind of clarify what change we might want to make? Like, what is the question you could ask that would trigger something to help us reflect more deeply on the relationship between our lifestyle choices and our dietary choices and our mental health outcomes?

• 1:44:59Speaker 01

  It would be, am I living a joyful life right now? Am I, and maybe that's a too strong a word, am I enjoying my life right now? Is everything perfect? You know, for most of us, it wouldn't be, but I guess I'm trying to reach... What am I in control of? Because that's where food is very powerful. We can make the change. We can make the difference. We may not want to make a change, but it's within our control. It's not a prescription. It's not something I have to remember to take. I can literally, when I leave, go to the supermarket and make a difference in what I choose. So, am I, am I happy with how I'm living my life right now? Is a good way to start.

• 1:45:44Rich Roll?

  I like it. Thank you.

• 1:45:46Speaker 01

  Thank you.

• 1:45:47Rich Roll?

  This was great. We did it. How do you feel?

• 1:45:50Speaker 01

  Um, I feel great.

• 1:45:52Rich Roll?

  The books are Calm: Your Mind with Food. That's the newest one. And this is Your Brain on Food. You can find them wherever you buy books. You can find them on your website.

• 1:46:01Speaker 01

  WomanIdoO, md.com.

• 1:46:03Rich Roll?

  Yeah. And is there anywhere else you direct people to learn more about your world?

• 1:46:08Speaker 01

  Um, social media. I'm at D R U M A N A I D O O on all social media channels. And I have a new mood food newsletter that we have updated and evolved. And you can sign up for that on my website.

• 1:46:26Rich Roll?

  Yeah, I saw your Instagram post about that. Very cool. This was great. Thank you very much. I loved it. Peace and plants. And hopefully we'll talk again soon.

• 1:46:35Speaker 01

  I hope so. Thank you so much.

• 1:46:36Rich Roll?

  Appreciate it.

• 1:46:49Rich Roll?

  That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests, including links and resources related to everything discussed today, visit the episode page at richroll.com, where you can find the entire podcast archive, my books, Finding Ultra, Voicing Change, and The Plant Power Way, as well as the Plant Power Meal Planner at meals.richroll.com. If you'd like to support the podcast, the easiest and most impactful thing you can do is to subscribe to the show on Apple Podcasts, on Spotify, and on YouTube, and leave a review and/or comment. This show just wouldn't be possible without the help of our amazing sponsors,

• 1:47:32Rich Roll?

  who keep this podcast running wild and free. To check out all their amazing offers, head to richroll.com/sponsors. And sharing the show or your favorite episode with friends or on social media is of course, awesome and very helpful. And finally, for podcast updates, special offers on books, the meal planner, and other subjects, please subscribe to our newsletter, which you can find on the footer of any page at richroll.com. Today's show was produced and engineered by Jason Camiolo. The video edition of the podcast was created by Blake Curtis, with assistance by our creative director, Dan Drake. Portraits by Davy Greenberg. Graphic and social media assets courtesy of Daniel Solis. And thank you Georgia Whaley for copywriting and website management.

• 1:48:18Rich Roll?

  And of course, our theme music was created by Tyler Piot, Trapper Piot, and Harry Mathis. Appreciate the love, love the support. See you back here soon. Peace. Platts. Namaste.