EAT THESE FOODS To End Inflammation & Reduce Stress TODAY! | Drew Ramsey & Rangan Chatterjee

Dr. Drew Ramsey 0:00 Depression is the most disabling illness in the world. And we just really asked a simple question, with all this nutritional information, what nutrients matter for depression? We found there are 12 that had significant levels of scientific evidence that they could help prevent depression and help treat depression. [upbeat music]

Dr. Rangan Chatterjee 0:20 I wonder if you would explain how you view inflammation in the context of our physical and mental health. Uh, but then also really split it up into body inflammation and brain inflammation, and how those two things sort of link together.

Dr. Drew Ramsey 0:34 For sure. Inflammation is, uh, a very important system. It, it's what protects us, it's what keeps us safe. Inflammation is really at the root of our immune system and how our body recognizes threats and injuries, and then eliminates them. Um, however, because there are a lot of things stimulating us, whether that's noise of the city or air pollution, by the way, very, very strongly linked to your risk of depression, or whether it is a stressful or toxic work environment, we are always wired and, and, and revved up. There's a lot that is stressing us and, and because of that, it's a little bit like... I, I, I make the analogy sometimes it's like if you went in to take a test in school and the fire alarm went off, and instead of leaving, they said, "Yes, this test is important. [laughs] Sit there, take your test." And you're taking the test, and then the sprinklers come on, you know, and it's, and it's messing up your work, and the, the proctor of the exam says, "Sorry, you know, it's a tough exam." Having too much inflammation is a little like that. You can probably still finish the exam,

Dr. Drew Ramsey 1:34 but you're just... your, your alarms are preventing you from, uh, uh, really living your best because they're going off inappropriately. Uh, inflammation is, uh, uh, very tightly linked to our food, 'cause the, the largest part of our kind of inflammatory or immune system is our gut. And so you think about food as, as really a set of signals and, and as a way to really fuel and nourish your immune and inflammatory system and, and also to regulate it. There's also this concept that a lot of people have heard about now called the microbiome or the idea of the microbiome. Uh, these... And these... The reason we're hearing about these two ideas, these are very linked. The microbiome is the set of organisms, primarily bacteria that live in your gut and mostly in your colon, and they're at the center of really helping regulate a lot about our body, but in- including our inflammatory response.

Dr. Rangan Chatterjee 2:26 Yeah. I mean, super helpful to, I think, explain that to people.

Dr. Drew Ramsey 2:31 I'm curious what you feel is really one of the best ways to explain inflammation, because you've heard so many people talk about it, and I really agree, it's one of those words that's easy to pass around, and I'm wondering how, how it sits with you in a way that makes sense and resonates with patients and people.

Dr. Rangan Chatterjee 2:45 Yeah. You know, a- as, uh, uh, I'm sure you would agree, you know, the way we explain things often depends on who we're communicating with. Um, a- as I'm sure you do, I change my communication style in clinic depending on who that patient is in front of me, their level of understanding, the sort of, the energy I get from them, the sort of, uh, the p- you know, the prior interaction. It all plays into it, but I guess in a, in a sort of public setting like this, how would I explain inflammation? Yeah, not dissimilar to you, I would say inflammation is the way that the body, um, tries to protect itself. So, uh, you know, we all understand, everyone knows the feeling of when they've cut themselves, and they cut their ankle, and it's bleeding, and then the body needs inflammation to try and repair that ankle, right?

Dr. Drew Ramsey 3:31 Uh, yeah. It reminds me, I remember once, uh, talking about anxiety and, and writing about it, and really talking about how it's a superpower. And it, it's funny, as you're talking about, you know, an- inflammation is a superpower. I mean, when you think that you can get cut or trip and sprain your ankle and, and the body, you know, protects itself, then repairs itself, while you're just, you know, you're sitting on the couch, you know-

Dr. Rangan Chatterjee 3:52 Yeah

Dr. Drew Ramsey 3:52 ... snacking. [laughs]

Dr. Rangan Chatterjee 3:54 Exactly. We don't, we don't have to do anything. You know, that, that our bodies are built to thrive, right? They, they will take care of that cut without us doing anything, which really is the miracle, I think, of the human body, and something we sometimes... I think we sometimes forget that in medicine, just how intrinsically powerful our bodies are. But that inflammation, I think, in the short term, you know, to, to s- to, to fix that cut, fantastic for your skin to repair and heal. I guess what we're talking about with, um, w- when inflammation is, is, is linked to lots of these chronic diseases, including depression and anxiety, we're talking about that chronic inflammation, that sort of low-grade, unresolved inflammation, and I often describe it to patients as saying, "Look, it's almost as if your body is trying to protect itself from attack every day, but it's protecting itself from the attack of your daily lives," whether it's your diet, it's your lack of physical activity, the, the chronic stress, the air pollution, you know, whatever it is, lack of vitamin D, all these things are... The body's interpreting that as a- an insult in some way, and it's, it's mounting its immune response through inflammation. While inflammation is one of those mechanisms to try and calm it down, but actually, if it's happening day in, day out, that's when it can start to become problematic.

Dr. Drew Ramsey 5:17 Yeah. And that, and that's where, as you ask and, and, and we should point out, talking about mental health, there is a real strong, uh, link and set of evidence now linking inflammation and chronic inflammation to depression and anxiety a- and as well as brain fog. You know, we really think those are symptoms increasingly people have kind of identified and complained, and also those are symptoms that often get explained in all kinds of incorrect ways and treated in all kinds of incorrect ways, both by conventional medicine and, and also by the wellness industry and supplement industry. So I think it's really im- important to talk about the reality of it. So the, the, the simple truth is, uh, when you have inflammation, a lot of us, you've experienced this, when you've had the flu or when you've been sick, you get a, a sense, a, a feeling of, um, uh, anhedonia, loss of pleasure, loss of engagement. You kind of retreat and isolate. Uh, a- and oftentimes our mood goes down. You just feel really sad and want to kind of curl up and rest, and that makes a lot of sense from your body's standpoint. They're kind of shutting things down, uh, saying, y- you know, "Hey, we need to heal and fight this bug." Um, anxiety comes on board where when we get ill, we get a little hypervigilant. Meaning that we're looking around, we don't, you know, we don't wanna be messed with, right? We wanna heal. Um, and then there's the little brain fog, where as you think about it, you know, y- y- if you're sick, you don't wanna be having all your best ideas, super creative, you should run to do this or, you know, take care of those errands or, uh, uh, right? Because, uh, uh,

Dr. Drew Ramsey 6:48 there's a, a kind of almost intention of your body's alarm system shutting down some of that process and having a little bit of brain fog. So in real life though, when we're having those symptoms, it, it's horrible. So there's some data, large meta analyses looking that anyone who's been taking an antidepressant, if they're also on any anti-inflammatory agent. And, and, and I do wanna note something a lot of people don't know, I didn't really know, is, is that SSRI antidepressants, which are the most common prescribed medication, are, they're often thought of as serotonin medications. They are, but they also, uh, help, uh, fight inflammation in a way that's really kind of interesting when you think about how they work. But i- back to this meta analysis, individuals on, uh, antidepressants who were given any type of anti-inflammatory medication got twice as better if you are on anti-inflammatory medication with your antidepressant. And so just to me as a clini- clinician treating depression and anxiety every day, it just brings that right into the clinical room. All right, how do you do that in a patient's life? Where is the inflammation coming from? How do you eliminate it? Can you? Um, how do you measure that? So-

Dr. Rangan Chatterjee 7:57 Yeah

Dr. Drew Ramsey 7:58 ... that's I think how, how it relates.

Dr. Rangan Chatterjee 8:00 What I think is really interesting for, for many of us is this idea that what we do to our bodies can affect our brains. So this idea that if we can reduce inflammation in our body, that can also reduce inflammation in our brain or certainly help symptoms in our brain, and you have mentioned the gut-brain axis before. Um, but I guess I'd like to tease out how exactly food is impacting what's going on in here, because there is, yeah, I guess structural components. Let's say you, you're having an omega-3 fat, and that's involved in the structure and many other things in the brain, but there's also this communication pathway where this is kinda sending signals as well, and I'd, I'd love to just unpick that a little bit. And, and also really understand, uh, Drew, when you have got patients in front of you who presumably by the time they're referred to you as a specialist psychiatrist, you know, they're presumably struggling in, in some way, in quite a significant way with their health-

Dr. Drew Ramsey 9:08 Isn't that, by the way, totally, totally F'd up about the mental healthcare system-

Dr. Rangan Chatterjee 9:12 Yeah

Dr. Drew Ramsey 9:12 ... all over the developed world? Like, you talk to me when it's like, well, got serious, so you had to go see a psychiatrist. That is such BS that needs to change because, y- you know, e- everyone needs to see you once a year and be like, "Hey," and like, if they're not paying attention to their health, you say, "Hey, you know, in some way you should pay attention to your health. I'm gonna take your blood. Hey, look, here's some stuff that's doing well, here are some things we need to work on." We don't do that in mental health.

Dr. Rangan Chatterjee 9:37 Yeah.

Dr. Drew Ramsey 9:37 The only time you get to see a mental health, a psychiatrist, is if you have significant symptoms. And, and it, I just wanted to point that out to everyone. I think it's a, it's a really shift we all need to make, to think about mental health and mental fitness and our own mental fitness, and how do we prevent these conditions, and then if we have them, really use everything that we have to treat them. So s- s- sorry to just jump in there about that. And I also wanna say, 'cause I'm a psychiatrist, that thing you're saying, like the brain and the body being different, I don't think like that. I, I don't, I don't in any way separate my body from my brain. When we're talking about inflammation in the body, that's, that's synonymous with me.

Dr. Rangan Chatterjee 10:13 Yeah.

Dr. Drew Ramsey 10:13 There is no inflammation in the body without inflammation in the brain.

Dr. Rangan Chatterjee 10:16 I get it. Me too. I don't, I don't really think like that. It's more about, I think a lot of people I've spoken to really do see the body like that, or they've been conditioned to see the body like that, and therefore it's about trying to help people understand that actually if your body's inflamed, your brain's inflamed. Uh, but what, do you need to get a certain buy-in with your patients? Like, do certain patients come in and you're trying to help them change their diet to help their mood, their happiness, their depression, their anxiety, whatever it is. Are some people skeptical, and if so, how do you overcome that?

Dr. Drew Ramsey 10:51 Well, I, I think everyone should be skeptical because it's mental health, and I think so many, because it's a subjective field, so many people have ideas and opinions and experiences of it. And so m- the first thing that I, I do is I, I'm a general psychiatrist. I take a good psychiatric history and I, I, I treat the patients in front of me. Um, I don't think about medications as really different than psychotherapy, as different than lifestyle. These are all really important tools to battle depression and anxiety, and I, I wanna try and understand for each individual, how do those fit in? Some people come in and they're like, "Zoloft worked for my brother. I need it. I want it now." Other people come in and, and, that's an antidepressant, you know, come in and they're really, you know, they're against medications, for whatever reasons. Uh, when it comes to food, I wanna be curious what people think, what they've heard. I wanna be clear about my intention that, you know, I, I have my own set of values and biases about how food can work and can't work when it comes to mental health. And so the first thing I do is try and check in and assess where is someone around those ideas, and where are they as an eater? And then in terms of buy-in, I, uh, try and have it be part of the ongoing conversation, uh, where I'm both, um, showing some enthusiasm about, uh, how nutrition impacts mental health. I'm trying not to be annoying. I find that doctors in general are really awful about food. We're really fear-based, right? "Oh, don't eat that 'cause you're gonna get a heart attack," you know? "Don't do this," or, "Whoa," you know? And, "No salt." It, it's not loving or kind, and, and I've really done away with that. I think people who talk like that from a medical perspective really aren't doing any good for public health. I, I think fearmongering is just silliness. You can eat all kinds of different foods and, and, and, and have a reasonably healthy life. I really try and focus on the hopefulness of it, that let, let... If we think about depression and anxiety in modern terms, in, in, in, in Eat To Beat Depression and Anxiety, I have a big, uh, graphic here, the new science of depression and anxiety. Like, let's just stop thinking about this as, you know, mental health is basically suicide and SSRIs. Let's really start thinking about mental health robustly. We, we incorporate these different factors in, in, in how we approach patients. So with food, um, what, what you see oftentimes is, first of all, mental health affects it, and we should be talking about it because, a- and we do talk a little bit about symptoms, right? Has, has depression affected your appetite? And a lot of patients say, "Yeah." And we say, "Oh, that means you have depression." Like, right, but what does that mean for us as clinicians? It means that your patient isn't nourishing themselves in the most important period of recovery as they're trying to get better from depression and anxiety. So what do you do in that situation? Well, in nutritional psychiatry and as we talk to and, and train clinicians, and we now have a really nice clinician community of nutritional psychiatrists, we think about all of the ways that you get more nutrients into, uh, a brain f- in, in different, uh, different ways. Like, if you don't have an appetite, soups and smoothies are really great for you. Uh, nuts, a handful of nuts is a great, great handful of nutrition, right? There's all kinds of ways to, uh, help accommodate where someone is in terms of, uh, th- th- their illness with nutrition and to incorporate that into treatment.

Dr. Rangan Chatterjee 14:06 I think one of the things I've, I've always loved when I've heard you speak, uh, or seen you on Instagram is there's a real open-mindedness, there's a real humbleness. Uh, I imagine your patients really, really enjoy their interactions with you. I would imagine from, from the sort of, um, the tone with which you speak, and I've seen you speak. What I'm really curious about is you obviously have a very personalized approach to each of your patients. You know, everyone has a different set of life experiences, family background, genetics, desires, needs. Yet you've also written this quite fantastic book, Eat To Beat Depression and Anxiety, and I'm asking this 'cause this is something I've struggled with in, in my publishing career, is I believe in personalized medicine, but then you're trying to write a book that's gonna help masses of people. Uh, I know how I've tried to do it, and I'm interested to... You know, how was that for you? Was that a struggle? Did you... Was that something you had to think a lot about because it's a great book, it's helping a lot of people, but how do you deliver that personalized approach in a book that's written for everyone?

Dr. Drew Ramsey 15:19 I, I hope in this book, Eat To Beat Depression and Anxiety, Chapter 6, Eater Heal Thyself, it does a good job of approa- helping people see how I approach food. This isn't a diet book. This isn't a, uh, this isn't a gimmick. This is really trying to ha- ask you as a reader, as an eater, to take a step back. There's been so much chatter, misinformation, so much removal that people have had from their culture, uh, of origin, uh, when it comes to their nutrition. Our, our, our sense of taste and, and sense of what's healthy for us has really been abdicated by a mix of big food and, and big science. In terms of food, nutritional psychiatry and, and the evolution of those ideas, as I worked specifically with, um, Laura Lachance, who's a, a colleague who came up to me at a conference and said, "I wanna, I wanna, I wanna do some work together." And we started trying to create a manual of nutritional psychiatry, of sort of how do clinicians do this. We created the Antidepressant Food Scale, and we just really asked a simple question. All right, with all this nutritional information, what nutrients matter for depression? And we found there were 12 that had significant levels of scientific evidence that they could help prevent depression and help treat depression, things like zinc and magnesium and B12 and omega-3 fats and folate, uh, and iron. And, and then we said, what foods on planet Earth, just natural, whole foods, have the most of these 12 nutrients per calorie? Really simple question. And that led to a list of the top plant foods and the top animal foods. And, and I... While I don't love listing foods like that, it, it led... Because everyone says, you know, "What's number one?" Watercress. And it's like, "Oh, I should eat more watercress to fight my depression." And, and, and what it really led me to understand, uh, is, these are called nutrient profiling systems, and the Antidepressant Food Scale was the first nutrient profiling system that was ever created specifically for mental health. And, and what Dr. Lachance and I understood is that if you looked at food in terms of food categories, and this is what n- nutrient profiling systems really encourage you to do, and what you see is what's, what's in the top five animal foods. You know, three of them are bivalves: mussels, clams, and oysters. Why is that? Well, if we look at one of the most important nutrients for mental health, it's vitamin B12, the largest vitamin, uh, we eat. You'd think we'd all know the... what is the top source of vitamin B12 in the natural world, and I certainly did- didn't. It's clams. I mean, who's called clam a superfood, right? [laughs] It's like, who said like, "Oh, you know, I'm going out tonight. I wanna make sure I recover from my hangover. I'm..." You know, "Getting a B12 injection." It's like, hell no, I'm having pasta vongole. Get my B12 levels up. I mean, it, it's... [laughs] So, uh, uh, l- looking at, uh... To get to your questions, how as an author do I personalize recommendations? I think, one, in, in trying to let people know the, my approach and goal of the book and the limitations of that, and then two, to try and replicate as much as I can the way that I, I think about this information with w- what I feel I, I hope you and I can, can bring to authorship, which is the experience of a clinician. Because of clinical experience, you and I have the privilege of, of hearing and sharing thousands of individuals and their families and their stories. And oftentimes, especially when it comes to mental health, a- and especially on social media, what's getting talked about and shared is an individual story. And there's real importance in that in terms of, you know, today if you have bipolar disorder or borderline character disorder or addiction or any substance use disorder, rather, uh, you can put in a hashtag and You see an advocate. You see a, you know, someone who's recovered. You can reach out to resources. I mean, it's really... You can direct message someone and be, you know, chatting with, um, a mental health advocate or even a clinician pretty quickly. So I think that's wonderful. And at the same time, though, what you're talking about is that w- when you see, um, uh, the aggregate of many, many stories, um, it, it does create, I think, a humility of understanding, um, the importance of our commitment to patient autonomy, our commitment to health, and then the many ways that humans define that. It's really... It, uh, I think sometimes early in my career I sound a little almost anti-vegan and, and I really shifted, one, as I, I was employing a number of vegans, [laughs] but, but also, um, as I began to really, uh, think about, um, freedom and choice, and again, wh- where I wanted to be in the conversation, which is helping people no matter what they're deciding to eat feed their mental health and take care of their mental health and prioritize that. And that, that, that should really be the top tier of our goal because that, that's the best... It's the... I mean, that's why we separate the brain and the body, or people traditionally do, is just the brain's the best part. That, that's all of it. That's like, that's the whole game, right? There's like, [laughs] you know, there's a lot of other organs you can replace. I always kind of joke sometimes. I say, "You know, when you go to, like, the home improvement store, there's a lot of body parts you could buy, right? You can buy, like, your kidneys, like filters. You can buy, like, pumps, like your heart." It's like consciousness, hopes, dreams, generator, you know, are, uh, like... I... You know, there's none of that anywhere except the human brain, so.

Dr. Rangan Chatterjee 20:28 Yeah, I think you've done a great job in the book actually. I think the... W- one of the things I really liked actually is this focus on dietary patterns. I think you're a fan of the traditional dietary pattern rather than labeling it around a particular country necessarily. I mean, we can maybe expand on that. But also you do focus in on these 12 nutrients, these 12 nutrients that can help us all build healthier, more vibrant brains. So, you know, that I really like the interplay between the specific nutrients, but also the, the dietary pattern. So I wonder whether we could spend a bit of time on what some of those nutrients are and then-

Dr. Drew Ramsey 21:05 Sure

Dr. Rangan Chatterjee 21:06 ... you can talk about how they fit into certain patterns.

Dr. Drew Ramsey 21:09 Yeah. I, I mean, r- the dietary pattern I think is a really brilliant shift that researchers made and, and you've had Felice Jacka on. She's-

Dr. Rangan Chatterjee 21:16 Yeah

Dr. Drew Ramsey 21:16 ... really, uh, you know, one of, uh, the founders of this field. I mean, she's done some of the best research and led, I think, really our movement. Felice, um, uh, Dr. Jacka ha- had actually the first real nutritional psychiatry paper ever published in The American Journal of Psychiatry, what we call the green journal, really kind of one, one of the top journals in mental health, and it was actually her, her PhD dissertation. I think a real inspiration for any out there who's in graduate school or thinking about a career. Dr. Jacka shifted careers, became an epidemiologist, got her PhD. Her, her dissertation gets published in the American Journal of Psychiatry, a paper based on it, which was a correlational study showing that dietary patterns... So it's not about just B12 or this or that, but a dietary pattern, so the pattern of all the foods you eat, uh, um, uh, a traditional dietary pattern. So this is, you know, foods everybody's gonna recognize. W- everyone's heard that phrase, you know, foods like grandma ate, right? So potatoes, tomatoes, you know, okra, salmon, beef, right? Stuff that is real food compared to a modern or a Western dietary pattern. And, and a traditional dietary pattern was correlated with a significant decrease in depression and anxiety. So it's just a correlational study, but really fascinating. And, and I like this shift because it allows us to eat pizza and chocolate cake and have the occasional beer and, a- and not freak out because we have a dietary pattern that's consisting found, as a foundation on really what are called nutrient dense foods. Again, those foods on the antidepressant food scale, like, you know, uh, leafy greens. You're always gonna have a lot of nutrition, not a lot of calories, and that's what we look for in nutritional psychiatry. And then in terms of individual nutrients in the book, I really try and, and break it down with these, um, illustrations.

Dr. Rangan Chatterjee 23:01 Yeah.

Dr. Drew Ramsey 23:01 Because, one, I, I found it was a lot to keep in my own head, like, oh, like, what's the top source of vitamin B9? Like, ah. And I, I just liked having a set of foods. A- and from that, you know, your question earlier, how do you sum it up, I found that that iterative process of writing with a... A- a- and working with my editorial team really helpful of like, look, you do... You know, we, we talk about the thinking and the power players, but if somebody's just getting started, what's a food they can pick up in the grocery store today? And that really inspired me to get very specific. And so in, in this book, we have a, a list of the power players, and the power players really represent each food category. So, um, red peppers are on there because they're one of my son's favorites, but they're also really, really high in vitamin C. They're easy to add into any dish. I, I find they're easy to snack on. They're easy to dip in hummus. They're easy to throw in your frittata. They're easy to throw in, right? They... And they last forever in the fridge. So that's one of those foods that for me is power player. And in nutritional psychiatry and eating for mental health, there's some other usual suspects, wild salmon. But really a- as a clinician, I find, all right, the real challenge is anchovies and sardines. Those were a challenge for me. I'm like an Indiana farm boy.

Dr. Rangan Chatterjee 24:09 A, as a clinician or as a parent or both?

Dr. Drew Ramsey 24:13 Well, I, I think first they were a challenge as an eater, where-

Dr. Rangan Chatterjee 24:16 Yeah

Dr. Drew Ramsey 24:17 ... all that omega-3 data came out and I'm like a low fat vegetarian who, like, turns up my nose at fish. And I was a little bit of a picky eater. I might have had some weird, you know, like I didn't like pie until I was like 12. I thought it was very strange. So, but fish was really hard for me. I didn't eat any fish until I... I don't know. I, I ate a little piece of sushi e- every now and then, but not like any cooked fish, not any bivalves, oysters, ugh. I, I had no idea. And then I just... I don't know. The data compelled me to get a little more curious. Um, my wife and I were living in New York, and I kind of like had this realization. I don't realize, you know, New York's great in all kinds of ways. It's also an island o- in the sea, [laughs] and there's all kinds of amazing seafood. And started meeting a lot of people in the restaurant industry and having a lot of friends who were young chefs, and just sort of Introduced me to simple ways to prepare fish, and I started developing my palate. One of the things I really encourage people to think about in, in the book, just like the way to think about your mental health in evolution, to think about your palate in evolution. And there are a lot of foods that I, I think we've lost. A lot of us have lost the tradition of, of, uh, of, of seafoods or nutrient-dense foods or how leafy greens are used. A lot of us don't have that knowledge of, of how to prepare and cook foods at home in very simple ways, that are very easy and economical but that support our health. And, um, so, uh, uh, the hope is to translate those nutrients, get people excited about these nutrients and what they do in our brain, but really translate them into foods, and then help people get those into our lives. That's why our, our, our newest program at our clinic, we have a virtual cooking school, the Mental Fitness, uh, Kitchen. And it's been so much fun. Uh, anybody can, uh, is welcome to, to join our classes, where we're really trying as a clinic to help people actualize this.

Dr. Rangan Chatterjee 26:00 Yeah.

Dr. Drew Ramsey 26:01 That if you need coaching around how to take care of your brain with nutrition and, and integrate these foods, if you need to learn some new recipes, if you need, um, some community support, that we really wanna, as a clinic, try and replicate some of the data. There's a great study, the Healthy Med trial. Um, and I don't know, I s- feel like geeking out on science with you for a minute, so let's just talk about the randomized trials.

Dr. Rangan Chatterjee 26:21 Let's do it.

Dr. Drew Ramsey 26:22 I'm gonna just like... All right. So there's all this correlational data, but like you and I know, like correlational data is great, but it's not gonna convince anybody. You know, I, I'm a Columbia psychiatrist. It's a very... It's a great department, but, uh, I wouldn't say it's conservative, but it, it is historical in the sense that it, it's seen a lot of things come and go. And it's not gonna be impressed by correlational studies. It wants, you know, uh, the, the, the serious clinicians, policymakers, they need to see randomized trials. So now there have been, there have been five trials of food specifically used to treat people with clinical depression. The first was by Felice Jacka. It was the SMILES trial.

Dr. Rangan Chatterjee 26:57 Yeah.

Dr. Drew Ramsey 26:57 Uh, Felice's been on the show. She talked about the SMILES trial. The SMILES trial's incredible. What it does is it goes into a mental health setting, m- about s- 67 patients. The majority of them are already taking an antidepressant or in some type of psychotherapy, so kinda like a clinic like our clinic, and they give people seven individual, uh, therapy sessions around dietary change by a nutritionist. Over 12 weeks, what they see is a third of individuals go into full remission from their depression. If this were a medication, it would be a multi-billion dollar blockbuster drug. It's all we would be hearing about. So food does this. That's one trial. That's the-

Dr. Rangan Chatterjee 27:35 But just, let's just, let's just... That was... I mean, I love the SMILES trial. I think it was a landmark trial when it got published. And let's just, just repeat what you just said at the end there. A third of the patients, like a third of the patients went into full remission.

Dr. Drew Ramsey 27:50 32.3% go into full clinical remission. And l- look, this, this is-

Dr. Rangan Chatterjee 27:54 That is incredible. Absolutely incredible

Dr. Drew Ramsey 27:56 ... this is, and, and in this trial, so remission is a very important idea. And I, and I think that let's sort of tease that out, 'cause there's response. Like, oh, like how are you feeling? Like, "Oh, you know, those avocados, that weird stuff Ramsey gave me, those brain food smoothies, like I feel a little more energy. Like I'm not crying. Like I feel a little better." But that, that's just response. Remission is actually you don't have depression anymore. And so it, it do- it does feel like an important thing to note that people go into full remission. Let's talk, how do they do that? It wasn't a lot. It's people started eating like one more seafood meal a week, and like a half serving of vegetables a day more, or, and like a, actually it was like a serving of vegetables, one more serving of vegetables, half serving of fruit, couple servings of beans and legumes a week, a serving of fish a week, and then the big thing they did is 21 fewer meals of highly processed or, quote-unquote, "unhealthy food". And-

Dr. Rangan Chatterjee 28:45 20, 21. Oh, so per week. So basically-

Dr. Drew Ramsey 28:48 21 fewer meals-

Dr. Rangan Chatterjee 28:49 Yeah

Dr. Drew Ramsey 28:49 ... per week, or fewer, you know... So that's snacks, that's, you know, that, that's the difference between, you know, going out and getting a burger and fries and, I don't know, making yourself a vegetable stir-fry. Um, uh-

Dr. Rangan Chatterjee 28:59 Yeah

Dr. Drew Ramsey 29:01 ... so that's the SMILES trial. Great trial. I- i- in America, to get a medication approved, you need two good quality randomized clinical trials. So this is number one. Uh, so what? 2017, I think, is this comes out, so four years ago. Also interesting, like translation to clinical practice. And we're, we're jumping up and down about this. We've trained, um, over 200 clinicians around nutritional psychiatry in, in, in our, um... We have a, an e-course and a live training that we do. But it's interesting how it takes a long time to translate. A lot of questions we get from clinicians, like, "Am I allowed to talk about food?" It's like, wow, it's like one of the most foundational pieces of mental health and brain health, and, and we're not even sure that we're allowed to talk about it sometimes.

Dr. Rangan Chatterjee 29:46 Yeah, I mean, this is, this is something, um, you know, I wanna hear about more of these trials that you're about to, about to share. But just on that translation to clinical practice, I r- I remember so clearly, I think it was three or four months after the SMILES trial came out, or maybe it was a year and four months. I, I can't quite remember. It was a winter conference, and I think that paper came out November 2017, if my memory serves me correctly. Um, and I was speaking at this Royal College of GP event. It was where we were teaching doctors. Uh, there must have been, I don't know, couple of hundred people, couple of hundred doctors in the room, and at the start I asked them, "How many of you talk about food or ask your patients who are coming in with depression about food?" And I th- you know, uh, this wasn't sort of measured in any way, but just from the show of hands, it was about 5% of the room. Uh, then I presented the SMILES trial, a few other papers, including your, uh, your 2015, uh, editorial in The Lancet Psychiatry, which I think you co-edited, about, um, how you wanna see nutrition becoming as important to psychiatry as it is in cardiology, gastroenterology, endocrinology. I presented that paper, that, that editorial many, many times actually. Um- And it was interesting. I, maybe 25 minutes I, I, I spent on this, and then I asked them, "How many of you are now gonna start having a conversation about food with your patients who are struggling with depression?" And pretty much everyone's hand went up. So it's, it's really interesting, isn't it, how, you know, there is this good data out there, yet it really isn't, I don't think, translating, or certainly it hasn't converted to mainstream medical practice yet.

Dr. Drew Ramsey 31:34 Well, it's really hard.

Dr. Rangan Chatterjee 31:35 It is hard.

Dr. Drew Ramsey 31:35 Because we frame mainstream medicine as we take care of disease, and we have a community standard of how to do that. And if you're gonna deviate from that community standard, you're putting yourself in, in some medical legal risk. If I have bad outcomes, someone comes to me, and, uh, there's a bad outcome, and they say, "Well, you know, how, how, how is he treating you?" I say, "Oh, he prescribes a Mediterranean diet, and we were, like, talking a lot." That, you know, that doesn't, that's not complete robust treatment maybe [laughs] in some people's eyes or evidence-based enough. Um, so, uh, uh... And then there's the question of how. That's why we developed our clinical training. Uh, 'cause I, I sat for years where, you know, I'd write little three by five card, like, little papers of, like, I'd hand them to patients, like lentils, okra. You know, I'd like [laughs] It's like, you know, these, these are some foods to try this week based on a conversation, right, you know, uh, uh, and that, that we'd had about their preferences. But, you know, how do you do it? And how do you incorporate it where... Look, people have a lot to talk about in terms of mental health, and one of my concerns is, you know, people have maybe forgotten I'm a psychiatrist, and they think all I do is, like, talk about food. Like, "Yeah, yeah, I don't wanna talk about your mom or your dad or your development or your trauma," and, you know, that's all I wanna talk about. I mean, I'll... And so how do you responsibly though drop a little intervention or a little evaluation first that's efficient? How do you walk through the day of an eater? How do you frame this? And so we really worked hard in our practice with, um, uh, Samantha El-Krief, who's, uh, really been, uh, such a, my co-conspirator, collaborator in terms of developing our clinical team. And, uh, she's essentially a, a early, uh, early fan of, of yours and, and, uh, besides seeing you early in that video, really kind of shared with me some of, some of your progress and got us really tuned in to, uh, everything you were doing a couple years ago. And so, so she and I have really put together, uh, um, all of the data to help support that because clinicians need to make inter- evidence-based interventions only, in my opinion, when it comes to food, or as best that we can. Some things we don't have evidence for. But where is the evidence on some of these conditions? It's quite robust for depression. Not as robust for anxiety, but there's certainly some data. And then what do you do? You know, how, how do you assess somebody, and then how do you activate changes? You said you're a great example. In a talk, you don't just say, "Hey, here's all this data. Hope you guys are compelled." You put people on the line. "Come on, put the hands up in the air, everybody. Do you ask about this or not? No. Huh. Here's all the data that's come out." And then you say, "Are you going to ask about this?" And you're making peop- you're... And the next time someone's with a new patient, they're feeling a little pressure from you to be evidence-based, and I think that's exciting. I, I, uh, patients aren't interested in being evidence-based. Patients are interested, I think, in, in getting better and also doing things that matter.

Dr. Rangan Chatterjee 34:14 Yeah.

Dr. Drew Ramsey 34:14 And I think what's exciting is, for me, uh, you know, a lot of times with mental health we're trying to either take something away from a patient in, in a certain way, right, a, a bad habit or a defense or a toxic relationship, um, or a substance. Uh, what, what I liked about food is, one, patients were already doing it, right? You're already eating three, four times a day. A- and so it was like a, it's a much easier pivot. You're already in the grocery store. If I can help you look right instead of look left, wow, I can make a massive outcome in your health, in your mental health particularly.

Dr. Rangan Chatterjee 34:46 Yeah. Let, let's talk about the evidence base for a minute because I think there's an interesting follow-up for me in my head, which is, you know, I've heard you talk about before how we can, uh, learn a lot about brain cells and brain function from its structure, right? So-

Dr. Drew Ramsey 35:01 Yeah

Dr. Rangan Chatterjee 35:01 ... um, we, we can, you know, you can expand upon that for sure. But then if we, if we take it further, right, and go, okay, there are certain nutrients, there are certain foods that help to build a healthy, more robust brain, okay? If that's the starting point, which kinda makes intuitive sense, I think, to a lot of people as well, that, yeah, well, kind of what we fuel that brain with will determine how it grows, what its material is, how it functions. So let's take that one step further. So we have some good studies on food's role in depression. Okay, great. So now we can make an evidence-based s- recommendation to our patients with depression. But what about those patients who don't yet have depression? They wanna stave off depression. It seems pretty reasonable that, hey, well, actually, if you adopt these kind of changes, you may, uh, reduce the likelihood of going down that slippery slope, but we may not have a trial on that. Uh-

Dr. Drew Ramsey 36:05 We have a trial on that.

Dr. Rangan Chatterjee 36:06 Oh, we have a trial on that?

Dr. Drew Ramsey 36:06 Trial on it. We have a trial.

Dr. Rangan Chatterjee 36:07 Okay. Well, you can tell me about the trial. But, but just to finish off that thought, it's basically, well, what about other brain conditions then? So you must see patients with bipolar and, you know, all kinds of different psychiatric conditions, and I don't know if we have trials on those specific conditions yet. But would it not stand to reason that, well, look, there's no harm really improving your diet, and improving our diet's gonna help our brain to function better. You see what I'm getting at? It's kind of like evidence is important, but we also need a bit of common sense as well at how we expand that to other things.

Dr. Drew Ramsey 36:45 Yeah. I, and I think e- exactly. And also i- i- it's how do we... You know, in medicine we get specific for conditions, and so there's that kind of u- universality about, uh, some nutrients, foods, concepts around i- uh, eating that are good for brain health, and that's always gonna be good for mental health.

Dr. Rangan Chatterjee 37:02 I mean, let's go back to some of those studies. You, you started off with the SMILES trial. Um-

Dr. Drew Ramsey 37:06 SMILES trial Healthy Med then comes out. Healthy Med, I love it. It really is what we try to replicate with our mental fitness kitchen cooking class. So it, uh, the Healthy Med trial, uh, took individuals with depression. Uh, if you look in detail at this study, there's a couple things that are important. The first, oftentimes people think, "Oh, like, food is for, like, mild depression." Like, so this study, 86.3% of the people in the trial have severe or extremely severe clinical depression. So, so this isn't mild depression. They get a little tiny dose of fish oil, not really n- enough in any way to make a difference with depression. The data on fish oil and depression is mixed, but it's a much higher dose. They get a couple hundred milligrams of fish oil, and they get a Mediterranean-style cooking class. What they see over, uh, three months and then at six months is a significant reduction in, uh, depression and anxiety scores that stay low. They drop quickly, and they stay low. And, and individuals are no longer severely depressed. And so a- again, in terms of risk mitigation, w- what was striking about this trial is antidepressants take a months to work. A lot of these individuals were already on medicine, so they, again, had a resistant depression that wasn't working. They get given a nutritional intervention and encouragement to eat better, and I think it's a 45% reduction in their formal anxiety rating scales and, and about the same for their depression rating scales. So that's the Healthy Med trial. And, and that's in some ways what we're trying to do with our cooking class, is really, you know, uh, once a month give people a feeling of cooking together, of, um, uh, you know, kind of sh- sharing the, the spirit of really trying to care for our mental health in an active way with our nutrition. Um, and then the joyfulness. You know, a big, big part that, um, Samantha brought to our practice and, and, and brings to our clinical work and our clinic, and, and you see her influence in the book, is really around an idea of joyfulness. As we, as we sat in the food space maybe five years ago, started working together and saw all the... I don't know, we're, we're both very peaceful, I, I think, kind of people, and we just saw this, there's a, a tone in the debate around food that we really wanted to try and transcend with a sense of joyfulness that we felt around, um, eating and nutrition and being really, um, in a, a, a sense of engagement and in a sense of a conscientiousness about o- our nutrition and the impact it has on our, our health and our mental health.

Dr. Rangan Chatterjee 39:38 You mentioned there was another trial which is showing that changing the food that we eat or certain dietary patterns can help reduce the likelihood of developing depression in the future. That sounded interesting.

Dr. Drew Ramsey 39:49 Yeah, yeah. You're not gonna... That's, so the, the, the... I think the best trial on that is, is back to a cor- a prospective correlational trial, which was an epidemiological study of 10,000, I think it was, like, 930-some-odd, uh, university students in Spain. And what that study showed is that i- if you look at them at the beginning of college or- and, and you look at the, how Mediterranean their i- their diet is, so it was a nine-point Mediterranean dietary pattern scale. If you look at people in the top half of that, so they're eating a fairly Mediterranean diet in their freshman year, and follow them over four and a half years, kind of checking in about who gets depressed and then, uh, and, and, and what they're eating, they found that there was between a 30 to 52% reduction in the risk of getting clinical depression. And, and they ran this as a really interesting study. They, they, they did a number of different models. For example, they looked at anybody who got, um, an antidepressant in the first two years of the trial and just, you know, take, took them out of the data set to really try and see, were really looking for people over the span of their college career eating a poor dietary pattern versus a Mediterranean dietary pattern. The, the trial that I was thinking about in terms of prevention, it's 'cause I think a lot about college depression. I treat a lot of college students, really love working with young adults. Uh, it's such a challenging time. I think for me it was a challenging time with my mood. Um, eh, such an exciting time of life for people, too, and, and depression, I mean, it's so crippling for individuals, um, you know, during their late teen and early 20s. Uh, there's a trial in Australia that's really fascinating. Heather Francis led the team. They looked at college freshmen that had poor eating habits and, um, had depression, and they did a very simple intervention. Th- this is, I, I sort of joke with clinicians, like, "If, if, if, if this can work, boy, we've gotta be able to be effective." This was just a 13-minute video and then a five-minute phone call a week later, and then a second week, uh, uh, one week later, so two weeks after the video, uh, another five-minute phone call. And the five-minute phone call was like, "Hey, Rangan, how are you? Like, you eating some veggies, man? How's dorm life? Like, you using the turmeric? How about the nuts?" And so they gave people a little box of nuts, nut butter, olive oil, and then cinnamon and turmeric. And so they send these into the college dorm and, and, and with, like, a lot of encouragement in the video like, "You, you can improve your mental health with food. Eat more vegetables, eat more plants." The cinnamon and turmeric, there's a little bit of data about those being good for brain health and brain growth. What, what they found is that just with that minimal intervention, individuals significantly shifted their diets. There was a significant reduction in anxiety, depression, and stress rating scales at three months and at six months. And this is, like, a, this is, like, 20 m- minutes, and there's, like... or 23 minutes, and there's no actual face-to-face human intervention. So very, very, you know, cost-effective intervention in terms of pr- potentially preventing college depression. So that's the trial I think that probably relates most to depression, those two, the Sun Navarro and, um, uh, and then Heather Francis's trial in Australia.

Dr. Rangan Chatterjee 43:05 Yeah. I mean, we'll get a hold of those and put them in the show notes for anyone who wants to sort of read those, uh, uh, further. There's a concept in the book I really liked, which was you like to help- ... your patients put their brains in grow mode. And I thought that was a really interesting way of thinking about it. So what is grow mode, and how do you help your patients get into that state?

Dr. Drew Ramsey 43:28 Uh, I encourage my patients, and, and really everybody with a brain, to think beyond serotonin. Our beloved serotonin, a wonderful, wonderful neurotransmitter, but it feels like the conversation about depression gets reduced, like that's the brain molecule that's involved with mental health. That one, and maybe dopamine. And I, I think that really above all of these players is BDNF, and BDNF is a neurohormone. R- Rangan, you, you brought up connection earlier, and it's really a, for me, a driving core principle of my own personal life, of how I, I think about my mental health and my happiness and in my family's happiness, and, uh, but, but also how I think about my patients, what I value. You know? It's, it's the kind of tentacles of your life reach out. Like, where do they go, and what are the qualities of those connections? And, and, and, uh, as a psychiatrist, I, I love this notion also that, like, like that's exactly what our brain cells do. You know, when you're learning, your brain cells are reaching out and, you know, like making, making new connections.

Dr. Rangan Chatterjee 44:23 Yeah.

Dr. Drew Ramsey 44:23 And that's what memory is. That's where our memories, like, live in these connections between our neurons. It's really-

Dr. Rangan Chatterjee 44:29 Wow

Dr. Drew Ramsey 44:30 ... just, uh, fascinating to, to think about the brain as this... Not, not what even I learned in medical school 20 years ago. I'm sure that you learned the same thing, right? Hey, you get, like, 90 billion brain cells. Like, don't mess with them, bro. Like, don't mess up. Don't do bad things [laughs] 'cause you don't get any more. And now we know that's wrong, that your brain is always, not a lot, but making some new brain cells. And, um, another Felice Jacka study, great study, and you're, uh, showing that between 60 and 65, individuals with a healthy diet, you could see a significantly bigger brain. Like, like a, a couple cubic millimeters more brain in the left hippocampus compared to individuals who are eating a very unhealthy dietary-

Dr. Rangan Chatterjee 45:14 Wow

Dr. Drew Ramsey 45:14 ... Western dietary pattern, right? That's a lot of brain cells, like two cubic millimeters. I mean, so that's exciting to me as a clinician. And, and, and I try and bring that hopefulness and enthusiasm because often when we are struggling with our mental health, we really feel badly about ourselves. We feel very down. We feel very stuck. Um, so the idea that, you know, this brain that I'm lugging around that's not really serving me [laughs] so well right now in this moment, I have the power to change that, and those things that I know help me feel better, exercising, sleeping well, um, eating well, connecting with loved ones, and playing, playing... I've got my... [chair thuds] I was feeling nervous for that. I like playing a little instrument, playing little music. But all those things, uh, support my brain making more connections in a very intentional way. And so I, I love the idea of neuroplasticity. Uh, it's really the, the most powerful way that food and lifestyle medicine can work for us, like literally giving us more brain resilience, more brain repair, and more brain power. That, that's what BDNF does.

Dr. Rangan Chatterjee 46:21 Yeah. It reminds me of, uh, just a few hours ago, I was having my morning coffee in the living room, and I was, uh, reading your book. I was trying to, you know, prepare for the, for the, for the conversation today. And my daughter came down, and I was on the page with BDNF on it. And so these, these illustrations in the book are fantastic. So let's see if I've got this right. But she came in and said, "Daddy, what are you doing?" I said, "I'm reading this book. I'm, uh, talking to a guy called Drew later." She goes, "Oh, okay, what's Drew about?" I said, "Oh, well, you know, he helps people improve how they feel, uh, through many ways, but one of the things he does is help people choose better foods." She goes, "Ah, cool." And so she came and had a look. She's only eight. And so she read out brain-derived... She couldn't quite make out neurotrophic, [laughs] so I helped her out with that. Brain-derived neurotrophic factor. But these illustrations are great because there were four foods that you'd listed in this, you know, gorgeous graphic, and we went through. You know, said, "Hey, darling, how many of these are you having?" So there was, I think, nuts. There was wild type seafoods. Um, there was berries. And there was dark chocolate. I think I remember that right. Because of these graphics, and she did as well, so then when my son came down later, we ticked off how many he does as well. So I wanna say thank you because I love chatting to my kids about all this stuff because, you know, I hope that by sort of feeding them this information at a young age, hopefully this will just sort of seep into their, you know, their subconscious minds as they get older. So we all, all of us now in the family know the four foods that according to Dr. Drew Ramsey, and the research of course, help us increase levels of BDNF. So thank you for that.

Dr. Drew Ramsey 48:03 My pleasure. And, and the best data behind that is the nut data. It's a really interesting part of that, uh... I think it's the Sun Navarro dataset. Maybe I'm not getting that right. But, but it, it was a study looking at, um... They gave people olive oil who are on the Mediterranean diet supplemental olive oil versus supplemental nuts, and literally, like, delivered it to the door. And were like, "Drink as much olive oil as you can. Eat all these nuts every day." And, and in terms of BDNF levels, what they found, a- and BDNF's not a perfect biomarker for mental health. I don't want everyone to think you should run out and get your BDNF levels measured, but, uh, just as a disclaimer. But, but the- they found is there was a protection. So it was like 78% fewer people had, uh, who ate the nuts that were, um, had severely low levels of BDNF. And so there's something there, and that's really the only, one of the only studies that's shown a real specific correlation. It's one of the reasons, again, when I hear patients are snacking and they're hungry in the afternoon or they're a little noshy and they need something, you know, a quick handful of nuts, or I'll mix, like, some, you know, nuts and dark chocolate chips and, and, you know, you've got, you've got a nice, a nice mix to keep you going that probably is good for your brain health.

Dr. Rangan Chatterjee 49:11 What is your view on things like supplements and probiotics?

Dr. Drew Ramsey 49:16 Certainly there are some supplements I think are important, like vitamin D. You know, is the data great around vitamin D and depression? No, it's horrible. There's no good data that vitamin D prevents mood or depression. Do I still think giving a little vitamin D in winter is helpful for my patients? I do. Um, so I ha- I, um, uh, omega-3 fats, if you don't eat fish at all, um, and you're willing to take an omega-3 fat supplement or liquid and, and you want a more naturalistic approach to try treating depression or anxiety, I certainly will use fish oil supplements, um, in that scenario. There are a few other couple natural antidepressants that, like St. John's wort, that have some good data on them. So, uh, at, at the same time, what I often see is that people are using supplements to avoid mental health treatment or to a- to kind of supplement or augment mental health treatment or replace it, and that always concerns me because it means you're working on your mental health alone. And I think it's always best to work on your mental health w- in partnership, whether that's with somebody you love or a friend or a counselor or a therapist or a psychiatrist, but, but because a lot of times I find people are taking things without effect, and, and that's medications, right? They've been on this or that medication forever, and they've still been chronically depressed, or they've been taking the supplement forever, and they're still not feeling well. In terms of the gut, I think probiotics are a good example. There's, there's l- very little data that there's a, you know, specific intervention in terms of probiotics that, that help with mental health. There's some data certainly that some strains of bacteria in our gut help us improve our cognition and help decrease anxiety, and that people who get depressed have different organisms living in their gut than people who don't. We know that right now. So how do you get a kinda better mix of bacteria in the gut? I think you do it the way that humans always have done it, and that's we ferment stuff, and then we eat it, and then we eat a lot of plants. And, uh, that, that's really i- if you look at how do traditional diets kind of line up and how are they different from the Western diet, they include more plants, they include more olive oil or some type of natural oil, they don't have processed foods, and they often have a lot more seafood, but they almost always have fermented foods.

Dr. Rangan Chatterjee 51:23 Yeah.

Dr. Drew Ramsey 51:23 Like a traditional Japanese diet or an Indian diet, right? There, there's all these ferments that happen, and that's what we seed the gut with in terms of these healthy bacteria. I just think, uh, and I like prescribing food better than supplements. I just trust it.

Dr. Rangan Chatterjee 51:37 Yeah. It's, it's a tricky one I think because, you know, I, I also adopt a food first approach. Uh, I do think supplements have a role for certain people at certain times, for sure. Um, and then, you know, again, just sharing what I've found with certain patients, I, I, I've got some patients with anxiety that, that come to mind, who will tell me that there's a particular liquid, uh, probiotic that they take, that when they're taking it, they really feel that their symptoms completely change, that they don't feel anxious anymore. And then when they stop, um, they come back. And, you know, that is not a clinical trial. But on that one-on-one individual basis, it makes you think, so, well, we know there's a gut-brain axis. We know certain trials are showing that s- different compositions of gut bacteria, uh, impact what is going on in the brain. And then so I just think, well, could it be that in some of these trials we've got people with vastly different microbiomes? And so-

Dr. Drew Ramsey 52:37 Yeah. I, I mean, I think you just said it accurately. In our clinical trials, we've never paid attention to the microbiome or inflammatory markers, so w- we're hoping that randomization works to really just separate out and, and make the populations equal. But it, it is kind of a curious thing.

Dr. Rangan Chatterjee 52:56 Yeah.

Dr. Drew Ramsey 52:56 And, and I think increasingly going, increasingly we're seeing in the data, right? Here's a trial, and one of the other things we looked at, there's a great trial in bipolar disorder, and one... It's a probiotic trial. So it was a trial at Johns Hopkins. They looked at, uh, 80 individuals who were admitted for mania, so they have bipolar I disorder, they've been hospitalized, they get treatment as usual, usually lithium, Depakote, or an atypical antipsychotic, so their medication, and then half of them got a placebo, half of them got a probiotic. What they f- and, and they measured something called an inflammatory index. Uh, th- this is not used a lot, but it's looking at how, m-, uh, sort of the, the amount of, um, uh, I think it was antibodies to certain things, uh, certain viruses that kind of give a sense of, you know, how much inflammation somebody has. Um, what they found is individuals who had a high inflammatory index who got the probiotic, there's a 90% reduction in the rehospitalization rate over six months compared to the placebo. We, we don't see effects that big usually in medicine. So i- you know, the idea there is that part of a manic episode, potentially, is related to a kinda inflammatory dysregulation or s- or storm somehow that is some- somewhat regulated or influenced by the microbiome. So that's, that's really exciting research. And I think in terms of your patient, what I get excited about in those stories is regardless of kinda the evidence, what you have there is somebody who's noticing something really empowering.

Dr. Rangan Chatterjee 54:28 Yeah.

Dr. Drew Ramsey 54:28 Something really good for patients with mental health concerns. There's this symptom I have, and I got this tool that works. Boy, I love supporting that, and I love, and I love trying to also then s- extend that. Wow. Huh. So what else can we do to improve your microbiome?

Dr. Rangan Chatterjee 54:44 Yeah.

Dr. Drew Ramsey 54:44 So you got the probio- right? Which I'm sure you did once you started thinking about are there prebiotic foods, right? Can we-

Dr. Rangan Chatterjee 54:48 Yeah

Dr. Drew Ramsey 54:48 ... are there things that are hurting your microbiome?

Dr. Rangan Chatterjee 54:52 Is eating for better mental health expensive, or does everyone have access to it?

Dr. Drew Ramsey 55:04 No. I think if you start eating for mental health, you're gonna save money. And, and according to the research, that's, that, that's true. The SMILES study, individuals saved, I think it was $140 a month. It was around $1,000 a year if I remember correctly. Um- uh, was estimated in terms of their savings as they began to eat more Mediterranean style diet. The, the key to eating for better brain health, again, is to really take a step back and think about the myths that exist around food, that it's complicated, that it takes a lot of time, that it's way too expensive. One of the power players in the book is red beans. Uh, you can buy those dried, soak them. I mean, you g- uh, two, two, three bucks a pound. In the UK, you know, a couple pounds I would guess, um, uh, for a kilogram. Um-

Dr. Rangan Chatterjee 55:48 Yeah

Dr. Drew Ramsey 55:48 ... so i- you know, uh, there's a, a, certainly cost is a factor. Uh, and we, we have a, a resource command on our website for, uh, brain food on a budget where we, uh, break down all of some of the, the, the best foods. And then, then I think it's, again, it's that challenge. Like, I really like wild salmon. Wild salmon can be, like, between 10 and $20 a pound unless you buy it canned. And if you buy it canned, boy, it's, it's, it's cooked right after it's pulled out of the ocean. It's in there. It's super fresh. You make it into salmon salad. You make it into salmon burgers. Uh, great value. That wasn't something that I ever really did until I got into this work. Or a c- a can of sardines or anchovies. So, um, and then I, I always think, look, of the things we have to spend money on, I wanna invest in my brain health and I wanna invest in my family's brain health to the best of my ability. And I think working on that, not, not with, like, extreme and harsh constraints, uh, and lots of guilt and shame, not, not any of that, but working on that with a sense of, again, joyfulness.

Dr. Rangan Chatterjee 56:53 Yeah.

Dr. Drew Ramsey 56:53 How can I engage my family in a loving way with food? How can we cook together? How can I, um, based on maybe a limited palate of one of my family members, you know, still get a lot of brain nutrition in there?

Dr. Rangan Chatterjee 57:05 Yeah.

Dr. Drew Ramsey 57:05 And, and to really... You know, I'm a parent. I know sometimes food is a burden, and you're like, "Oh my gosh, I can't cook another meal [laughs] and do another dish." But I try to get back to that reset as much as possible.

Dr. Rangan Chatterjee 57:17 Yeah. We should cover the environment at some point in this conversation because I know that all this talk of fish, um, for a lot of people, they get very upset because they're very keen to try and help the environment, the climate, and they don't like people promoting fish or they... You know, I feel we should at least have that conversation.

Dr. Drew Ramsey 57:38 There should be environmental concerns about what we eat. I think the environmental debate has really been framed in a way that revolves around some in- misinformation.

Dr. Rangan Chatterjee 57:50 Yeah.

Dr. Drew Ramsey 57:50 And I think it's really concerning. For example, the misinformation regarding things like fake meat and Impossible Burger. Maybe misinformation is a strong word, but the way that that kind of a way of creating food is being framed as somehow healthy when essentially it's food processing of the same ingredients that are being used for the last 50 years that have ruined our health, um, compared to, you know, something like grass-fed beef, a local beef. And, and that the environmental, you know, kind of debate is like these plant foods are good and meat food and seafood is bad. Um, and I think that's really overly reductionistic. I think it leaves out, for example, some of my clear experiences. Like, where does your organic kale come from, folks? So it's all grown in manure from dairy cows. Or most of it is. Just they scoop it up in the conventional dairies, and they, they ferment it or they get it, you know, really hot to kill all the chemicals and reduce everything down, and they spread it on the field. And, and, and that's where organic kale comes from. And there's somehow that, like, that organic kale is, like, revered and pulled out separate from the system that supports its growth, which largely revolves around manure, because if you're not using manure on your fields, then you're just using chemical fertilizers, which usually the same people who, or the same kind of, let's say, groups or movements that are really supporting plant foods and not eating animal foods I don't think have spent a lot of time growing food. And if you spend time growing food, you spend, uh, especially on farm, small farms, you spend a lot of time with poo and manure and animals. Small farms have always worked that way. I think that the concerns about the way the meat system exists are 100% valid, right? We have a system that wastes meat. We have a system that repurposes and process meats into foods that are horrible for us from, you know, all kind... Horrible for us, all kinds of, um, you know, meat pockets and meats with fried breading around them and sweet meats. Um, i- in terms of seafood, the seafood, uh, uh, i- is a really, um, uh, to me, important place to be an eater because it gets me at least minimally involved in the system by using my food dollars to support people who are, for example, taking care of oyster beds or to support, um, farmers who are growing mussels, a very environmentally friendly way of producing food. Um, uh, I certainly appreci- if I'm being conscientious of the fish that I'm buying. I'm not buying things like, I don't know, farmed tilapia or farmed shrimp. Uh, I'm trying to buy mostly wild type seafoods. I'm trying to buy small fish and encouraging people to buy small fish, more anchovies and sardines, you know, less tuna, less wild salmon. So, um, those are all ways I think that we can work to improve-

Dr. Rangan Chatterjee 1:00:47 Yeah

Dr. Drew Ramsey 1:00:47 ... um, uh, our impact. I, I, I, I also think there is lots of other new concerns that we don't have many answers to, but I'm gonna go down with the fish, is kinda what I've decided. If we're gonna, like, destroy their environment and fill them up with plastic, I'm... I don't know. I'm just gonna suffer the same fate as they do. [laughs] Maybe that's, maybe that's strange, but, um, uh, uh, I certainly think there's also things like-

Dr. Rangan Chatterjee 1:01:12 Yeah

Dr. Drew Ramsey 1:01:12 ... you know, I don't eat fish from lakes or fish from rivers 'cause those are all polluted. Um, but again- We know about that because people were eating those foods. And then because of that and because of our interest in nutrition, there's a lot of cleanup efforts that have come-

Dr. Rangan Chatterjee 1:01:28 Yeah

Dr. Drew Ramsey 1:01:28 ... in terms of how do we reduce an im- you know, the environmental impact on our water supply.

Dr. Rangan Chatterjee 1:01:33 Yeah.

Dr. Drew Ramsey 1:01:33 Um, I think overfishing is a, is a huge concern. I think slavery in the fish industry is a huge concern. I don't wanna minimize these concerns. Um, but for me personally as an eater, and then I guess for me as a nutritional psychiatrist looking at the data, and then also somebody interested in brain health and brain development, there's a great, uh, book on, uh, uh, human brain evolution by Bret Steka- Stetka, and, and he talks about and, and writes about the science of how our human brain's evolved and the importance of small fish and shellfish. So I think I also eat those foods in some ways out of respect of our history and genetic history and evolutionary history as I've, as I've understood it through experts like Bret. Um, and, a- and to really, um, you know, do my best, uh, to, to be responsible in those seafood choices. I don't think that's in any way a complete answer, but, um, it, it's, it's where I am now-

Dr. Rangan Chatterjee 1:02:32 Yeah

Dr. Drew Ramsey 1:02:32 ... which is trying to eat three to four seafood meals a week. For me, that consists of a mix of anchovies and sardines, usually on gnocchi or over a pasta, um, [laughs] or on a Caesar salad. Um, usually, like, a oven-roasted wild salmon filet, probably trying to get maybe six ounces or so into every family member at least once a week. And then trying to eat mussels or other bivalves, particularly u- uh, ones that are farmed in the US. There's some concern about increased microplastics in the stomachs of bivalves, particularly in the report I saw coming out of China.

Dr. Rangan Chatterjee 1:03:06 What, what is bivalve? Could you just explain that for people? I didn't know that term till I, till I read your book.

Dr. Drew Ramsey 1:03:11 Bivalves are mussels, clams, and oysters, and so they're a grouping in the seafood family, mollusks. And, and, um, they, they're filter feeders. And so, you know, i- if, uh, understandably, people have concerns. Are they filtering out all the plastics and the toxins? And, and, you know, it depends the water that they're grown in. The, uh, truth is that when you... that these foods that are very good for us bioconcentrate nutrients. And so by, by doing that, if you grow food in a toxic environment, it's gonna bioaccumulate some of those toxins, and that, that data is really getting misused to then vilify these foods-

Dr. Rangan Chatterjee 1:03:49 Yeah

Dr. Drew Ramsey 1:03:49 ... um, as opposed to focusing on, all right, how can we all stay clear on this is a really important food supply. 70% of the planet's an ocean, right? You don't have to do anything. Un- I mean, think about es- especially when people are like, "Oh, no fish. Eat more plants," it's like, have you grown some plants? 'Cause I have. You know how freaking hard that is? You know how much diesel fuel it takes? You, first you gotta level that field, right? Then you, then you disc. Then, uh, depends on what you're planting. You're either seed, uh, uh, drilling or you're, you're planting seedlings by hand, right? Then you're weeding. Weed, weed. Or you're spraying. Then, then you're fertilizing either with manure, top dressing, right? Then you're tending to the plants. Then you're, you're harvesting. Then you're processing that food. Then you're driving to market, right? This is so energy intensive. Um, a- and just compare that with, uh, you know, it certainly takes a lot of energy, but catching anchovies.

Dr. Rangan Chatterjee 1:04:46 Yeah.

Dr. Drew Ramsey 1:04:46 Right? Uh, uh, you don't have to plant it. Um, you don't have to tend to it. You just catch it. So, you know, I, I think that, um, the sea makes a lot of sense to me, and there's also more than fish that comes out of here, uh, out of there. There's seaweed, um, you know, which I think is, is a really interesting and important, uh, human food.

Dr. Rangan Chatterjee 1:05:05 Yeah. What you're speaking to is that lack of connection, you know, that lack of connection to the food supply, and you're someone who has literally spent a lot of time growing food, so you, you understand what it takes to grow different types of food. Whereas I think many of us are trying to enter the environmental debate from a theoretical position, from sitting on the fence looking down, going, "Oh, this is what we need to do," whereas I guess it's probably the farmers who know best how we can actually, [laughs] you know, improve the food supply in a much more environmentally friendly way.

Dr. Drew Ramsey 1:05:40 Well, I mean, a- a- the reason I don't like to trash talk about food in that way is that farmers are the number one group after physicians in terms of suicide risk, and that in India and America, there has-

Dr. Rangan Chatterjee 1:05:53 Yeah

Dr. Drew Ramsey 1:05:53 ... been thousands of farmers who've died by suicide in the last two to three years. And so there's a way that as we trash talk, and, and I would agree in a kind of, you know, uh, polite and educated but often, you know, minimally informed way, it's easy because it's confusing, and there aren't clear answers to take strong positions, and that's where I've really, um, really worked hard to, to get into [laughs] more of a stance. Um, we have a show on male mental health with my friend, a psychiatrist-

Dr. Rangan Chatterjee 1:06:24 Yeah

Dr. Drew Ramsey 1:06:24 ... Greg Scott Brown, and Greg and I talk a lot about this idea of curiosity before judgment. I really wanna be curious and not make a judgment of things a- and, and realize that some of this stuff is too big for me to have a full comprehensive understanding of, and I'm gonna just, I'm gonna do the best that I can given my limitations-

Dr. Rangan Chatterjee 1:06:45 Yeah

Dr. Drew Ramsey 1:06:45 ... and, and, and the possibilities in front of me.

Dr. Rangan Chatterjee 1:06:48 Curiosity before judgment. I really, really like that. I was gonna ask you what is the, um, what is the most important lesson that you have learnt in over 20 years of seeing patients? Uh, I'm not sure if you've just answered that or not without realizing it, but I mean, if I were to ask you that, what would you say?

Dr. Drew Ramsey 1:07:08 Spending important time with your partner and your kids. I think that's the least valued, most important thing that I've learned. Nobody's gonna give you a spot on your resume 'cause you're a good dad or a good partner. Nobody's gonna give you a promotion or give you more money for that. But I, I think that that's the most, um, deeply gratifying, uh, human experience, at least for me, in terms of what I've been doing with my life around kind of family.

Dr. Rangan Chatterjee 1:07:32 Yeah.

Dr. Drew Ramsey 1:07:32 Um, for other people, um, if that isn't your, your structure, I, I think really being intentional about the quality of interaction. I'm just struck that I talk to many people for 45 minutes once a week, and over time I realize I know them better than, you know, many people in my own life, simply by just really listening to all of the nuance and intricacy going on in their inner world.

Dr. Rangan Chatterjee 1:07:58 Yeah.

Dr. Drew Ramsey 1:07:58 And, and how hard it is for us to get into that space with people these days.

Dr. Rangan Chatterjee 1:08:02 I mean, I find that through this podcast a lot, I f- I find sometimes, wow, I've had a two-hour conversation with someone where I've been listening, attentive, not looked at my phone, not looked at my emails. I think, wow, I, I, I know some of my guests pretty well. I probably... When was the last time I had a two-hour conversation with some of my friends like that where we weren't distracted at all? Do you know what I mean? It's really been very humbling for me to go, "Wow, maybe that is something I can take away from the podcast [laughs] into the rest of my life."

Dr. Drew Ramsey 1:08:36 One of the things th- that struck me about you over the years is the amount of vulnerability, uh, uh, that you've been sharing about, uh, y- your, really your own mental health. I think that's quite rare in this space, especially for men. And, and I was really curious in a broad way to, to ask you before we end, um, a- about some of your take on the struggles that men have in terms of their mental health and talking about mental health, and particularly with this, this paradox, I think, in masculinity where, you know, it feels like modern masculinity really is revolving more around a, a, a notion of strength through vulnerability. That, that I can be very open, humble, non-defensive, and, and, and that makes me stronger and, and more settled. Uh, but that's not in any way how masculinity has been built in the past, right? Tough, strong, silent, stoic, grit my teeth, get through it. I don't have pain. I don't have depression. A- and, and, and, and that's led to m- men mainly treating mental health through substance abuse. So 50% of men in America, one in two, will have a substance use disorder in their lifetime. It's led to men being, and particularly white, white males are, uh, uh, 75 to 80% of all suicides in the US. Um, and, and it, it's something I've been trying to wrap my head around, bo- both honoring the importance that we're at a certain moment in kind of the patriarchy and reckoning with masculinity.

Dr. Rangan Chatterjee 1:10:02 Yeah.

Dr. Drew Ramsey 1:10:02 But also for those of us who are, are men right now, how do we think about mental health and, and, and, and improving our own mental health and ideas around male mental health?

Dr. Rangan Chatterjee 1:10:11 [lips smack] Yeah, I think it's, it's a big challenge. Obviously, the statistics on male mental health are, are pretty alarming and worrying. And I have thought a lot about this as to why has this really become such a problem. And I think just expanding out for a second, I think as modern life has changed so rapidly over the last 40, 50 years, I think women and men have both had their struggles in, in very different ways. I think a lot of women, a lot of my peer group, my age group who I talk to, a lot of my male friends' girlfriends or wives I speak to really struggle with anxiety, with depression, with a lack of purpose. There, there seems to be something... And I appreciate I'm a man speaking about this, so this is just my perception from what I've picked up, that there's a real, um, there's a real trickiness of actually, you know, some of my peers have, you know, been to university, got, had decent jobs, and they, uh, decide to start a family. They, they, they get pregnant. They have the baby. They're, let's say, staying at home for a period of time, and really feel this kind of lack of, "Oh, man, I used to have a, a really important role in society. I used to really contribute with other adults at this job, whereas now I'm just at home with the baby. And I may be isolated as family. Maybe we've moved for work, so there's no one around me. There's no friends, there's no family." So and then they see, like, these female celebrities on TV who seem to have the perfect boyfriend and kids and the perfect body, straight, you know, six weeks after pregnancy, which is then blown up in the press. And so there's this kind of feeling of discontentment that I just can't compete with this kind of manicured and probably unrealistic image that's there in front of me. So I, I, I think the changing gender roles are certainly, uh, playing a role here. And then for men, I think, you know, uh, again, I'm not, I'm not sort of, um, fantasizing about the past where, you know, where women, um, maybe, you know, knew they weren't gonna get a job. Their role was to sort of bring up the family. I'm, I'm not at all saying we should go [laughs] back to that, just to be really clear. But I think for a lot of, a lot of men struggle with this idea that, you know, they kind of were brought up with this idea that the man should be the breadwinner. I think it's just trying to fit... It's trying to understand where we fit into this new way of living. And I think depending on how we were brought up, depending on what we saw in our parents, that often conditions us to what we think the world should be like or what our expectation is. I think that plays a role. I'll tell you one thing, Drew-

Dr. Drew Ramsey 1:12:56 It, it's so hard because I think even in well-meaning, uh, parents, um, of the last generation, there is a profound amount of, uh, not subtle and not so subtle misogyny.

Dr. Rangan Chatterjee 1:13:08 Oh, yeah.

Dr. Drew Ramsey 1:13:08 There's profound support for sort of patriarchy and gender roles. I mean, it's really, it's really challenging to unwind. I, I think what you're speaking about is how, you know, as you start a family and you see some of these traditional gender roles are like, I don't know. Like, I remember when we had our first baby and, and I thought I'd be a really, um, you know- [smacks lips] Uh, uh, eh, you know, like right dialed into parenthood. And there was this way that, that I didn't quite know what my role was. You know? Like, I wasn't a breast. And when like really there was a lot of crying, like I could do so much, but like I, I wasn't, I wasn't gonna really... You know, I'm not mom. [laughs] And, and I, I kinda came up with this phrase early. I said... It was a joke with a friend. I said, "You know, m- uh, daddies aren't mommies." And, and a- as much as I'm, you know, a firm believer in, in full equality [laughs] and a full feminist-

Dr. Rangan Chatterjee 1:13:55 Yeah

Dr. Drew Ramsey 1:13:55 ... uh, uh, uh, the, there is a way that, um, for me, fatherhood put me into kind of, uh, I would say worship and adoration of, uh, m- my wife, but of women in general.

Dr. Rangan Chatterjee 1:14:08 Yeah.

Dr. Drew Ramsey 1:14:08 And of really just profound ways that motherhood is not celebrated, that lactation and breastfeeding is not supported, and that, that we really have our priorities wrong. I mean, uh, it, it-

Dr. Rangan Chatterjee 1:14:19 Yeah. Uh, uh, I, I couldn't agree more. I f- I, I had that same realization. You know, I'd grown up, you know, thinking about equality and, you know, I w- w- this... A- and I, I completely support that. But I remember, yeah, like you, this moment when my son was, was crying, already fallen over. And, you know, I f- I thought, "I'm a pretty hands-on parent. I'm always around. I'm doing this, I'm doing that." He didn't want me. He wanted his mom.

Dr. Drew Ramsey 1:14:45 Yeah. [laughs]

Dr. Rangan Chatterjee 1:14:45 Right? That... And, and for me, I think it was an affront to my ego at the time all those years back. But, uh, actually it is really... And I, I see this w- certainly with my wife and, and, and other women. I, you know, have a newfound appreciation of how incredible, uh, they are, you know, going through childbirth, you know, you know, growing another, uh, organism, animal [laughs] inside them. Growing another person. You know, that is something we will never do. You know, we will never experience what that is like or that, uh, the pain of, let's say, childbirth and how one gets through that. You know, I, I really see a resilience in women, or I've got a newfound appreciation of that resilience in a way that I possibly didn't have 10 or 15 years ago. When it comes to men, in terms of your n- original question, I will say something I observed in the lockdowns here in the UK was that when people were out for their, let's say their daily walk here, you'd often see women walking with other women. Like, almost certainly there'd be two or three women or two walking together chatting. I rarely saw men doing the same thing. For me, if I go out, it's by myself. If my wife goes out, she meets a friend, and they go and catch up whilst they're walking. And I'm not saying that's the whole picture, but it just made me think, "Wow, there's something about that." Men are more and more isolated.

Dr. Drew Ramsey 1:16:10 When you go out with a group of guys, right? You go out with a group of women, first thing, they start talking about the kids, right? You go out with a group of dads, sometimes I leave and like I realize, "Dang, like we're awful." Nobody said like, "Hey, how are the kids? How are..." You know, like sometimes, but oftentimes it, you know, it, it just kind of-

Dr. Rangan Chatterjee 1:16:24 Yeah

Dr. Drew Ramsey 1:16:24 ... has woken me up to, uh, you know, again, just kind of biases and values that, um, I wanted to check and make. You know, I, I noticed that after dinner. I made sure the next time I, I made sure I asked everybody about the kids.

Dr. Rangan Chatterjee 1:16:39 Yeah.

Dr. Drew Ramsey 1:16:39 You know, and got that conversation going.

Dr. Rangan Chatterjee 1:16:40 But, but, but I think men and women, there's also... We c- we can support equality, but also recognize that we're, we can be different in some ways as well, and we don't have to nullify that part of ourselves. I think that is, again, it's like everything we've been talking about. There's nuance to everything. It doesn't have to be-

Dr. Drew Ramsey 1:16:58 The uncomfortable part for a lot of men is also really being very, very clear and committed to the notion that there's lots that women are better at.

Dr. Rangan Chatterjee 1:17:05 Yeah.

Dr. Drew Ramsey 1:17:05 'Cause I think part of really being seen and perceived as the dominant gender for so long i- is that that's really threatening, the idea that women are actually much better at a variety of things than men.

Dr. Rangan Chatterjee 1:17:15 Yeah.

Dr. Drew Ramsey 1:17:15 And, and I don't, I don't mean to be so sort of gendered in this, um, uh, because that conversation has really opened up over the past four or five years. But, um, I do, I do think that part of what we're speaking about is where mental health for men is challenging, and I think, uh, uh, because our role is really in transition.

Dr. Rangan Chatterjee 1:17:33 Yeah.

Dr. Drew Ramsey 1:17:33 And one of the, i- in the sense of, you know, just simple things for, for younger men, like what makes a good man today?

Dr. Rangan Chatterjee 1:17:39 Yeah.

Dr. Drew Ramsey 1:17:39 You know? Like, how do you date today? How do you show respect? What is masculinity? And especially if you're from a more, let's say, traditional culture, where it's not as easy as maybe it is, I don't, I don't know, for me to kinda like, I don't know, define modern masculinity here in America.

Dr. Rangan Chatterjee 1:17:54 Yeah.

Dr. Drew Ramsey 1:17:55 Because like we're constantly evolving and renew, as opposed to like, no, what a man is in your culture is really defined very differently and in a much more probably nuanced and historical way.

Dr. Rangan Chatterjee 1:18:06 Well, Drew, I'd love to go deep on that, and maybe next time we get together for a conversation, either at your farm or next time you're in the UK, we'll, we'll definitely follow up there. Just to sort of close off this conversation, you are a pioneer in this area about food and mental health. You know, you've been practicing this way. You've been researching this for many, many years. I think you've done a great job at putting it all together in your latest book, Eat To Beat Depression And Anxiety, which is gonna be super helpful for people. Just to close off this conversation, the podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of life. And, you know, wondering if you have at hand... I wonder if you have any closing words, any closing thoughts, you know, about things that people can think about introducing into their lives right now, no matter where they fall on that mental health spectrum, that's gonna help them get more out of life.

Dr. Drew Ramsey 1:19:05 What I would think first is validating the importance of self-care, and that self-care isn't selfish, that self-care is foundational. And be clear and rigorous and kind and loving in your care of yourself, starting with the words that you use and, and, and the time that you give yourself, to the types of nourishment and the foods that we've talked about in this, in this episode that fuel the brain and can fuel and improve mental health based on the most recent research I also hope people feel inspired to do something, that mental health is an active process. Increasingly in our clinic, we talk about the concept of mental fitness, that we're really working on improving our capacity for emotional connection, our capacity for love, our capacity for creativity, that, that we're really i- in, um, our daily lives and rituals and habits, we're, we're, we're trying to promote a set of lifestyle choices that to the best of science ability to tell us what's good for our brain is, is really, is really supporting us and supporting our mental health. And there are lots of ways to do that, I hope is the other good news you hear, and lots of science supporting the notion that your brain and your mental health evolve over time, um, and that the, the more that you learn about the self, the more that you experiment a bit with things like food and improving sleep and improving your movement. Feel Better, Live More is a mental health concept. Feel better is really saying when we feel in the upper echelon of our mental health, the world and life is amazing. We are filled with love and creativity and spontaneity and connection and, and we live more. And, uh, when we're missing those elements, and we've all been in states probably where we've had more of that and states where we've had less of that, and the world can look like a very, very, uh, dark and isolated and unfriendly environmentally, uh, you know, increasingly distressed place. Um, so, uh, I, I hope everyone hears encouragement to feed their mental health, that nutrition is a neglected piece of the puzzle, but also that nutrition isn't the only piece of this puzzle, and that putting together your mental health is just a really important place, really rewarding place for you to spend time and energy and to invest in. Noth- nothing will give you better dividends and more rewards than taking care of and investing in your mental health.

Dr. Rangan Chatterjee 1:21:32 I love it, Drew. Thanks so much for making time. Really, really enjoyed our conversation together. Thanks, man. Appreciate it.

Dr. Drew Ramsey 1:21:39 Take care.

Dr. Rangan Chatterjee 1:21:39 [outro music] If you enjoyed that conversation, I think you are going to love the one I had with the incredible immunologist Jenna Macciochi all about the immune system. It's right there, so give it a click and let me know what you think. And click here to download my free breathing PDF. Gut bugs, the microbiota, are one of the key educators of the immune system