Facebook Live: Using Food to Help Heal the Brain

Apollo Health’s Chief Science Officer Dr. Dale Bredesen and Chief Health Liaison Julie Gregory were joined by Dr. Uma Naidoo, a Harvard professor of psychiatry and author of the book “This Is Your Brain on Food.” Dr. Naidoo, also a professional chef specializing in food and its relationship to psychiatric and neurological health, discussed the gut-brain connection and how this important “ecosystem” directly impacts our “food mood connection.”

We’ve included a complete recording of the session and a full transcript below for your convenience.

Watch here:

Transcript:

Dr. Bredesen: Hello everyone, and welcome to Facebook Live. It’s my great pleasure and honor today to welcome Harvard professor of psychiatry, Dr. Uma Naidoo. Uma, it’s so great to have you. Dr. Uma here, she has written a fabulous seller called “This Is Your Brain on Food”, that you can see behind her, and she’s really a pioneer in the area of food and its relevance for psychiatry and for psychiatric disorders. And of course, we also have Julie Gregory Julie, welcome, and thank you so much for joining us today.

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Dr. Bredesen Maybe to start a little, because this is I think such a relevant area, not only for our own interest in cognitive decline and of course cognitive optimization, but for so many people that are impacted by these things that have implications, again, for neurodegenerative diseases as well as psychiatric manifestations. So, you have a very interesting background. Dr. Uma, can you tell us a little bit about how you got to be doing what you’re doing?

Dr. Uma Naidoo: Well firstly, thank you so much for inviting me, and hi, Julie. Great to meet you. It’s a little bit of a long story because as with all things, they start in childhood. I grew up in a large family and I, for some reason, didn’t want to go to preschool because I wanted to actually hang out with my maternal grandmother, to whom my book is dedicated. My mom was in medical school and so during the day, I would hang out with my grandmother. Actually, both my grandparents, and from then I naturally learned some healthy eating. Maybe it was unintentional, because she would pick fresh vegetables from the garden. I’d help her prepare things. We’d eat lunch together. They taught me yoga and meditation, and there were doctors in the family, but there were also a couple of Ayurvedic practitioners, so conversation was interesting, and that mind/body connection was something I absorbed from my environment.

Then I had a very, very significant moment early on in my career where I was a very young resident and a patient that I’d prescribed Prozac for, and as you know doctor, it can in some patients cause weight gain. So, he came in about two weeks after receiving his prescription to accuse me of causing him to gain weight, and I knew that it wasn’t me because I had his baseline weight. In Boston, our favorite coffee is Dunkin’ Donuts, and he had this very large 20 ounce cup of coffee. He walked in, and he was carrying this cup of coffee. I said to him in order to distract him, well, tell me what’s in your coffee. But I want to say there was something in my process that was making a connection. And so he looks in his coffee and it ended up he was using a quarter cup of processed creamer and 8 teaspoons of sugar. So, I very quickly sat down with him. I’m not a big calorie counter, but in this instance, it was a way to convey empty calories to him. And my aha moment was really when his eyes lit up and he realized, wow, now that I know this, I can do something different.

It was very powerful. That if someone had the information, which as you well know as doctors, we’re just not taught enough about. That really helped me to spring forward in to studying nutrition, and later going into culinary school, which I have to say was more of an ode to Julia Child as my food hero. And coming from that large Indian family, I didn’t know how to cook because there were always grandmothers, and aunts, and older cousins in the kitchen. So when I was studying, Julia Child was on public television in Boston, and she was a great encouragement because she would make all these mistakes and she’d be able to get over them. So it helped me grow my confidence.

So all these things, I was very fortunate Dr. Bredesen, that they came together for me because I continued to pursue more of what I call a holistic integrated and functional approach in psychiatry, which is looking at the whole person. Very much like the work that you do. Not having it be siloed in to just one thing only and collaborating with other clinicians.

Dr. Dale Bredesen: Great. And tell us a little bit about the program you’ve set up at Harvard. You have a very, very interesting, and I would say unique program for major universities like Harvard.

Dr. Uma Naidoo: So, I had the opportunity to start a clinical service, so an outpatient clinic, as part of our department, that focuses on nutritional and metabolic psychiatry. It’s within the hospital and it really is dedicated to helping people who want to come in, whether or not they’re prescribed medications, whether they’re involved in a certain form of therapy, all of which I believe are critical for improvement of mental health symptoms. But they want to focus on this nutritional psychiatry element to improve their well-being. And I was fortunate enough to have great mentorship that supported this idea. And I’ve been able to do that.

Dale Bredesen: Yeah, it has been surprising to me how many of the things that you and I studied in medical school, where it was unclear what was causing it. We don’t know what causes this problem and it ends up being things that are very relevant. The food that we take in, the toxins we’re exposed to. The things that we really did not know about there at the time.

Maybe you can give us a one case example. Someone who came to you with a psychiatric manifestation that responded well to your program.

Dr. Uma Naidoo: Absolutely. I had a patient pre-COVID who lived close by to the hospital in a very nice area of Boston. She was a young professional. She was not yet married and was very successful in her career. Normal weight, exercising, doing all the things to keep healthy. But she received a promotion at work about 18 months prior to her coming in to see me. She had received this promotion and she presented to me with severe anxiety. Her primary care doctor sent her to see me for a Zoloft prescription. She actually walked in saying, Dr. Naidoo, I need a prescription for Zoloft, I can’t take it. And she was feeling extremely anxious.

I sat her down and took a proper history, which all of us doctors are taught to do. And, as I traced it back, 18 months prior she’d had this dramatic change because eating her meals at home, taking lunch to work, walking her dog every day, doing her yoga class, maybe having a glass of wine once a week with dinner. She was now traveling most of the week, eating in airports, at fast food restaurants, from the bar fridge when she arrived at hotels late at night. Now socializing as part of the networking for her new job, so drinking up to two to three glasses of wine a night, whereas before she was barely drinking anything.

Dr. Uma Naidoo: So, she had developed significant gut dysbiosis. And, although she had previously not had any symptoms of anxiety or mood disorders, she was now presenting significant anxiety. And, because she was someone who exercised regularly, she hadn’t necessarily gained weight, but she was eating poorly. Eating differently.

She was very open to holding off on starting any medication. She was functioning. With my clinical assessment, she was safe to be able to do this under my guidance. And so we did it very slowly. She started to experience good effects within two weeks, but over three months she really worked hard to reverse those symptoms by how she ate, how she started to pack snacks with her when she traveled, how she just cut back on the alcohol at these networking evenings, and things like that. She was really one of the success stories I remember because she continues to do well, even though she’s advanced in her career because she’s learned these tools of how to eat better, how to meal prep, how to take things when she’s on the go, and integrate it into her lifestyle.

Dr. Dale Bredesen: Fantastic. So, one of the most interesting things to me is, in your book you talk about these various issues from ADHD to depression to PTSD, and various psychiatric diagnosis, that are highly relevant for cognitive decline. And certainly depression, we see with type-3, so called toxic Alzheimer’s, depression is a relatively common presentation. Recent study actually showed that people who have essentially ADD or ADHD are at increased risk for dementia. Then we see autism and ADHD as being very much polar opposites in so many of their presenting symptoms.

So, it’s intriguing the relationship. Now, how many of the people that you see actually have some cognitive changes, some brain fog or some actual cognitive decline?

Dr. Uma Naidoo: Absolutely. I’m especially seeing brain fog during COVID.

Dr. Dale Bredesen: Yeah.

Dr. Uma Naidoo: As you know, individuals who have survived COVID infections, those who’ve been fortunate to survive, many of them now have long haul syndrome or they have symptoms that are separate to that but include brain fog and fatigue. And certainly some mood symptoms. But, also in my general clinic pre-COVID and during COVID, there’s a significant amount of concern about cognitive health. Maintenance of memory, how do you eat better for better cognition and longevity. It’s certainly something that I’ve written about in my book, and I feel that a diet is really one of the pillars. Nutrition and lifestyle are key factors to how people can improve upon their mental health in general, but including cognitive health, mood, anxiety and other conditions.

Dr. Dale Bredesen: Absolutely. And certainly we’ve been saying repeatedly, anyone who has had COVID-19, and I just got over the Delta variant myself despite full vaccination, despite full precautions, my wife and I both got this on our first trip. Delta is everywhere. I know we’ve crested, we’re beginning to come back down nationally, so hopefully that trend will continue downward, but it happens. So, for all of us who had that, we all need to be on active prevention for cognitive decline. We are all increased risk. Just as we are if we’ve been exposed to air pollution or high levels of mercury. Just go down that list.

Dr. Dale Bredesen: So, maybe Julie, let’s come to you for a moment. We’ve talked so much in the past about cognitive issues that you dealt with years ago, and things that you’ve continued to optimize. But we’ve really talked much less about some of the things like anxiety, some of the ways that it affected you psychologically. I know you talk beautifully in the book about your interactions, where you husband would come back from Europe and would actually be able to tell that there was a change just in a short week. And how that really crushed you in your interactions with your son. So, could you talk a little bit about the various psychological issues relevant, and the how you ended up affecting these when you did the appropriate things via exercise, sleep, stress and so forth and so on?

Julie Gregory: That is such a great question. I think my journey began with a lot of anxiety because I learned nine years ago I was an ApoE4 homozygote. At that time, there was a paper out of Duke saying that I had a 90% chance of developing cognitive decline. As you know, I was experiencing symptoms at the time. It was pretty terrifying. So, I had to deal with that anxiety, and it was something that I wasn’t comfortable talking to people about.

So, what I did is I turned all of my energy towards reading everything that I could. Every study I could find. I wanted to learn all I could about how I could best support my brain. As you know, I first turned to the Alzheimer’s association, and they told me that Alzheimer’s can’t be prevented, can’t be treated, is incurable and progressive, and most people are dead within 10 years. So, that only heightened my anxiety. But when I started to dive into what my brain needed to function better, and I started to act upon that, when I started to change my diet using food as medicine, optimizing sleep, focusing on stress and doing all the right things, things turned around.

I recently had an interesting experience. I had a sinus infection, and I had to take antibiotics. This was about a month ago. I developed depression at the end of my course of antibiotics. And thank goodness I recognized it and I woke up one morning and I said to my husband, I feel so sad. And I’ve never dealt with that before. And I said it must be the antibiotics. I got on a good probiotic. Of course I’m always working on good gut health. Within a week or so I felt better, but it was such a powerful illustration of how something so small like that can affect mood.

Dr. Dale Bredesen: Great, thank you. And then, Dr. Uma, let’s come back to you. So, not only are you a board certified psychiatrist and best-selling author, you are also a trained chef. Talk a little bit about your training as a chef and how that informed what you’re doing in psychiatry.

Dr. Uma Naidoo: Thanks Dr. Bredesen. I came to it later in life because I was really a self- taught cook in my younger days when I moved away from my family to study. As I mentioned, I was not cooking. My mom recognized that I loved science, so she taught me to bake. When I went to culinary school, I chose a local school in Boston because I was actually working full time. And I’d spent some time studying pastry, of all things, at the Cordon Bleu in Paris. And I did that when we went on vacation there. I was so excited about the culinary arts and I wanted to see the authentic school where Julia Child had studied.

When I returned to the U.S., I’d really had this excitement in me to complete training. The how wasn’t quite clear. I spent some time at the culinary institute at Hyde Park, and really, really loved it. Was encouraged by a chef mentor there who sort of took my interest seriously, even though I was already a physician at that point. So I decided to find a top rated local school where Julia Child had actually been a patron and lived close by when she was alive. So I did that, and to be completely honest, a lot of the things I studied and did, didn’t come together in a cohesive way until a little bit later on.

And it was speared on by things that I loved to do. Cooking, food, nutrition, were things that I really cared about. Like I said, I was raised that way. They brought me closer to home, closer to family. Mental health and psychiatry, I care deeply about. I don’t know if you’ve ever had this experience, everyone watches the food network, even if they don’t cook. It’s just this observation I’ve made. It’s almost entertainment that people have. So, I’ve realized that food was a really great way to begin a conversation about mental health. It’s something that people feel less stressed to talk about. They enjoy talking about food. Most people do. So for me, it’s an easy in to really uncover something that might be going on and a way to help someone. That was my [inaudible 00:17:17].

Dr. Dale Bredesen: Fantastic. And one of your areas of expertise of course has been called “Mood Food”. For those of us who want to be in a better mood, what do you recommend?

Dr. Uma Naidoo: Absolutely. Well, the first thing is understanding the gut brain access and understanding that the ecosystem that exists between the gut and the brain is super important. And that the gut brain connection explains the food mood connection. And what I mean by that is the gut and brain are far apart in the body. We don’t necessarily think, oh, they’re connected somehow, but in fact they are. They’re connected because they originate from the exact same cells in the embryo. Then these cells divide up and form the two organs, but then connect throughout life by the 10th cranial nerve, the vagus nerve, which then acts like a two-way superhighway for chemical messaging between these two organs. This happens 24/7, 365 days a year, and it is key to aspects of explaining how what we eat impacts our mental health. Why? Because more than 90% of the receptors for serotonin, the gut, and many, many of these hormones or these neuro chemicals are produced in the gut.

So, it makes sense then that if someone is prescribed a selective serotonin reuptake inhibitor, an SSRI like Prozac and Zoloft and others, that they might initially have some gastrointestinal discomfort. So it also helps us understand that there’s this connection. So once you know that you understand that as you eat food, on days that you’re eating a healthier diet, the breakdown products of digestion are healthier products of broken down fatty acids. When on days that you’re eating at a fast food restaurant or going through the drive thru lane, eating a lot of high sugar foods or finely processed grains, foods fried in processed vegetable oils, etc. The breakdown product’s more toxic to the gut microbes, and you have to maintain this balance within the gut microbiome because if you only feed the bad microbes, then you are setting your gut up for inflammation. And gut inflammation ends up being neuro inflammation, as you well know. And that’s when I see an uptick of mental health symptoms. So that balance becomes key.

So, easy, easy ways to do this. Think about one unhealthy habit that you that you started during COVID. I think each of us has something that they struggled with during COVID in terms of eating. Try to stop there. Easy ways to start healing the gut include things like eating prebiotic foods, oats, bananas, garlic, leaks, and onions. Start to include these in your daily diet. Add in some fermented foods; kimchi, kombucha, dairy. Add these in because the live active microbes again support the microbiome. Spices are something to lean in to because I see calorie free, sugar free, salt free. And things like turmeric and saffron have a good amount of evidence of improvement of symptoms of mood. So add in a quarter teaspoon of turmeric with a pinch of black to soup, tea or smoothie.

So, those are just some ways to get started. Then there’s always the omega-3 fatty acids, which also have good effects in cognition, so those are good ones. If you don’t eat seafood, and you’re not a fan of fatty fish like salmon or anchovies or sardines, then you can have some plant based sources, which are less available to the brain and body, so it’s a short chain omega- 3, but you can still get them in chia seeds, black seeds, hemp seeds and things like that.

Dr. Dale Bredesen: Yeah. And in your practice, in psychiatry, when people are coming to see you with various psychiatric manifestations, how often do they have either some gut issues. Whether it’s leaky gut, whether is dysbiosis, whether it’s something else. How often are these things linked to their psychiatric disorders?

Dr. Uma Naidoo: I would like to say 100% of the time, but for the sake of being balanced in terms of response, I would say 80 to 90% of the time the gut is almost always involved. It really is very rare that I have someone who’s not having some form of a gut issue if they are asked. Sometimes people have taken it as just normal that they have an upset stomach almost every day. Gas, bloating, discomfort. They assume that they have a condition that is not necessarily dysbiosis, that it’s either something else gastrointestinal wise and for that reason they’re having discomfort.

When we really, really break it down, unpack the information, some gut healing is often what will help both. Firstly because it’s dealing with inflammation and inflammation is now being touted as really the underlying cause of so many conditions in mental health. So once we start to heal the gut through how they eat, the reduction of stress as well, mindfulness, better sleep, hydration, all of these things become important. Exercise as well, but nutrition being the focus , they do start to feel emotionally better.

Dr. Dale Bredesen: Yeah, fantastic. I remember so well in medical school seeing people with schizophrenia, and of course this was called many, many years ago, dementia pre-cox, with the idea that this was actually a form of early dementia. And indeed there are some relations such as, reduction in spines on [inaudible 00:23:18] for example. So there are some relationships there, and of course at the time the only thing you could really do about it was reduce the dopaminergic neurotransmission with things like Haldol and stelazine many years ago.

Dr. Dale Bredesen: Have you had good results with dealing with people with schizophrenia using a nutritional approach or do we have a long way to go still in this area?

Dr. Uma Naidoo: So, I think that it depends on the extent of the schizophrenia. Someone who’s living in a group home setting or is still being frequently hospitalized, I would say, not that they can’t eat healthier or develop some healthier eating habits if they don’t have them, but they may be more of a challenge. But here’s the perspective on it. What we’re eating in mental health and regular hospitals, some are not good for individuals. I think that with schizophrenia, if someone is living at home, living with family, stable on medications, I’ve had some good results with just tweaking the diet, working with them on eating healthier so that they fend off the weight gain that often occurs with some of the stronger anti-psychotics and things like that. So just maintaining an exercise program, eating healthier, using a different dietary plan than unhealthy foods which they might be more used to eating.

So I would say more stable cases of individuals who are either living at home or independently versus those who are not able to really function independently and live in a group home or being hospitalized a lot.

Dr. Dale Bredesen: Yeah, you mentioned earlier of course the pandemic and we often talk about the fact that as bad as the pandemic has been with over 700,000 Americans now passed away due to COVID 19, it’s still dwarfed by Alzheimer’s, which will take the lives of somewhere around 45 million of the currently living Americans. I just got another email last night from a doctor whose mother developed dementia, and clearly this was accelerating during the time of COVID 19. She didn’t have the same interactions. What do you recommend nutritionally for the people who’ve been isolated, who complain about the social isolation with the pandemic?

Dr. Uma Naidoo: I think that’s a really tough one because on the one hand we absolutely need to stay by the guidelines that are being offered. But it’s been very hard emotionally for people to be separated from family, older individuals separated from their grandchildren and even their own children, has been extremely hard. So, if we are at a place now where we can walk ourselves back to some normalcy or somewhere in between. Reintegrating your family, friends and loved ones using safety guidelines, depending on the area that becomes important. Vaccinations become important. And then eating healthy and maintaining a healthy lifestyle becomes important. Spending some outdoor time. Spending time with family helps to reintegrate individuals to some lack of isolation that they had been experiencing. I’m a big fan of people doing FaceTime and Zoom meetings if they don’t live close by to family. Integrating with their community if they’re able to and if it’s safe enough to do so now. Those types of social supports are key to maintaining healthy cognition, healthy mood and just normal social functioning. Which I think has been very hard for people.

Dr. Dale Bredesen: Great, thank you. And then a fascinating one is autism. As you know, one of the suggestions in the past has been that anticholinergics may actually be helpful in autism. The opposite of what we think about of course with Alzheimer’s. And indeed, some of the biochemistry is opposite. You have reduced a beta, you have a change in the signaling of APP, more toward what we think of as the synaptoblastic effect. You have an increase on average of in BDNF, and increase in brain volume, so in some ways this is almost like a developmental anti Alzheimer’s. Could you talk a little bit about what you recommend for people who are dealing with autism or with Asperger’s?

Dr. Uma Naidoo: Absolutely. Sometimes there are slightly more challenges in these areas. Part of it is when there might be Asperger’s or autism in a young child, as you know sometimes, they develop fixations around food, certain patterns of behavior that they are strongly adherent to, and it can be difficult to do that. But, when we can, interventions around healthier eating. If they will only eat a square green food, how can we put good nutrients into a version of that, that’s not a packaged processed food. I know it’s tough on parents, tough on families to do that, but that’s one way to make an intervention. Behavioral interventions become important, community support, appropriate schooling, and the right settings. But nutritionally speaking, if we can find a way to help them eat healthy, that is critical.

There’s some research that’s been done on a gluten-free, dairy-free diet. And I’m not sure that we know that there’s enough evidence around that, so I’ve always leaned on the parents and their experience with their child. If they notice a change in behavior, symptoms are worsening. If they say have gluten or have eating a sandwich or they are drinking milk or eating yogurt and things like that, then it’s wise to cut back on those foods that maybe causing an uptick. I have them log the foods along with the behaviors and that becomes important. I think it would be inaccurate for me to say yes, you just have to give up those foods. I think health eating is the cornerstone of how we need to help them.

Dr. Dale Bredesen: Yeah, fantastic. And then if we can talk for a minute about PTSD. Again, such a common problem, and of course only more issues with the pandemic, and with witnessing relatives and loved ones be lost to this. On a nutritional side, how do you deal with people who have PTSD?

Dr. Uma Naidoo: Absolutely. So, first and foremost, recognizing that even individuals during the pandemic, who were not first responders or may not have lost a loved one, have been traumatized just by the experience of the pandemic. That becomes important, especially with the people that were so isolated, just acknowledging there’s an issue. But some of the foods that we can add to their diet include things like blueberries, omega-3 fatty acids, seafood or plant based sauces, spices like turmeric. And one of the things I find very important for them to understand is that there are glutamates, which can be natural glutamates or MSG that are found in food, which can actually cause an uptick in symptoms. And I’ve noticed that many of these foods, actually we might be talking about something like miso, which is a fermented food. Tomato sauce, which one wouldn’t necessarily think of as an unhealthy food on its own, unless it was store bought and had a ton of sugar. Parmesan cheese. So these are just a few things that, and I have a list in my book, of glutamate containing foods that one has to be careful about when one is struggling with these symptoms.

Dr. Dale Bredesen: Absolutely. This is fantastic. Okay, there’s some excellent questions here. Let’s take a couple of these questions.

So, Lou says with the ReCODE protocol, the hardest thing is the nutritional part. Fair enough. As we’ve talked about many times, we’re trying to get you to a synaptoblastic biochemistry here, a neurochemistry. And we’ve got to have a set of things that do that, which is the idea behind KetoFLEX 12/3. So she says, it’s like having to cook all over again. It’s gotten expensive buying organic.

And Julie, I know you’ve talked and written about this extensively. What would you recommend to Lou, who is dealing with the expense issue in buying organic?

Julie Gregory: It certainly can be expensive if you’re going to Whole Foods and buying all of your organic food there. Walmart has an enormous organic section in my city. So, Sam’s Club has got lots of wild caught seafood. So if you sort of expand your net, there are less expensive ways of finding these healthy foods. And Lou, I totally agree, at the beginning, it’s overwhelming. When you go from a diet that includes refined and processed foods to eating only whole food after preparing it all yourself. At the beginning I felt like I was in the kitchen nonstop just chopping all day. But over time, it becomes your lifestyle, it really does become easier, and you find less expensive options.

Dr. Dale Bredesen: Yeah, great. Good point. And Dr. Uma, what do you recommend for your patients who are coming in and saying, hey, how do I get organic food, in terms of expenses. My food bill is going to go up.

Dr. Uma Naidoo: Absolutely. And I think that’s a relevant point, not everyone has the same access. There’s certainly differences in social demographics in this country and it continues, so I think being sensitive that, especially mental health becomes important. So I walk people through a few different things. I talk to them about team 15 and the dirty dozen trump environmental working group. I post these on Instagram, so that they know the foods in the produce that they should be getting that should be organic versus the ones that they don’t have to. That’s one tip.

Dr. Uma Naidoo: Another tip is how they shop in the supermarket. Fresh organic can be quite expensive. But frozen organic can be more family friendly. Large bags that can be stored in the freezer, and in the United States, our frozen foods are flash frozen, so they’re frozen at their peak. And unless the actual frozen food has a sauce or syrup or extra sodium in it, it’s usually a pretty healthy option for them.

Another one is that we used to talk about avoiding those center aisles in the supermarket because of processed foods, but you also get beans, lentils, canned salmon, canned mussels, canned oysters. These are great brain foods. Rich in zinc. So, if someone cannot afford the salmon in the wild caught salmon at Whole Foods or the seafood section, canned, there are some options there as well to get in the nutrients.

Dr. Uma Naidoo: So, those are just some of the tips to manage with the organic issue and then to also look for the organic produce on sale. The foods that are organic on sale that we can balance up in your budget. It takes a little bit more planning, it takes a little bit more work. But if you care about it, I think it’s a little bit worth it.

Dr. Dale Bredesen: Yeah, we use canned wild caught salmon all the time. I think it’s a great option. So one of the things I think is important for all of us to realize, cognitive issues are so common with dementia, it really dwarfs the COVID 19 pandemic. And on average, what the statistics show is a person going through Alzheimer’s, will spend a total of $350,000. It’s horrible. Much of it of course going to nursing homes. Of course that’s changing. We’re very excited about Marama, with Dr. Heather Sandison, where they’re actually getting people to improve in the assisted living facility. But what I recommend to people is, take one tenth of that and save 90% of it, take one tenth of that and that should be able to keep you sharp until a hundred, by buying the appropriate things, by getting the appropriate tests, by getting on an appropriate prevention or earliest reversal program. Really, actually, you can save yourself a tremendous amount of money, rather than spending a tremendous amount of money.

Alright, Elizabeth says, hello gang, growing numbers of psychiatrists like myself doing functional medicine too, hallelujah, fantastic. We want to offer our patients options and give them their health autonomy back again. Hooray for the psychiatry revolution. So, thank you for the huge part you’re playing in that Dr. Uma.

And then Katie says, yay spread the word. We need more chefs to learn to cook for nutritional as well as taste.

Absolutely, and again, thank you Dr. Uma for leading the way.

And then Lou says it’s been two weeks that I cut out all sugars and dairy and I’ve noticed my mood has changed for the better. I was always so edgy, and anything would get me upset.

Great point, and I’m sure you’ve probably already heard this many times. Dr. Uma, what do you recommend when people are coming off this, do you ever recommend exogenous ketones or do you ever recommend that people look at their ketones, and do you think that that is also relevant for their mood or not?

Dr. Uma Naidoo: So, ketones are definitely relevant. They’re relevant in certain conditions in mental health. If people want to on a certain program and are checking say their urine ketones or looking into that, it might be appropriate. These days, from when I first started my clinic to now, almost every single plan is highly personalized. This is really because microbiome is like a thumbprint. So individuals have different responses. I think that what becomes relevant is food logging of where their symptoms lie with mental health and what they’re eating. So the gentlemen who had given up refined sugars and dairy, if he’d noticed something that I call body intelligence, and he’s making that connection, that a sole elimination of bad food becomes important.

I prefer to test. And like all doctors, tests don’t guess. So whether it’s vitamins, nutrients or checking for whatever electrolyte they might need, we do that too.

Dr. Dale Bredesen: Yeah, great point. And then Huma says, kids in college who are also working to support themselves are finding it hard to eat healthy. Nutrient dense foods takes some focused attention toward grocery shopping and meal prep.

And actually, our two daughters both went through this in college, and now in their post college careers. And it’s interesting. They’re much better than we are. They’ll bring stuff home. Oh, look what I found here. What’s interesting, people find over time the really healthy things that are actually delicious and wonderful and that they really enjoy.

So obviously you’re right at a university there. At Mass General. What do you recommend to the college students that you see Dr. Uma?

Dr. Uma Naidoo: Absolutely. Well, it’s much like the advice we gave earlier. It’s meal prep, it’s working within a budget, what you enjoy eating. Cleaning up the kitchen. Taking out the processed, packaged, ultra-processed shelf stable goods that might be convenient, but they have unfortunate ingredients in them, which are not great for the mental health.

So, if we talk about the 80/20 rule, in nutritional psychiatry. If 80% of the time they can eat a plant rich diet with clean proteins, whatever type of diet they consume, knowing the foods to avoid and cut back on. And maybe getting rid of their stock up on cookies or maybe they’re stocked up on chips or whatever it is. That type of negotiation in their own kitchen, whether they share dorm kitchen or they have roommates, it becomes critical.

And then, getting into the habit of meal prep becomes key as well. With some college students, we work with them on sort of a budget for all the roommates together. So, even if one person’s responsible that week for buying the food, they share that, and obviously it has to be like minded students that are living together that want to improve their physical and mental health. And we do lots of fun stuff like that to help them create a better way to eat and to feel better.

Dr. Dale Bredesen: Absolutely. And Theresa says, thoughts on fructose and fruit.

And actually, just Friday before last, I had wonderful outdoor meeting Dr. Robert Lustig and we went through some of these issues related to his interest in fructose in ATP, in metabolism and how this is so critical for brain. So maybe, Julie, you could talk. I know you’ve written a lot about effects on metabolism and their effects in turn on cognition. And obviously fruit is kind of a double edged sword. Lots of good things, but also some things to be concerned about. So, what do you recommend to people that are concerned about the fructose in fruit?

Julie Gregory: I think in general, fructose in fruit is much safer than artificial fructose in refined and processed foods. But I think even with fruits that are high glycemic, we still have to limit them. For those of use that are focused on cognition, we need to focus on wild berries and specific fruits that have been shown to improve cognition.

Also, eating fruit in season. I think many people can overdo the fruit because we bring it in from all different countries now and it’s available all the time. And people have lost the concept of seasonality. That’s something important to keep in mind as well.

Dr. Dale Bredesen: Absolutely. And Dr. Uma, what do you say to your patients who are asking about, I love fruit but what can I have and what should I avoid?

Dr. Uma Naidoo: So, in mental health they have to be concerned about weight gain because many medications have been prescribed. Some of the unfortunate side effects include weight gain. So, I prefer lower glycemic fruit, wild berries, different types of berries. And wild berries have twice the amount of antioxidants as regular. So, even if you get wild blueberries in the frozen section, get those.

And then I’d also like to say, eat your berries, don’t drink your berries. Because the fructose level and fructose available to your body and your brain changes when you pulverize or juice the fruit.

So those are some of the guidelines I’ve used in mental health. I think fruit are very important because of the fiber and nutrients. It’s just the amount and the type. So, if I have a patient struggling with their weight or working towards a weight gain and they’ve started to have poor metabolic health, then I really have to stay away from mangos and pineapples, the higher sugar fruits and really stick with berries and things like that.

And also portions. So a couple of servings a day and then if they’re running in to problems with their blood glucose, then we even have to treat that further.

So, while I support fruit, it’s a very careful evaluation.

Dr. Dale Bredesen: Yeah, which fruits, etc.

So then Deborah says, I believe a garden, or potted porch or balcony will help with the expense.

So, absolutely great point.

And Sarah says, Trader Joe’s has very good prices on organic foods. Another great point. Donna says, I hate seafood, I have to lean on whey protein.

Okay, but be careful. The long chain fatty acids, the DHAs and EPAs and things. Not as easy to get with that obviously.

And then Huma says, I’m a physician and I can’t tell you how many physician friends say that they are having memory trouble in their 40s. Our lifestyles make it hard to practice what we preach.

Absolutely, I think that’s such a good point Huma. And one of the first patients I dealt with was a brilliant physician, who has a very, very active practice. And we’d go home every Friday night and eat a carton of ice cream. Just everything was cortisol stressed to the max. Had positive PET scan, ApoE4 positive, positive family history. Clearly had MCI by cognitive testing, and who did beautifully and increased his hippocampal volume beautifully and did very, very well on appropriate things. But of course, had to fundamentally change the way he was eating and contributing to his own lack of nutrition. So again, very, very common problem.

I’m sure Dr. Uma in your practice you must see many physicians who are struggling with these same sorts of things, where it is very tough with the lifestyle, and especially with interns and residents, who really have it tough.

Dr. Uma Naidoo: Well, they have it tough and internship and residency breeds really poor eating habits, just the nature of the work. Eating on the go, skipping meals, standing while eating, grabbing a sandwich from the lunchroom and eating it later. So, part of it is walking ourselves back from that situation and founding out how they can really install healthier eating habits because they are so stressed, and they are so busy. But then that’s where the holistic integrated approach becomes important with the functional lens. So, mindfulness, yoga, outdoor time, taking a walk on the lunch break. Having caffeine only early in the day. Hydrating throughout the day, even if they haven’t eaten, making sure that they hydrate. And then meal prep. It goes back to meal prep or healthy options that they can obtain on the go.

So, you’re absolutely right. I think that traditionally, as physicians, we tend to not always have the healthiest lifestyle habits because of the nature of our work.

Dr. Dale Bredesen: Absolutely. So, this has been fantastic. Dr. Uma, could you tell people where can they reach you, how can they find you, what are your social channels, etc. What’s the best way to hear from you? From Dr. Uma Naidoo.

Dr. Uma Naidoo: Absolutely, thank you. So, my social handle is @drumanaidoo. You can subscribe to my newsletter, where we put out current research and updated information every week on a Friday. And that’s @umanaidoomd.com. And we have some free guides that we give you to check out where to sign up and you’ll see information about my upcoming course, which is my first course in nutritional psychiatry. That will release later this year. So, I’m excited about that and I’m excited to share.

Dr. Dale Bredesen: Fantastic. This is the future of psychiatry, so very, very excited. Thank you so much for joining us. Professor Uma Naidoo, thank you for the fantastic work you’re doing, and we look forward to future books and I really encourage everyone to read “This Is Your Brain on Food”. Outstanding book written by Dr. Naidoo and thank you once again.

Dr. Uma Naidoo: Thanks so much Dr. Bredesen, I really appreciate it. Nice to chat with you Julie, take care.

Dr. Uma Naidoo: Thanks so much Dr. Bredesen, I really appreciate it. Nice to chat with you Julie, take care.

Dr. Dale Bredesen: Bye-bye Julie, thank you.