So often, conversations regarding healthy eating go straight to health matters below the neck - things like weight management, heart health, managing cholesterol and diabetes. But some doctors believe that we should be focused on feeding what’s above the neck – our brains. Dr. Drew Ramsey calls himself a nutritional psychiatrist. He’s an avid researcher of the connection between food, brain function, and mental health at Columbia University – and, he’s a farmer. Contributor Shauna Sever spoke to Dr. Ramsey about his work and how we can work more brain-boosting foods into our diet. Ramsey also shared with us his recipes for Whole Roasted Chicken with Anchovies and Olives and Mussels Three Ways.
Shauna Sever: When you get a new patient in your practice who's struggling with their mental health, say depression or anxiety, what are some of the questions that you seek to answer in those initial meetings with them?
Dr. Drew Ramsey: When I meet a new patient, I do a general psychiatric interview like all psychiatrists. In addition to that I really want to pay attention, as many of us do, to the lifestyle factors that influence my patient’s mental health, and those include food. We do a very detailed walk through your day as an eater; I call it a simple food assessment. Just really trying, in broad brush strokes, to understand: What's your relationship with food? What are the main foods you eat? That part that often gets missed – and is very important for a nutritional psychiatry evaluation – is asking, where is your motivation, and what are your personal goals with food? We have a lot of ideas in medicine that we're going to tell people what to do. Behaviorally that doesn't really work as much as partnering with people and asking them around their motivation and their goals, and of course trying to influence those.
We look at what's missing. There are certain food categories that most Americans, and most of our patients, are struggling with. Things like seafood. The average American eats 14 pounds of seafood per year, and it's probably not the best seafood for your brain, which are going to be more of the smaller fish, fish that have high amounts of docosahexaenoic acid (DHA) and other long-chain omega-3 fats. Anchovies, for example, are a great brain food.
Another food category is the leafy greens; they’re a great food category that a lot of people – well, how many options do you have in your house? You have a couple salads. But to really think about those as a critical base of the diet because they’re so nutrient dense; they have all these important brain nutrients like foliate and calcium. Of course, with all this new science about how the gut influences our mental health one of the benefits to eating more plants is you're getting more of these fibers, that healthy bacteria in our gut.
Dr. Drew Ramsey Photo: Ian McSpadden
SS: Is the goal to get patients off antidepressants or antianxiety medications and use food as medicine?
DR: I'm in the service business and so I try to serve my patient’s needs. I believe lots of people need to be on antidepressants and their very effective medications for certain individuals, and I've seen that in my practice. I've seen a lot of times where my work in nutritional psychiatry gets misinterpreted – and interpreted in almost a dangerous way – is the idea that all of our mental health problems and symptoms can be fixed simply by eating more of this food or that food. There are certain foods that the human frame and the human mind have always done well on. We're really missing most of those in our modern American diet; weaving those back in involves some challenges for us.
SS: A lot of what you talk about, and I'm hearing you say, is you're focusing on adding foods rather than eliminating foods from the diet.
DR: Yes. I think it's a tragedy that there's been such an invoking of food fear. It started with cholesterol and fat, to really rather ridiculous notions that when it comes to how a population should think about food. I really love the idea that as physicians, as a health care system, we want to promote healthy lifestyle, and we do that by leading by example, by giving people practical choices and being partners with our patients. I don't want to shake my finger about the fact that you ate a cupcake. I want to talk about all of the exciting ways that you're incorporating plants into your diet, or that you're at least trying seafood because you don't like it. Those to me feel like critical clinical conversations that we're seeing much more of.
SS: You've talked about the leafy greens and seafood. I also know that you talk about beans as being an important food. What about those are beneficial for the brain?
DR: Nuts and beans are good examples of foods, first of all, that fit everybody's budget. One of the critiques of the food movement is that kale and wild blueberries are expensive stuff. So, with beans and nuts you get a very nice price point.
Nuts are great because they are a nice mix of good fat, the fat that everybody agrees is healthy for us, monounsaturated fat, the same fat that's in olive oil. And nuts have a great minerality. In things like almonds there are some special nutrients that you don't find a lot of places, like Vitamin E; you find a lot of Vitamin E in almonds. So, nuts make a great snack. That's one of our interventions at the clinic. We work with a lot of snackers. Grabbing a handful of nuts is a nice way not to bump the blood sugar, but to get some nice slow-burning carbs, some protein, some fats and some good brain nutrients.
Beans, lentils, black beans, red beans, they’re just great brain food. Actually, the small red bean has more antioxidant capacity than almost any other food according to the USDA. People aren't saying red beans are a super food, but they really are. And again, with this movement we have towards more plants, a lot of families struggle with that. What does that mean? How do you get protein in a meal like that? How do I get a filling meal? Beans are a great example of something that's quite accessible to folks and a nice way to get a plant-forward or vegetarian meal in there every now and then.
SS: What's so special about fermented foods? Because these are foods that are having a moment, they’re quite trendy, but it's good to hear that they're good for our brain.
DR: Fermented foods are fascinating and captivating us; they’re having a moment for a number of reasons. This is the way that all cultures have always stored food. The easily accessible sugars get digested by bacteria and create things like yogurt, kefir, kombucha. The interesting thing is that these bugs – I call them the good bugs – are what I feel are some of the essential ingredients to a healthy human brain.
The good bugs have this critical role in our inflammatory system. Everybody's heard of this buzz word inflammation that's running around everywhere in medicine – we’re trying to cool off inflammation. Even with depression, dementia, this has become a way that we increasingly think about those diseases. And so, if you think about cooling off inflammation and where it comes from, one spot is looking at what’s called dysbiosis, where people have different types of bacteria living in their intestine. How you can imagine this, it's kind of like a zoo down there. And you've got some animals in the zoo that are very peaceful, they calm down inflammation. And then you can have some animals in your zoo that are causing some problems.
There's a tremendous series of communications from the gut and the brain. There’s this giant nerve, the vagus nerve, that wanders down from the brain and listens to the gut. Fermented foods give us some nutrients that you don't find many places, like Vitamin K2. They help us populate the gut with healthy bacteria and help us maintain a diversity in our bacteria. It's one of those common-sense rules that those are foods that have been around the planet for a long time; we've coevolved with them. So, adding some of that into your diet, we feel, is one of those moves that helps people eat in a more brain healthy type pattern.
SS: I know some people are wondering, “Why can't I just take supplements?” What's the difference between taking supplements and eating whole foods in terms of brain health?
DR: Before we get into the science of that, let me answer as an eater and ask listeners to think about this: When was the last time you went over and had a really nice time, a nice laugh, making a meal of supplements and serving them to your friends and family? That to me is the first difference. Supplements give us this idea that there's a way to access health without engaging in our food and our food system, and that is false. There's no insurance for us not having a healthy food system and there's no insurance for us not eating the foods that we were made to eat. And, unfortunately, that's where we are right now.
I hear this a lot where there's a lot of push of supplements. It’s been this side effect of Instagram and of social media and of all these algorithms, that the amount of information – I would say misinformation – that people get about what they need to be healthy is just shocking. The algorithms find you, they generate fear, and they sell you supplements. Before 1912 we didn't know what a single vitamin was. There was a lot of human creativity, human happiness, human love before 1912. So, I think that certainly in some situations we need supplements. I take a little Vitamin D in the winter when I get low. If I'm feeling down, if I haven't eaten seafood for whatever reason, maybe I'll take a high-grade omega-3 supplement. But, looking at the supplement to be the foundation of our health, that's just never made sense to me.
The data of that. I mean what is most highly correlated with taking a multivitamin if you're a woman over the age of 50? It's your risk of death. The data on supplements, if you look into it, it’s a very deregulated industry, generally full of all kinds of strange things that people depend on for their health as opposed to more evidence-guided or evidence-based treatments, or just good common sense simple treatments like food.
SS: You are an avid farmer. You have a farm in Indiana. That's your roots, that's where you're from. And a lot of times in your work you often talk about the role that food plays beyond just the eating of it. You talk about the sourcing, the preparing, the sharing of it, the nonnutritive aspects of brain food as being just as important for our mental health and general well-being. I love this idea of connection over food as being a good part of us feeling well and enjoying life.
DR: There's a simple lesson in biology that structure equals function, and the structure of our brain is one of connection. When I evaluate someone, I'm looking at their mental health, and I think about what are the connections in their lives, how did they form those connections, how do they maintain those connections? I think about that as the real evidence of a brain that's more connected.
There are all these non-nutrient ways that we can think about our mental health and the mental health of our community that revolve around food. What I like about that, first of all, is people are much more interested in talking about food than they are talking right away about mental health. Although, thank goodness, that's changing a little bit. It's a way of really thinking about these other non-nutrient or nonnutritive factors. Sourcing your own food. Just imagine the experience of going to your farmers market and having that community experience. It's so critical to our mental health. And think about the way that if so much of our community revolves around food – bumping into friends at the grocery store and at the farmers market, seeing folks who grow your food, shaking their hand, maybe even paying a little bit more for it – those are ways that we can use food to build resilience in our mental health.
There are a lot of things we need to do to defeat the mental health epidemic, and I want to be clear that I think food is just one part of that. Don't think that you can just eat a certain way and have optimal mental health. I spend a lot of time with people doing psychotherapy, I prescribe a lot of different types of medications to patients as responsibly and effectively as I can, but food is certainly a part of the picture.
SS: On The Splendid Table, time and again, we talk about food as being this universal conversation, and you could meet a complete stranger and strike up a conversation about how you eat and what you like to eat. It almost seems like talking about brain food is a really simple way to destigmatize mental illness, talking about feeding the brain as opposed to what's wrong with your brain. Do you find this to be true or an easy entry point in talking to new patients or talking to other people about mental illness?
DR: I certainly do. A couple of years ago, as I was giving more public speeches about food, I promised myself that I'd use the words suicide and depression in every talk. I was really nervous about that back then. And what I found is that everybody meets my gaze in those moments, everybody knows what we’re talking about. Everybody’s having this conversation and is concerned about their mental health. So, I do believe it's a way for us to start thinking about mental health as brain health, that you're feeding your brain. As we think about brain health and what we can all do to improve our brain health and emotional health, I feel that we begin to take on the mental health epidemic together. The only way that we're going to defeat it is if we talk about these conditions, if we properly diagnose them, and properly treat them.
I believe the new part is that we empower patients. One of the things I like about food is the fun that it brings into the clinical room for me. It’s really a gas to hear about what people eat, how they eat, their favorite foods, the little habits they don't tell people. And then it's such an intimate way to know someone and influence them, to partner with them and think about how they nourish themselves in the most granular way by what they eat.
SS: Talking a little bit about the future of mental health here. If we know that getting enough brain food can improve our mental health as adults, decrease depression and anxiety, how do you feel about eating these foods as a preventative measure? I have children and I know that you're a parent. Do you think about that when you're feeding your kids, almost as a way of warding off mental illness starting at a young age?
DR: I think the evidence body is growing; it's an idea right now, and there's some evidence. Evidence-based medicine means that we're constantly adding to the evidence base. On the treatment side, does it help improve treatment if when I start Prozac I also do a detailed dietary analysis and help someone change their food? There are a couple studies that suggest it can help.
Prevention is really where we can have the largest impact in terms of mental health. Depression will be the largest cause of disability in America and worldwide starting next year, in 2020. And when you think about that, it’s an illness that's coming for all of us, coming for our families and our kids. What do we do about it? How do we help patients before they meet me? How do I help you before you have a mental health symptom?
So, then we get into these ideas around lifestyle factors, and can we feed our kids in a way that prevents mental health problems. I think the downside of this – and I guess, the caution of it, the underbelly of it – is we don't want parents who don't feed their kids right, or the kid who is a very picky eater, feeling like, “You caused a bipolar disorder because you didn't feed your child salmon.” Mental health disorders are a mix of genetics and environment. When you look at what environmental factors we have the most control over, for sure it's our food. Maybe it doesn't feel that way all the time, but we really do. You decide what goes on the end of your fork. I think it's one of the most powerful ways that we can intervene with our children's brain health. There are a lot of complex brain genetics in terms of our mental health and what happens. And again, I hope that people approach this with an attitude of love and kindness, that we're all doing our best to improve our own mental health and making food choices that –according to our values, beliefs, and as much evidence that is out there – suggests that we are doing our best.
Do I intentionally feed my kids with the hope that it helps their mental health? Of course, I do. Just like all parents make decisions about their children's future that we hope is the best for them. And I talk to my kids about it. Another thing is that it opens up a question where I feed my kids almonds and say, “These have a ton of Vitamin E, sweetie, these are really good for your brain,” and I'll tell them a little bit about that. One of the things we all know as parents is simple nutritional psychiatry. What happens to your children when they don't eat lunch, and you see that instant shift; there's a profound effect in terms of food and our mental state.
SS: Well thank you so much, Dr. Ramsey.
DR: My pleasure. Remember to eat your leafy greens and seafood, everyone.
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Shauna Sever is the author of the cookbooks, Marshmallow Madness!, Pure Vanilla and Real Sweet. Her next book, Midwest Made, is now available for online pre-order (Release date: October 22, 2019). She is also the voice behind the baking blog Piece of Cake. She's appeared on The Today Show, Food Network, Home and Family, Serious Eats, Chow and Ulive.com. Her writing and recipes have been featured in O, The Oprah Magazine, Food and Wine, Bon Appetit, Fine Cooking, Family Circle and USA Weekend.