Dr Rupy: Dr Uma Naidoo is a Harvard-trained psychiatrist, a professional chef, and a nutrition specialist. Honestly, she puts me to shame. It was a pleasure to host this internationally regarded medical pioneer in the more newly recognised field of nutritional psychiatry. In her role as a clinical scientist, Dr Uma also founded and directs the first hospital-based clinical service in nutritional psychiatry in the USA, and she's also director of nutritional and lifestyle psychiatry and nutritional psychiatry at Massachusetts General Hospital, whilst also serving on the faculty at Harvard Medical School. Honestly, it was just breathtaking to read her CV and then meet her, well, virtually anyway. And you can understand why Michelin-starred chef David Bouley described her as the world's first triple threat in the food as medicine space, and she's quite simply the shining star when it comes to doctors looking to introduce nutrition and lifestyle into their practice. She's also been asked by the American Psychiatric Association to author the first academic text in nutritional psychiatry, but she's already the author of a book you can get your hands on right now in the UK called The Food and Mood Connection. And in the States, it's called This Is Your Brain on Food. On the show today, we talked about a bit about Uma's upbringing, her family roots in Ayurveda and how her grandmother really did influence her love of medicine and food, culinary school and why she went in the middle of her medical career, nutritional medicine and its scientific shortcomings, as well as her dietary agnosticism, which is a term I'm quite comfortable using now because I feel that there are many ways in which we can use food regardless of which dietary paradigm you choose to abide by. Food irritants to mental health, including trans fats, additives and sugar, the use of spices, fibre and plants. Honestly, spices is one of my favourite bits of this conversation because it was a shame we didn't get to meet each other in the kitchen as I usually do with my podcast guests, but one day I'm definitely going to be cooking something with Dr Uma because she's just phenomenal. We also talk about the vagus nerve as a bidirectional superhighway of information between the gut and the brain, as well as the connection between diet, OCD, PTSD and anxiety, as well as her culinary hacks for making healthy food taste absolutely incredible. Unfortunately, as we are in the middle of a pandemic, we had to do this via Zoom, so the audio quality isn't as good as I would have hoped. However, I hope that Dr Uma's insights are enough for you to stay, to keep your attention throughout the whole podcast because you will genuinely find some nuggets of information there that will help you as we start 2021. Without further ado, here is my conversation with Dr Uma. Well, I want to talk to you about, I want to go back to the start. We've got a bit of time, so I want to talk about how you got into medicine and your journey thus far into becoming the person to go to when it comes to nutritional medicine and all the stuff that you're doing with educating us as professionals and colleagues alike.
Dr Uma: Great. Well, thank you. That's a great question. You know, it goes back to my family. I grew up in a large Indian family in South Africa, and so there were, we were four generation, we are four generation South African. And interestingly, much of the family dynamics were around the kitchen and spending time together. There's a lot of focus on that, but there's also a very big focus on education. And there were, I come from one of the, at the time that this was published, we were one of the, the family with the largest number of physicians in one family. So, you know, I think generationally there was a real focus on education and that type of stuff. But I say that because there was this interesting focus of delicious food, but also health. You know, there were, everyone was, not my grandparents, they were educated in other things, but my, my aunts and uncles were in the profession and we also had teachers and a dentist and a good mix. So there was always this focus of healthy, delicious food and love and nurturance. And because there were so many cooks in the kitchen, and so many aunts, my grandmother, my mom, my older cousins, I never needed to cook. I could just hang around and, you know, look at everything. I could help out little tasks, but really I was, I was, you know, as a kid growing up around this and I really loved it. But my mom recognised that I loved science and she is a double-boarded physician herself and recognised that and taught me how to bake. So I couldn't handle the oven, I was too little, but you know, she taught me how to measure and that was a great joy. So I was able to interact with everyone around that. But the joke goes that, you know, just before at the time that I was getting my husband was only going to eat cake is what they all said because she can't cook. So cooking actually was something that came to me later when I needed to and I was studying and moved away. But it also was that great connection to the food and love and spices and nurturance and I felt that that really fulfilled something that I took with me. And it also became the space of mindfulness and creativity for me. So rather than being afraid of the kitchen, I put on public television, which is the only thing we could afford. And Julia Child was there, she was tossing omelettes and you know, this wonderful show on PBS in the US called The French Chef. And I thought, well, if she can do it, you know, I'm sure I can figure this out. So I get recipes from my mom, I'd email and call and get everything and try it out. But for me, it became this great space that I, that I thrived in and I, I was enjoying it. It wasn't a hardship to make a meal at the end of the day. And that developed, but also alongside that, this background of medicine and education and nutrition, and I wanted more of that. And as I was studying, I realised, you know, there was a real gap in how we're expected as doctors to speak to patients about so many things in terms of food, but we're really not given, certainly the US medical schools, some of them have really taken the lead in culinary medicine and things, but not everyone has. And I felt I didn't know how to, but I was learning about medications that had devastating side effects, psychotropics as well as other medications. So I thought, I need to do something about this. And being someone who's sort of a lifelong learner, I decided I wanted to do all of it. And it was a very seminal moment, which I've spoken about before, where, you know, I was being challenged by a patient and I was very junior at that time, and he claimed that he gained all this weight on a medication that I had prescribed. And I knew technically the data was unlikely to be true. It was a short time, I knew his baseline weight, I knew it wasn't me, and it wasn't a huge weight loss in two weeks, you know, he had just been gaining weight over time. And I recognised what he was drinking in that moment. And the connection, the penny sort of dropped for me. He was drinking this very large coffee in Boston, it's everyone's favourite coffee. And I asked him what he put in it, and I was able to analyse for him the number of sort of bad calories that were, the unhealthy calories that were going into the coffee, that he wasn't accounting for the eight teaspoons of sugar, that he, you know, he just wasn't, and the fact that he had one like that in the morning and maybe one later in the day. And to me, that was a powerful connection because if you could explain to someone in the moment, here's what you're eating, this is what's happening, here's what we can change, you can form a connection with them and empower them to know that through food, through what they're drinking and eating, they can make a difference. And it really ended up being a very positive patient-doctor relationship in my training, and I felt that that needed to be more that I did. And I began to ask questions of people, lifestyle, beyond just a social history and what we're taught to do, you know, proper history and things like that, but ask a little bit more, what are you eating? You know, if you wait, you might gain weight on this medication, what are things we can do to help you? And so that was really how this interest first developed. In the last decade or so, a study of nutrients and certain ingredients and certain foods and certain minerals have all really, I feel, amalgamated into how we eat. You know, we eat a plate of food, we don't eat an ingredient. And I think that for me is what nutritional psychiatry does, it puts it all together on a plate for people. And this is how to break it down. Certainly is the way that I work in the clinic that I run and with people, because no one just eats methylfolate or folate, you know, you eat, you eat a whole plate of food. And so some of my mentors did all of those studies decades ago, but I think interpreting it for people becomes important. But, you know, as I say all of this, my detour to culinary school was that was just pure passion. I thought, you know, Julia Child could do it later in her life as a second career, why can't I go? And when I think, when I think back to, I don't really know how I fit it in the hours, it had to have been, you know, pure passion because it was a lot of long, long days and a lot of yelling and screaming and a lot of hard work, but I really enjoyed it. And, you know, when I came out of it, when I graduated culinary school, I realised that maybe there was a way to start using this. And part of it was being a passion project. I was studying on the fly, you know, I was studying at dinners, I was studying out at birthday parties because that was the only way to integrate all these different things. And people, you know, my family still laugh at me, you know, it's like she's bringing, you know, she's going out to dinner and she's taking her culinary books with her. But, you know, you have to, you're having exams and tests all the time because it's a fast-moving syllabus. But I really didn't expect to do well. I expected just to get through, you know, and when my chef mentors helped me recognise that there was a real, there was something I could offer, that helped me blossom as well. And that's was really when I started to think, well, you know, how can I bring this into my day-to-day practice? And that was how the language of my work came together. But, but I have to, I always preface it, and I forgot to say this, that, you know, there wasn't a grand plan. I knew that I wanted to, from very young, you know, I was the little kid with uncles and aunts who were doctors examining them with the fake stethoscope or whatever it was, like little kids do. But I knew that I was destined towards medicine and it felt like the right foot for me, but I didn't know that I would put together the other pieces.
Dr Rupy: Yeah, I mean, it's such a wonderful story and I really want to like pick on on a few elements of that story. The first is the fact that, you know, you see cooking and the art of preparing food as a mindfulness exercise. And I always like to talk about this because people always ask me on a personal level, you know, how can you cook a meal after, you know, a long shift in A&E or a long shift in clinic or whatever. And I find it like this incredible release. So the fact that you share that is, is brilliant. And the other thing is, you know, that turning point of the patient coming into see you and having that sugar-laden high bad calorie drink with them, the coffee, yeah. And, you know, how the kind of penny dropped. And for me, it was a patient, I talked about in my TEDx talk actually, where I was really excited about nutritional medicine in general at the time. This must have been about seven years ago before I started the Doctor's Kitchen. And I wrote down all this stuff for this guy because he wanted to like try and help his weight control and his type two diabetes and all the rest of it. And I remember leaving him leaving with like a recipe and I gave it to him with the ingredients to get. And he turned around and he was like, so just one more thing, how do you make oats? I told him how to make oats. And it was just that the basic level of cooking that we've kind of lost throughout our generation. So I just wanted to ask you about how was that the turning point for you when it came to how you need to give nutrition information alongside therapy? Or did it even start even way back? Was that sort of the use of herbs and spices and that sort of Ayurvedic perhaps element? Yeah, did that come in through your family life as well?
Dr Uma: It did. So, you know, it was interesting that it did come in through my family life because we also had a couple of Ayurvedic practitioners as well as allopathic medicine doctors. And so, you know, there would be my grandmother as well, as well as, you know, what your grandmother tells you to do and you know, if you had a little sniffle or you had whatever the symptom was, she would have something she would make for you. Now, she wasn't a trained physician, but she was definitely the matriarch of the family and she would say, you know, have this. And so, you know, I grew up with what is now a very expensive drink in American coffee places or tea places called golden milk. You know, I would like have it as a kid. And things like that, you know, so yes, it came from that element, but I think that for me, the connection to that aspect of my childhood came through moving away and needing to bring something with me. And literally, one thing you could either carry or recipes you could bring quite easily are spices because you can buy them in any country and blend them together if you're taught how. So that was one thing, recipes were another. And, you know, when you move that far away and you change climates and you move to Boston in the far northeast, which is, you know, a lot of days of snow and a beautiful city, but a lot of days of snow and you're very used to a different climate, it was comforting. And I think all of those things combined are what I brought with me. But, you know, the other thing that we would have conversations around is my mom was, you know, was was was always encouraging healthy eating. She was an excellent, is an excellent cook and an excellent baker, but she focused on, you know, she would teach us things like, well, we're doing this and we're tweaking this recipe and we're going to eat a little bit healthy, or we'd, you know, she'd learn new dishes. So that was in my, my heritage as well. The connection then happened with the patient was that I could empower someone, especially, you know, when you're a young doctor and you realise you have such power with a prescription pad. And you also realise, well, people are really taking you seriously all of a sudden, you know. And a prescription pad helps that and your white coat and your stethoscope. But I think at that moment, I realised that I could help him empower himself. And that was very powerful that, you know, people often come in and especially with psychiatry, they, it still has, still has up until now such a stigma and people feel so at times ashamed to ask for help or say that they're not feeling well or they're feeling anxious or they're just feeling blue. And I feel like food for me fills that gap of having the patient, the client be part of that relationship in a, in a way that they feel empowered and they don't feel like they're just being told to take this and go and do it. And one other caveat I'd add to that is to speak to your oatmeal story. I had a client come, a patient come in once and it was, you know, from a really, let's just say a business executive. And you know, someone who's eating out and really knew the world and travelled. And at the end of the consultation, she said, you know, I love everything that you said, but I don't know what to do with an avocado. You've mentioned it many times and I have no idea what to do with it. So, so for her, even her husband cooked most, mostly at home because she travelled so much for business and it was, and she knew the kitchen, but she really didn't know when you get an avocado, what do you actually do with it? And I think it speaks to that translation that I think that you do certainly, and I've tried to do is, is translating it for people, writing it down or providing a plan because I know that I started at a very different point myself. So I knew what it was like to be able to bake a cake, but you know, bake a cake, but really not be able to make dal except to watch to remember what my mom did, you know. So, so to break it down for people becomes very important too and putting it in their control.
Dr Rupy: Yeah, I love the fact that you made the decision to go to culinary school because that, I mean, I know David Bouley has described you as the world's first triple threat for food as medicine. And I can see why because, you know, a professionally trained chef plus doctor plus someone who is, you know, excited and literate in the academic science, you know, it's, it's, it's quite an amazing combination. And I wonder if we could touch on perhaps turning towards the science, some of the key studies as well as obviously the influence of your, the matriarch of the family as you were growing up. But perhaps some of the key studies that really influenced your opinion on the impact of nutritional medicine and how that relate to psychiatry.
Dr Uma: Sure. So, you know, way back when, decades ago, things like folate, methylfolate, magnesium, omega-3 fatty acids, vitamin D, all of these have been studied. And I think for me, what was compelling is looking at the research to write the book that involved what's the current research? What are the studies saying now? And what are the studies saying in terms of an actual dietary plan versus one ingredient? And of course, the Mediterranean diet and its elements really hit the high notes with things like depression and anxiety. As do things like omega-3 fatty acids because it turns out that there are studies, including human trials, in both depression and anxiety. But then I found, started to find unusual things. And when I think about nutritional science, I, there are two things I consider, not only the quality of the study, but also I don't, I don't exclude animal studies. And I don't exclude animal studies because, you know, you can't euthanise humans to look at someone's brain. And since I'm interested in the brain, I'm interested in the whole body, but I do love the brain. I have a soft spot for the brain science part. You know, you can't actually euthanise humans to look at that. So I can't, I really look at what the quality of the animal study is and especially with the burgeoning amount of microbiome research. The other is that if it's a small study, you know, you have to compare it to the fact that pharmaceutical studies are never not going to be funded at the level that they're at. So when you're trying to do an epidemiological study looking at nutrition and nutrients, certainly many of my colleagues have done such wonderful studies, but, you know, it's harder. And so I always, I place it in context. And what I found was in reviewing the literature that there were some really unusual things, like nitrates drive depression, that, you know, and nitrates are frequently found in processed, as processed meats and other things that are processed. But also that, you know, there's actual science behind the study of added sugars, the brain science related to depression and anxiety. People just think, well, you shouldn't eat unhealthy foods, you shouldn't eat junk food, you shouldn't eat, you know, candies and pastries and stuff like that. Now, but they don't necessarily put it together with the brain science. I think that the gap I feel exists is that we talk to patients about a family history of diabetes or struggling with their weight or hypertension, but we're really not talking to them about brain science and their emotional health. And with the pandemic, what's really come forth is the extent of mental health issues that are emerging. You know, the CDC released some data a few months ago at the end of June, and 11% of Americans considered suicide during the pandemic, which is a very scary number as a psychiatrist, that they actually thought about it. So this, this impact is not necessarily something we're seeing. You know, we've had suicides in first-line responders in the United States, and it's been very sad. It's the amount of stress, the amount of burnout people are feeling and the cries for help that we're not seeing. So I think it's, I think that the fact that we're not putting together food and brain science and mental wellbeing is a real gap that as doctors, we can, we can start to fill and maybe speak about more. And that to me is probably the most important part of my message.
Dr Rupy: Yeah, absolutely. And I totally agree with that because, you know, it's, you're going to be hard pressed to find the perfect set of studies to compare with the other interventions that we have in our clinical toolbox. You know, as I think as physicians who are interested in nutrition and are actually able to interpret the literature, it's, you know, a very interesting set of skills that we have. And we recognise that nutritional medicine has some scientific shortcomings, but it's about combining all that evidence and interpreting it in a way that is pragmatic. And this is why I love, you know, the fact that you're not ashamed to say, you know, yeah, I look at the animal studies as well. And, you know, I try and pick out what the mechanisms might be and how that might apply to the person that's sat in front of me.
Dr Uma: Absolutely. You know, the, it's about, it's about interpreting information as a physician or as a clinician back to someone who needs to feel either emotionally better or physically better or both. Because there's so much hype and there's so many either blogs or articles online or parts of the newspaper that provide information. And their role is to provide the information. When a patient or a client or a human being just reads that information, they don't know which diet to follow, what's the new ingredient, what's the new superfood. And I think putting it together in a balanced way for individuals and saying, you know, despite my own personal diet, I as a mental health clinician really have to meet people where they're at because they're coming in for their emotional wellbeing. And even if they don't meet, you know, the DSM-5 diagnostic criteria, which frankly have a lot of shortcomings because no one, not everyone fits into a box, but people may not be feeling well. So whether someone's carnivore or vegan, you know, I've got to find a way to take that diet and make it work with what information I have. And the only way to know that is to know the information that's out there and see what I can tweak in a very personalised plan for them to feel that they can feel emotionally better. But I will say that, you know, spices have a good amount of evidence behind them. And I'm, I'm, I'm so, you know, speaking back to my, my grandmother, you know, apparently, apparently, you know, they definitely knew something. So, so that, that has been cool.
Dr Rupy: I 100% want to talk about spices, but before we get onto that, you mentioned added sugars and the way in which they may be responsible for driving psychological issues that you see. Are there any other irritants to the brain or additives that you might think that we should be a bit more careful of in terms of what is available on the market?
Dr Uma: Sure. So, you know, there are some categories, none of which will surprise you, but I think what is different is that people don't always associate it with mental wellbeing. So, for example, there are studies of trans fats that are associated with a higher level of aggression. You know, with processed foods and ultra-processed foods, they are thought to be gut disruptors. And by being gut disruptors, set up, if you, if you're eating a processed food diet, you know, you are starting to disrupt your gut and over time, the gut inflammation and dysbiosis will cause neuroinflammation and mental health symptoms. And I've seen that clinically. The other, other categories of things are processed vegetable oils, which are obviously less expensive and so used in fast food restaurants and certain, certain other restaurants as a cost-saving measure. Now, I think that what people don't realise is things like processed vegetable oils drive anxiety. So because what they do is they flip the omega-6, omega-3 ratio and set up inflammation. So that's another category. And then artificial sweeteners, you know, we, we know that added sugars and certain forms of sugar are not good for us. But then when we, when individuals are trying to do the right thing and maybe try to come off sugar, they move to an artificial sweetener. And that can be problematic too because there's certain ones that really worsen anxiety. Sucralose, unfortunately, stevia also was one, was one that in studies we found worsen anxiety, but in other, in other, at other times, stevia, a little bit, you know, to sweeten something, I think is totally fine. My patients unless they have significant anxiety. But just an awareness, yeah.
Dr Rupy: Yeah, absolutely. And you know, when I see patients that are sick enough to have to be institutionalised for a short amount of time, hopefully a short amount of time, or if they have to, you know, endure an admission, they have access to a lot of takeaways and foods and basically that list of food that you've just gone through is what they survive on during their admission because a lot of them are take, I'm not going to generalise, but a lot of them are doing takeaways. I just visited a psychiatric inpatient unit a couple of weeks ago because we're hoping to do some work with them with our culinary medicine UK organisation. And they just listed out what they were having. It's pizzas, it's takeaways, it's the pot noodles, all that kind of stuff. And you just think, wow, like when they're that vulnerable and they're that sick, the least we should be doing is offering them the choice and informing them about what could be better for them or not, you know, it's, it's super sad.
Dr Uma: It is super sad and I think that, you know, diets in, in certainly many of the US-based hospitals are not, you know, not good for cardiac health and they're not good for mental health. So I couldn't agree with you more. I think that would be a fascinating thing to try to change. And remember that, you know, with mental disabilities that when someone, and that's why I mentioned being diet agnostic, when someone's suffering and it depends on the level of illness, if they're in the hospital, they, you know, they obviously have met certain criteria to be there. And sometimes their level of functioning has lapsed. And the first thing, one of the first things to go is what they eat because, you know, it's so much easier to just order takeout or get something that's in a package or frozen with multiple additives and, you know, which of course we know from the processed and ultra-processed category are just not good for their brains.
Dr Rupy: Yeah, yeah. I love that term diet agnosticism. It's definitely a term I'm going to start using right now because a lot of people assume that I'm vegan or vegetarian. The reality is I eat everything, but I'm largely plant-based and I think it maps on quite nicely with what everything you talk about from the perspective of mental health and otherwise.
Dr Uma: Exactly. I mean, you know, the thing is that, you know, the fun thing in mental health is, you know, some of, some of what you're taught separate to diet because you're certainly not taught nutrition when you're doing psychiatric residency, but is that, you know, you sort of do meet someone where they're at, whether it's therapy or analysis or whichever form it is, you know, or medication even. But I also think that the same thing applies to nutrition. I think that no one likes to be told what to do. So if I can have someone buy into a healthy habit that they can embrace in that first visit and start to tweak it from there, I think it's important. And, you know, again, it's like, no one cares what I eat, but I really want to be able to share with them what the, what, what, you know, where the science is that we know that changes all the time. As I say, you know, I could quote a study today and there's probably 19 studies that we can find that refute it. That's always the case in nutritional science. And I think it's about interpreting the best benefit for that, for that patient, depending on what they eat.
Dr Rupy: Yeah, absolutely. And it's, you know, it speaks to the new sort of wave of clinicians being more, more in line with personalised medicine and actually making, you know, making that sort of decision in combination with the patient in front of them rather than just saying, this is what the evidence says, this is what you should be doing and being a little bit more authoritative about it. I want to talk about spices. Now, it's a shame that we're so far apart so you can't be cooking for me in the kitchen studio here.
Dr Uma: I know, we have to do that. We have to find a way to get over the COVID hurdle here.
Dr Rupy: Absolutely, yeah. So, I mean, spices was definitely one of my entry points into, into just cooking actually. My story is my mom taught me how to make a Thai lemongrass curry just before I went to medical school. And I got this reputation as being the guy that could cook food, but in reality, I only had like three or four recipes in my repertoire. So to like keep up this pretense of me being a good chef, I had to, you know, learn some more. But spices fascinate me. Perhaps it's, you know, my sort of Indian heritage and the Ayurvedic sort of influence. But why don't we talk about spices, the ones that you are a huge fan of from both a culinary perspective and perhaps a nutritional medicine perspective as well?
Dr Uma: Sure. So, you know, I'll start with turmeric and because there's a significant amount of evidence in several conditions, starting off with depression and anxiety. And the way that I think about it is that if someone is not cooking, that they can still use turmeric. It's available in our supermarkets in the spice aisle. I'm not asking them to buy the fresh root. I always warn them about the colour and how to work with it. But basically, you know, they can add a quarter teaspoon at least to a soup, a smoothie or a tea or something told me coffee recently. That was a nice surprise. But he said, I can't taste it and I want to have it and I heard it's good for me. And so I thought that was interesting. But, you know, the pinch of black pepper has a significant amount of evidence behind it. So adding, adding the pinch of black pepper makes it almost 2,000% more bioavailable to your body and your brain. And so the hack that I have for that is I have my glass jar of turmeric. You know, I know other people may have, not you, but other people may have a smaller bottle, but what I do is I grind, I grind in my black pepper in that, kind of blend it together because you don't need much, but it's there. So I never forget it. And then if I want more pepper in whatever I'm making, I add a little bit more. But that is significant and I think that it's an easy hack, it's something easy that you can do. The other interesting thing about turmeric is that say someone is more plant-based and we know there's a lot of evidence about omega-3s and we mentioned that earlier, but not everyone eats seafood. And, you know, if you're eating plant-based sources of shorter chain omega-3s like ALA, it turns out that curcumin makes the conversion to the longer chain omega-3 more efficient. So if you're making a chia pudding, chia pudding has a source of ALA, chia seeds and basil seeds, those types of things. So say you're making a pudding, you know, just adding your little bit of turmeric to that because it'll make that conversion if you, you know, say you're plant-based and you're not eating fish. So that's, that's another, that's another thing that I think helps people. And then, you know, saffron. Now, you know, unfortunately, the culinary use as much as it's amazing, it doesn't necessarily, the amount that you need in terms of studies for depression is obviously more. So that's one instance where, you know, a supplement may be appropriate, the right one, because supplements in the United States are not FDA regulated. So I have to be cautious about which ones people take and just discuss it with them. But that saffron really had a significant amount of evidence for depression. And then, you know, capsaicin and chili peppers, one of the cool things that I found was that different types of, because I know you cook with these as well, the different types of kind of sweet peppers and peppers in general actually help things like brain fog. So, you know, it's, it's really cool different types of information that I was finding. And, and things like, you know, the allium family, so garlic, the fact that it's, it not only has the spice effects, but it also is a prebiotic. So as a prebiotic, it is giving really great fibre to the gut microbes. So, you know, there's a whole, whole reason to be adding in prebiotic foods. So, so I, you know, I, what I enjoyed about the learning path here is that it brought, it brought back some, some information that was nutrition medicine and nutrition and mental health and nutritional psychiatry related in terms of boosting your brain power with those ingredients.
Dr Rupy: Yeah. I've definitely learned a whole bunch there. I'm still like in awe of the turmeric stuff with the, with the,
Dr Uma: It's one of my favourites, yeah.
Dr Rupy: Yeah, yeah, no, that's brilliant. I mean, do you have like any thoughts on nootropics or adaptogenic supplements? Just for the listeners, these are sort of either drugs or supplements or substances that can improve cognitive function, particularly executive function, and adaptogens are sort of like, you know, the non-toxic plants version of those. But do you have any sort of ones that you veer towards or veer against?
Dr Uma: So, you know, I, I am sort of neutral on them and I'll tell you why. The reason is that for my book, I actually went, you know, went into all of the references around nootropics and foods. And I really didn't go, the scope of the book, I found that if we went into adaptogens and those types of, let's say ingredients, that it probably would be too broad-based. So I just don't have off the top of my head the data on those types of things. I'm not really against them. I think I personally feel if something is working and the person has checked it out with a good doctor like yourself and they're using it and they're feeling good, that's the most important thing. But can you always adjust your diet in a better way? I think any one of us can.
Dr Rupy: Yeah. Yeah, the way I tend to see supplements is sort of like the cherry on top where you really want to get the foundation of everything else, like fibre that I'm sure we're going to go on to talk about, and all the other sort of lifestyle measures before we start thinking, okay, we'll just take this supplement every day, even if it's a whole food or high quality, it's going to magic everything away. That's not really the reality. Just before we move on to obviously the topic that we have to talk about, the microbiota and fibre and how that has an impact on brain health and mental health issues. Are there any specific interactions with medications that people need to be aware of, particularly when it comes to certain spices or or ingredients?
Dr Uma: Sure. So, you know, there's some data on, and this I feel is a little mixed. There's some data people will say, well, you know, can I take turmeric with a blood thinner? And I feel like that's something they should be discussing with their physician because a lot of studies have shown a good amount of high-dose turmeric that is used in a culinary way or used, you know, through eating or used through a supplement that are pretty safe. And so I would just say to a person like that, always just check that with your doctor. But I have had no, no one really run into those issues. And I'm talking about, I want to be specific here and you'll understand why, you know, this is not for IV use, intravenous use, in a, in a drip. It's, it's, this is, we're talking food, we're talking adding it to a tea and that kind of stuff because there's actually a case study of someone who died from that in California. And so, you know, I think that, that's where I think in the world of nutrition and medicine and nutritional psychiatry, I have to be super cautious with people. You know, for one thing, someone told me that pizza and Coke is vegetables and that's a vegetarian diet. Now always remember that. I was like, you know what? Technically, you've actually, you've made me pause. I'm like, well, that's a good one. So I always, I'm very, very specific when I, when I have this really cute slide of a picture of a rainbow because I love to bake, but in moderation, but you know, a rainbow-coloured cake. And I'll say, you know, we want you to eat the rainbow, it's not that rainbow, it's, it's really the, the fruits, vegetables and, and that type of stuff and the colours and the polyphenols.
Dr Rupy: Yeah, yeah. And I love your approach to food actually because obviously going through culinary school, you know, you have to be a lover of food. You can't just be a health freak and just only eat the vegetables. You need to be able to appreciate the textures and the flavours and the stuff that isn't as healthy for us, but feeds our soul in a completely different way.
Dr Uma: Absolutely. And it's about finding, it's about a person finding that balance, you know. I think, I think, I think it is kind of, you know, I've sort of evolved my attitude on this as evolved because I, I have talked about, you know, people instead of having a cheat day, have a treat day. But then I realised that we're calling something a treat, but we know it's unhealthy because what are the things that you and I just talked about at the beginning of this conversation? The stuff that we know is not great. So we have to reframe that and say, hey, you know, it's my birthday, I'm having cake or whatever it is. But, but it's really not something that I think we can justify in terms of nutrition. So that part becomes hard.
Dr Rupy: Exactly. Yeah. Fibre. So this is something that in the UK, as I'm sure is the case in the US, I'm certain of it in the US, it's hugely lacking in people's diets and sort of the wellness industry has capitalised on this fear of being protein deficient when actually we need to be looking at fibre. I wonder if you could sort of shortly describe why fibre is so important through the lens of nutritional psychiatry and ways in which you've found effective to try and increase people's fibre intake, but also the different subtypes of fibres too.
Dr Uma: Sure. So the one that probably comes to mind in terms of, you know, just one of the high points in nutritional, nutritional psychiatry is really fibre is your friend when you have anxiety. And it is your friend because fibre is more filling, you feel more satiated, your blood sugar is more even, and especially if you're obtaining fibre through food sources that are more complex carbohydrates, you know, so beans, legumes, vegetables that have, that are rich in fibre, that is going to help you really even out the kinds of symptoms that happen with anxiety. But when it comes to fibre itself, you're absolutely right, you know, the United States, I think we eat, the there's some varying data on this, but we definitely, we probably eating about half, but probably much less than we should be eating in a day. And, you know, I think that people don't realise that the term fibre gets confusing because you either think supplement, so, you know, an older patient who's struggling with constipation and is asking for a supplement because of that, it's actually not, not that, it's, it's part of our daily diet and it should be. And I think that, you know, just understanding that through the nutrition lens that, you know, fibre comes from vegetables, from fruit, I like to talk about, you know, low glycaemic fruit like berries, beans, nuts, seeds, lentils, legumes and healthy whole grains. So, so you can't get it from seafood and animal protein. And no matter how much of it you eat. So having those, you know, the colour of the rainbow, eating the colour of the rainbow for the rich antioxidants, eating the colours for the biodiversity of the gut, brings back fibre to your gut. Now, the second thing is, if people do then grasp that they should be eating more fibre, and it's easy to do by just adding more veggies and your appropriate servings of fruit in the day, then it becomes, you know, well, the function of the fibre is to help your microbiome thrive because the fibre balances out the biodiversity and feeds the microbes in your gut, of which there are about 39 trillion. So by feeding them in a good way, by nurturing them, you know, I say happy gut is a happy mood. And the reason is that when those, when those microbes are functioning for you instead of against you, and they are working against inflammation being set up in the gut and against leaky gut, which is intestinal permeability, then they are helping you and they are forming the short-chain fatty acids through the different interactions that your brain actually needs to function in a good way. And, you know, it's, the gut microbiome is surprisingly important in mental health. Not only is, do the gut and brain arise from the same cells in the embryo, they're connected by the vagus nerve, which you know, and then more than 90% of the serotonin receptors are in the gut. So, you know, it's a, it's a, it's a really big wake-up call for mental health in terms of saying, well, there are these connections and I think that if we start paying attention to them, we can eat healthier for a better mood and other symptoms.
Dr Rupy: Yeah, absolutely. And I think, you know, getting that message across about the variety of different types of fibres, you know, the beans, nuts, legumes, all the things that don't just provide fibre, but they provide, you know, a cornucopia of different micronutrients. But also, I just wanted to double-click on the vagus nerve and the role that plays in both gut health and and mental health as well. What do we know about that communication pathway between them? And as you eloquently described, the fact that the gut and the brain arise from the same embryonic cells almost speaks to why they should be connected and how we need to sort of re-establish that relationship which we traditionally thought as very separate, the mind and the body and that, you know, that sort of philosophical distinction isn't really in keeping with our physiology.
Dr Uma: Absolutely. I think that's an, that's an excellent point. And the reason is that we do see the separate and I think that, you know, even references, the way that we speak about it at times, but they do come from the same cells, from neural crest cells, and they develop and then they move apart in the body, but then the vagus nerve forms and the vagus nerve directly, anatomically, biochemically and physiologically connects these organs. And I think about the vagus nerve as a two-way superhighway. It's this, you know, bidirectional flow of chemical messages that's occurring all of the time. And it is transporting these messages that could definitely at any, at any given time impact, you know, over time impact mental health and mental wellbeing. Now, the connection happens, but then other components of the gut are also important. For example, the gut houses a huge amount of our immunity. And, you know, we should be paying attention to immunity all of the time, but especially now. So it's, it becomes a much more important organ than people realise. And the vagus nerve, for example, there's a form of treatment for depression called vagal nerve stimulation. And, you know, it is has been tested to improve depression. And it again speaks to the power, I guess, of the vagus nerve because it is interacting with the brain, it is helping to change chemical messages. And, you know, there's, there's research has shown that in a 24-hour period, we can change the impact of the microbes on our microbiome. So you could, you know, decide on that fast takeout and takeaway food at a fast-food restaurant, or you can, you know, you can make that healthier, some of the healthier dishes that you cook, you know, and you can make that choice to make that at home today, something simple, it doesn't have to be, you know, I say, we're not asking you to cook soufflé. You can, you can make a really simple, delicious meal with whatever it is that you eat, you know. And you make that choice and in that 24-hour period, even if you don't physically feel the difference, you are starting to change the, the really the landscape of your microbiome. And if it is that fast-food restaurant, over time, it's going to set up inflammation. By the way, fast-food french fries have sugar in them and people don't realise that. They have sugar in them. They have, they have sugar in them. They're highly, not only are they highly processed and have very little potato in them, base potato, but they, the research and development had has shown that that makes them hyper-palatable. You don't taste the sugar, but the set, you know, the, the, the fact that they're hyper-palatable, you always have to upsize. And then when you buy the biggest size, you can't put them down. There's a reason for that. So, so they certainly have the sugar in them and, you know, our taste buds go crazy and we want to eat more.
Dr Rupy: Yeah, absolutely. Yeah. It's, it's incredible how like food, and you, you've got insight into this, obviously, you know, having been to a former culinary, had a former culinary education, you know, how to make food palatable, indulgent, you know, enjoyable for those reasons. You know, it's, it's interesting like how the food industry is quite misaligned with our health and our wellbeing. And we have to work with them, I think, to, to really rectify the issues that we're seeing at the moment. I wonder, I want to go back to that point actually about palatability of food and textures and stuff. But your book, which is incredible, talks about perhaps some of the lesser-known mental health issues that aren't talked about through the lens of food, namely OCD, PTSD, as well as overall brain health and neuroinflammation. I wonder if what we've talked about now is related to all those different, different types of mental health issues and whether they share mechanisms in terms of, you know, how nutrition could potentially alleviate or help in management of them.
Dr Uma: Absolutely. So I think that the common, the common, I would say the common thread is really the, the easiest way to understand it is through the gut-brain axis. And understanding that, and this is what I do in the book, is really work through the different studies that, the different studies on different foods and ingredients, but also the studies that are related to the gut microbiome and how they may impact things like substances that could impact OCD. And also the, the other thing that I felt was important for people to know was foods to avoid because just like we need to know foods to really include in our diet, we also might want to look at the items, the food items in our environment that we, that we should be avoiding because they might be driving symptoms. So if someone's struggling with OCD, you know, monosodium glutamate and other glutamates are found in some ingredients they might be eating because the ingredient may not be thought of as unhealthy. So it may be some tomato sauce, it may be miso, which, you know, miso is a great fermented food, it's excellent for the gut. And yet, you know, if they're eating some of those foods, certain parmesan cheese, mushrooms, spinach, those actually contain glutamates and may be worsening OCD. So it's, it's really, that's where we come back to that more personalised format to a nutritional psychiatry plan because that individual may have to avoid certain foods that in other contexts may be somewhat healthy, you know, not considered unhealthy. And even though I don't like to sort of demonise one ingredient over another or exclude foods unless someone's really allergic or has a food tolerance or food sensitivity or has celiac disease or non-celiac gluten sensitivity, you know, I don't usually exclude foods. But I do in the instance of certain conditions. So in OCD and in anxiety, there was definitely an association with gluten. And so that, you know, that association became important to understand and then make sure that if someone is struggling with those symptoms or worsening or an uptick of the symptoms to slightly sort of cut back on those foods.
Dr Rupy: Yeah. And how do you quantify that? Do you do like a short period of removing said foods and replacing it with other healthy alternatives and monitor what happens or?
Dr Uma: Yes, so it usually is a slower elimination and if someone has an uptick of their certain symptoms and really from the dietary history and asking them to document what they're eating in a meal and sometimes, you know, I've had this happen with sources of caffeine, like there are over-the-counter headache pills that have caffeine in them for migraine headaches. And, you know, sometimes the source is not even a food, it's just checking out a proper history and finding out what someone is consuming. So I've had that happen with, you know, with someone who was getting super anxious and not understanding why. But with this type of thing, say in OCD, is, you know, just trying to slowly cut back on something and see, say over a week, are you noticing a change in symptoms? Obviously, if there's a very significant reaction that's bad, then we ask them to remove it entirely and we, you know, there might need more diagnostic testing. But usually it's sort of a, a slow cutting back of something. Same thing with sugar, even if I want someone to really cut back on the sugar, I don't want them to do it overnight. I've had that happen to a few patients and they have severe anxiety develop and someone even developed panic. So, so you have to be careful about, you know, the body going from tons of candy bars to zero the next day. You know, maybe you've just, you change to, to fruit or you do something in a slow and steady way that's, that their body kind of doesn't feel, feel shocked by the change in that ingredient.
Dr Rupy: It's amazing that I've recalled this story before on the podcast, but I had a patient who came in for more than 24 hours, we were investigating her for a completely unrelated, and she developed a headache. And everyone was worried about sepsis and actually the start of something that we had to investigate with a lumbar puncture. And I remember we did a more thorough history and it turns out she's an avid coffee drinker, like five or six a day, and she hadn't had a coffee for 24 hours. And so she had this massive caffeine withdrawal headache. Yeah. So you have to be like wary about this. And to your point about taking a thorough history of the diet and everything else and substances and supplements and really nailing down what else could be there. It's almost like, you know, being a proper detective.
Dr Uma: It is, it's like being a food detective, really is because it's sometimes it's, it's not even that someone's, you know, trying to eat something healthy or do, do something that's, you know, and again, you know, I don't like paradigms that are great, there's something is wrong because when people feel blamed, they can't make a healthy habit change. Blamed or shamed. But, you know, something like a headache pill, that to me was wow, you know, it didn't occur to me and yet I see it all the time. And same thing with caffeine, you know, you just assume, oh, it's got to be something much more serious, but it could be just caffeine withdrawal that's causing it.
Dr Rupy: Yeah, exactly. I wanted to close with a few questions about like top tips for patients. You know, being an NHS doctor and someone who sees a whole plethora of different patients from across the spectrum of wealth, education, opportunity. I wonder what are your best tips for, for trying to get people to start on a healthy eating journey, healthy lifestyle journey that could be better from, you know, to improve their brain health and lessen the risk or perhaps even help manage mental health issues overall.
Dr Uma: Sure. I'll preface it by saying that, you know, in my book, I go through lots of food lists and I only say that because I have these sort of pillars of mental health and then I have the specifics in the book. And I share, you know, I share both in different contexts. And the reason I say that is, like I mentioned earlier, it's also important to know things to avoid for certain conditions as much as know things to embrace. But some pillars that people can start right now today are things like eat whole, be whole. You know, so, so eat, eat whole foods as much as you can and when you can. Avoid the packaged, processed foods. And, you know, and another one is, you know, eat, eat the orange, skip the store-bought orange juice because people think, well, my doctor said oranges are good, I'm going to buy the store-bought orange juice. The ones in the United States have tons of added sugar and no fibre. So, you know, those, those types of things are simple things that you could look at what you're eating right now and change. The third is eat the rainbow. The polyphenols and rich antioxidants from fruit and vegetables is super important for the antioxidant and anti-inflammatory effect on the brain. And if, you know, you have been eating a poor diet and have had some problems with your gut and the balance in your gut, it might actually be leading to brain inflammation in a subtle way that may be driving symptoms. So I don't just say eat the rainbow because it's, you know, it's a great thing to say. It's there's actually science behind it in terms of mental health. The fourth one is pre- and probiotics. Just, you know, eat more, eat more prebiotic foods and probiotic can be a supplement, but fermented foods are great. So miso, kefir, kombucha, always, you know, be concerned about the added sugar, certain sauerkraut, pickles, tempeh, things like that are great for fermented, fermented foods. In other words, all of these, all of these principles or pillars really feed your gut. And by taking care of that, you ultimately are going to be taking care of your mental health. And so, you know, I, I would start there and the fifth, of course, has to be spices. So, so if it's, so if it's something you, you can't cook or you don't cook, if you can start to add, you know, turmeric and a pinch of black pepper to your smoothie or to your soup today, you know, that's, that's a good, good healthy start right there. But any, any one of those pillars is a good way to start working back towards sort of your mental wellbeing and setting the stage for sort of improving your gut health and reducing any subtle signs of inflammation that you might or more overt signs of inflammation that you might have in your body.
Dr Rupy: Yeah, I think that's an amazing set of principles and it really does speak to my heart, especially the spices one. For my own learning, this is me being rather selfish now, I'm interested in the culinary techniques that you have come across that really heighten that sort of indulgence of food. Now, I've heard you talk about using an air fryer to match sort of the texture of chips, right? Or you guys call them fries or whatever. Yeah, so have you come across any other sort of like gadgets or any other sort of culinary techniques that you've, you know, you've found that make healthy food just taste that extra amount of deliciousness?
Dr Uma: So, you know, I'm going to go back to spices and this is a technique you know, but you know, I didn't, I used to watch my grandmother do this all the time, but I didn't know what it meant. So there's this technique that they teach us in culinary school called blooming spices. And it's really about having the oil gently heat up and throwing in, I saw my grandmother do this all the time, you know, one of the things could be the way you think about tadka. So, so, you know, you add your spices gently to this kind of oil that's heating up and it really emits the aroma and the flavour. And then you add in your other ingredients. So I, I really didn't understand that until I was taught it, even though I'd seen it so many times. But it brings out the flavour and I actually think that the, the, I really feel like to eat healthy, I shouldn't have to compromise flavour. I feel very strongly about that because if you give someone something that's not tasty, they're just not going to follow the habit. And, you know, it's got to be, it's got to be tasty. And spices is an easy way to do that. And the thing is it can be done, you know, it doesn't have to only be done with Asian or Indian spices. It can be done with whether you're going in an Italian direction, whether you're going in a French direction, Mexican or Portuguese, you can embody those spices in that way. And then, you know, the other, the other thing that I, that is not so much about flavour, but about being smart about eating healthy is that, you know, you're taught how to cook and freeze foods in culinary school. I know it sounds like a very basic thing, but things like lentils, you know, I batch, I'm the other, the other, my other favourite new kitchen toy is the Instant Pot because the Instant Pot, I love the air fryer for things like zucchini fries or zucchini chips, or I have a recipe that you would like, you might even make it, it's like cauliflower florets, but you make them with buffalo sauce and you make them like, you know, they have buffalo wings in the United States. So, so it's a good, good air fryer recipe. And then the Instant Pot, I love for this reason, I can pressure cook really great sources of plant-based protein like lentils and beans very quickly. And, you know, when I do batch cooking like that of say different types of yellow lentils for dal, I will pressure cook them, cool it and then freeze them. And then they're ready because whenever I want to make either dal itself or a sambar or a lentil soup, you know, they're all, those things make it easy for you. You can also do chili and you can do, you can make yogurt in the Instant Pot, it's amazing. That's my other, that's my other one. You can, yeah, so the Instant Pot has a setting to make yogurt and you can make your own homemade yogurt. There's some, there's tons of recipes on the internet, but basically you, it's a much slower process and it's really, I've tried it, it's really delicious.
Dr Rupy: That's amazing. I could talk to you about food all day long. That's awesome.
Dr Uma: Me too. Yeah.
Dr Rupy: I know that you've been asked by the American Psychiatric Association to author the first academic text in nutritional psychiatry. You've written this incredible book, This Is Your Brain on Food, which I highly recommend to everyone listening. But I also know that you founded and you direct the first hospital-based clinical service in nutritional psychiatry in the USA. How did you set that up, first of all? And what function does that provide at the moment? And I'd love to know how we could potentially do something like this in the UK as well. It's so, so needed.
Dr Uma: Well, so I think I was very fortunate to be mentored well and I, I really do acknowledge people who supported my career path and stuff that I love to do. I had the chance, you know, I was doing this kind of work and a discussion with a mentor led to really being put together with another clinician in my department who really loved nutrition and was more senior. And I, you know, really put together a presentation about the work I was doing in terms of writing my book and the sort of blogging that I was doing at Harvard Health Publications, really my interest in the work. And, you know, I decided to move in the area, I work in a large hospital, but move towards it in a different, into a different area and then begin this as a formalised way to run this clinic. And really with his support and the support of my department chair, and the objective here was to focus on the information, try to get more data, try to see whether we could, um, really build it up as a matter of interest. The book, you know, is almost an amalgamation of many, many years of practice. So even before this formal clinic began. And of course, the patient stories are somewhat merged so that for obvious reasons. And that was really how it came about. Interest, someone, you know, recognising that I had a passion for doing this and me putting it together, presenting it in a cohesive way that this is how it would run and this is what we would do. And I, I feel fortunate, you know, it's small and growing and I think the book, by the way, in the UK, I don't know where all of your audience is, but in the UK, the book is called The Food Mood Connection, same book. But it has, you know, things like chips instead of fries. We had to pay attention to that. And, and so it just has a different name there. But, you know, it, it, it's hopefully the book will be a guide for people based on the work that I've done. And I think in terms of setting something like this up, I feel it's driven by individuals like yourself, really on the cutting edge of nutrition medicine, nutrition and medicine and culinary medicine and saying, we really need to formalise this. And then, after me a job, I'll come over.
Dr Rupy: Honestly, Dr, this has been such a pleasure. I could talk to you all day about food and one day we will definitely get you in the kitchen here or me wherever you are and then we'll make a meal together.
Dr Uma: I would love that. I'm in Boston and I same, same applies to you. If you, if you make it across the ocean, definitely look me up. I would love to do that. It was an absolute pleasure. You had such great questions and insights, so I enjoyed it too.
