Dr Drew Ramsey: To me as a clinician, it creates a distance between us and a person's known experience. And it enters it from as you said, a dismissive tone. I don't think juice fasts work. As opposed to the curiosity that we need as individuals. Where'd you hear about that? What happened? What'd you feel like? Are you going to do it again? What was your favourite juice? We're all of a sudden now, you and I are having a conversation about your experience of food because it's yours. And so when I find myself in that defensive spot, this isn't science-based, this person, I really try and take a step back and I encourage everybody to do that and try and what is conjuring that feeling for you.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life. Can we eat to beat depression? Mental health is a hugely complex, multifactorial issue with multiple causes that can have its roots in pain, psychological trauma, childhood and the complexity of family life, but through the lens of traditional psychiatry, food, inflammation and the importance of gut health and nutrition have largely been ignored. Now we've had some incredible guests on the pod to talk about this very subject in the past, including Professor Felice Jacka, Dr Uma Naidoo and Drew Ramsey himself, but the magnitude of the problem and the need to continually address these issues that are responsible for the leading cause of disability worldwide really does motivate me to continue to have these difficult but important conversations on the podcast. Now, as always, Dr Drew brings his unique and humble style of humour, joy and playfulness to what is a difficult topic to talk about. And this isn't to understate the subject, but to make it, I believe, more accessible and to provide almost an invitation for more discussion around these topics and I personally humbly tip my hat to the work that he has done and continues to do in teaching both the public and fellow clinicians in the the value of nutrition and medicine. As a refresher, if you haven't heard my first conversation with Drew, Dr Drew Ramsey is a leading innovator in mental health. He combines clinical excellence, nutritional interventions and creative media and his an assistant clinical professor of psychiatry at Columbia in an active clinical practice role in New York City. His latest book that we talk about today, Eat to Beat Depression is perhaps what I believe is his best yet, which includes a practical guide on how and why food is central to psychiatry and how you can take care of your brain and mood with food. I really hope you enjoy today's discussion. You can find the recipe that Drew made me for the first time on the podcast on YouTube and the podcast show notes, plus the links to his courses and TED talk that I highly recommend you listen to at thedoctorskitchen.com. For now, enjoy the podcast and listen right to the end for his three top tips. Drew, thank you so much for jumping on the podcast again. It's great to have you. You were honestly one of the most popular guests of last year when it came out and the number of messages I've had to get you back on, to talk about the subject again, to do more stuff on your chosen specialty and how nutrition crosses that. Honestly, it's it's a pleasure to have you back on.
Dr Drew Ramsey: Rupy, it's nice to see you again, especially now in the middle of the pandemic and to and thank you for that. I'm glad everybody listening is glad. I'm glad to be back and I'm glad that the message resonated and I'm I'm excited to talk about really how everybody can maybe take that information to to the next level. And also Rupy, congratulations. I just love, I think I got probably the first, one of the first US copies of 321. And I felt and it's such a beautiful book. I'm sure everybody listening has has gotten a copy and seen it. I just love, it's really influenced my cooking as as you'll see, I've got a question. I mean, I guess as we're supposed to talk about books and stuff, but I'm I've got a lot of questions for you because I'm here anyway. But it's really good to see you, man. Thank you so much for having me back on.
Dr Rupy: Yeah, definitely. Well, I want to get primarily into your latest book. You've done a whole bunch now, as well as your TED talks and your practice and all the rest of it. But why don't we start with, I can't cook with you today, unfortunately. It's one of those situations where I'm not.
Dr Drew Ramsey: They told me, they told me that you didn't want to cook with me because I needed a lesson first to get my skills up to speed. That's what your producer told me. Karen was like, Drew, you're good, but you're not Rupy's level yet. He's going to, I've got knife skills. I got this dull knife you're going to help me with. That's not, okay, you're moving, I hear.
Dr Rupy: I'm moving, I'm moving. So all my stuff's packed away in boxes. But you're going to take us through, this is going to be a podcast first. You're going to take us through a recipe, a formula for a pesto that's something that you're you're super interested in and passionate about teaching people the sort of ways in which they can heighten the nutrient density of their food through the lens of nutritional psychiatry.
Dr Drew Ramsey: Yeah, that's exactly right. I mean, I think you and I are brothers in culinary medicine in the sense of really how do we use these foods to support our mental health. Incredible research coming out about that. In Vietnam, there was a study of multi-hospital system, looked at over 10,000 patients. And cross-sectional study, so you're not the strongest data, but they found a 1,000% increase in depression for people in quarantine when they were eating an unhealthy diet. And you don't know studies, you don't see that sort of risk factor, right, of a 10.6, so 1,060%. And so I think more now more than ever, we all know, unlike last time when we spoke, we've been in quarantine in lockdown for you in the UK. And so we really have this need both to look at our relationship with food. We're all cooking for ourselves like never before, but also how do we support our mental health right now because I mean, everybody's getting challenged so much by this virus.
Dr Rupy: Yeah, exactly. And you know, no more than ever have I noticed that both the media and the government are taking mental health even more seriously because I think a lot of people understand, and this is something I want to get into a little bit later about post-viral fatigue and the how it mimics a number of other conditions that we we see already in practice. But you know, we're all waiting for this tsunami of mental health related illnesses that are going to occur at a much later date after the immediate aftermath of the virus at the moment. So, you know, that is something that I I'm almost like it's in my gut and I'm priming myself for it and I think we need to have those honest conversations now to anticipate what the inevitable is.
Dr Drew Ramsey: You're right. Everybody is gritting their teeth in a way as we power through this. There's some light in the sense of vaccines. There's also still lots of concerns and unknowns, variants popping up. And in that state, it's hard to grieve. And grieve for whether you've lost a family member directly or whether you've had COVID and lost some function or whether you've lost your job or or just lost your life as you knew it, which so many of us have some aspect of that, really just lost things. And processing grief as everybody listening knows, it's really complicated. None of it's linear. You know, over time it gets better, but then you have, I don't know, I left my quarantine of 10 and a half months for the first time. A very, very, I hope safe, socially distanced U-Haul drive from Indiana to Wyoming without going in a public restroom in case anybody listening is wondering. But all of the feelings my family and I were having in the midst of being excited to be out and and at the same time, all the powerful feelings of you know, what the world is like right now. And so, so you're right. We we are going to be confronted with that and need space for that. I think it's also so hard for our colleagues in healthcare where they were already working at the max. Now it's been so much more. There's been so much trauma that people have seen and been through, so much emotional trauma as you know, Rupy, you're on the front lines. And and it's not like then you're going to get a month off. You get a little time off, but you'll be back in it again and and and that's that's what we signed up for in healthcare, but I think everybody has a version of that personally right now. And it's why nutrition and food are important. I signed the contract for this book in February. So literally COVID came out and we're sitting and I'm sitting with all of the data about how food influences the risk of depression and anxiety. And then the new exciting data, really a lot of it from coming out of Australia and the UK, a lot of interesting research on how can we use food to better insulate people against depression or if you have depression or anxiety, how can we use food in the way that culinary medicine hopes us that we will and and tells us to with the most recent science to help people get better. You know that even with our best treatments, psychotherapy, antidepressant medications, not everyone's going into full remission from depression and anxiety. We also know a lot of people don't have access to treatment, but everybody is doing their best to maybe feed themselves, especially your listeners for their their overall wellness. And so nutritional psychiatry, this phrase Rupy used, as everyone who listened to the last podcast, this is really about how do we take food and apply it to mental health. And so everything's been horrible about this. There's no silver linings in this cloud, but it's been it's maybe hopeful that there's been such an openness now that we all have about our mental health. You've been through, you've been through COVID, you've been through the wards, you've been through the ICUs. I mean, it's um that's affecting you and I think you're talking about that more, everyone's talking about that more. And then because we're at home, everyone's talking about food. You're just kind of like scratching your head. I don't know how many of you have had that experience of gone back and gotten something from restaurant or carry out. And you're like, whoa, this is really salty or this is really expensive. What was I doing?
Dr Rupy: Yeah, absolutely. Listen, let's uh let's uh go for the positive tone and I want to congratulate you on your new book. Incredible. Tell us the title, tell us sort of the uh the theme behind it and this exciting recipe you're about to to make for us.
Dr Drew Ramsey: Yeah, so the book is Eat to Beat Depression and Anxiety. And the book centers around the new science around nutritional psychiatry, food and mental health. And I'm really big on, I like talking about the nerdy stuff, all the nutrients. So we go through 12 nutrients we can talk about that that a colleague and I recognized and published in the antidepressant food scale. And these are the nutrients that in the scientific literature are most related to depression and anxiety. And we and then we ask that question that's so important because we get so fixated on, you know, B12 and magnesium and and omega-3 fats and which fish oil capsule to take, but where do you find those in food? I'm sure you've had this feeling also with our colleagues in medicine where we're talking about folate, but if you go around the room, say, hey, where do you find folate? Yeah. I'm like, you know, in a prenatal vitamin, the supplement aisle. It's like, well, lentils, asparagus, right? So the book and my work, I really hope to educate people around what foods you find these nutrients in. I think that's the best place for there to serve your mental health. And also, I think with depression and anxiety and mental health conditions, what makes those conditions so hard is unlike, you know, I've got a I've got a little uh new spot here on my face, right? You can see it. I know what it is. I know what to do about it. But mental health, it's it's it's not something we can see or touch exactly sometimes. And and so what to do then about it can be elusive. Going to therapy, which I highly recommend. I've been in therapy forever. It's it's a wonderful, I think, process of self-improvement, but not everybody is from our culture that's going to do that or has access to that or is comfortable with that. Medications again, helpful to a lot of people, but food, food's in everyone's everyday life. And so, so the book really revolves around this new information, the important foods, and then really getting to the nitty gritty of some of these issues like the inflammation, the microbiome, and how those are really, we we toss those around talking about those in terms of heart health, but those are really profound new ideas in terms of mental health and brain health. And then the book gets into a six-week plan. You know, I'm a clinician. And so I'm not a I don't know, I'm not a I do a little research, but I'm really interested in the rubber hitting the road as we say. How does this information get people better? How does everyone listening to this podcast, is there some way that through this conversation, through the next few minutes, can we can we say some things that that shift how you think about food a little bit so you're better feeding your brain? And and so the book has a lot of illustrations. I hope people will check it out. It's to really encourage folks to be creative and joyful in their eating. That's the other part about the book that's new for me, Rupy, is taking that clinical work of being a psychiatrist and getting to sit with patients and and being a psychiatrist and then asking people in detail about their food has just taught me so much about food and so much about my patients that I never would have known and really so much about mental health. And I wanted to take that in this book and put it together. It's in some of the chapters where I really I talk about diet culture and personal motivation and really how can we tap into something that is really beyond and above all of the noise of what people are telling us to do about food and really tap into your own sense of joyfulness, your own culture and food. You know, what I'm going to prescribe for you to if you're depressed, Rupy, it's going to be different than I'm going to prescribe for someone else or someone listening because you all have unique tastes as eaters, unique values. And as a psychiatrist, which I think puts us in a little bit of a unique spot in the nutrition world, I'm really interested in you being you. You know, I'm not interested in you being a vegan because that's right or you being a carnivore because that's right. I'm really interested in what about that makes you feel great and and how that works for you and what the implications are of your diet and dietary choices in terms of what other foods you might need to emphasize. So that was a long-winded spiel of the book, which ends in a six-week plan to really help people actualize. You know, we talk about mental health awareness, but I'm really big these days on mental health action, right? Can you hear this and do something different today? And and that's really what my hope is for the book.
Dr Rupy: Definitely. I mean, there's a few things I really want to unpick there. And the one thing that I think that you've mentioned a couple of times is the cultural aspect around eating food and how important it is to in a sense, personalize your suggestions to the person in front of you. I've always said this on the podcast, you know, just because a Mediterranean diet has been demonstrated to reduce the risk of cardiovascular disease or improve your ratios of cholesterol and the various ways in which we measure the risk factors surrounding cholesterol, doesn't mean you need to create a diet that is Mediterranean flavoured. It can be as reflective on the person in front of you as much as what they're used to eating. So meeting them where they're at is something that I've learned from, you know, over 10 years of of experience now doing this. But I I wonder if you
Dr Drew Ramsey: You're a clinician, but you're also from a culture that's super healthy for mental health and it's not Mediterranean. And so there is a way that the Mediterranean diet has become, you know, the beauty of the ball. And the data for mental health really exists around all traditional diets. There there's not as strong data because there are only randomized clinical trials using a Mediterranean style diet. But when we think about what does that diet do, it's the same thing that your your style of food does. You know, um and it it's a lot of plants, it's a lot of fibre, it's a lot of um these really interesting phytonutrients in plants that I think become an interesting part of the argument. They're so lots of nutrients, we say nutritional density. But yeah, we have to personalize it. I think that's something that's gotten lost in medicine where I think it's part of the wokeness that's happening where there's been this hierarchical top down. Like I am the doctor as authority. Let me tell you cholesterol and fat are bad. So is meat, so is eggs, so is dairy, plants are good, go. And and that really that didn't, and I don't even think there was like plants are good. There was just like eat other things than that. And and I found that really, I got caught up in that in college and in medical school as a low-fat vegetarian for over 10 years. Um I I I grow my own food out on our farm in Indiana. So I bought into a lot of that and and it left me being, I would say much more prone to depression, much, I would pass out in class a lot in the middle of the day, not because of any, you know, hangover or anything like that. I was a very sober person, but but um more so just this overwhelming fatigue. And you know, so I think like you, I really was influenced on how food information leads to changes and leads to changes in health. And then in as I added in more of these foods that we talk a lot about in the book, we have our power players, which are, everybody kind of gets down to like, all right, all right, great health science, microbiome, like, what do we eat for dinner? And so our power players are really foods from each, what we call food category. So nutritional psychiatry, instead of trying to say, wild salmon and anchovies, I say, Rupy, tell me about your relationship with seafood. I know there are a lot of amazing shrimp dishes in the book. But I was also curious about like your experience with things like mackerel and salmon. I get really curious about your relationship with bivalves. You know, how do you feel about clams? And to hear about that, to hear what what really works for you in that food category. Um I've met a lot of people on a plant-based diet who love muscles. And I mean, I light up when I hear that because the muscle has every nutrient that you would ever need in a vitamin to go with a vegan diet to have nutritional, what I did in my last book, talk about eat complete, getting all of your nutrients from food.
Dr Rupy: Yeah. I mean, you know, again, I I think one of the words that I picked up on there was um traditional. So, you know, what is the traditional diet for you? And my traditional diet, you know, I'm Punjabi Indian, so my traditional diet is lentils and whole wheat and spinach or a stew that we call saag, which is basically every dark green leafy vegetable you can imagine smashed into this delicious pan with a few spices to make it, you know, even more delicious.
Dr Drew Ramsey: Saag, the dog here is this uh this yeah, this like that's one of our, that's definitely one of our favourite dishes of your cuisine. That's that's a staple uh for a while when we lived in New York. So
Dr Rupy: Amazing. Yeah. And you know, you can make that whatever way you like um in terms of whatever greens you have available to you. So, you know, those sort of elements I think are super important to remember that we can eat with uh our cultural heritage in mind. But I think another thing that you spoke about was micronutrients. So I I think as clinicians and even in nutritional science, because a lot of the research papers that we have available to us are either funded by supplement companies or use supplements because it's far easier to perform that type of research means that
Dr Drew Ramsey: You know, it's it's better science. Exactly. You know, vitamin C versus placebo, amazing science. I love that science. Double blind. Exactly. You know, we haven't, I don't know how we're going to solve this, but there's just you cannot placebo control food. Yeah. You know, say like here is, boy, that salmon tastes the same, looks the same, like the saag right here, totally the same. You're like, that's the placebo salmon. Yeah. That's just so there are inherent flaws in the way we're ever going to be able to do dietary interventions, plus the expense, plus the compliance and all the other uh caveats to to doing that sort of science. But I I I think that's kind of why we fall back on the need to look at micronutrients in isolation. And then you have some, you know, key things. Oh, vitamin B12 or folate's really good for this or omega-3 long chain fatty acids, you got to get that for your brain health. And in reality, it's looking at that incredible science and, you know, some some great studies out there, but translating that into a plate of food, which is something that you do very well. Um and you're about to show us as well with your
Dr Drew Ramsey: I'm going to get my stuff on camera. You know, it's it's it's a little everybody listening. I got super nervous this morning cooking with uh cooking for Rupy. I'm also not in my home kitchen. So I'm going to show everybody a a kale basil pesto. But but before that, Rupy, I have a couple of questions for you. And um and one of them is as I posted on Instagram, my cumin conundrum. So in our clinic, the brain food clinic in New York City, we've got a wonderful therapist and food coach, Samantha El-Krief. Samantha is a huge fan of cumin. So about a year ago, you know, I said I I you know, how we all want to spruce up our diet a little bit or I don't know, I like progression in everything that I'm doing. You know, just a little bit of, I don't know, we've got a couple of my favourites here like this is one of the power players, this uh purple yam, right? Because it wasn't probably a lot of people listening know, oops. See, I'm already spilling olive oil everywhere. Um the colour purple denotes anthocyanins, these these really interesting molecules that we know protect the brain and they figured out now, at least a paper, an article that came out in Nature, that the way, one of the mechanisms by which they decrease inflammation is by how the anthocyanins uh influence the microbiome. That it's not a direct brain effect, it's a microbiome effect, at least one of the mechanisms of the anthocyanins. And so, so foods um when we think about the food categories, before I cook, just basic idea in the six-week plan, not to give away the book, everybody, I hope everybody will check it out, but is to really focus on these food categories that in our clinic, we see people struggle with. So leafy greens is one of them. Again, really nutrient dense. You're getting all of this vitamin K, vitamin C, vitamin A, these carotenoids, all these phytonutrients, fibre. Um so how do we how do we increase the nutrient density of someone's diet with leafy greens, with rainbow vegetables like those purple yams, with seafood, um with nuts, beans and seeds. One of the reasons that I love pesto is it's a way to get more of these really healthy oleic acid fats. Everyone debates about fat and I don't know, I'm just I guess I'm a psychiatrist. I'm not really scared of it emotionally. Like I'm happy to confront me, but you know, I I also kind of curious where everybody agrees. And everybody agrees about olive oil and monounsaturated fats. And and so nuts, um it's interesting, one of the molecules when we talk about mental health, everyone gets all excited about serotonin or dopamine. One of the molecules that I've really been promoting, it's my favourite brain molecule is BDNF, brain-derived neurotrophic factor. And it's this neurohormone that really coaches the brain or encourages the brain to sprout new connections, to reach out uh to and and I I like thinking about that. I like thinking about neurons the way I think about people. Like when I met you, Rupy, you know, it was a great connection. We had a great meal at a great restaurant. It was like, I just knew we're going to be friends. And and how that kind of, you know, just I don't know, lights everybody up when you have that experience, right? And the same thing I think happens to neurons. They reach out, they touch another neuron and they're like, whoa, like, hey, hey. And so BDNF encourages our brains to do this, to literally make new connections. It also encourages the birth of new brain cells. And that's such a new idea that it really hasn't translated into clinical medicine enough because it sounds kind of crazy. But when I finished medical school, year was 2000, we learned you don't make more brain cells in adult life, a process called neurogenesis. We now know that's wrong. That's how actually some of these new um medicines that are being tried for depression, things like ketamine and even some of the hallucinogens like psilocybin, there is this notion of them inducing rapid neurogenesis and new connections in the brain. And so food can also do that. The reason I'm saying all this is there's only one study ever that I've been able to find in the scientific literature. Everybody listening, you look around, there are going to be more, but prove me wrong. I hope there are more. And it shows that nuts, there's a study of the Mediterranean diet plus olive oil or the Mediterranean diet plus extra nuts. And people who got extra nuts over a couple of years, they had this protection where they the protection against severely low BDNF levels. And it's not a perfect biomarker for depression, but it's just a really interesting finding. Because like this like neurohormone that makes your brain grow and new connections, like I want more of that in my blood, right? And so, so nuts, I think are a good way to do that. These are pine nuts, which are the classic pesto, because I also think as you're experimenting with food, you want to kind of take something you like and add in something new. I'm kind of a fan of you change one or two things. And so if you have not really done a lot of pesto, you've had it once or twice, you've had your gnocchi genovese in the restaurant or I I think that you know, maybe try a new nut or add in another green, but get used to that and then start to jazz it up. But nuts are one of the key ingredients of pesto and again, great source of fats, fibre, phytonutrients, also really interesting in their minerality. We're looking for things like magnesium or iron, nuts and seeds and beans are an interesting spot. I've got a bunch of
Dr Rupy: Drew, I I just want to I just want to say I love the way you talk about food and you make those analogies like, you know, how BDNF coaches the brain and how it's like, you know, meeting a new friend or meeting someone that you're going to gel with for the first time. Like I would love to be a fly on the wall in your psychiatry clinic because I can imagine, you know, this is kind of the way you get people on board.
Dr Drew Ramsey: Psychiatry clinic is like a bummer. And and I really try, I I don't want to ever avoid sadness or grief. I mean, it's like good therapy. It's not a stand-up comedy time, but I do think there's something about humour, healthy humour that really is important. And I think there's something about creativity. The reason I love being a therapist and a psychiatrist is the amount of creativity. I mean, literally, you can say anything. And and if it's in, if it's thought out, if it's in the spirit of being helpful, it's in the spirit of understanding something deeper, um it it and so, but thank you, Rupy, that's very nice to say. And it leads me to your, because I have questions for you, sir. As I said, everybody, I hope you check out the book. We're going to make some pesto, but let's get down to breast tax here, which is when we did the antidepressant food scale, watercress, right, which is this leafy green right here, came out as the number one plant. And again, these were the foods, the top plants and animal foods that have the most of these 12 nutrients. I just thought, why don't we just do the simple math and like, if you want to have the most nutrient density of these antidepressant nutrients, B12, folate, what foods should you eat? So watercress is number one. And I was and and so then as I said, I'm not at my home, I'm in Wyoming. I'm there's like some random, nice grocery store down there. I'm walking through to get my kale for the kale pesto that we're going to make and to see if they have some sad basil, which they did. Um but it's not looking so freezing up a little water. And then there it was. It was like a sign from the universe. You're going to get to talk about watercress with Dr. Rupy. But I've only and this is again talking with patients about food. I once talked to a woman from Haiti. And she said, oh, watercress, we serve that at every meal. Wow, really? And again, this notion of traditional diets, right? No one would ever say or no one has said yet, like I should prescribe a Haitian diet to fight depression. But if you at least base your dietary or some of your choices on this research that we've done, watercress would be in there. But Rupy, what do you do with watercress?
Dr Rupy: So, watercress, I think is one of the most phenomenal ingredients. It grows all over the UK. We have it in this probably the same amount in terms of the stores in the US in terms of abundance. It's always there. It's one of the highest um levels of vitamin K and folate, but it also is part of the brassica family because it contains sulforaphane and a whole bunch of other um phytonutrients that give it disease fighting properties. The way I tend to use watercress because of its bitterness is with um something that kind of mellows the flavour. So you need almost something sweet to go with it. So it does work as a finishing ingredient for a curry, um particularly if you've used some sweet uh herbs in the curry like holy basil or something like that, throwing watercress at the end. The other way I like to use it is in a in a ranch dressing. So um when you combine tahini, olive oil, a tiny bit of uh like a sweetener like a maple syrup or something, a little bit of chili and you put that over the bitter leaves of watercress, again, it kind of mellows that quite strong flavour and uh I I I love using it in that respect, but it can be quite bitter for people who are not used to those dark green leafy vegetables.
Dr Drew Ramsey: Thank you for that, doctor. That's exactly what I needed. And uh watercress uh ranch dressing to tahini. I mean, that's that makes my day. And again, I think I also want to bring that up because watercress, like seafood, was not a part of my diet. When I was a resident at Columbia, um and where I'm still on the faculty and and where I've really gotten to develop a lot of these ideas and and have great colleagues in mental health really kind of pushing, you know, good science and good clinical care. Uh it's just uh you know, it's not something that I ate. And and so I think take Rupy's advice of, you know, add these things a little bit. And and I love the idea of putting it in. I I started to see like a there's a dish is aloo chole, the the potatoes. Yeah, yeah, yeah. You know, kind of a nice cooked down tomatoes and sometimes chickpeas, right? With a little bit of water because I was having it, it's super bitter. So this is something that maybe you'd try in a pesto. Um the other thing that at least in the book, we um use a uh you know, one of my favourites, which is taking your traditional basil and adding in some kale. And so what I would do if I had a food processor, which, you know, I did, I want everybody to know I tried. I mean, I tried with the blender and that is a sad looking blender. But uh I'll chop this a little bit maybe. Um and I'm just going to chop it all roughly together now because I love these greens and I don't need them blended up too much for me to really enjoy them. And then
Dr Rupy: I just want to uh just um uh just explain to the listeners. So there's something I I I think is super innovative because it's almost like a combination of your your previous books. You you've created this anti-depression food scale of nutrient dense ingredients that contain those 12 sort of nutrients that you want to try and get more into your diet to eat complete as you say in your in your previous book. And you've given that scale in your in your book and and you know, these are some of the ingredients that you're using with it. I think that's a really good way of doing what we were saying earlier of translating that research into something that's that's truly achievable for people. Um you know, and and and you know, creating pestos like this.
Dr Drew Ramsey: You know, when it's when it's a recommendation like, you know, eat less of a nutrient, I think we just, you know, our educational systems haven't really raised people or educated people around where to find these foods. And so as you're saying, it really pushes us towards a model of nutrition that's based on one, it's just based on science. It's not based on all of what traditional food has taught us. And two, it it tends to get people really fearful and anxious they're not getting enough of X. And you know, how can you get it's it's we call it concrete thinking in psychiatry. Where it's not nuance thinking, it's like B12 good, need B12, take more B12. Yeah, yeah. You know, and that's not how nutrition works. Um so and everyone just this is my favourite thing to do with kale and so again, usually I just put this in a food processor, but if you have some hot pasta or hot gnocchi, um and maybe brain health people don't like to say pasta and gnocchi, but I do. And um they they say I'm a parent pioneer in this field, so I'm just going to say it now on this podcast. I think pasta is a great way to deliver brain food, just like I think potatoes are a great way and and brown rice is a great way and I'm a fan of all those. So definitely, definitely. It's just I think this is shiffonade and so my other favourite recipe in the book is the uh all kale Caesar because I I think I told you my my favourite piece of historical research on the last podcast, Rupy, did I tell you about that? Tell me about it again. Ancient Rome. Did I tell you about ancient Rome? No, tell me about it. So people when we had National Kale Day, we still have National Kale Day, but when we're promoting kale, people were saying, you know, it's a fad food. People still say this, like a fad food. You know, really kind of talking negative. And then there are these researchers that found in ancient Rome, these like ancient like kale um like drawings and and this this notion that ancient Romans ate kale and then of course, you know, it's true, right? Because they they all watched what they said, right? All kale Caesar. Yeah. All right. So we take our kale and here I've blended up a bunch of garlic. There's like four or five cloves of garlic, olive oil. So garlic, olive oil and I got some of the greens all, you know, in there. I'm just going to throw in this shiffonade I like again because I make this all kale Caesar salad with it. And do the same thing. I'm just going to tear the basil up.
Dr Rupy: Well, I I I just want to go back to one thing you said earlier actually about, you know, um potatoes and pasta and stuff. I think, you know, a lot of people have a bit of snobbery around food and that you can't eat certain things or you can't label it as healthy, but really it comes down to a couple of things, um quality and dose. If you're eating quality foods with whole grains and you're getting enough of the variety and you're getting, you know, a moderate amount of whatever it might be, whether it be a processed product or sugar or um even fats to a certain extent as well. You know, when you've got the right combination there, then most meals can be considered healthy and you can make it a brain healthy meal, a heart healthy meal and a mood healthy meal as well.
Dr Drew Ramsey: Yeah, I think these things really combine well. Just a little tip here because of my past life as a um kale lobbyist and head of, you know, a large kale mafia organization. The potassium is in the stem of the kale. And so it's one of the reasons that blending it up in a food processor or putting it into a smoothie, you know, a lot of people, you'll, you know, you'll see this, right? We'll we'll strip the the kind of uh uh kale off the spine and throw in the leaves. So I did not know that. That is news to me. So I've got my pine nuts and my uh pistachios is what I decided to add in. One of my favourites, I'll do almonds in here, walnuts, a little bitterness in there sometimes, but you can really use any nut. And again, as you think about diet, having diversity is good. With the different nuts, you're getting different phytonutrients, different colours mean different phytonutrients. Um and so
Dr Rupy: I love the tip about the stem. Honestly, that's news to me. And I I think, you know, the the the way I see sort of using the stems and the roots of ingredients is from the fibre perspective, but I didn't realize about the concentration of potassium. That's super interesting.
Dr Drew Ramsey: Just for the listeners, you're you're mixing it around in a bowl. And so, you know, the idea is, you know, lots of, sure, a little little carby, lovely bundle, but lots of um garlic, lots of olive oil, lots of greens, lots of nuts.
Dr Rupy: That I mean, that looks fantastic. And it's a meal straight away. And you know, that would carry very well into the next day and it would intensify in flavour and, you know, the bitterness would mellow if you leave it overnight as well even. So that's uh congratulations. My chef hat goes off to you. Thank you. I mean, people ask about gnocchi. The other reason I like gnocchi is just to mix up my pasta game. It's the same reason. Oh, there you go. Right? Where I like potatoes as I've said, great source of potassium, great source of iodine. Gnocchi are also really easy to make at home if you're having that, you know, crave to make homemade pasta. You can definitely make wheat-based pastas or buckwheat-based pastas, another great soba noodles is a fun way to do this. And then I'll also make a big batch of this. So Rupy and I are both busy docs. And uh I've got a family, I've got two kids and a wonderful wife. And so anything where I can make a batch and stick it in the fridge of something that, you know, my kids love hummus, they love pesto. It just it just helps, right? For for life happens and you need a quick meal. And so pesto freezes really well. Actually, when I went to medical school, because we have a farm in Indiana, we make lots and lots of, I mean, a basil plant will be, you know, I don't know, four or five feet high and it's just so much pesto in there. So my mom would make these like packets of pesto and wrap them up in wax paper and put them in the freezer. And so a lot of times I'd make some gnocchi or I'd get a, I wasn't really eating any fish, but I'd, you know, get some veggies or I'd make a little pizza, but instead of just cheese and tomato sauce, I'd put in a big crumble of pesto. And again, just bumping up that nutrient density.
Dr Rupy: Yeah, definitely. I mean, that that's fantastic tips. And I think, you know, there's so many different ways in which to use that structure that you've put in the book as well to incorporate a variety of things. And I love the use of pistachios as well. That's definitely one of my favourite nuts.
Dr Drew Ramsey: I'm podcasting at altitude here for the first time and you know, I'm in okay shape, but it's uh it's I was like, is this my anxiety? It's like, no, I'm just like 7,000, 8,000 feet. Um You look like a pro, man. You look like a pro. I do hope that the plan really helps people actualize this information. The plan goes through six weeks to really this idea that that um when all of our, when you prescribe antidepressants or do psychotherapy with people or give people supplements that we think have an antidepressant effect, we really are looking at day 28, four weeks out. That's what most of the study kind of endpoint is. At four weeks to a month, does this medicine, supplement, uh intervention, does it get your symptoms lower in depression? We then noticed in a large American study called STAR*D that some people got better at like five weeks and six weeks. And so now I tell patients it's like four to six weeks. And and when you think about that, okay, what are antidepressants doing? Well, first of all, antidepressants fight inflammation. People don't know, but antidepressants like Prozac and what we call in the US or fluoxetine, they're they're massive central anti-inflammatories. But this idea that part of what's driving depression for some people, we know depression comes from a lot of different places. It can come from our psychology, it can come from trauma, it can come from inflammation, like if you're, I don't know, have celiac disease and you're eating lots of gluten, you're going to have inflammation in your gut, you're going to have inflammation in your brain, and you're going to have, actually a study of individuals with celiac disease, when they went on a gluten-free diet, at the beginning of the study, 75% of them had severe anxiety. And it was about three times the the um normal population, the regular non-celiac population. And it kind of makes sense. Celiac disease is, you know, you've got cramping, bloating, diarrhoea, it's horrible. They got on a gluten-free diet, their anxiety levels went down to matching the regular population without celiac disease. So this is is one example, you know, of how things like inflammation influence our mental health. So we walk through people through the information and then through the plan. And then the last part of the plan is called your food roots. It's really again guiding people through some exercises, some some self-query, but with specific instructions. So week one's leafy greens, there's leafy green recipes like the pesto. With the real cool thing of like, let's eat leafy greens this week. What does that mean to you? What's it going to look like? Which ones is it going to be? And then checking in at the end of that week, how'd it go? Um the last week is really about getting your sense of your um source of food joyfulness and how to connect. Again, just like those brain cells we talked about, Rupy, reaching out, connecting, that really is my model because when I meet people, excuse me, when I meet people and I hear their struggles with depression and anxiety, I'm usually hearing about how those symptoms are really eroding the connections in their life, the connections to their self-esteem because of their work, because their work function isn't as good, their connections to their loved ones because they're really focused on how badly they feel because they feel so awful that you don't have that um capacity for, you know, the best of what we do, connecting with people, engaging with one another, helping one another. Um and so I really hope to help people connect up to no matter where you live now. And I tell a story that when I got really back into food after leaving the farm, it was when I was in downtown Manhattan. And I was suddenly living next door to a farmer's market again. And all of a sudden, I'm eating all this diverse fresh produce just like when I was growing up on the farm and and and and so to to really connect and make connections with your food community. And so each of these sections has recipes to help people incorporate these foods, really with the attention to a lot of people don't like seafood. I didn't like seafood for most of my life. I eat every type of seafood. So I want to explain to people about how that happened for me, but also how maybe it can happen for them. Same thing with leafy greens. You and I know we promote a lot of plants. A lot of people just for whatever reason don't like this or that. Okay, again, how do you meet people where they are and work with them?
Dr Rupy: I just want to uh just um uh just reiterate, you know, just how much I respect you because of the humility that you've demonstrated by appreciating the impact that people who are influencers and people who are on social media have in a positive way on other people. I think as medics, we are, you know, expected to be dismissive of anything that isn't within our sort of medical realm. But the fact that you appreciate that there are people putting out positivity that that benefit people in a way that perhaps a physician could not. I I think it really just demonstrates um just how nice a person you are. And I'd love for you to to round up this conversation perhaps with maybe three tips that have been taken from your latest work um that could that could get people sort of thinking about food and nutritional psychiatry in a way that you kind of want people to to move toward.
Dr Drew Ramsey: All right. Well, for sure, I'll give three tips. I think, Rupy, also to that end of what you're saying is a basic rule of mental health and psychiatry that I've learned, which is around defensiveness. And when we find ourselves in a sense of of of defending our turf or dismissing other people's work or, you know, hearing that the juice cleanse worked, even when we don't believe in juice cleanses, it to me as a clinician, it creates a distance between us and a person's known experience. And it enters it from, as you said, a dismissive tone. I don't think juice fasts work. As opposed to the curiosity that we need as individuals. Where'd you hear about that? What happened? What'd you feel like? Are you going to do it again? What was your favourite juice? We're all of a sudden now, you and I are having a conversation about your experience of food because it's yours. And so when I find myself in that defensive spot, this isn't science-based, this person, I really try and take a step back and I encourage everybody to do that and try and what is conjuring that feeling for you? In terms of three steps that that come from the new book, Eat to Beat Depression and three kind of in some ways basic tenets of nutritional psychiatry. You know, I I would say that my work on this book has really what bubbled to the top for me was really a sense of engaging in a mindful way with self-nourishment that that has a a feeling of joyfulness. Not not that every time I'm here at the stove or on the road that I'm like, oh, you know, wow, this salmon cheese croissant, you know, oh my goodness. But but that when that you're really intentional about having time to structure your nutrition, your cooking and your self-care and to get to a state of joyfulness about it. Because I think so often we get into this and it's a mindset, right? The food is a burden, it's boring, we don't want to do it. And to me that in some ways is an element of a type of depressogenic, I don't know, attitude. Right? That you're not really worthy of care or that there isn't an easy way to do it because you're a smart, thoughtful person. Um I I think so that first tenet, I guess would be find joyfulness in your in your self-nourishment in food. That's why one of the big power players, I can't believe that this is at the end is the biggest selling point of the book is dark chocolate. There's a whole freaking food category on dark chocolate because dark chocolate is such an amazing brain food, but I think it illustrates this principle of have fun and enjoy food. This is this is a can be a really delicious and joyful ride as you nourish your brain. This isn't about deprivation. I think a a second uh rule for me is or kind of idea from the book is really around the dynamics of brain growth. I kind of put this sort of holy trinity of neuroplasticity, brain growth, inflammation, which is, you know, us not dealing with our exhaust and the microbiome, which is this idea of the way we eat shapes how our gut works and all of these bacteria that live in our gut that are healthy and and promotes how they modulate and really run the immune system, but also communicate with the brain. And we go into a deep dive of this in the book of a lot of the studies that showed the types of food you eat influence the bugs in your gut and the bugs in your gut actually influence things like how well you think or how emotional you are or even how anxious you are. I mean, it's just fascinating new science. So I think that's the kind of second bullet point. Um and then I think the third is to connect that if you're not connected to your food supply, if you're not connected to the, I heard a great quote from a chef uh said something about, you know, you you shouldn't ever cook food when you don't have love in your heart. And I was like, damn, that's a tall order at 6:00 a.m. I'm making pancakes. I'm not in the best mood. Like is there love in my heart and scrambling these eggs? But I thought it was a really beautiful intention to have. Yeah. That when you're cooking for the self and other people to to really be intentional about what that is, that that is at the very base of nourishment. There cannot be human love without proper nourishment because without proper nourishment, we are anxious, we are depressed, um our thinking is foggy and cloudy and we can't really, you know, for everybody listening, you know what it's like when you're functioning at the best of your ability. You know, we all and often times we'll think back to that time, like, oh, I remember that time back then. And and I really, you know, if there's a closing point, Rupy, is to challenge everyone to really get very clear with yourself of that you can get to that spot in 2021. Uh that there are lots of tools you have at your disposal to to get there. Food is one of them. And that there can really be this kind of um expansion of your ability to connect both with self and other. And so I hope the book sparks a discussion in that. I hope the e-course and clinicians watching, coaches, psychiatrists, psychologists, therapists, really any flavour. They say, who's the course for? It's like anybody who talks about mental health. If you're a trainer and you're talking to people about mental health, why not have the latest information so you can make recommendations with a little more confidence or a little more nuance. Um uh but yeah, I think this notion of really nourishing our brains for optimal connection, I guess is my hope and to think about it that way. You know, when you when you got that little gnocchi in your mind and you're looking at it and it's just cheese and tomato sauce and you're like, I could make this gnocchi more nutrient dense and it'll take better care of my brain.
Dr Rupy: Drew, honestly, it is always a pleasure chatting to you because you're able to blend humour and a sincere uh approach to some very sinister and serious subjects with, you know, a respect for the science, respect for patients and, you know, just again, bringing joy to everything that you uh you you're involved in. Um it's always a pleasure to chat. You're welcome anytime on the podcast. Honestly, I I mean that you are one of the most popular guests that we've ever had and I just can't wait to see what 2021 brings for you and the book is absolutely fantastic.
Dr Drew Ramsey: Well, thank you so much, Rupy. You know I love I love speaking with you. I can't wait to cook with you someday. I hope everybody will just put it out there in the universe that Rupy and I can cook for you all together someday because I I really like that. And and I just hope that everybody listening just really hears my message, the the most important message beyond my book and and food is just that you take care of your mental health and you prioritize that above anything because when you take care of your mental health and you build your mental fitness, what you're going to bring to your own life and to the lives of the people around you, I know this from my personal experience, I know this from all the patients that I work with who have really been on a journey of healing that that um great things will happen, great things will come from that effort. There there is no better spot for you to focus your effort in my opinion. I guess I'm biased as a psychiatrist, but just also as a as a person, as a man, as a father and a husband, I just I want everyone to really feel encouraged to to take care of your mental health in a in a really intentional and daily way. And and if anybody listening is struggling and I I always want to end on this note is is to reach out to someone and let them know. I think both Rupy and I know as we've dealt with our mental health and being docs that it's so easy to isolate and sit alone with this stuff. And so if anybody listening is having a hard time, please, please reach out to anyone because I know that your community, your friends, your family, your connections, they want to hear about it and they want to be helpful too.
Dr Rupy: Mate, that is such a lovely way to to end it.
