Podcast: How Do I Eat Better to Improve My Mental Health?

Guest Bio

Drew Ramsey, MD, (@DrewRamseyMD) is a psychiatrist, author, and mental health advocate. His work focuses on nutritional psychiatry, male mental health, and optimizing mental fitness. He founded and leads the Brain Food Clinic, which offers consultation and integrative treatment regarding depression, anxiety and emotional wellness concerns. He is an assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and in active clinical practice based in New York City and Jackson, Wyoming.

Inside Mental Health Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Episode Transcript

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone. I’m your host, Gabe Howard, and calling into our show today, we have Drew Ramsey, M.D. Dr. Ramsey is a psychiatrist, author and mental health advocate whose work focuses on nutritional psychiatry and optimizing mental fitness. To that end, he founded and leads the Brain Food Clinic and is the coauthor of “The Antidepressant Food Scale.” He’s also the author of the award-winning books “Eat to Beat Depression and Anxiety” and “The Happiness Diet,” among others. Dr. Ramsey, welcome to the show.

Dr. Drew Ramsey: Gabe, it’s great to be here with you. Hey, everybody.

Gabe Howard: I was super surprised to learn that the phrase You Are What You Eat was originally coined all the way back in 1826 by a French author. The literal translation is, tell me what you eat and I will tell you what you are. Now, I just point this out because I’ve very much always associated that phrase with the recent emergence of the diet culture, like in the seventies and eighties. So I really thought it was just kind of a new thing. But it appears that the connection between what we eat and how we feel has been discussed and for the most part understood for literal generations. Yet it seems like we’re all still confused by the idea that eating potato chips and fast food for breakfast will make us feel bad for the rest of the day. Dr. Ramsey, why the confusion? Shouldn’t this just be obvious by now?

Dr. Drew Ramsey: Well, one would hope. I mean, we like potato chips and our brain is wired to seek out easy, safe calories. And we’re very busy. So it does make sense that you are what you eat. And everybody does have an idea that what they eat affects how they feel. It is very interesting, having been in this field, nutritional psychiatry, for the last 15 or so years, there’s a surprise when you’re working with patients and you start to ask them about their diet, not with the idea that that’s the silver bullet. Not everybody is struggling with depression because of issues with gluten or whatever, but we know that food plays a central role in brain health. We know it’s the most modifiable, probably most impactful lifestyle factor that’s under your control in terms of impact on mental health and brain health. So I think we’re in the midst of a revolution. I mean, I think we’re hearing more and more about this and more and more people are paying attention because one thing has become clear to all of us, mental health is serious business. We’ve all got to work on it and diets are part of that.

Gabe Howard: I believe that some of the confusion is, of course, media and advertising and even conversations. I think about my own childhood. I live with binge eating disorder. I used to weigh 550 pounds; I now weigh 240. And I’ve been in long-term recovery at a healthy weight and understanding my eating for, you know, well over a decade now. But I, I think about Gabe Howard all the way back at the beginning when I believed that a muffin had less calories than a donut. And the reason that I believe that is because the local bakery told me so. They’re like, Well, do you want a donut that’s unhealthy or do you want a muffin? A muffin is healthy.

Dr. Drew Ramsey: Right, maybe it has some blueberries or bran in there.

Gabe Howard: Well, yeah, they really just did a better job of the muffin was elite. It was higher, it was more expensive. You know, donuts were, that’s garbage eating, but a muffin. A muffin. Do you think this is contributing to the misunderstanding of food? Because I ate that muffin and I believed that I had a healthy breakfast.

Dr. Drew Ramsey: Yes. And first, thank you for sharing about your own journey of weight loss and just the power of that, because I think it demonstrates something that as a clinician, I see on a daily basis that people take control of their lives and make incredible changes. So it’s very nice to be speaking with someone who’s done that. I think you’re speaking about the way that you’ve given over our common sense of authority and not really had nutrition basics as part of our education. And that has allowed, I would say, media messaging and whoever you going to kind of point at in terms of leading the charge, whether it’s misinformation online, whether it’s folks trying to sell you a supplement, whether it’s big food, trying to convince you that processed food under a variety of labels, the most recent is Fake Meat is Better for You. We’ve given over our authority and some common sense. So a muffin and a donut are basically the same. They’re both a lot of both highly processed foods. They’re both commercial baked goods.

Dr. Drew Ramsey: And so commercial baked goods like those that you mentioned are some of the top food categories or foods that contribute to a depression risk, sugary sweet empty calories. Potato chips you mentioned where people have gotten really confused. I recommend potatoes. We have potatoes all the time in my house. Potatoes are a wonderful food, especially if you can get into sweet potatoes, purple sweet potatoes, all kinds of different potatoes. And so understanding that difference between a potato chip and a potato and all of those basic pieces of health information that people have lost, and it’s one of the reasons that food is making us so sick.

Gabe Howard: It’s fascinating when you mentioned the potatoes versus potato chips and how you have potatoes in your house all the time. My brain immediately said, no, no, no. Potatoes are a starch. No, no.

Dr. Drew Ramsey: Right.

Gabe Howard: Those are carbs. You can’t eat. I almost corrected a PhD, written numerous books. You are the expert. I want to make it very clear I respect your expertise and I almost interrupted you to explain to you why potatoes are bad.

Dr. Drew Ramsey: A lot of people have that reaction because some carbohydrates are fine for you. And the reason the carbohydrates have a bad name is because the carbohydrates, especially fast carbs, simple carbs, the carbs that are there in commercial baked goods and sugar, and they don’t come with any fiber. They tend not to come with a lot of nutrients and they raise our blood sugar very quickly. And with potatoes, especially roasted potatoes, you get more resistant starches. You also get a lot of nutrients and you eat them more slowly. And so an oven roasted potato with lots of olive oil and some herbs and garlic, I think that’s a brain food. Whereas a potato chip, which is mostly vegetable oil, that’s where most of the calories are coming from in a potato chip. It’s not coming from a potato. Empty calories. You’re mainly getting fats and a little thin layer of starch. So. Yes, it’s a good point. I would say that part of what’s happened with the modern American diet called the mad diet or the sad diet. There’s been such an obsession with calories as opposed to caloric quality that when people look at a hamburger, they say, oh, the red meat is awful. The red meat is not the majority of the calories, nor probably the majority of the health problems in that burger. But that kind of nuance gets missed.

Gabe Howard: We really have an all or nothing when it comes to food. When I talk to everybody, they’re like, I’m all vegetarian and that’s why I’m good. I’m all lean proteins and that’s why I’m good. I’m all low fat, no sugar, and that’s why I’m good. And then when somebody comes in and says, I eat a little bit from every category, everybody’s like, Oh, well, you know, if you just cut out and there’s always like that just one thing.

Dr. Drew Ramsey: Right. Right. Everybody loves that. It’s the silver bullet.

Gabe Howard: Yeah. Get rid of eggs and you’ll live forever.

Dr. Drew Ramsey: I love what you’re saying. You’re putting a little piece of psychology that’s really important. You’re saying that we make these changes, we live by these rules and quote unquote, that makes us good. Let me just righteous, more environmentally sound. And I think that is probably at the core of the pathology we have about eating that. It doesn’t revolve around reasonable science, good randomized trials, and our sense of what really works for us. It is you’ve lost 300 pounds; you’ve figured out what works for you, what doesn’t, what might work for other people. So that’s great food and I can’t have that in my house. Not a great food for me. And you’ve dialed that in over the years and you see that in the result that you’re at what feels a healthier weight to you in a good way to you. So that’s something that I think everybody needs to do. I got really tired of diet culture. I’m a psychiatrist. I’m really interested in creating more love, kindness and human connection in the world. That’s the basis of my work and the basis of mental health, and I wanted to do that with food. Mental health generally approaches food just through the lens of eating disorders. And I just thought, we’re missing. We’re missing such an opportunity to help individuals with depression and anxiety or people who are concerned about maybe their cognitive ability or anybody who’s in recovery from addiction. Right? What should they be eating to best fuel their mental health? What should they be eating to fuel their brain health? And very quickly, calories are important, but that is not going to answer that question.

Dr. Drew Ramsey: And neither is some processed food or new supplement or new energy drink. Now there are a handful of trials, about four, showing that using dietary nutritional counseling in the setting of a mental health clinic like ours, the brain food clinic, you can really help people achieve remission and do much better in terms of their mental health, particularly with depression. That’s where there’s really some basic principles of foods to add in. So instead of worrying whether somebody’s eating a steak or not, occasionally I worry, are they eating fermented foods? What fermented foods? How are they eating them? How do they enjoy them? Are they eating alone or with other people? Do they cook for themselves? Did they feel secure in their food supply? I just went through do they eat seafood? Do they eat leafy greens? So a nutritional psychiatry, we go through these really high yield food categories to try and get the most of the nutrients that we know are most clinically related to depression, anxiety and other mental health disorders. And that’s how we design your diet. And I think it’s a much kinder, friendlier, more mental health way to approach food that allows us to have a joyful relationship with our nourishment.

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Gabe Howard: And we’re back with Drew Ramsey, M.D. speaking about how what we eat impacts our mental health. Speaking for me personally, I suffered from a lot of depression, and I know that went hand in hand with the eating disorder, because one of the things that I tried to do is think about, okay, when was Gabe happy? And I was happy at birthday parties. So I went out and ate a lot of cake. I like cake. Cake is good, but I don’t particularly have a sweet tooth. But I found myself eating just massive amounts of cake. And I realized through, you know, psychotherapy and eating disorder treatment that what I was trying to do is recapture those happy feelings, the happy feelings of the birthday party and the celebration.

Dr. Drew Ramsey: You love the party and you love the socializing and the celebration and cake is kind of associated with that.

Gabe Howard: Yeah. I loved everybody getting together.

Dr. Drew Ramsey: Yeah, it’s like when folks stop drinking, if that’s part of their mental health journey. There’s that question of like, but I love getting kind of, I don’t know, loose and rowdy with my friends, you know, like,

Gabe Howard: Right.

Dr. Drew Ramsey: When do you do that? I also think about all of the foods in the American diet that we celebrate generally tend to be not either very healthy or now they’re kind of derivations of what could be a reasonably healthy, nutrient dense meal. And instead we really modified it and kind of fetishized it in a way that it’s really cheap and really unhealthy and it kind of doesn’t matter what food you look at, even birthday cake. Birthday cake used to be a real treat you got on your birthday. It was made with fresh ingredients. That’s not what cake is these days.

Gabe Howard: Along those same lines, let’s say that I would have had a better understanding of my body and nutrition and food. And I thought, okay, I want to eat something that makes me happy. And instead of going to birthday cake, which was clearly the wrong answer, I would have thought, okay, like what can I eat to improve my mood? What are some types of foods in some ways of eating that we should be looking at in order to help relieve depression and anxiety or at least, have a better mind body connection.

Dr. Drew Ramsey: Yeah, for sure. Let’s talk about where the science is. And also just that thinking you’re talking about we’ve got to step away from a kale salad is going to be a miracle. If you like kale. A kale salad or leafy greens are a great part of a healthy dietary pattern because of the principles of nutritional psychiatry. But we’re looking for simple, whole food ingredients that are very nutrient dense and leafy greens are very nutrient dense. There’s a lot of misinformation right now coming out about leafy greens and kale and kale, the very healthy food. I would pick organic kale if I were you. What I would ask you to think about is your dietary pattern, Gabe. And so just kind of thinking back and really broad brush strokes over the past three or four days and think about the foods you eat. And I kind of look through that. I look at breakfast and I’d see, okay, am I seeing things like whole fruits or am I seeing eggs? Am I seeing oatmeal or am I seeing muffins and donuts and pastries or no breakfast? Sometimes people are skipping breakfast. I do this often. I’ll have my coffee and it’s kind of getting a groove and I’ll eat later in the day.

Dr. Drew Ramsey: It feels really like a good thing for me, but mostly having having a think about some of the variety of breakfast lunches and dinners. And so I’m looking for that dietary pattern. Where I’m going to start is I’m going to look for food candidates. You’re doing a great job in, but maybe a little shift with health. So let’s say that you really, really are loving, I don’t know, white chocolate pretzels in the afternoon. Right. I look at something like that, which is just empty calories and I go, okay, what do you like, dark chocolate? Do you like almonds? Can we swap that out for a dark chocolate almond and give you the same sweet, crunchy, delicious treat but give you something that’s a little richer? Real hard to kind of binge on in a certain way and has lots of nutrients. Dark chocolate and vitamins and almonds are amazing for the brain. For mental health, almonds are full of vitamin E, really interesting, fat soluble vitamin. The food categories we focus on because we see people have a real problem with them. And the brain food clinic really comes down often to helping people with plants and creativity and enjoying plants in very simple ways. A lot of oven roasted vegetables, helping people with seafood, really challenging food category.

Dr. Drew Ramsey: This is where you get launching omega three fats along with iodine and a complete protein and B12. Really, really great food category. But a lot of people get really concerned and not really well prepared in terms of simple things like making great Caesar salad dressing with real anchovies or roasting some salmon, wild salmon at home or making shrimp tacos really easy things that again, are high yield food categories and then fermented foods. People tend to struggle with fermented foods. There really is a lot of science about this idea that microbiome, all the bugs that are in our gut and a lot of evidence emerging that if we shape and kind of curate a population of gut bacteria that feeds on plants and fermented foods, we do two things in the data. Once they just came out of Stanford, really interesting, showing a real boost in immune status if you eat a lot of fermented foods. There’s also some preliminary data in terms of helping with depression, anxiety, as well as potentially with bipolar disorder. So again, those aren’t the only treatments. But if you’re somebody who’s struggling with those disorders, the idea that the food you eat can help you, I think is really empowering the patients.

Gabe Howard: What about like emotional eating, this idea that something strong is happening in my mind and I’m going to get food to cure it? How do you break that cycle or is it unbreakable? Is there better choices to be made? What would you say to a patient that’s like, look, every time I get anxious, sad, crying, stressed, boom, food. And that’s not the best decision for me.

Dr. Drew Ramsey: Well, let’s say you’re probably more of an expert on that than I am in some ways, because you have the lived experience of it. I would say my, my, my experience with individuals struggling with their mental health, there is a lot of emotional eating. And I think easing individuals into sitting with those feelings and sitting with the feeling not not pathologically of hunger, but if we’re triggered and really anxious and we run and eat a bag of chips to really start unpacking those feelings, what’s going on? What are the alternatives? And thinking about what’s not happening? A lot of times when we eat our feelings, we’re not we’re not really doing what we need to in terms of processing the emotional experience we’re having, fitting that into our own personal narrative and then doing what we need to do in mental health sometimes, which is tough, you know, this, which is we’re having a lot of symptoms or brain’s telling us to do something that we know is not going to help us. And we make a decision to make the best choice for our mental health. And I think learning those skills takes time. The way through is via awareness and understanding and compassion.

Gabe Howard: I really appreciate what you said there about my personal lived experience and really about a patient’s lived experience. Because when I was challenged with, okay, does it work? It wasn’t the doctor prescribing, talking, telling me. It was just a simple question. Does it work? Does the emotional eating work for you and give you the results that you want? My knee-jerk reaction is, well, yes, I feel better. Okay. How long? Maybe. Maybe, maybe 3 minutes. Maybe five. Okay. Well, how many hours are in a day? What are your goals? What do you want? Yeah, I want to feel better all the time. And by asking me to help design both in terms of how I got to the outcome and what I wanted the outcome to be. It was it was excellent. And it is how I’ve been able to stay in recovery long-term, because I’m following a plan where I worked with practitioners who helped me design a plan that worked for me.

Dr. Drew Ramsey: Gabe, that’s a huge point. Anybody who is struggling with a health condition knows. We celebrate your success. But I think you, with your lived experience, also know on a day-to-day basis. Some days are easier than others. And it’s not that every day you spring in a bed feeling amazing and make all the right choices. And that’s where staying in some sort of maintenance treatment is really helpful for people.

Gabe Howard: And by paying attention to it, you can do things to maintain it, improve it, change it, alter it. And I think with food, everybody acknowledges that they eat. Everybody eats, but not everybody is willing to admit that they have an issue with eating or that there is an issue at all. And the way that we seem to determine this is by your looks. If you’re pretty, you don’t have an eating problem. If you’re not pretty, you do have an eating problem. The problem with this, of course, is it’s subjective, right? It’s completely subjective. And we see this in in in eating disorders all the time where people are at healthy weights, but they can’t see it. Is this getting the population in trouble?

Dr. Drew Ramsey: Well, I think there are a few ideas in here. One is around convenience, and I think people tend to like that when it’s sort of when you start feeding somebody very you know, they’ll start sitting at the table. We like to be taken care of. We also like food to be mindless, easy and delicious and fast. We’re so busy that I can I can go down three meals a day in just a few minutes in the modern world. I think it’s also important to separate out some of what contributes to disordered eating and the treatments around that from kind of the notions of nutritional psychiatry. I trained at Columbia and still on the faculty there, and Columbia Psychiatry is really renowned for eating disorders. So any sort of research and treatment which really kind of revolves around sort of distancing oneself from putting values on foods and especially in early treatment, whereas nutritional psychiatry, I wouldn’t say is the opposite, but is really asking people maybe not to scrutinize, but to think carefully about the foods you’re eating because of their impact on your mental health. And certainly, I don’t want nutritional psychiatry in any way to contribute to people having disordered eating. And I think that’s where we really focus on an idea of joyfulness that so often, I think people, as you saying, are receiving food, whether mindlessly or engaged in it with a really it’s the enemy as opposed to food is really nourishment. And there’s a very rich and rewarding relationship for most of us in there.

Gabe Howard: Dr. Ramsay, before we get out of here, I know that you have recipes, and the recipes help with certain things. I believe you call them brain healthy recipes. Can you talk about your favorite one and why?

Dr. Drew Ramsey: Sure. So all of my books have recipes. I’ve been blessed as a psychiatrist to get to write cookbooks. What a treat and what an honor to kind of again, the rubber hits the road. How do you actualize all this advice as a clinician? That’s what matters. I can talk about leafy greens all day long. There are some great ways to help people get them. Often people think, I mean, eating salads, I’m okay on salads. I like salads, okay. But that’s not the majority of my leafy green consumption. We get a lot of stewed greens. Yesterday had some bok choy and a ginger beef broth. I make a lot of pesto and you can make pesto out of all kinds of different greens and nuts and almonds, walnuts, pistachios. The classic is pine nut, basil, garlic, olive oil and a little parmesan cheese. But you can do all kinds of versions of that. From no cheese version to using I use my favorite is a kale basil and then a pumpkin seed and cashew pesto.

Dr. Drew Ramsey: So there’s a pesto formula in the new book, along with lots of illustrations. And then there’s another I really like. It’s a wild salmon burger. I wrote the book in the middle of the pandemic, and so I’d always wanted to know and use canned fish more than I did. I used little anchovies, but I never used much canned salmon. So there are two great wild salmon burger recipes in our house. Make them in little croquettes and they’re just really delicious with a little dipping sauce. Really great way to get those omega three fats. So those would be the two recipes I would recommend. And I hope anybody interested in this kind of information of integrative mental health and how to take care of your mental fitness. I hope you’ll check out more info on my website, DrewRamseyMD.com. I hang out on Instagram pretty regularly. I’m @drewramseymd there, and I look forward to connecting with everybody. And most importantly, no matter who you are or where you are, I just hope you hear my encouragement, my hope for you and your mental health. Food is not the only piece of the puzzle, but nutrition and nutritional psychiatry are certainly important fundamental parts of us taking care of ourselves and nourishing our mental health. And I hope you hear my encouragement to do whatever you can today to take great care of your mental health and those that you care for.

Gabe Howard: Dr. Ramsey, thank you so much for all of your information.

Dr. Drew Ramsey: Gabe, thank you so much. It’s been a wonderful conversation. Yeah, I wish you all the best in your own journey and I really appreciate everything you shared. Really made it a meaningful conversation for me.

Gabe Howard: Oh, you are very, very welcome. And to all of my listeners, thank you for being here as well. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also an award-winning public speaker who is available for your next event. My book is on Amazon because, well, everything is. Or you can grab a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and hey, can you do me a favor? Recommend the show to a friend, family member or a colleague. Whether you share it on social media, text it or just plain old word of mouth, it is very helpful in getting the word out. I will see everybody next Thursday

on Inside Mental Health.

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