Food and Mood: Nutritional Psychiatry, the Microbiome, and Mental Health

Kalea Wattles, ND:

Mental health disorders, including depression and anxiety, are a major cause of disability and reduction in quality of life worldwide. Many people who experience these conditions do not achieve lasting remission from pharmaceuticals or talk therapy alone. In the past 10 years, the practice of nutritional psychiatry has developed to help fill this void. Focused on integrating dietary change into a broader treatment plan that may include medication, talk therapy, and other approaches, nutritional psychiatry has helped many patients.

Uma Naidoo, MD:

But a nutritional psychiatry plate really should have tons of colors on it because the different colors represent plant polyphenols and phytonutrients that are important for your gut microbes. And when they interact with the gut microbes, they produce positive substances for your gut, like short chain fatty acids, super important in mental health. So it's not just the colors, it's what those colors represent and what they mean in mental health.

Kalea Wattles:

I'm your host, Dr. Kalea Wattles, and on this episode of Pathways to Well-Being, Dr. Uma Naidoo joins us to discuss the connection between food and mood and how dietary change can impact the gut microbiome and improve mental health outcomes. Dr. Uma, welcome to the show. I'm so excited to chat with you today.

Uma Naidoo:

And thank you so much, Kalea. I'm really happy to be here and to chat with you. Thanks for inviting me.

Kalea Wattles:

Well, I know that many of us in functional medicine have a personal story. That's really what brought us to the field. We learned out of necessity. And I know that you have a personal story about how you started thinking about the importance of nutrition and health after receiving a difficult diagnosis. Would you be willing to share a little bit about your story?

Uma Naidoo:

Yes, I'm happy to. That was actually kind of the second aha moment in my career, but it happened when I was feeling otherwise healthy, busy running my clinic, which I founded and direct at Mass General, which is the first and only clinic of its kind in nutritional and metabolic psychiatry. I was happily working, enjoying what I do, and was unexpectedly diagnosed with breast cancer. And it really came out of, it certainly was a bit of a shock because not only, I think most people would be surprised by a diagnosis like that, but I wasn't feeling sick. I wasn't feeling different. I was probably working more than I should've been and definitely more stressed than I should've been. But with access, you know, with being blessed with access to great medical care, I went from, you know, finding a lump to diagnosis and treatment in rapid-fire time. And on the morning of my first chemotherapy treatment, I was just really feeling incredibly anxious, and this was new for me. While I treated and helped people in my clinical work for many years, I had not really experienced it in this way. And I, you know, part of it is, of course, I knew all the side effects of the medications I was about to face that morning. And I paused for a moment in my kitchen because my ritual in the mornings, I always make my grandmother's golden chai, and it's something that I love every, you know, every day or as many days of the year that I can have it. And as I was making, kind of going through my little ritual, I thought to myself, "Here I am, I'm facing all of this, and I'm feeling so anxious. Why am I not doing what I teach and help with and practice every single day? Why am I not leaning great, more into how I can help myself with food and nutrition and everything else?" And I realized it wasn't that I was not eating healthy or anything like that, it just was that there was a gap, that there was something I could do, because I couldn't control the medications I was taking. It's a very humbling experience to be on the other side of the prescription pad. And I really acknowledged that and realized, "Well, I'm going to take this into my own hands, and I'm going to eat differently. I'm going to really up my game." And that moment my mindset changed. It was, you know, "I'm going to take this on in a different way, knowing that I have these tools in my toolkit that I share with my patients every day." And I will tell you that during the course of my treatment, which was long, my doctors would ask me every single week, you know, "What are you eating? We know that you bring your own lunch and you pack your own snacks for chemotherapy day." And I would kind of, you know, I would, I was really doing what I was teaching my patients to do, and it was a very powerful lesson because they were absolutely amazed that I incurred little to no side effects. And I do credit it to taking care of myself in that way. And it really became, that work in nutrition and mental health really became a blueprint of my ongoing work in the clinic. But it was a very big aha moment to realize that, you know, I could tap into this, I could do more. I could do it on a deeper level. So that really helped me. And I didn't mean to be my own patient or to be a patient in the whole mix, but I think that it was a very powerful lesson as well.

Kalea Wattles:

Very powerful, and how empowering to have this mindset shift that there's actually a way that you can participate in your health care and not just let health care happen to you.

Uma Naidoo:

Correct, because it's so used, we are so used to being on the other side of the discussion, you know, e-prescribing or giving advice, and it's very, very humbling to be on the receiving end. And when you face this long list of medications and you know the side effects, it's very scary. It's also very humbling. You sort of think, "Well, I have to do this. What else can I do?" And it was then that I realized, you know, why am I not looking at the big picture? I talk about integrative health and integrative psychiatry and, you know, a model of care that is integrated and functional and holistic. Why am I not doing it? So it was a good lesson for me.

Kalea Wattles:

Dr. Uma, I think I heard you say that your diagnosis was your second aha moment. Was there an initial aha moment? I have to ask.

Uma Naidoo:

There was, you know, early on in my career, so I'd always had a very strong influence of food, family, culture, spices, and healthy eating. When I started in residency, I knew I loved psychiatry, and I wanted to go into that. I was really taken aback by the fact that we were not asking, we were prescribing medication that had weight gain side effects and other metabolic side effects, and we were taught all the facts for and against and the risks and benefits. But no one in the room with a patient was asking about what they were eating, what they were doing for exercise. We were asking some social history questions, but that was about it. And very early on as a junior resident in my clinic, I was treating, I was working in a community clinic, and a patient came in two weeks after his first appointment with me. So it was a little soon to see him, but he asked to see me and booked, and he was very upset. Came in and kind of, I wouldn't say yelling, but you know, he was a little gruff, he was a little upset. And he said, you know, "I read about the medication you prescribed," and it was an SSRI, "and it said that it causes weight gain. And here I am struggling with weight and, you know, you caused me to put on this extra weight." And I said, you know, I'll call him Bill. And I said, look, why don't you have a seat. Let's talk about this. That's why you booked to see me." And of course, I looked, you know, looked at the computer, and looked at all the stuff I should. And obviously it wasn't that, you know, two weeks he had gained this weight from the medication. And rather than try to, you know, wrestle with him over when and how, I was struck by the fact that he had a very large, like 20-ounce cup of coffee in his hands. So he, you know, Boston, Dunkin' Donuts is a favorite. He had a massive cup of Dunkin' Donuts coffee. And so I said, "Bill, if you don't mind me asking," as I'm looking this up, "Can you tell me what you put in your coffee today?" And he was like, "Well, you know, I get it at this store every day, and they put, you know, this much cream, and they put that amount of sugar." And so I said, "Well, hold on a second. Let's calculate that." I said, "What you're showing, and if you show me on the cup, that's more than a quarter cup of processed, highly sugared creamer with a lot of ingredients that have stabilizers, colorants, all sorts of things and preservatives." And I said, "And the number of sugar you said from the packets of sugar you described," I said, "That's eight teaspoons. Eight teaspoons is this number of calories. It's this number of grams." It's, you know, I broke it down for him. So while I'm not a massive calorie counter, in that moment, I was able to say to him, "This is, before you even start your day, Bill, this is the number of empty calories you're consuming. And that's even before you eat your breakfast. So let's look at how we can tweak things in your diet." I saw, you know, like it's like a light bulb went off in his head, and that really was my first aha moment, because I realized how powerful it was to give someone simple information that they could actually work with. Because he immediately realized that he could do something, and he didn't require a pill to do it. It was just a habit change. And while it's not just a habit change, a lot more goes into that, he was willing to make that adaptation. So we worked together to tweak things in his diet. He still enjoyed his coffee. Was there a healthier way to do it? You know, and we ended up having a really therapeutic continued relationship, and over time, he didn't need a higher dose of medication. In fact, he started to lose weight because we really actively worked on it. And that honestly was like my, without knowing it, almost a test case of how powerful this can be when you can show someone some simple ways to do it.

Kalea Wattles:

Well, I so appreciate how you highlighted that you helped this patient discover an awareness of how their food was affecting their body. But you didn't say, "Stop drinking coffee and stop doing these things that bring you joy." You said, "How can we modify this behavior so that you still do what you love, but in a way that's more health supportive," which I just find to be so sustainable. And that struck me about your approach in that moment.

Uma Naidoo: 

Thank you, the whole idea is that, you know, there's a reason that they don't have reunions of the very famous and sort of reality TV shows about weight loss. A lot of those individuals, and I say this with immense respect and empathy, you know, they lose the weight, but it's not sustainable. And I think that finding lifestyle changes that become a part of someone's lifestyle habits are the only way that we can adjust our nutrition. Because when you present people with a protocol or just something that they have to do, and they have to do it overnight or they have to give up these foods and exclude stuff, it becomes very hard, and they tend to not do it. They do it in the short term, and they can have some even positive gains, but they can't sustain it.

Kalea Wattles:

Right, well, based on these light bulb moments you've had with patients and your personal experience, I'm starting to see this picture emerge of how you became so interested in this food-mood connection, and I think it's so fun. I've seen you described as a triple threat in the food and health space because you're a Harvard-trained psychiatrist, but you're also a certified nutrition specialist and a professional chef. What a well-rounded combination. Can you tell us a little bit about how these different training areas really inform your current clinical work?

Uma Naidoo:

I would, thank you for that. I would love to say that I had a grand plan in life, but in all honesty, you know, I was a preschool dropout. I insisted on staying with my grandmother. I just refused to go to preschool. But also, that was a very important part of my food journey. Food was also always a very strong influence in my life, and I learned to cook later in life because I came from a large family, and there were many cooks, literally many cooks in the kitchen, and so I would hang around shelling peas and doing all sorts of stuff. I knew it was important to me. And as I learned to cook as I was studying, the great influence on television, of course, I was, you know, not able to afford cable television, so I would see Julia Child on "The French Chef," and I loved it, and I was immediately attracted. So I'd be studying away and watching her. So there was that influence, and I at a certain point in my career realized, you know, when I read about her life and her biography, she had gone to culinary school later in life, and it was actually her second career. Many people don't realize that. And I thought, "Well, I'm doing something I love. Why can't I also, what's stopping me from doing, you know, cooking? Why can't I do that professionally?" And that's really what drew me to culinary school. So it wasn't a plan that these pieces would come together, but as my work evolved, I realized that I was probably in some unconscious way putting the pieces together of what I really cared about, because I knew there was this gap that doctors have. We don't study nutrition, so if you need to know nutrition, you've got to go outside of medical school. Because about 20% of our schools at the moment, from my last check, I mean there's a lot of advocacy that I'm involved in going into trying to change this, but at the moment it's not as though you learned that much nutrition in school. And although there wasn't a grand plan, these pieces of my life really came together and ultimately led to me founding my clinic at Mass General and putting this work into practice. But alongside that was also the emerging science and research around the gut microbiome.

Kalea Wattles:

Yeah, well, I'm starting to hear these little pieces. You said you didn't want to go to preschool and stayed with your grandmother, but it seems like that was important because then you used your grandmother's chai recipe. So this was really informing your journey and your love of food and health.

Uma Naidoo:

It really was. She was much more fun than preschool. You know, she and I would have much, a lot of fun together. A lot of it involved, you know, some of her preparation of food, but I would be around, not doing so much because I was so little, but I was around that environment, and we'd have these really entertaining conversations, and I would ask questions, and you know, if we were picking vegetables in the garden, I would be like having, I'd have a hundred questions about what we were doing. So it was actually much more richly informative of my life and career, but it is kind of funny that, I still say to my parents, I still say to my mom up till today and my late dad, you know, "How did you let the little, like a little peanut get away with it?" You know, I would just refuse. They were like, "Well, you loved your grandmother, and she really loved having you, and we knew you'd learn so much." You know, "You wouldn't suffer from being a preschool dropout," as I like to say.

Kalea Wattles:

Yes, school of life, that's beautiful. And I'm so fascinated with this connection of taking these cooking skills and food preparation skills and applying that to our nutritional recommendations. I did my undergraduate degree in nutrition, and part of that was culinary training. And I realized how it's easy to say eat vegetables, but if someone doesn't, or they believe that they don't like vegetables, being able to say, "Well, add fat and cook, use these cooking methods and add herbs and spices," and having that contextual framework is so helpful when we get to the implementation stage.

Uma Naidoo:

It's so true, and just being able to interpret a simple thing. I had a very high-profile executive that I was working with, and he said to me, you know, he loved to cook, and oh, he wanted to cook. He didn't know how to, but when he did learn, he loved it. You know, he said, "I hear about avocados all the time, but I don't know what to do with them. You know, and I know they're healthy." So we can't assume that if someone even has access and they know what to buy that they know what to do with it. So I think that just being able to interpret a recipe, simply explain to someone how to make that chai tea or how they can add some spices to something to liven up a, you know, a dish that they know how to make but make it different is so powerful, too.

Kalea Wattles:

So powerful. We've heard you described as a nutritional psychiatrist. Can you explain a little bit, if that term is new to anyone, what does that really mean?

Uma Naidoo:

Yes, of course, a nutritional psychiatrist is a more nascent area in psychiatry. I'm excited to say, though, that it's really gaining traction, and nutritional psychiatry is the use of healthy, whole foods and nutrients to improve your mental well-being along with any other forms of treatment that you may be involved with. So it could be talking therapy. It could be medications that your doctor's prescribing. It's really meant to partner up with any other treatment that you are involved in. And it's meant to provide an additional tool and toolkit for many individuals who, like my patient Bill, just wanted to be able to do more to feel better. They may not know it, but they're looking for more solutions. Like in functional medicine, we always look for root cause, or we think, really think out of the box about someone's care and how can we truly find a solution for them that is sustainable. So, in a similar way, nutritional psychiatry wants to offer these enhanced ways of thinking about the food-mood connection to improve mental well-being.

Kalea Wattles:

What I'm really learning, as I hear you speak about this, is how there's certainly this benefit on our mood and our mental health, but I can also see how making these dietary changes has a benefit that rolls into prevention of many other chronic diseases. So it's almost, it's really powerful that someone might access care because of their anxiety or their depression, but it gives us this point of contact where we can shift their health trajectory and prevent all of these other downstream effects. So just wanted to commend you for the work you're doing because I think it's…

Uma Naidoo:

Thank you.

Kalea Wattles:

Really rolling into so many body systems, and I think that there are some pillars of nutritional psychiatry, and I'd love to learn a little bit more about what that looks like.

Uma Naidoo:

I would love to share that, too. I just want to respond to something you said, because I think it's hugely important, and I appreciate it. You know, someone said to me in passing recently, "Well, you know, the work that you do in nutritional psychiatry, it sort of helps all conditions, and it's sort of a generic improvement for people who have medical conditions or mental health." And they were sort of misunderstanding conceptually that there's so much developing and ongoing research and science behind actual types of food and improvements in mental health symptoms. Because to your point, the benefit of working on a nutritional psychiatry treatment plan also will help other conditions because you're eating healthier, you're paying attention, you are naturally learning portion control, how to eat healthier whole foods versus processed foods. And so many things, we see so many parameters improve, but it also uplifts and improves your mental health. So it's not just this, you know, it's not a blanket effect. So I appreciate you saying that. So to answer your question about the pillars in nutritional psychiatry, I narrowed it down to principles that can really help people with how they can improve their mental health by instituting principles that they can practice every single day at every meal and that are easy and sustainable. So the first one is eat whole, be whole. And here, you know, it's the idea of skip the orange juice in the store but actually eat the orange, because that has the vitamins and nutrients, all of the fiber that your body needs, whereas the store-bought orange juice has the fiber removed and a lot of added sugars. The next one, the next pillar is to eat the rainbow, which is really, we hear about these colorful foods that we should be eating on our plate, but a nutritional psychiatry plate really should have tons of colors on it because the different colors represent plant polyphenols and phytonutrients that are important for your gut microbes. And when they interact with the gut microbes, they produce positive substances for your gut, like short chain fatty acids, super important in mental health. So it's not just the colors, it's what those colors represent and what they mean in mental health. The other one is the greener the better. Now, I get the eye roll a lot of the time when I talk about this because people feel, you know, "She's just asking me to eat more salad." But leafy greens are rich in folate, and low folate in the body, it's vitamin B9, has been associated with a low mood. So, so important to be eating the leafy greens so that you actually can improve, you know, over time build up the folate levels and help your mood. Another one is consistency and balance are the key. And this is where I talk about the 80-20 rule. So you know, 80% of the time we're trying to eat healthier options, make better choices, and 20% of the time, we may, you know, not, we may come across a cupcake if we went to a child's birthday party or we have a celebration going on. But if we can actually balance it up with being consistent and finding that we have a routine that works for us, that becomes important. So, you know, don't regret something if you go out with friends and you end up ordering some French fries. Enjoy it but then move on knowing that you can correct, course correct to a healthier option the next time. And then the last one is avoid anxiety-triggering foods. And the reason I say, I have that pillar in this because so many people don't realize the foods that they are eating, which could be impacting a symptom like anxiety. And so just like I did with Bill, just cleaning up, you know, the amount of sugar someone's consuming, processed creamer and all of that, becomes so hugely important.

Kalea Wattles:

I really appreciate how these pillars are so approachable, and I think parents of young children like myself are rejoicing to hear if we make good choices most days, when we encounter the cupcake or the pizza party, it's okay in that 20% window as long as we're making consistent good choices. So thank you for highlighting those pillars. Are there some conditions that you tend to treat most often using this nutritional psychiatry approach?

Uma Naidoo:

You know, I would say that the conditions, I see all types of patients in my clinic, but the more common conditions that I'm seeing so much these days are individuals struggling with depression and anxiety, which often can run together, so a little bit of mood, problems with mood, and you know, a lot of anxiety that's been going on in the world. So I'd say those are the most common, but people are also concerned about their cognition, wanting to eat for better brain health and brain focus and attention. So all of that are definitely the more, fall in to the more common category of people that I'm seeing.

Kalea Wattles:

We've talked about utilizing some nutritional interventions for supporting those who may be using medications or talk therapy. Are some of these foods, can we also apply them in a preventive medicine way to really help set ourselves up to avoid some of these mood disorders or mental health disorders later in life?

Uma Naidoo:

I think that, you know, for me, the best way to answer that question is sort of assessing where someone is at and seeing what they can do to really fine-tune their nutrition plan, and how can you up your game like I did just before treatment? I was generally eating healthy, but I really tapped into the spices that I knew, those fresh vegetables that I really needed to nourish my body. I just cooked them more often, because you have to be a bit more careful, started to make smoothies. Now, smoothies are, you know, if made healthily, they definitely can be something you have once in a while. You shouldn't, in my opinion, you shouldn't be depending on them every single day. But I used things like that. So teaching people, understanding where they're at and then teaching them tweaks to what they're doing and then offering them things they can implement, maybe it's a smoothie recipe, maybe it's making a tofu scramble or an egg scramble in the morning loaded with veggies, finding ways that they can improve upon something they're worried about is usually key. And most often someone will come in and say, "Well, you know, I'm really worried because I don't have time to eat breakfast, and by nine o'clock I'm so hungry, I go to the office, and I have three cups of coffee and three donuts." You know, they usually know something that's not working for them.

Kalea Wattles:

Right, and I've heard you speak in other venues about the stress that our food anxiety can cause and how that's not good for our mental health and our mood and our cognition, either. So, like you're saying, gaining these skills that help to remove some of these obstacles that you've been worried about, if you don't know what to eat for breakfast and now you can learn these kind of simple, modifiable behaviors, that's helpful on a number of layers here. Are there some culprit foods that you see most often, really there's a benefit when they're eliminated from someone's diet, we see a positive impact on food or mental health?

Uma Naidoo:

Sure, you know, you're not going to be surprised by the fact that I'm going to name the added sugars as a food that's not great for your brain cells, your neurons, your brain health, your mental health. But what I often find is people don't realize savory foods have so much of added sugar, things like ketchup, certain brands, store-bought pasta sauces, store-bought salad dressings, and it's the added sugars. Like, I've often, people will hear me talk about blueberries and buy a blueberry fruited yogurt. Now, in a half cup of blueberry fruited yogurt, you can have upwards of eight teaspoons of sugar. So people fall into that trap not realizing, yes, plain yogurt, if you consume dairy, can be rich in probiotics and great sources of some nutrients for you. But if you add that in the fruited version versus just have plain yogurt at home and adding berries, totally different product. So these are the little traps that they fall into. Another one is unfortunately moving, making a really concerted effort to come off sugar-sweetened beverages and soda but then going to diet soda, and the artificial sweeteners in diet soda can be very disruptive to the gut. So just having people understand that these are things that are pretty much are big culprits. It's not just sugar, it's the sugar you realize isn't, you don't realize it's in certain foods that you're eating. You know, when you are eating candy or cake, the sugar, but we don't really realize the amount of sugar in things like that glass of orange juice versus eating an orange or that half a cup of fruited yogurt.

Kalea Wattles:

Or your cup of coffee that you've been drinking, right?

Uma Naidoo:

With the eight teaspoons of sugar. 

Kalea Wattles:

Right, on the flip side of this, are there some foods that are your favorites, you keep them stocked in your own kitchen, that you recommend because they tend to be helpful for mood or mental health?

Uma Naidoo:

I love keeping, having a good stock of fermented foods that I can pull from because I love the flavor, the taste. So I always keep some in my fridge. And just a little tip, if you're purchasing them, buy them from the refrigerated section, because it's all about those live active cultures. So I like keeping fermented foods that I will add a little bit to every meal. I love having a, always having a stock of leafy greens and colorful vegetables, you know, sweet peppers, you know, carrots, zucchini, eggplant, all sorts of vegetables that I can pull from during the week. And I try to do a day or half a day of food prep for the week, which makes it easier. And I say to people, you know, you could, that could be Sunday to someone and Wednesday to another person, but if you put aside the time, you'll prep those foods. I always have on hand nuts and seeds. So I have hazelnuts, macadamia, chia seeds, walnuts, things like that that I can make chia pudding or very easily convert into some type of food that I love. So it helps, always stocks some basics, and because I'm vegetarian, I always have, you know, organic, non-GMO, a block of non-GMO organic tofu, some tempeh in the fridge, all things that I can use if I'm hungry.

Kalea Wattles:

The theme I'm hearing is that you keep it pretty simple.

Uma Naidoo:

You have healthy ingredients that are ready to go. I keep it super simple.

Kalea Wattles:

And it doesn't have to be complicated.

Uma Naidoo:

Super simple, yeah, super simple. I love to cook, but I also am super busy, so having things on hand like celery, you know, chopped into celery sticks, I can just grab a little bit of nut butter and have that as a snack. So it's easy and ready to do, but I know I'm nourishing my body and my brain, and it's not going to take a ton of time when I'm busy.

Kalea Wattles:

Right, well, clearly, I think we're convinced nutrients have a direct impact on the brain and our mental function, but now you've mentioned a couple times this potential impact on the gut microbiome and the influence of the gut-brain axis. Will you share a little bit with us about how our dietary choices can influence our gut microbiome?

Uma Naidoo:

I would love to. So the gut and brain originate from the exact same cells in the human embryo and then they divide apart, form these organs, divide apart and on two different parts of the body, but they have the same origin. Then the gut and brain remain connected by the 10th cranial nerve, which is the vagus nerve, and this wandering nerve in the body connects these two organs, but I also like to say it acts like a two-way text messaging system, always messages transported back and forth up and down all the time, and these are chemical messages. Now, when you think about that, so these organs originate from the same place. They connect, remain connected, but they also remain biologically, physiologically, and biochemically connected because the 90 to 95% of serotonin and the receptors are in the gut. Some is in the brain, but there's a very large component in the gut. So chemical messages are being transmitted up and down in the gut-brain ecosystem all of the time. So I like to explain to people that when they eat a healthier food, when they're eating that healthy meal, the breakdown products of digestion help and interact with the gut microbes. They feed the gut microbes. They help them form positive substances, in the breakdown products, things like short chain fatty acids. So, for example, those plant polyphenols are one example as well. And those breakdown products are helpful and healthy for the gut environment. They're anti-inflammatory. They are antioxidant-rich. But on days that you, you know, are eating a fast-food meal and that's maybe what you're subsisting on, the breakdown products are more toxic to the gut. So they interact with those gut microbes, but the breakdown products are toxic and start to damage the single-cell lining of the gut and start to damage the entire junctions and start to cause leakage over time. And that's how you end up with conditions like leaky gut, intestinal permeability over time and inflammation and dysbiosis in the gut. So it's, you know, it's more complicated than that, but if you just look at the ability to eat a healthy food or less healthy food, that's the effect on the gut. Now, where the research is at is in terms of understanding how these gut microbes affect our health, our mental health, the strains that are more, you know, more prevalent and more important for us and things like that. But it's an exciting area of research that I know will help us even further define our recommendations moving forward.

Kalea Wattles:

Incredibly exciting field of research, and I can't wait to see what happens over the next five or 10 years. Do you find that a large percentage of your patients who are experiencing mood disorders or really need support with their mental health have gut dysbiosis or something going on in their GI system?

Uma Naidoo:

A lot of them do, a lot of them do. And often, you know, just symptomatically, I'm hearing symptoms that over time they've actually developed dysbiosis without knowing it or without realizing it. So the gut-brain connection is one of the mechanisms that we understand in nutritional psychiatry. There are others, but this is the one that I feel is so linked to that food-mood connection because people can actively make a choice about what they eat, actively include certain foods and spices in their meals and start to improve that gut dysbiosis.

Kalea Wattles:

Absolutely, and do you find as the gut microbiome becomes more diverse or more healthy that mood symptoms naturally improve?

Uma Naidoo:

Yes, as you notice, as you heal the gut microbiome, as you heal that dysbiosis and attain a greater sense of balance in the gut, you will see people improve anxiety, have a better mood, be able to function at a better level, have better focus. It's really wonderful to see.

Kalea Wattles:

Wow, yes, thank you for sharing that. I want to talk a little bit about how we could personalize this approach, because in functional medicine, that's always our goal is to really tailor our treatment plan to the patient in front of us. So for someone like me who's in primary care who might be listening, do you have any tips or tricks for us about how we can apply the concepts of nutritional psychiatry in a way that's really tailored to that patient in front of us?

Uma Naidoo:

Yes, I feel that understanding what that patient eats and what they enjoy, you commented earlier on, you know, not asking people to give up something they enjoy, but to rather take that and tweak it in a way to make it healthier, a healthier option for them. I think a lot of it has to do with what someone is eating actively. So unless they come in and all they're eating is French fries and fast foods, if they're eating, you know, if they're trying to make some healthy efforts, maybe honing in on what they can improve. So personalization, not only, let me also say personalization can be done in many different ways. One can be testing. You know, one could be looking to see if there are nutrient, mineral, or other deficiencies. One could be looking at the gut microbiome through gut microbiome testing, but there are different forms that we could do this. But if we're looking to personalize it just in a nutritional way, I think working with someone, their conditions. For example, I had someone, a patient who came in for anxiety. She was also an insulin-dependent diabetic. And what we found is by improving her diet, which the purpose she came to see me was to help anxiety, so working and tweaking her diet not only improved anxiety, but her endocrinologist contacted me and said, "You know, I can lower her insulin after years of struggling to stabilize her blood sugar." Now we know there's this connection between mental health and metabolic health, but that is one of the first few cases I really recall seeing that so beautifully be displayed in how she did. But that was involving personalizing the treatment plan. Because she was diabetic, there were certain foods she could eat, certain foods she really had to stay away from, but also she had an issue with anxiety. So I had to put together all of those factors to come up with the right plan for her.

Kalea Wattles:

Right, so it's really about what the patient needs in that moment, their medical history, their preferences, and putting that all together to create a treatment plan that they will actually feel drawn to implement.

Uma Naidoo:

And want to implement and find, you know, easy enough to implement. I also developed, and we just released a course in, which is the first primary nutritional psychiatry, it's an online course for clinicians to be able to really learn the basic tools to start working or integrating principles of nutritional psychiatry. And so that course is available online at Mass General and is intended for clinicians to be able to really have their first brush with nutrition and mental health and understand the principles.

Kalea Wattles:

Oh, very good. We're always learning and integrating these new tools. As I've listened to you talk about the power of nutrition, I'm thinking about how these skills and these values that we develop around food can really roll out into our community, into our family systems. And I have young daughters, and just thinking about how I can show them the power of nutrition from an early age, and so I wanted to talk a little bit about the pediatric population, because it seems like we're experiencing this rising level of depression, anxiety, other mental health issues in children. Is there anything you can tell us about how we might be able to help our younger patients integrate nutritional psychiatry principles?

Uma Naidoo:

You know, I think it's sort of, for me, it starts, again, in the kitchen, but I think that when and how children are exposed to and introduced to food becomes important. And rather than having them be, aside from the experience of preparation of food, purchasing of food, including them, the experience from early on becomes key. Helping them choose different colors of fruits and vegetables, guiding them towards healthier choice. So, you know, instead of the candy that's multicolored, why don't we apply that same principle to vegetables. Helping, having them help, like really drawing from my own childhood, helping them help with food preparation that's simple and safe, shelling peas, you know, pulling the ends off carrots, whatever it might be that is safe for them to do, but really has them feel and be a part of the food experience, helps them learn to enjoy it and then a sense of accomplishment when they eat something that they've helped prepare. I think that those initial principles are important, and if we can do them and if we have the ability, I think that's great because we do know from neuroplasticity the brain can change. We know that a child's brain is developing. We know that it is very, very influenced by environment but also by nutrition. And so feeding their young and developing brains with the right nutrients becomes incredibly important and key. So those are some things that I like. And also helping to devise recipes, which is simple and straightforward, but making them colorful and fun for kids. So, say they love French fries. Can you make zucchini fries in an air fryer? Can you make carrot fries that are colorful? You know, something that's fun for them to enjoy, but it's actually incorporating healthy food as well as making it tasty for them. You know, and as they grow to teen years, having them really be part of that food experience in the home as much as you can I think becomes key as well, as much as they'll be interested and want to do. But I think that's one good way to start them off.

Kalea Wattles:

Yes, well, Dr. Uma, I'm so glad you remained under the mentorship of your grandmother because I think it gave you all of these insights into how to apply these things today.

Uma Naidoo:

Correct, and I think she'd be happy with where I ended up despite not going to preschool, so thank you.

Kalea Wattles:

Well, we've had such a rich conversation about nutrition and the connection with our brain health, our mood, our mental health. Is there a clinical takeaway as we wrap up our episode today that you'd like our listeners to take away from this episode?

Uma Naidoo:

Yes, I always love people to realize that we, as in ourselves but also the patients that we treat, the power is at the end of our fork. And if we just remember that and integrate that more often, we realize how powerful every bite of food can be and how it can work for our better health but also our better mental health.

Kalea Wattles:

Beautifully said. Thank you, Dr. Uma, for sharing your insights and your experience with us today. It's been just such a pleasure to chat with you

Uma Naidoo:

It's been so lovely to talk to you. I look forward to keeping in touch. Thanks for having me.

Kalea Wattles:

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