Nutritional Psychiatrist Shares Diet Mistakes that Cause Depression and Anxiety | Dr. Drew Ramsey

And the number one cause of disability according to the World Health Organization worldwide and now in the US as of 2020 before the end pandemic is depression. Hey everybody, welcome to another episode of Health Theory. I am here with Dr. Drew Ramsey who's an author and one of my favorite things in the known universe, a nutritional psychiatrist. Dr. Ramsey, welcome to the show. Thank you, Tom. I love that nutritional psychiatry is one of your favorite things. We're finally calling it that. We're a real field and it's really great to be here, dude. Man, my pleasure. And as I look around and think about what's going on right now, especially, but just in general, the mental health epidemic really terrifies me. And as somebody who's an active clinician, what are you seeing right now? Like, is this a time where things are ratcheting up or do I have a delusional view? You're absolutely right. There's an epidemic. I mean, everything's going up. Depression is up. We've posted some statistics on our Instagram about a study recently showing male depression up 60 70%. What time period? That's over the last year. So what can we do to keep ourselves mentally fit and what can we do to save off depression? And that's where nutritional psychiatry comes in because really to date along al along with exercise, but really the nutritional psychiatry data is the most compelling and the strongest because like you're already eating and in terms of an intervention from public health, that's awesome because we can shift that. But but food and nutrition, there was a study that came out of Vietnam uh that looked at over 10,000 people cross-sectional studies, you know, not the strongest data, but but strong data in terms of looking at a correlation between nutrition and depression for people who went into quarantine. And they found that the risk of depression during quarantine, if your nutrition is bad or the worst compared to the best, it went up over 1,000%. Oh god. So exactly. So this gets to an interesting intersection that drives my fascination with this which is all right as somebody who struggled with anxiety I can tell you diet exacerbates it but I still need a trigger of some something of an emotional nature. So it becomes really hard to tell is this something that I ate or you know have been shifting my microbiome over the last month in a direction that's not very useful or is it I'm just freaked out about this thing. How do you help people begin to tease that out? I think that's the question that we're in and and that nutritional psychiatry tries to help people sort out because it can be all of those things. I am first and foremost a therapist. I love long form listening to people's free flow unconscious and helping them find the meaning in it and the purpose in that. So when you tell me there's a your your hum of anxiety, I would say one that's probably one of the reasons you're quite successful. It's a I wrote a piece for men's house called your anxiety is your superpower and and and I think that's true for a lot of people and then when it perks up is you know I would say part of you taming or mastering or say riding your anxiety is you find the meaning in that right and so that's one reason it goes down then there's that what I consider more biological anxiety you wake up in the morning with a panic your heart is racing now again that can be psychology there are things that do that to us that freak us out whether it's grieving or loss or parenthood or intimacy. I mean that that happens. But there's something when it's biologic that we we really feel and that's where I think food really does play a role. If you think about your brain is the lens through which you're filtering all this data, right? Is is the lion on the screen a line on the screen or is it actually in the room with you about to eat you? Your your brain is very good at sorting that out. Um and and if we think about the quality of that lens really being influenced by a few things or a few processes one you mentioned like the microbiome that's really talking about inflammation right how does this word of inflammation affect the brain if we think about it in terms of my favorite concept these days neuroplasticity right brain growth and and brain change over time uh definitely food influences that there are bunch of uh specific you know molecular mechanisms where we can see that now and so that's How I think about the way that we try and sort that out is thinking, have there been changes in your diet? Sometimes I'd eat zezy. People are like, "Oh my gosh, my anxiety is so much worse." It's because I'm just I freaked out. I'm just eating comfort foods. I've eaten pasta for 3 days. I haven't had a vegetable. I'm just drinking soda again or I've had a bunch of One of my patients is having a problem sleeping and really nervous. And she's scolding me. She's like, "You know, you say you're a nutritional psychiatric. You haven't asked me about my food in a while." And I was like, "Touche." I was like, "Good point." And she's drinking like six cups of coffee a day. And and not that like bad bad you coffee is bad. I don't believe that's not nutritional psychiatry. That's what separates us from everybody else in the food advice business. You love coffee. Great. I'm going to figure out how to make coffee work for you, Tom. I mean, but but more of Do you ever try to put limits on that though? Cuz I when I hear you in particular talk, you are so kind and so like, hey, you like uh ice cream and coffee. Like we're going to find a way to make ice cream and coffee work for you. Avocado. That's like one of the best desserts. the espresso over ice cream. I love that. Isn't there a point though where that like makes it so hard to to actually address the problem that you without judgment I'm not saying they're a bad person for doing it but that it's like if somebody comes to you and is like man I'm really tired of having a broken hand and you're like yeah I'm no judgment on you hitting your hand with a hammer but maybe we should stop that like that's how I really think about even in my own life for instance dude you can't imagine how much I love those white monsters they're calorief free And I used to drink three a day plus two diet cokes and it was glorious. You lost a lot of weight. I was so lean you can't imagine. It was amazing. One of the most successful periods of your life perhaps. It actually was one of the most successful periods of my life but it was my anxiety was through the roof and I didn't at the time like correlate the two. So now that I can see literally if I drink a Monster, I can feel that the sense of anxiety start in my belly. It's so weird. It's weird that I didn't notice before, but like the thought of trying to eliminate my anxiety without eliminating the drinks seems next to impossible. Can I help you change via kindness, via being a hammer? Please. Yes. And and I think that that it's a really good question. And I think some people do need the hammer. I think in in the wellness and food world, that's fear that I'm going to get you to change because I'm going to tell you about the toxins in your diet. I'm going to tell you how you're shrinking your brain. I'm going to tell you how you're in some ways broken. I just think that's probably what you're sensing is I'm a I'm a clinician and I just sit with real people and real patients. You see somebody who's come in and they're on a bunch of strange supplements and eating really weird food and they have a lot of bad anxiety. I do hear what you're saying and you're right. There are foods that people do need to cut out of their diet. Diets need to drastically change. I don't want my kindness to any way um any way obscure the laser-like disdain I have for the modern food scape, for how much it's crippling our health and mental health, for how ridiculous it is that we um focus on the healthcare crisis without the food crisis. There's definitely things that I want people to do, but I want it to come from them because that's what I believe I believe creates lasting change. That's in some ways what the new book is really feel what's different is really asking people will you please stay uh take a step back from whether kale is right for you or not or whether you should take a fish oil supplement or whether you should eat keto and just can we think about you as an eater? Like what is like where are you from? like what does that mean to you? What do you like? Are you trying to get at something emotional there or are you trying to get at um like a lot of people will say whatever your ancestors ate, you're going to have a microbiome that's tuned to that of a feeling. You're talking more emotionally here. You know, I'm talking to both of those things. Our ancestors had different microbiomes because they led a more dis uh natural lifestyle both in terms of food, in terms of sleep and you know lots of lots of good things for your microbiome in in the ancient world and in the modern world on the right types of farms. Um I think the emotional part is really important because it's why diet culture fails and it's why diets fail. It's because while people look towards advice and expertise over time, natural psychological maturity and development requires us to create our own stance. So you Tom are your own eater. You're your own kind of searcher and explorer of culinary space based on your values. You know, I hope um part of people moving beyond some some of the symptoms of depression and anxiety and how those end up relating to food really comes to to people giving themselves a more accurate diagnosis and and instead set of motivations. Okay. So, let's go through then some of the things that are actually triggering that. And what I want to do is say, okay, that we're beginning to in your field of nutritional psychiatry, we're developing for people old enough to remember this reference in Wheel of Fortune, there was a final puzzle that you had to solve. And nobody wants to look like a jerk. So everybody started guessing the exact same things. R S T L N E. Those were the letters. Everybody picked it. So finally the show cotened on to the fact that everybody picks the same letters. So, let's just give them the RSTLNE. And then now we're gonna let them choose a few extra things. We're going to pick a puzzle that we know they're going to get all of the RSTLNE, so it better still be difficult. So, I want people to that's sort of the basics, right? Cut out the sugar, don't excessively drink, um you're getting most of your protein from fish, lots of veggies, eat the rainbow. That's sort of our RST LNE. Now, one first before we go on to the additional things that we're going to add, why does that matter? Why is that are sort of the the main thing that most people in your field are going to agree on? We're going to agree on that because it's going to do a a few things that we think are going to help in terms of mental health and brain health. Specifically, eating in that what you're describing is a dietary pattern. And I think we should just call it a traditional dietary pattern because Mediterranean I think is I think it's in some ways like not being woke and and I don't mean that about you. I just mean that in all of us like every healthy diet we're like Mediterranean and it's like okay like that's one studied but the same data at least in mental health exists for the Japanese diet for the Norwegian diet for a traditional diet. Oo then give me how are you defining traditional? Is it whole foods in the way that your ancestors just ate it and then thusly whatever that is across all cultures should be relatively good or is there something else lurking in the word traditional? I think there are a few things lurking in the word traditional. I think traditional foods um one had to be grown reasonably closely and and you didn't do much with them besides cut them up and like sauté them, right? Or or or boil them together. You were more efficient. You valued your food more. I mean, anybody listening who's grown their food, I I I try and grow some of our food, you walk out and like, wow, that that crop was there yesterday, then the bugs ate it all. You know, it it just it was this moment of like, wow, to not to fail at this and then go hungry is something that none of us really experience anymore. So, I think the things that exist though, your question, the traditional diet is one, let's just talk about what's not there. All that, you know, those dietary principles that you talked about, they they're not there. uh they are lacking of course ultrarocessed foods. So everybody says these are evil just quickly because I think everyone knows the reason I think they're evil is in the way that they tend to increase inflammation and inflammatory markers that's bad. And when we think about things that people put in food that we have a response to like I don't know carrageenan or food dyes or um preservatives or pesticides it's just stuff that we've never eaten before in mass quantities and there is some physiological artificial sweeteners okay it's not sugar but your body is like wow sugar kind of right I don't think that's probably good for your pancreas and so uh so traditional diets are missing all of that stuff they're missing seed oils and vegetable oils and the ways that we eat them. The major we say the most Americans eat fat and sugar. What that means is glucose, liquid sugars, right? Which again leads to an insulin spike that leads to us adding on visceral ataposity and fat. That is not just storage energy. That is metabolically active tissue that also produces and creates and makes inflammatory factors. By going traditional, you cut a lot of that out. You cut out trans fats. There are no all trans fats. There's vicinic acid um and there's CLA which are are two kind of trans fats that are really interesting and probably healthy. But in terms of an all trans fats like we have in parts hydrogenated cotton seed and sunflower and safflower all these oils, you don't find those in nature. So you don't find those in traditional diets. And and so that's that's the stuff that gets cut out. The stuff that gets in there, you just mentioned all of it, right? You just get more nutrient density. You get more phytonutrients. You get more diversity of plants. to get more diversity of animal proteins. Sure, you get more seafood, but you also get more bone broth and you get more marrow. And um so I think those are all the reasons traditional diets tend to win. And then there's the part I talk about this in the book. It's the last step. I'm just going to give it away of our six week plan or my six week plan because you have to make a plan, right? Um uh it is not about a food. It's about you connecting to your food roots, your food community. Because the other thing that changes in traditional diets is you know who makes your food and you share your food. I mean Tom, you tell me why you think that matters. Like what's the difference for you when you sit around with a group of people and you cook something together or a farmer gives you a box of food or throws in something extra versus eating alone like slamming slamming your monster drinks. Okay. Well, so let's not let's not quite go there because that one I will say is I could sit down with all the people in the world and we all share a monster and it's still going to be problematic. So I'll go to the beginning part of that question which is really interesting and this is somewhere you and I differ and that's why I want to ask you about your horses because I'm incredibly intrigued. All right, there's two types of people in the world. 98% of the world are forest bthers. They love to go walk in nature. Oh my god, it's amazing. and it really does something to them psychologically. Then there is 2%. I'm obviously making these percentages up, but there are city bthers. Now, nothing makes me feel more creative or alive than a big city. I love being in New York. I love being in Tokyo. Um, so I may find that what you're trying to explain to me is the missing piece of my puzzle, but I don't have the intuitive connection. I don't seek out farmers markets. That doesn't hold any interest to me. I don't care who the farmer is that gave it to me. I don't care where the food came from. If if it tastes good and it's good for me at a cellular level, I'm all about it. So, it is interesting to me. Yeah. T I mean, I'd love I'd love if I could be a part of a piece to uh or missing piece of a puzzle for you. I can tell I can I can tell you some of my associations and and I'd love to know more about you because one I I think it's important to honor that there are some people who just for whatever reason don't like these things and and and and I think we pathize that you put yourself in the 2% right it's almost like the 1% like the people who don't like nature like I don't like the forest bathing what I always think is interesting as a psychiatrist I think that the tone that you're noting is my curiosity of like what what that means to you like when that started and also like how you've learned about it. And so I'd be really curious for you of of any of those experiences like in nature that are good. And I think also we make this artificial. I love that thing you're talking about too. The city has been amazing for me. I've written four books in the city. I've become a psychiatrist. I've I have friends. I love to stay out late into the night and watch all of what happens as you mash people up without any of the inconveniences of nature. Now, I wonder if part of why it's not appealing to you is it's inconvenient. I've been living on a farm for the whole pandemic. I I look like I have some issues. I'm covered in cuts and scrapes and and scars. I've been attacked by a rooster. I've um struggled with a new tractor. Um I it's it's very inconvenient. It's very hard to grow food. It's very hard to be close to nature. But by not caring at all about where the calorie comes from, you're really kind of in that alpha predator status in some ways that I just I I mean that's true about us. And I think there's probably some argument by not caring and just eating in the most efficient way like simplest calories and I think you I think they're interesting arguments around the efficiency of that. But I think from a mental health perspective there there is something to the nature be really interesting as you think about this piece of the puzzle for you like like what what enhances and allows you to enjoy nature. It's interesting. It's where like these new treatments are coming on my line in my field like psilocybin mushrooms like one of the things that really often happens when people have psilocybin mushroom trips. There's now research about that uh coming out of multiple major academic centers about how it influences depression. And anybody's ever taken those things like one of the things they talk about and experienced is this powerful feeling of being in nature right of being connected. And the number one cause of disability according to the World Health Organization worldwide and now in the US as of 2020 before the end pandemic is depression. And so if you don't have a brain, you know, the goal of my work is really to get people as a psychiatrist back into grow mode, right? Where you're connecting whether for you, I wouldn't focus on the country in the nature. I'd keep that in my back pocket. But the way the food relates to this is the brain is not really in grow mode. And there's not a ton of data behind this, Tom. I mean, there's some, right? BDNF is like a new popular molecule everyone listening should know about. It's this idea your brain grows in adult life. Like when I tell people I'm a psychiatrist, people think they think my favorite molecule is serotonin. It's like actually it's like I don't know like serotonin's fine brain molecule, right? But like why serotonin over dopamine? Like what about GABA? What about glutamate? It's like okay BDNF rules them all because it makes your brain produce new brain cells. So what I want to understand is what's going on either in the brain or the gut or elsewhere that makes going to the farmers market knowing the guy that gives you the food knowing the farm that your food knowing not even just that hey it was close actually knowing those people. So it seemed like such an interesting insight I wanted to see um what's going on neurologically or at the gut level that makes that matter. you know all the loneliness data how loneliness is like the new heart disease the our new surgeon general Vivic Murthy wrote a book on loneliness that that uh I think that food connects us and as I said earlier there's a really simple lesson in biology 101 everybody in college had this lesson structure equals function you look at a cell under the microscope and and its structure tells you something about itself so what's the structure of a brain cell of a brain cell is about making connections The idea being if we take this lesson of connection, I think farmers markets and knowing where your food comes from is one aspect of eating for improved better mental health and I think it does help people connect. I see this a lot. I I was shrinking in New York City. People move in all the time from out of the city and it's a really lonely scary place. you go and if you can go to the farmers market and you're with people and you're interacting with people, it's not like it's a panacea, but I think it gives people uh uh one option to connect. I think what's much more important than that is is focusing on the foods and the nutrients and the way of shifting people's eating away from calories towards nutrient density and traditional dietary patterns and I hope influencing them with this new science. So when we think about around how food actually helps treat clinical depression or can help treat clinical depression allows us to really talk about this in a much more definitive way because we know a lot of people listening I mean 40 million Americans have uh clinical anxiety something like 18 million Americans have depression but let's just say you know the lifetime incident of depression uh pretty high. I mean, you at one point if you looked at data like uh I always want to get the study right, but I remember I saw a shocking statistic years ago that it was something like a quarter of women of childbearing age were taking an anti-depressant. Whoa. So you you see well the you know it seems high but the the regular statistic just of the whole population is about 12% 11 to 12%. And it seems high, right? But it's sort of hard as a psychiatrist to see those numbers. And some of that says, well, it's good that people are getting treatment, you know, like what do those numbers mean? And and and what we also know is no matter uh um how many folks are aren't taking meds, a lot of people aren't getting into full remission. I think that's where food comes in. And so you can see where nutritional psychiatry I think is really important that if I then ask you hey you're living on energy drinks and diet coke I'm going to at least hit the brakes before I do anything and say okay like I don't know like have you heard about traditional diets Tom? Yeah that's where it starts to get interesting to me is you can shape your physiology. So when I think about what I was doing to my microbiome and what ended up changing my behaviors is like you were saying earlier, if you can get people to understand what's happening, then you might be able to get them to start making changes. And so once I understood like I didn't know at the time I was drinking the um the monsters, I didn't know that the microbiome existed. I had never heard the word because the one thing life has taught me is that just when you think you understand, you realize there's some much larger connection. So, you do a really good job in the book of giving people exactly the things that they should be doing. So, we've talked about a big chunk of it already. So, we know we're going to be focused on whole foods, talked about a traditional diet, defined what that is, which is actually really interesting. One thing that um I have never h that's not quite true. I've never heard anybody talk about it as clearly as you with um by valve foods and getting into some of the the things that we can do that are seafood based and then also your sort of putting it in historical context of we probably didn't come up on the grasslands and I'd love to hear more about that and sort of how that led you to realizing that there's potential big benefits to seafood. Okay, thank you. That's a great question, Tom. I think quickly it's just the notion of nutrient density, meaning what nutrients are you getting for the calories you're eating? If if calories make us, you know, fat, as a doctor, I was confronting that a lot or obese, right? We want fewer of those. Well, we we still need all the nutrients for our brain. Then I'll just data started coming out about the omega-3 fats when I was a resident. We're all like talking about fish oil and I was kind of into integrative stuff and I didn't eat fish and anytime I see something kind of like with you. [laughter] I was like and it and I said where did all these fish oil omega-3s come from? Like they obviously come from fish. I'm like all right well if I'm I'm going to be like a brain healthy guy and eat this way and I'm a low-fat vegetarian. I need to add in this disgusting food fish seafood. So I slowly added this in living in New York because you realize well you're on a coast and I had all these friends who were chefs and I and I really started finding ways that I liked seafood. And the reason is that nutrient density when we think about brain health comes down to B vitamins, magnesium, iron. We did a research study, a really small study that I did with Dr. Laura Leance who's also a psychiatrist where we just said if we look at all the literature, what are the 12 nutrients that are most important for brain health and specifically depression? That's the most debilitating disease. like does something stand out and there are 12 nutrients that had really as we went through like levels of evidence significant data of both epidemiological studies but also clinical trials. We took those 12 nutrients and I think this is the most important thing people miss. We turned them into food. We asked what foods have the most of these nutrients and you mentioned by valve. So, usually with these scales, like the Andy, the aggregate nutrient density index, it's all plants because plants always have fewer calories. And I didn't like that cuz 98% of people eat meat or seafood. And and I was curious. So, we listed all the plants and they're what you'd expect. Lots of leafy greens and rainbows. But in the animals, three of the top five are by valves, muscles, clams, and oysters. And when we when we're talking about that scale, these are things that contain the 12 um key nutrients. They they contain the most they're the foods with the most of these 12 nutrients. So I know that number one on the plants is water crests which is really uh you know kind of leads for leafy greens but so are all lettucees kale uh collards kale it's like number 12 or 15 red peppers pomelo and so that's the way I get to these foods is through nutrient density that then leads us to food categories and so the bio valves and seafood are a food category because they're the most concentrated and only source of longchain omega-3 fats the omega-3 fats we make them in our liver a little bit when we eat plant omega-3 fats But there's reasonable data, especially when you think like the pregnancy data, like women who eat more fish, their babies tend to have like higher verbal IQs um and less behavioral tested. Yeah. Nine verbal IQ points if you feed pregnant women if you give them salmon. Um, there have been some really I'd love to do a hardcore data deep dive with you because I'm really curious what you think about the studies, but the there's a variety of data that if you feed kids, pregnant moms, and individuals more seafood, you see lower rates of depression in bipolar disorder. Actually, one of the first studies in nutritional psychiatry looked around the world at intakes of seafood and found that cultures that eat more seafood have lower rates of bipolar illness. Do you know what the mechanism is going on there? Is it just the brain is starved for quality fat or No, I would Well, I would say that let's think about the functions of those fats. EPA structural fat, but also like the 007 fat because it functions to create all these things called resolins and neuroprotectins, which that just sounds good. I want more of that like resolving that inflammation and neuroprotectin like that's literally what they do. DHA against structural fat. About seven to eight% of dry weight of the human brain is DHA. It's the longest fat you eat. And then EPA is more functional. EPA is kind of it is like aspirin. When you take a lot of EPA, you increase your bleeding time. As we said in my first book, the happiness diet, happiness diet, it makes your blood kind of silky smooth. So less clotting, less inflammatory response and EPA, ecosentinoic acid gives rise to ecosenoids. The kosenoids are they're like the um I don't know the specialist agents in our immune system, right? Where they they're like snipers. They they basically regulate the immune response and it's more specific than other inflammatory factors the um that come from the omega uh six fats which are more like the SWAT team or more like the Marines where like we're going to save you but there's going to be a big mess. And and so that's where we we always say wild salmon, right? Or fish oil pill, but part of making this list of foods and other things on there are wild meats, organ meats, is to kind of create a conversation. It's not like you got to eat all these foods and and then to do the shift into what are called food categories. Whether you eat water crust or kale or arugula or collards, eat leafy greens. So I don't know how familiar you are with um Dr. Alan Goldhammer. um he's probably the most extreme dietician I've spoken to and he talks about getting people all the way down to a diet that includes he prefers pure vegan um and no oil, no salt, no sugar. And he's the first person I've heard sort of be anti- um olive oil. What's your take on especially olive oil and salt? What's my take on extreme veganism? I I think that in terms of olive oil and salt, I'll tell you this. Salt, like cholesterol, like saturated fat is a real red herring for people who are eating salt from the salt shaker and eating natural foods. The only thing you need to worry about is getting enough salt. For people who are eating processed foods, where 95% of sodium consumption in America comes from, right? That's where it comes from. It's things like tortilla shells. it's things um uh you know it's in everything it's in soda so these so that's where I come down on salt and the reason it's an issue is we have so much obesity we have so much high blood pressure and diabetes that and people are eating processed foods in terms of olive oil I just really think the folks who are pushing the extreme low-fat diet probably that thing you're talking about how kind I am I struggle with that sometimes because I think there are a lot of people who aren't clinicians who don't see patients I'm not saying this doctor is one of them and who don't understand the implications of their very harsh, inaccurate, and not evidence-based advice. And it's where I really have always been in a millu that if you're going to say a food helps somebody with a serious illness like depression or heart disease, like you need to have some evidence behind you other than just our clinical experience. So, I think it's hard to prove that consumption of fats is bad for human health. I haven't seen that in the data. I've seen no data that also olive oil separates out in any way. I've certainly seen data that trans fats, again, man-made fats are bad. I I think saturated fats are a big family of fats that do a lot of things like they have antibiotic properties. How does that affect our microbiome? Like same thing as those phytonutrients. Like I'm not sure it's just all the fiber and all that stuff. We're also taking in all these really interesting antibacterial and antiviral compounds when we eat plants and those certainly shape our microbiome. It's actually you know we all say blueberries and blackberries work by like um you know anthocyanins are so good for the brain. Nature published this study that anthocyanins prune the gut and lead to changes in the gut that lead to changes in kind of serotonin dynamic dynamics that lead to the changes in the brain that it's not like the anthocyanins are up here. It's that they're working down in the gut. And so I was going to ask do you do microbiome testing when you have somebody coming to you? Yeah, I do this really really advanced medical procedure um where I ask them what they eat and when you tell me what you eat and a little bit about your medical history, it's not 100% but it's certainly accurate in the sense that it doesn't change it. We we only look at tests if it's going to change our recommendation. And um so I don't test microbiome. What I want to hear is diversity of plants and what fermented foods do you eat? And if if if I don't hear anything about that, I'm going to try and add those in gently. And then I think sometimes like a month probiotic supplement is an interesting idea. As I say in the book and I say throughout all my work work, you can't have good brain health without good gut health. But I think that again, this is the kind of thing that gets a little I would say manipulated, right? where people as opposed to turning to food and things that they can do, there's this idea we need an expensive test and lots and lots of probiotics. And I don't know, it kind of it goes back to that connection thing like the microbiome of the soil leads to the microbiome of the the plant, right? Like sauerkraut. I remember the first time I made sauerkraut. It reminded me of this lesson in medical school when they were telling that bacteria was everywhere, all over every surface of everything. And I looked down and like every medical student looked down. We look at our hands and and the you know the professor Mark Braun sort of smiled and he's like that's right you're covered in a layer of bacteria too. It's everywhere [clears throat] and like how you make sauerkraut. You just chop up a cabbage and all the bacteria that are naturally on there fermented and you know it's sort of a it's this interesting really interesting cycle between us and the bugs. [snorts] All right. So I want to get into that cycle now. So, you're somebody who was living in New York, thriving practice. Um, did does one of your parents have um signs of cognitive decline? Did I understand that correctly? Yeah, I mean that's Yeah, both of my parents I mean both my parents are in their 80s and and definitely there's some there's been some cognitive decline on on uh uh on both ends. So you move in to their farm in Indiana and now from what I hear, you're not going back to New York after years of living on the farm. You're now going to Wyoming. So I'm running this romantic notion in my head. If you take the kids out of the big city, they're on the farm. They're more connected. They know the neighbors. They're out playing in the dirt. They're everybody's feeling better. You're feeling more connected to nature. Yes, you're covered in scratches and scars, but man, like being there, working with your hands, being around the animals, making your own like, you know, goats milk kafir and all that, and you're just like, we can't ever go back and now we're going to, you know, find something maybe that's a little closer to a small city, but we still want to keep this lifestyle. Is that actually what happened? Because you I think you have to talk about your horse. I think what you described is why I moved out of the city is accurate in what I experienced. Um, I was living in New York with my uh, wonderful wife and two wonderful kids and living in this kind of boxto box great urban existence. I rode my one-speed bicycle at a sprint through Central Park on my way to work in a beautiful upper westside building where I have a great office and we have a great network of friends and and all the stuff that New York offers. And something was just not feeling right. I I don't know how to describe it. I started going back to the farm more on the summers. I started really as you try and do that and you're not there every day. It's hard to farm and garden. It's just an everyday thing. It's it's a it's a meditative process in a real way that I don't know how to describe it. It's just you really like you have to check in every day. And there aren't many things like that anymore than like email. And and I think there was also something about the natural rhythm that with the kids and my own kind of stress level. Again, not that there's anything wrong with raising kids in a city. It just, you know, the part that really pushed it for me, Tom, is I got tired of shushing my children because children are supposed to make noise. And I love the noise they make. I love all the songs. I love the screams. And the idea that I as a parent was sh like some rando neighbor downstairs is upset that I have children. I just couldn't handle that anymore. It felt oppressive. And so I did find all of that in the country. and and and you asked about my horse and and my my horse my daughter started as we moved to the country started riding. I'd owned horses since I was a kid. And I've always loved horses and and um and then as she started riding um it was nice and I went to some horse shows and and then when the pandemic hit and it was pretty emotional and I'm seeing lots of patients. I I my wife started riding and really and she hadn't ridden much and was I would say nervous and scared and it really did something for her and just emotionally and then I started riding and I'd ridden as a kid but I'd never been like with a like a real trainer to really teach you how to ride a horse. Within a few months, I'm like jumping a horse over two, two and a half feet like jumps and you go from this like being scared to having some I wouldn't say mastery, but just being challenged and then it's like a lot of things I do like surfing and snowboarding. It to me it's this feeling kind of a flying where you hit this really altered state where you and this animal are kind of in this space and where you're thinking what I love about it's like you're thinking about how much your little toe is cramping and hurts or that the caner is like a little bit like wonky and you don't know why you know I don't think we can discover that without time out outside of the city we both love. So, it was a place I put myself to go between these two contrasting worlds is I I guess I wondered the question you're wondering. What if it's great for me? What if in my family? What if it what does it feel like? What do I learn there? Yeah, it's interesting, man. Um, I've really enjoyed getting to know your work and your thoughts and now certainly getting to ask you things directly. There's I I see you as a vanguard of what I think we may have to do to unwind uh where people are mentally right now. And I'll lay it out as I see you and you tell me if I'm sort of on the path here. Um obviously I love cities and cities have brought us both a lot of things. I love modern living. It's brought us a lot of things. I even love social media. It's brought me a lot of things including um tremendous business success. But I also see that there's a downside to that and that social media can be outright dangerous that city living has so obscured uh a historical or traditional way of life where we have literally developed genetically to be in that kind of environment and we're now once removed. And you look at skyrocketing depression, you look at skyrocketing anxiety, you look at um, you know, a lot of the sort of pathiz things that that there is a beautiful side to, but there's also the potential for it to spill into the pathological and seeing people who are successfully unwinding that sounds a lot like what you do. Whole food first and foremost. um making sure that you're eating diversity, managing for the microbiome, steering what you eat by how you feel psychologically, which is something that I think until this movement of nutritional psychiatry came along was such a disconnect. And people had no sense of how the two things come together. And so when we before we started rolling and you joked and said that your psychiatrist was a little jealous of your horse and you were joking of course but saying like you know I get more out of my horse and I thought there's probably truth in that joke of just you're you're doing something that makes you to use your words feel more connected to use my word more grounded. Tom I really I think it means that we want to continue the conversation. I'm really curious about I feel like we have a similar set of questions because I think there is there is going to be a revolution I think in how we're living. I think uh in terms of really people who are wanting to optimize their health, not wanting to squeeze in a two week vacation someplace nice in the sun, but to live a life where there's more nature and more exercise and more groundedness and connectedness. And I think the pandemic's really accentuated that. I think food is one of those pieces of it that we have a lot of control over. It's why I like it as a factor in mental health. I think it's where it's different than our other treatments, right? Whether Prozzac works for you or Zoloft or lithium, like we're both crossing our fingers when I prescribe those that they that they work. And they do for a lot of people and they don't for some people. Same thing with psychotherapy. Uh and you don't really control that too much a little bit. But whether food can work for you, whether there's nourishment or whether there are certain nutrients that your brain needs that really most Americans aren't getting. You know, I think uh that's one of the things that connects. We're talking about a rural city, you know, kind of urban divide. One thing that's interesting is both of those places have horrible mental health crises. It's not like country live in is like free of depression and anxiety. Um, and another thing that connects that is as much as there is a wellness movement, the general American diet in both of those places is just really atrocious and damaging to brain health. And so, um, but I like that we're ending with unanswered questions. That's always the sign of a good conversation. The interesting thing is I think there are a lot of remaining questions. But what I see in you and what I hope people will take away from this interview is that there is like there is you can't just give people a pill, right, for the sort of ultimate solution here. But you have very prescriptive things that people can do. You know, we've walked through what they can do with the food. We've walked through some of the things that they can do with lifestyle. And until you have tried all those, my hope is that people don't lose hope. I mean, I think that's also the most important point or and it's just that people don't lose hope. I mean, I I I have treated people with every type of mental illness and it's actually what gives me hope. It's what gives me strength and resilience. I've just seen people who have it uh so hard with what happens in their minds. And to see them just do amazing things, start companies, have families, transcend it, get sober, whatever it is for that person, it's just it makes me very hopeful. Everybody listening should have hope no matter where you are, whether food helps you or not, whether you want to eat some of these foods or not, that that there is a path forward and there's always a path forward. I think Tom, your story really demonstrates that of just the I think often times we think about wellness in as a moment in time and we forget about our own personal development and evolution. Development is one of those words we use in adolescence and I think we've just forgotten that so much complex development happens in adulthood uh and and to really honor that and encourage that in ourselves and in each other and and I hope I hope my book really pushes people towards that with food. You know, not that there's exactly the right perfect brain healthy diet, but for you there is there are those foods that work for you. There are the foods that hopefully include some of these power players in my book like red beans and olive oil and by valves and fatty fish that we talked about and lots of dark chocolate. We didn't talk about dark chocolate. It's one of my big favorites. Um so, and I think that does make a difference. It's like that little step that helps motivate us and keep us going and inspire us. No question, dude. Where can people find you? I assume the book is available everywhere books are sold. That [snorts] is 100% true. People can find me on the internet at my website drew Ramseymd.com. I'm also on Instagram where I'm pretty active is Drew Ramsey MD. And we've got some great pre-order incentives for the book that people can sign up for on our website. And if clinicians are interested in this and want to learn how to be a nutritional psychiatrist, we have the first course where people can become trained to do this kind of work. And Tom, thank you so much. I hope everybody will will will check out the book and and I really appreciate your support of nutritional psychiatry and and personal optimization and more grounding and being open about how we really can be empowered to take care of our mental health and our brain health and that really is our biggest asset. Awesome. Thank you so much for taking the time. Thank you for writing the book and guys definitely check it out. I think that what he's touching on in nutritional psychiatry is the future. It's critically important and if you're struggling with any sort of mental illness, don't let there be a stigma. Know that there are options and this book is an phenomenal place to start. All right, speaking of phenomenal places to start. If you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. Thank you guys so much for watching and being a part of this community. If you haven't already, be sure to subscribe. You're going to get weekly videos on building a growth mindset, cultivating grit, and unlocking your full potential.