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Nutrient density is the amount of nutrients per calorie. By using fear-based messaging and focusing only on singular nutrients, medicine has failed in providing patients with adequate nutrition advice.
Instead of focusing on so-called “superfoods,” nutritional psychologists emphasize food categories.
Seafood and particularly bivalve mollusks (ie, oysters, mussels, and clams) provide important omega-3 fats. Leafy greens are also key, containing water, minerals, vitamins, and phytonutrients.
Fermented foods such as kefir, yogurt, sauerkraut, and sourdough bread may be beneficial for microbiome, brain, and mental health.
Data on the best diet do not drive individual choice. It’s more useful to have a conversation with patients about their personal preferences in what they eat and why.
This transcript has been edited for clarity.
John Whyte, MD, MPH: Hi, everyone. I’m Dr John Whyte, chief medical officer at WebMD. We’ve talked a lot about weight gain on our show and the results of a poll conducted by WebMD. Living through this challenging time doesn’t mean that you can’t also eat healthy. In fact, eating better might actually help you deal with anxiety.
I recently had the opportunity to chat with Dr Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University in New York, about tips for eating healthier during the pandemic. In this episode, Dr Ramsey talks about the relationship between diet and mental health as well as how to enjoy comfort foods that are delicious and nutritious.
When people are anxious, often they’ll turn to comfort foods. Those foods are not fruits and vegetables. They tend to be chips, ice cream, and foods that tend to have a high sugar content. How do we address this issue of using food to deal with anxiety?
Drew Ramsey, MD: In nutritional psychiatry, where a lot of the focus of my work is, how can we upgrade that behavior to something that’s good for the brain? I eat emotionally, for sure. When I desire things like carbohydrates, I think about how I can increase the nutrient density of a dish. You mention people craving ice cream. That’s a fine choice sometimes; it’s easy, it’s quick, it’s satisfying.
On other nights, do a simple swap with a full-fat yogurt with added dark chocolate shavings, berries, and nuts, or have a cup of tea with honey. I know tea sounds silly as a replacement for dessert, but just try it as an experiment.
If you’re craving comfort food, how about a kale mac and cheese? It’s delicious and quite nutritious.
Whyte: Kale? Is it delicious?
Ramsey: Bottom line is, increasing the nutrient density of your comfort foods is the way to win. You still get that satiation of soothing yourself with food. We want to encourage that behavior in patients and help them increase the nutrient density of their meals (ie, consume more nutrients per calorie). An easy way to do that is to consume plants and bivalves like mussels, clams, and oysters.
What we work for is less shame and fear around eating for patients. We’ve really failed as a medical profession in giving nutritional advice, and in my opinion, we’ve really been centered around singular nutrients and fear-based messaging. So we try to promote a very joy-based message of “Mother Nature makes a lot of amazing food for you. It’s all nutritious. Let’s figure out how to help you have a diet that supports you,” especially now during quarantine, with restricted eating and shopping behaviors.
Whyte: Are there a couple of superfoods that you recommend most people start consuming that maybe they’re not? For instance, I always talk to patients about blueberries as a superfood that they should consume every day.
Ramsey: I love blueberries, especially the anthocyanins in them. That’s really the only reason that blueberries are a brain food. They’re a low glycemic index food and got some press because they contain anthocyanins. Lots of things have anthocyanins. Blueberries are great, but in nutritional psychiatry, we focus on food categories.
A food category so many Americans are missing when it comes to eating for brain health is seafood. We eat about 14 pounds per person per year. We don’t have a recommended daily allowance in the United States for long-chain omega-3 fats (found in foods like bivalves — mussels, clams, and oysters). I love seeing them on patients’ menus. They are easy to cook at home and are delicious. All of the benefits you get from seafood, you get from bivalves.
We look for other food categories like leafy greens. I talk a lot about kale. You don’t have to eat kale, but these leafy greens are in the most nutrient-dense food category. They contain water, minerals, vitamins, phytonutrients, and some fiber.
Whyte: I actually like kale. I’m not sure about the mussels and the clams.
Ramsey: Another simple option is small blue potatoes. The anthocyanins you love in blueberries are also in blue potatoes. They are a nice resistant starch if you cool them — a very calming, satiating, and delicious comfort food that’s also packed with potassium, folate, and fiber.
I also really love and recommend fermented foods these days, based on all the science coming out about how the microbiome affects energy metabolism, brain health, and mental health.
Whyte: Give us some examples of fermented foods.
Ramsey: Fermented foods are things like kefir and yogurt. Those are probably the two most commonly consumed in America, but fermented foods are part of any culture. Kimchi, sauerkraut, natto, tofu, and sourdough bread — these are all fermented foods that have some live bacteria in them. When we think about having a healthy, diverse microbiome, it’s a two-step process for most people: eating more fermented foods and eating more plants.
Whyte: Is there any role for supplements in your diet?
Ramsey: Certainly supplements play a role, and I think many people push them in medicine as an insurance policy. I’ve always taken a little contrarian stance on this. I don’t think that we can medicate or supplement our way out of the general health and the mental health crisis that we have. I think that we have a tremendous problem in America with the foods that we eat and how we approach nutrition, wellness, and health.
There are supplements that play a role in mental health. We sometimes use omega-3 fats to help augment mental health in depression. There’s not really a lot of data about any of these supplements. There are data about zinc, but instead of a zinc supplement, I’d love to get patients to eat more pepitas, oysters, and foods containing zinc.
Whyte: Are you a believer in intermittent fasting?
Ramsey: I am. I like intermittent fasting, ketones, and the idea of ketosis. I think so often in dieting, nutrition, and medicine in America, we are a country of extremes. To like ketones and intermittent fasting means you’re a “ketogenic guy.”
Whyte: Do you like that diet better than the Mediterranean diet? All the data support the Mediterranean diet.
Ramsey: Well, I don’t think data is what drives individual eating choice. As a clinician and nutritional psychiatrist, if I meet you and you want to be a carnivore, I want to hear what that’s about for you. If I meet you and you are in the midst of a horrible depressive episode and you’re a vegan, I want to hear what that’s about for you.
I don’t want to come at this like, “Let’s get you on the Mediterranean diet because that’s what all the data say.” I don’t find that to be effective medicine with my patients. I hope we’ll listen to some of what’s coming out on how psychiatrists approach food and how we approach patients. We have a different setting in the sense of maybe having more time. We also have a stance that is maybe a bit less paternalistic.
For an individual, I want to think about what elements of the Mediterranean diet translate to them. If somebody is using a lot of corn and soy oil, I’m going to want to hear about olive oil and their experience with it.
Whyte: Okay, but then why do you like ketosis?
Ramsey: I like ketosis occasionally because it’s a state that all traditional cultures have engaged in. When you look at the Mediterranean diet, I feel what’s really missing from the data is that the Mediterranean lifestyle includes 1-2 months of fasting a year. If you’re Greek Orthodox, you’re fasting a lot. You’re either not eating dinner or you’re on a fast during the day or you’re cutting out certain foods.
There’s something about fasting states that is very spiritual. It’s very deep; it’s very centering. And there’s a lot of interesting data about when we are in ketosis, our brain metabolism shifts profoundly. Right now, if you ate carbohydrates, your brain is running on carbs. Every neuron is firing on glucose. If you move into ketogenic states, where you’re getting more ketosis, your brain starts to shift. In ketogenic states longer term, up to 75%-80% of all brain fuel comes from…
Whyte: Yeah, in fairness, if they’re done correctly. There is some prescriptive nature of the ketogenic diet, so there are some elements of that. I could argue that there is the DASH diet as well, where there’s very good data.
Ramsey: There are so many diets, right? There’s the DASH diet, there’s Mediterranean, there’s paleo, there’s Whole30. There was an amazing study about ketogenic diets, looking at 3-year outcomes in diabetics and showing phenomenal numbers.
Whyte: Well, I want to be fair to the other diets as well.
Ramsey: And I think this is where the public and clinicians maybe shy away or get a little confused. That’s where nutritional psychiatry really helps us get back to basics.
Whyte: I might have to make some kale mac and cheese tonight. Thanks for watching Coronavirus in Context.