 Hi, everyone. Thanks so much for coming to my talk and lasting out through 4 o'clock on the second day. So if you don't know who I am, I'm a clinical psychiatrist. I'm not a researcher. I have a tiny fingertip in academia. I do teach the introduction to psychiatry class, interviewing part at Harvard Medical School. I have a hobby, which is my blog, which is why I'm here, which is evolutionarypsychiatry.blogspot.com. My disclosure is I am paid for my evolutionary psychiatry blog at Psychology Today online. But I don't have any research interests. I don't have stock that I'm aware of in pharmaceutical companies, et cetera. So I'm going to talk about what not to eat. And when I originally did my presentation for the brochure, it was supposed to be for 40 minutes. So I have 20. So I cut back what we're going to talk about. But I just have a couple of things to talk about. And if you have questions, I'm really interested in the research. And if I know about it, I'll let you know kind of all the latest stuff. So if you have a particular question about an anti-nutrient or something, we're going to start out about with trans fats, which everybody know I'm speaking to the choir here. But everybody knows that these are bad, but it's sort of describing why and how to kind of keep avoiding them even now. They're formed primarily from the partial hydrogenation of vegetable and seed oils in our standard American diet. The one at the top, more biochem, is linoleic acid, which is the primary omega-6 fatty acid in corn oil. And that does not look floppy. But in the real life, it's very, very floppy. And the bottom one is a saturated fat steric acid, which, in the right configuration, stays fairly rigid and stiff and has some nice properties in the membrane. The middle one is what happens if you take a polyunsaturated fatty acid and you inject hydrogen on it. And as you can see, it goes from these cis bonds, which are up there, cis just means like that. They make a little house to a trans configuration, which is like this. And it looks a lot like the saturated fat. So it has nice properties for your Pillsbury biscuits and your crusts, and taking those heart-healthy vegetable oils and making them into nice, stiff margarine. But our bodies can tell the difference between steric acid and the trans acid. And our bodies know that it's not supposed to look like that. And it screws up a lot of stuff. And it's also highly correlated, if it's in your membranes, with sudden cardiac death, which is not that common, but pretty dramatic when it happens. They're found in baked goods, fast food, margarine, commercial icings. Fortunately, in the US, finally, they got around to the FDA came out and said that trans fats from industrial processes are unsafe at any level. And they started to make people label them. And at that point, the amount of trans fats and the food supply dropped precipitously. In 2008, California became the first state to ban restaurant chains. In some cities, such as Philadelphia, Baltimore, New York City, and Boston and Brookline, which I learned yesterday in the law presentation, they've also banned or severely restricted the use of trans fats in restaurants. But the caveat is, is some institutional foods, like the big vat of vegetable oil or margarine or whatever they might be sending to your school or your hospital or this, they're not required to label it. So you may still find significant amounts of trans fats in your restaurant foods. Some of these cities have that ban, but it's not true of the entire US. However, because I think of mostly the bans in the foods at your grocery store, or at least the forced labeling, the US population-wide sampling of at least white male adults actually showed a 58% decrease in the plasma levels of trans fatty acids between them measuring in 2000 and 2009. And this was in many, many states they measured this. And in Denmark, they banned them earlier and they've noticed a precipitous drop in the rate of sudden cardiac death. That obviously all these are confounded, but trans fats are probably a part of that. However, I know that some of us like to cheat every once in a while. I know I do, but I was alarmed when I found out there was kind of a big expose in February of this year about trans fats that are still available in the food. And I don't always, and maybe you don't always read the labels. Some people always read the labels, but some of them, the Marie Kaliner's dessert pies, Pop Secret Popcorn was a big offender here. Walmart Stick Margarine, Pillsbury Biscuits. I used to love those when I was young. And Long John Silver's Fried Foods, they topped the list with seven grams of trans fat per serving. Which is a lot. And you can also round 0.49 grams of trans fats down to zero grams on the label. So I'm always suspicious of those Doritos packages that say zero grams trans fats. Cause if they throw in a lot of vegetable oil in there and frying it, I don't know, anyway. So what gets confusing and what I did wanna clear up for myself as well as everybody else are these ruminant trans fats. It's actually a different trans fats. It's a vaccinic acid and it's the top one. And it's found in grass-fed butter, breast milk and all of your dairy products. And it's higher actually in grass-fed products than it is in corn fried products. And the industrial trans fats are this oleic acid, which is on the bottom. You can't tell a whole lot of difference between those, but apparently our body has. The problem with the literature is that they often put these together, particularly in the scanty mental health literature. So, but in animal studies, it's very clear that the bottom are nasty and the top seem to have some protective anti-cancer benefits, at least. And so what do they do? It's a little bit of speculation, but your brain's 60% fat by dry weight. So if you have all these weird, strange looking, creepy fats that are in there, it's gonna cause membrane and communication problems. There's some evidence that a lot of the membrane problems regulate causes of obesity, diabetes, and all of these issues, because the membrane is scrambling to change its configuration to help the signaling be good. So if you have these weird fats that it's not really aligned with, it'll do some things to try to get the signaling to go through, and some of these things will result in inflammation and issues and problems. And I think the biggest problem, or a bigger problem is that it seems to displace our very, very important omega-3 fatty acids from the diet, which are already rare. Displacing the omega-6 fatty acids probably isn't that big of a deal, because we eat so many. But displacing the N3, getting trans fats instead of your omega-3s, it's really bad for your brain. And all we have, there's not a whole lot of data with mental health, but I just wanted to go into it. It's been linked to depression and observational studies. Those studies did not differentiate between the ruminant and the fried trans fats, but in the US, most of our trans fats are from the margarine and those kinds of foods. Fast food is also linked to depression, bipolar disorder and ADHD, except in Germany, where fast food is actually not linked to depression, but the opposite. And low omega-3 is linked to ADHD, depression, psychosis, and dementia. So this summary, we know they're unhealthy, they're still unhealthy. The bands are good for the population and I think one way of regulating that I think is actually a good idea, force them to label it so that you know what you're eating and you can make your own decision. And if you're going to eat processed food, maybe avoid the pop-secret popcorn or at least look at the labels. Maybe the February expose cause them to change their minds. But in long done silvers, I'm not gonna be eating there anytime soon. And I wouldn't worry about trans fats from ruminants. So the next thing I'm gonna go over is the carbohydrates. I hope we don't have shell shock from that at the end of the day. And all I can say for the literature describing how carbohydrates affect mental health sort of is a general rule. It's basically all over the place. The studies all have different designs, different kind of people who started it. Sometimes carbohydrates are things like soda or glucose infusions and sometimes it's rice. Sometimes they're in mixed macronutrients and so it's really hard to kind of sort out. But the main linkages that they found is people who are vulnerable to hypoglycemia or more likely to be violent end up in jail and be very irritable. And caffeine and alcohol will exacerbate this blood sugar drop. So you get kind of a violent person. They fast all day, they go out to the bar. They have their Red Bull and vodka. 90 minutes later they are being pulled to jail for a knife fight or whatever. And there's actually quite a bit of literature linking the violence angle. I was surprised by how much there was and I'm wondering how many lawyers are gonna start to do oral glucose tolerance tests on their clients. So low blood sugar will cause a surgeon stress hormones which will, maybe you can be stronger and faster but you'll be anxious and aggressive. And when you really look at it, about one in 40 people will have a truly low blood sugar, meaning we'll go down to the 40s after a bolus of a pure carbohydrate meal. Proteins and fats tend to ameliorate this effect. And other people will notice changes, anxiety, issues with blood sugars in the 60s which is much more common. And I'm actually a person who if I eat pure carbohydrates, the sort of sugary stuff about 90 minutes later you do not wanna be around me a majorly cranky. I haven't done any violence that I'm aware of. In several studies on violent offenders, those with the lowest blood glucose values during a glucose tolerance test tended to be the most aggressive and have the worst history. And they also tend to be the biggest drinkers. In the possible mechanism, low levels of brain serotonin are associated with enhanced insulin secretion which increases the tendency to develop low blood glucose levels. And then the only other literature, again it's pretty scanty, women with PCOS, they notice they tend to have bigger blood sugar swings and reactive hypochlycemia kind of feelings in 90 minutes after a high carb meal, feeling just really nasty and low and shaky and more likely to engage in binge eating. Now women with PCOS aren't necessarily insulin resistant. There are a number of reasons for PCOS but a lot of the time they are. And in women of normal weight with PCOS, as we've talked about in Chris Masterjohn's presentation today, et cetera, you tend to, the obesity may be a compensation in helping regulate these insulin and things. And so if you're normal weight, you don't have that compensation. They tend to have more wild fluctuations in their blood sugar and have more of this effect. And interestingly in a study of diabetics, blood sugar was not correlated to mood at all except the day after they were stressed they had higher fasting blood sugar the next day. Which makes sense because if you're stressed you're shooting out cortisol which increases your blood sugar, et cetera, et cetera. So the weird thing about carbohydrates is that there are these very famous doctors from MIT, the Wurtmans and Harvard I believe who have this book called the serotonin solution and they recommend that you eat lots of carbohydrates, pure carbohydrates and marshmallows, that kind of thing on an empty stomach to help give you a surge of serotonin into your brain and make you happy and contend that low carb diets cause depression. Carbohydrate ingestion does lead to an increase in insulin as we talked about before. It drives some amino acids into the cells that causes tryptophan to be shuttled through the blood brain barrier. It's a relatively rare amino acid and it's the precursor for serotonin and melatonin. And adding protein to meals does kind of decrease this effect unless you do it with tryptophan supplements which people do to rats and athletes and things. Proteins and rice have enough protein to undo the effect in some studies. So we're really talking about marshmallows, lemonade, really kind of a natural, pure, pure carbohydrate foods that you wouldn't really find as much in nature. Eating carbohydrates before bed has been shown in small studies to decrease sleep latency which is the difference between when you go to bed and fall asleep so you can either toss and turn for 15 minutes or if you're within 15 minutes is considered a good sleep latency. And it's probably because the carbohydrates could increase tryptophan into the brain which becomes serotonin which becomes melatonin which tells you to go to bed. So four studies lasting from one week to one year directly comparing low carb diets to high carb they showed better mood and increased serinity in the high carb dieters but each study had some real problems. The one week study was in cyclists and I can't think of anything that would make cyclists more cranky than suddenly depriving them of all their carbohydrates and studying them for a week before they become used to the new diet and then this is terrible. I feel rotten and I can't, I'm bonking. And then the one year study which hopefully would have given us some actual real data unfortunately in the low carb arm they had twice as many people in antidepressants. Now they swear in this long convoluted paragraph in the paper that if they take all the people in antidepressants out of the study it didn't change the final but there weren't that many people and there were 12 people in the low carb arm on antidepressants. So I wish they had randomized them better so we'd have better data from this study. And most of these short studies, very short studies trying to figure out these effects they use glucose drinks or they might use high GI rice versus low GI rice. But you know the real world we don't really eat that way unless you're a teenager or something like that. Like I was when I was eating you know Skittles for a meal when I was 17 and being really cranky 90 minutes later. So sugar, sugary snacks, candy and soda may be an exception especially to these vulnerable young brains. And then I do have to mention actually Victoria Prince on the audience sent me this study and it's eat fat and be happy. The study compared to 41% diet which is kind of a regular middle of the range diet versus the 25% fat diet should better move less tension and less hostility in the higher fat diets but that's not a high fat low carb diet it's just kind of a normal diet. And let's talk a little bit more about soda just like trans fats we know that's probably not good for you and in all these observational studies soda consumption was correlated with poor mental health increased aggression knife fights in school and beating up your girlfriend and things like that. And also a bunch of people have something called fructose malabsorption which is very interesting. And in this the small intestine glute five transporter doesn't take fructose variant very efficiently. So what happens if you eat a bunch of fructose sugar high fructose corn syrup, soda, watermelon and other high fructose things it goes down kind of isn't absorbed and it goes down and feeds all the bacteria and your colon which go whee and they're like so excited and they get so much to eat and they bloom you can get kind of gas and kind of crampy and have some loose watery stools but it's also highly correlated with inflammation low serotonin and depression which is interesting and nobody knows about this it's literally 30 to 50% of folks of Western or Central European ancestry and 15% of these other ethnic backgrounds in the US alone that's 60 million people it's tons of people and the incidence of depression in the US is about 10 to 20% at any given time so we're kind of overlapping these things how many people don't drink soda or don't drink fruit juice at all? Maybe a lot of people in here so these high fructose and high sugar foods are gonna be problematic and many vegetables in the very sensitive and wheat products wheat actually does this too wheat has fructans which are cleaved off and they act the same way as they're digested and they can feed the bacteria and it seems to again cause inflammation and intestinal blooms it doesn't necessarily cause these IBS irritable bowel syndrome kind of symptoms but eating starch interestingly enough can increase the uptake of fructose so if you have a banana which is much more starch than glucose a ripe banana anyway then even in people with fructose malabsorption they can seem to tolerate that and absorb a higher amount through their Glute 5 transporters and it's especially prevalent the correlation with women maybe this is why women are much more vulnerable to depression than men whether or not carbohydrates affect your mood then whether you love your marshmallows or you hate them and you feel cranky will depend largely upon the context your gender, your biochemistry, your micronutrient status whether or not you have really good Glute 5 transporters or not maybe whether or not you have a high number of copies of salivary amylase there's a lot we need to know about this and in general I would tell you to avoid marshmallows particularly on a fasted marshmallows I would avoid micronutrient poor foods soda, juices, candy and processed carb heavy snacks in many studies however in general if we have to take what we have which isn't much people are happier, sleep better and more serene with some carbohydrates on board but the rigorous studies that I would really be interesting comparing these fat adapted low carburs with the dieters, you know the dieters eating natural safe starches sigh, have not been done and I'm pretty sure that's the end we have time for some questions apparently I've worn everybody out it looks like any science behind higher protein higher fat kind of diet and serotonin or dopamine levels in the brain the only, there were some studies there in young college men that did correlate tryptophan levels with the, they actually fed them lean cuisine with different rices some of them low GI, some of them high GI that's the only thing I'm aware of and in rats they can make them serotonin toxic to where they scratch themselves to the point where they have a deadly ulcerative disease with a high carb diet and tryptophan supplements so I don't know if that answers your question but yes? Emily, so let's say I get a typical 40 year old woman that comes into my office with mood issues, depression where do you start, what are kind of the basic steps that you could do? Well, you know for talking I kind of try to make sure that they're not vitamin deficient and you really kind of take a full bore approach really get a detailed psychiatric history obviously we're kind of talking about fructose malabsorption if she has IBS symptoms, et cetera you can do a test it's actually fairly easy a fasted test, you drink some fructose and then you measure hydrogen that expelled hydrogen in your breath I'm not aware of anybody who does this except some GI docs but in general they will defer the testing and just say stop eating like a jerk take out the soda don't have juice all the time and see if that improves your IBS symptoms and they've done low fructose diets on people with fructose malabsorption with depression they found that clinically that their symptoms improved so we do know from a randomized controlled trial that this can be an effective treatment for depression however it was just a very small trial in Germany I'm not aware of anybody who knows about this it could be millions and millions of people in the US so I'm excited about going out to I'm going to speak at Grand Rounds and other places around Boston where people will be doing research and so they might be interested in this though it's not going to be funded by Coca-Cola is that answer? I would tell them, the first thing I do is say oh especially if you have, I talk, you know high sugar diets and soda can cause the bacteria I talk about the bacteria in blooming it's kind of visual and they're like oh yeah there feels like they're you know maybe it's not entirely accurate but people like that and I say try taking it out for two weeks no soda for two weeks, no fruit juice no watermelon and see if that helps so some people will need the more fructan avoidance entirely diet which is actually pretty you do avoid onions, garlic, Jerusalem, artichokes I don't know how many people eat those but plus wheat products you know things like bread that have high fructose corn syrup in them, things like that so it can be pretty strict but people have a lot of improvement if they have IBS and they're sensitive to the fructans and VODMAPs yeah? What sort of research have you seen on artificial sweeteners and serotonin and dopamine signaling? That's a great question and unfortunately though I I've looked sometimes for that but I haven't found it it's hard to, I haven't found anything in humans Do you know of any studies that will be done to talk about those artificial sweeteners and what they're doing to our brains and if that's been maybe the cause of depression on low carb diets or whether it was the low carb diets themselves? That's a great question and I wish they would do the research I don't know Okay, thanks