 Welcome to Ancestral Health Today, evolutionary insights into modern health. Welcome to Ancestral Health Today. I'm Todd Becker. We're talking today with Dr. Emily Deans. Dr. Deans is a board-certified psychiatrist and psychiatry instructor at the Harvard Medical School. She writes a blog on evolutionary psychiatry based on the observation that our brains are healthiest when we embrace a diet and lifestyle that reflect the conditions under which we humans evolved. She embraces a broadly paleo diet including meat, fish, nuts, vegetables, but avoiding grains and foods with unnaturally high fructose or omega-6 fatty acids. And she also advocates getting plenty of sleep and play in your life. Dr. Deans has presented at the Ancestral Health Symposium in 2012 and 2018 on topics related to this theme. So today we'll dive into this emerging field of evolutionary psychiatry and what some of the recent clinical studies are telling us about the connection between food and mood and what we know about the mental health of populations eating a more traditional or ancestral diet compared with those eating a typical westernized diet. Welcome to the podcast, Emily. Thank you. Happy to be here. Great. So maybe to get us started, how would you define evolutionary psychiatry? And there's some related terms like nutritional psychiatry or food and mood. Yeah. How would you do that? Evolutionary psychiatry is really kind of two major academic kind of pursuits. One of them is more academic, but it's not very practical, which is how do genes determine mental health and are there any evolved mechanism by which that happens? And are there genes perhaps that maybe in certain combinations making more vulnerable to schizophrenia, but perhaps in different combinations, some of those same genes might make a population have more creative people, for example. And was there an evolutionary advantage to that? And there's some interesting studies along that and I write somewhat about that. But most of what I consider evolutionary psychiatry is more the ancestral health paradigm, which is kind of assuming, okay, we've had what 9,500 generations of humans and all but the last maybe what 500 were mostly hunter-gatherer and then after that was agricultural and really only the last four or five or industrial and then we're sort of at generation zero for the digital generation. So how is the difference of how we evolved and how our brains evolved reflected in our mental health and maybe can we adjust things without throwing the baby out with the bathwater because we've made tons of progress with our health with very modern things like water treatment plants and antibiotics and vaccines that are helpful and save millions of lives. But is there some aspects to how we live now in this digital age that affects our mental health for hunter-gatherer, mostly hunter-gatherer brains? That's great. And then the term nutritional psychiatry overlaps to some extent with this field or? It does though they and I bet I guess I consider myself the most what I'm used often practice is more like nutritional psychiatry though it's hard to split it out because I also talk to everybody about sleep and activity and everything. But nutritional psychiatry is the field that explores and does academic research in how does nutrition and what we eat affect our mental health. So but that academic strain of psychiatry really comes out of nutritional research in general and it's more focused on you know a lot of the diets they've said were best for cardiovascular health so it's a little slightly different than thinking about a paleo diet but there's almost no evidence for paleo diets you know because people just don't study them but there's lots of evidence for example for Mediterranean diets nutritional psychiatry. Well so you're trained as a psychiatrist and you teach psychiatry so what got you interested in this connection between diet and mental health because the field of psychiatry seems to be largely focused on pharmaceuticals or tuck therapies and diet is a relatively striking you know entry into this field how did you get interested in this? So when I trained I guess I finished up my residency in 2004 which is the final you go to medical school and you go to college then you go to medical school and then you go to residency in the U.S. and psych residency is four years and what really interested me you know medications are very useful particularly in certain circumstances right when I finished training is a lot of data came out about how a lot of the medication especially with antidepressants and SSRIs that a lot of the data had been kind of hidden but when they didn't work and so we had more you know the science was saying oh it works better than it does. I think we knew in practice that it didn't necessarily work as well as we would hope and I'm not to say that they don't work very well for some people and they don't seem to work at all for other people but I was really interested in alternatives if the medicines were going to be perfect and then we're going to be this all this cure all what alternatives do we have to helping people's mental health and then especially we're also the mental health system is totally overwhelmed and are there some preventative things that we can do for the population level or recommend them upon a population level that could prevent people from ever having to see somebody like me and so I and to be honest therapies just I'm not that interested in it takes a long time and a lot of patience I do have some therapy patients but a few because as I can how many that I can sort of sit still for that you know for that long time and do really really active listening just super important I just don't have the energy to do that you know 40 hours a week so I was really interested in alternative medicine you know supplements and diet and exercise and how that affected mental health and I started to read kind of like layman's books on the subject and I was interested in paleo at the time because I had actually lost weight after my having my second daughter with paleo and I've also noticed that my skin looked really great and my my nails really good like my body really responded quite well to a paleo diet and I thought well you know if you're if it's showing up in your skin and it's showing up in your hair and things like that it's probably showing up in your brain too and so I started to look at popular books at the time and I found unfortunately when I looked at the references in some of the popular books the books were really not they were really overblowing the findings now this was back in 2008-2009 so I decided the only way I can really look at this is to actually look at the references myself and write about it that's the best way for me to learn is to kind of write about things and maybe sort of teach other people and that's how I started my blog which very quickly was pulled on to psychology today and I was very lucky because right about that time is when Felice Jacka really started doing some of the first really high quality studies of diet and about it she started off with large observational studies there are others but she was really doing because a lot of the studies before that were frankly poor quality in food and food anyway so it all happened at about the same time and so that was fortunate great so there's a this part of it came from personal experience and then an interest in really finding solid evidence-based approaches to backing this up rather than what's out there sort of in the popular press so let's dive into that a bit what's some of the best evidence you've seen that really connects diet to conditions like depression anxiety and other mood disorders so there are many different types of scientific studies observational studies basically follow a group of people over time and just sort of see what happens in all the large observational studies a lot of them are piggybacked and they're best if you follow them as you go along so you don't pick a group of people and say oh what have you been eating the last 10 years and how do you feel now because that's not very good data because people aren't very accurate about what they've been eating for the last 10 years but most of these studies were tracking they're very large studies for cardiovascular health and what they did was they didn't have psychiatrists doing interviews of patients and diagnosing them with depression which is the gold standard they just had people fill out questionnaires about their mood along along with tracking you know cardiovascular things and in several of these studies show the people who ate more tradition who were the quartile or quintile of food that was most like a Mediterranean diet which is lots of fruits and vegetables whole grains fish you know omega 3s those kinds of things and in other cultures similar studies were done and the people who adhered more to the traditional diet so in Japan a traditional Japanese diet in Australia more of a traditional sort of ranch style diet where you're you know eating meats that you've garden foods and meats that you've killed like that well obviously they didn't have to kill the meat being the study in Australia but you know what I'm saying and they found that those people had lower in the population had a lower incidence of depression compared to people who ate mostly processed food for example and that was repeated again over and over sort of all over the world in different cultures and then the second level of evidence or a higher level of evidence is actually doing a randomized controlled trial there are a couple ways that they did this there was one sort of a surprise trial in the United States I think it's called the smiles to it and this was actually trying to do an intervention for for depression and older adults who are at high risk they had like a minor level of depression they weren't particularly depressed but they were at high risk for developing depression over time and so they did a study where they tried to give sort of like a low-key supportive therapy and then as the control arm thinking that this wouldn't have a mental health benefit they gave people nutrition classes and cooking classes and they found that actually both groups had lower risk of depression than doing nothing so it kind of ruined their original experiment because just intervening with having people cook more fresh foods and eat better more fresh and home cooked foods improve their depression or lower their risk of developing depression so they got two papers out of it instead of one but the other big study was actually Felice Jacker ran out of her food and moon center in Melbourne and she did a randomized controlled trial this one is actually the smiles trial and she actually treated people with major depressive disorder so they were diagnosed by psychiatrists and the control group was a just like a group meeting together it wasn't really therapeutic and what she did was do it do a Mediterranean diet the only difference between the depression diets that they use and the Mediterranean diets that they use for like cardiovascular research is they do add in a bit of red meat not a ton but you know a couple times a week it's that's whereas usually in the cardiovascular they knock out red meat altogether and the reason she did that is because in all the observational studies with no red meat there was no effect on depression so it's it was thought that just you know a bit of red meat might be helpful and there's some things in red meat like iron and creatine and things that there's a mechanistic reason why they might be helpful for depression so in the studies with a Mediterranean diet they weren't adding red meat so her study was different in that one variable right right and when I was talking about the observational studies of the Mediterranean diet those people ate all sorts of things and it's the one who adhered the most to the study diet that they were recommending they tend to have less depression but they're still probably going to be eating red a little bit of red meat down again in this dietary trials where they actually give people strict diets for cardiovascular disease often they will emit like do a low cholesterol diet for example and so for that they will emit red meat and in those studies there was no effect on depression it didn't make people worse but it also didn't improve people who had a depressed mood whereas the the diets that had a little bit of red meat actually did improve depression as long as it was a more traditional more fresh foods and less processed food diet so you mentioned some of these earlier studies were really looking at other end points like cardiovascular health and the the the mood impact was a secondary output right it wasn't that wasn't the the intent of the study whereas the study cited by Felice Jacka was intended to look at mood effects so right and that's that's much more of a interventional or a sort of a cause and effect type of a study then right yes and they there was another study in Finland that was similar they had mixed results um but they were there were some issues with that study but it's very it was very it's very difficult to do she did maybe 200 people 185 people um half controls half a diet and um it was uh she said the biggest problem with that study was the recruitment because it's a it's a big ordeal to sort of oh i'm going to change my entire diet and you know and uh one of the interesting things she found because what people do worry about when they do more fresh cooking and home cooking is that it's going to cost more um but actually she found that people now these are Australian dollars but the people saved you know 10 to 25 dollars a week actually on the study diet so what what were the conclusions of the study in terms of any impact on mood conditions so there were a couple things that she'd found in this and other studies which is that people with major depression had decreased depressed mood and the effect size was a similar to an antidepressant um so it was very similar to a pharmacologic intervention and uh she did another study where she followed the um size of a certain part of the brain that's important for sort of like thinking in memory over time and the people that was interesting too because the people who adhered more to um fresh foods diets you know everybody's brain shrinks over time and this was over a couple decades um but the people who adhered to uh less of a processed foods diet their brain shrunk less this was the whole brain or the hippocampus it was um the hippocampus hippocampus yeah which is really key to you know memory and things like that right and processing yeah that's so these are real effects I mean that's that's pretty uh striking now what about um other uh mood disorders like anxiety or or psychosis or bipolar are there any studies showing effective food on those conditions so there are observational studies on anxiety they're they're very all the effect that's similar to the depression but just a far fewer of them um I'm not aware of any randomized controlled trials of food for anxiety there's also really nothing for the other conditions partly because it's it was hard to enroll major depression which tells me it was sort of a stable or a little bit older population so if you're going to have people stick to a diet and stuff it's going to be a little bit easier I'm very hard with chronic psychosis and things like that what they have been trying to do or have tried to do or run a few ketogenic diet studies like in psych hospitals um as far as I know those are still ongoing um they're small they're very small trials of things like gluten-free diets um and uh but really these are just pilots we're talking really a few patients um and there's some studies of ketogenic diets um and sometimes they've been extremely helpful but there's nothing big nothing big yeah I I I'm sure you're familiar with Chris Christopher Palmer's work right and so yeah I think he's looked at ketogenic diets um I don't know yeah and he's getting some funding to try to run some real studies I believe but it's down I don't know it takes a long time it takes a long time yeah and and it's it's harder to get funding for food studies right you're not getting the kind of funding you would get for a pharmaceutical right yeah it's a lot in the U.S. you know the the things to get funding are pharmaceuticals or devices so there are lots of really interesting devices uh that people are thinking about for a major depression like the magnets and um even light like light um laser light and LED light going through your eyes and your brain uh and your like they literally put like a helmet on there's interesting studies but of course people can make a lot of money with these devices whereas they can't really make a lot of money if you just shop at the grocery store right so you know we've been talking about the effects of diets as whole diets right Mediterranean or ketogenic or low carb or whatever but are there you know sometimes people are interested in specific components or ingredients so omega-3 fatty acids or effects of dairy or fermented foods or specific micronutrients are there any good studies there that point to the effects of single dietary components on mental health so the study of nutritional research has been an abysmal failure usually when they study uh single components especially on large populations so for example for a long time they thought oh vitamin E might help with the dementia for example and they found that vitamin E actually probably just makes it worse if you do high-dose vitamin E um and you know vitamin D for almost anything except for if your vitamin D is low and your bones are cracking um you know vitamin D in high doses generally hasn't helped any condition on its own um however that said omega-3s are actually uh a little separate from that they there have been studies like problem omega-3s and things like probiotics is that it's not like prozac which is a fluoxetine that every fluoxetine is the same we're talking about omega-3s and you're talking about uh probiotics most of the studies use slightly different formulations of things so it's difficult to sort of compare them to each other but for example the ISNPR which is the International Society of Nutritional Psychiatry Research they came together and did a position paper on omega-3s and in there which you can look up and in that paper they said you know they compared the studies of omega-3s with studies of um simbalta which is a major antidepressant one of the relatively newer ones and they found that the effect of omega-3s on depression was similar to the effect of simbalta so again another um with you know low risk of side effects maybe a little bit higher chances of bruising and bleeding things like that so um it makes sense you know if you don't want to see a doctor and you're not suicidal and you don't need to see someone right away if you want to add some more fish or maybe add some omega-3s to your diet um all of the studies just um to put this out there all of the studies where it had an effect on mental health and there's some for anxiety like in medical students etc all of them were um so there's several omega-3s ALA and then that's metabolized into EPA and DHA uh EPA and DHA are really only found in animal foods however you can make DHA from algae for example if you're a vegan but um all of the studies for a mental health and omega-3s its EPA has to be greater than the DHA so a DHA only supplement was not uh sufficient to do anything for depression it has to be EPA alone or EPA greater than DHA so if you are buying an omega-3s thinking I have a bit of anxiety maybe this will help just get your EPA greater than your DHA great so I guess another form of evidence and this gets back to one of the uh the themes of ancestral health is this idea of evolutionary mismatch right right uh the that our our bodies our brains evolved under conditions that were very different than those in modern society and and the diets were are quite different if you look at pre-industrial uh hunter-gatherer populations or pre-agriculture populations or even if you look at current existing uh pastoralists or or populations that have less exposure to a westernized diet have you looked at that sort of anthropological evidence on a population level and does that provide any insights into uh how diet can can impact mental health uh in those populations versus ours that's a difficult question because um and I think we have more evidence historically you know there's evidence even back in rick and roman times writings people experiencing major depression um they even use there's like lithium um springs that they would bring people with melancholy to yeah there's a long history of if people are feeling down and out and they have the means uh they used to just ship them off to the seaside because they had better air fish you know lots of minerals if you're bathing in the sea um so uh and a populate you know it's difficult to assess the mental health of of different populations because the social context uh the social context and the anthropological context is just a hundred gatherer populations would be so different than ours that we can't even really use the same rating scales so to my knowledge that really hasn't been done um certainly before processed foods existed there was definitely there was definitely depression there was definitely psychosis um so it's not all related to that and there's definitely there are a lot of myths for example that in hunter gatherer societies that people with psychosis are treated very well are considered you know like shamans etc but honestly um having talked to um a professor over at harvard who had spent a lot of time over in africa for example and he said a lot of times they were tied to a tree in the middle of the camp and people would throw food at them and not get near i mean they were not treated well you know it was it's a fantasy that psychosis is somehow just misunderstood as a part of the human condition it's it's it's awful but how about how about depression and anxiety is can you say that that that was uh a rarer in in those earlier populations or we don't know that's a tough question too because you'll see evidence that depression and anxiety actually have actually been increasing every generation but again it's it's difficult to really address that because were they even diagnosed were they ignored i mean i even have certain populations uh come to me you can't you know i might recommend in in the u.s for example if i have someone with psychotic illness um there are many like family help groups for example for families of people with mental illness and sometimes i've spoken to people from different cultures they said oh no we couldn't possibly go to a family help group because then people would know yeah there's such a stigma stigma that it's really difficult to sort of compare apples versus apples there are dapples and apples it's apples and oranges so i think all we can say that it's always existed that my theory i think is that a processed food and then also the sleep habits that we have now our electronic our lights too late our all these kinds of things do add to the inflammatory burden because it's very clear for example that our populations now are very different with regards to cardiovascular risk and obesity of course that's obvious i'm not sure that it's you know is rampant processed food making all of our mental health worse on a huge population level i don't know i guess i think about and this is less data this is more sort of anecdote making hypothesis is sort of the nice way to to describe it but you know certainly i've had experiences in my life where i ate you know a sticker's bar or something high in sugar and a couple hours later maybe i ate it at three o'clock right and then a couple hours later when i was driving home from work i was in a really crappy mood from my sugar crash or whatever it was and if we as a population just really ate better with less you know high sugar and high processed carbs so that you're not having like sugar oscillations throughout your day and it's definitely so when your glucose level falls that does lead to higher cortisol so there's definitely again a physiologic mechanism for that so cortisol is a steroid and it can make you kind of cranky and maybe more aggressive so would we not have so much road rage if people aren't having like 3 p.m um processed food snacks or does it or does that make you fat and happy i don't you know um so uh those are the kind of questions i sometimes think about you know yeah certainly i experience a much more even uh energy level and mood uh staying low carb or keto or even doing intermittent fasting there's less of that sugar sugar down yeah i'm down yeah so i so that's this is kind of interesting you know the evidence from studies uh whether they be in interventional or not or hard to tease out all the variables and similarly anthropologically cultural effects dietary effects that's hard to tease apart but physiology is something we can look at right that's that we do it experimentally so there's a couple of theories about why food about how food interacts with mental health you mentioned inflammation uh there's talk about um i know that uh chris palmer and his book brain energy thinks about mitochondrial dysfunction as maybe one of the drivers you've mentioned um brain chemicals like bdmf uh there's the microbiome uh there's hormones there's a number of different ways to approach this physiologically if you look at it from if you look at it physiologically what to you is the most um compelling argument that food affects our physiology in a way that can affect our mental health positively or negatively is it inflammation or is it something else so i get i would and this can be variable depending on the condition the person um but i would put sort of on a population level my hat is on the inflammation side of things and inflammation is a horribly overused word but also and it encompasses a lot and so maybe it's unfair because obviously mitochondrial dysfunction is a very specific thing whereas inflammation can mean issues with your microbiome which also has uh it changes your hormones um and they there's definitely been studies for example people with acute bipolar uh episodes in the hospital and they measure inflammatory cytokines which are these little chemical message messages in our body they're huge super high levels in fact similar to people who are in that medical icu um who are very sick slightly different um inflammatory cytokines but there's definitely inflammation going on when people have bipolar disorder mania for example and they're in the hospital um and there's also you know these bi-directional um uh if you have um depression you're much more likely to have diabetes and if you have diabetes you're much more likely to have depression depression it goes a major depression it goes both ways so that in fact higher risk in fact most risk for mental illness it kind of comes all together meaning that if you're higher risk for one mental illness you're probably higher risk for several of them it just kind of depends on your combination of genes and whatever's going on to which one that you get is it more anxiety and depression do you happen to have a set of genes that makes you more vulnerable just gets a print just gets a friendier bipolar etc etc um so i'm going to go with the inflammation as the main driver however there's some super interesting studies regarding mitochondria and the ketogenic diet does help the mitochondria make um um make power better it kind it can bypass some of the comp complexes that if your mitochondria aren't working very well it can kind of jump start them it can be sort of like better fuel in the brain for um and it's fairly specific to the brain actually because ketone bodies aren't going to be high anywhere else right um so so what do you what do you think of of chris Palmer's theory that mitochondrial dysfunction really underlies a range of of mental disorders that it's it's common to them do you think he's oversimplifying it or do you think there's something to that theory i guess i would weigh on the side of it's probably a bit of an oversimplification but you know i i don't know if i've ever met chris Palmer but i know i've talked to him many times and he's not um uh he's generally very careful clinician sometimes sometimes when he talks on social media or whatever it's sort of generalized but that's how you have to talk on social media so you can't do the specifics of the thing on twitter x or whatever it is and um and there are some interesting data points for example there was this uh he wasn't a psychiatrist uh he was a neurologist and he did some very interesting studies of people who had just died who had schizophrenia both on medicine and not on medicine so it wasn't a medication effect and um he did very fine um biopsies of the parts of the brain you know like the prefrontal cortex and stuff that has lots of deficits in schizophrenia and was able to find in these cells um uh that these uh cells had problems with glycolysis so just one of the major um ways of creating energy in in in the brain and then or actually the whole body glycolysis runs everything plants too anyway so um the uh um another interesting piece of evidence for example is if you add a phosphocreatine when you're starting an antidepressant there have been decent studies showing that uh that makes the antidepressant work a lot faster and now what does phosphocreatine do it helps um you recycle your energy batteries of the cell not the batteries but the the actual molecules that the that are power in the cell that like power things they're called ATP and phosphocreatine is one of the um precursors of ATP so it helps you replete your ATP faster and faster and so adding phosphocreatine to an antidepressant help the antidepressant work a lot faster so that's evidence that it's a power problem in the brain right are there are there natural dietary sources of phosphocreatine or are you looking at this purely as a supplement this was a supplement study okay creatine is found in skeletal muscle so uh we're talking so that's another another it might be one of the red meat advantages that again i'm not suggesting a carnivore diet or anything like that um would be better for depression or anything but um certainly no data about that but um that might be a reason why in those interventional whole diet studies that the ones without any red meat weren't as effective or didn't work great so we've talked so far really about evidence and the the the rationale for looking at food as a a key effector of mood but let's let's turn now to your own practice right you see patients um how do you work this into your own practice do you uh do you look at food as an alternative to medication is that where you start do you look at combinations how do you actually in a practical sense uh employ diet in your own psychiatric practice so first off as a psychiatrist i'm usually the fifth or sixth person who's seen the person they've already gone to their primary care they've gone to their therapist they've gone to a nurse practice chair they've gone to another psychiatrist and finally they show up at my door and so 99.5 percent of the patients i ever see are already on medications so what uh i primarily do is try to get a really detailed history and part of that history i ask about diet and diet and food are uh really fun to talk about with people because it's a big part of people's lives it can be a part you know if someone is chronically obese they might just sort of hate food or they might really love it but they've had they people can have really strained relationships with food people have had histories of eating disorders etc and so gaining that history and then what what do you normally eat and so then i might see if there's some vulnerabilities for example if someone's an eget they're a higher risk of having low b12 low b12 is associated with depression um they also might not get any they might only get the ala omega threes and while we can break down ala into epa and dha which are the two components that they've been proven to be helpful for the brain and in fact the human brain i think has the highest concentrations of dha of most mammals um anyway so uh a vegan might be more vulnerable to have deficiencies in that or we're considering supplementation or could they maybe add some fish or some muscles or something like that which are fortunately things like muscles are really good sources of zinc b12 dha and epa and uh muscles oysters clams all all those yeah yeah they're actually really good sources they don't they don't have a face the muscle's mother doesn't miss it now a lot of vegans will eat them anyway but it's just again if someone is sort of an ethical vegan um they might be open to adding the stuff or supplement you know um and other people they might have been told oh i need to avoid red meat all together you know my dad died of a heart attack when he was 58 and my cardiologist told me to avoid red meat but then they have a low iron and they have um maybe uh low b12 can also be if you're avoiding a lot of meats and so i might say i'm also going to say oh eat red meat for every meal that's not what i would suggest but i said you know it's probably not going to hurt your cardiovascular health to have a steak every couple weeks um and that way you know you can get your iron up you don't have to take a pill that kind of thing so once you you can also talk you're talking to an older person who has significant depression and they have dentures they don't fit very well and so they're losing weight and they're not able to get all the nutrients they need and a solution for that person might be you know this is when you talk about ancestral health this is not the not the right direction but more supplements than possibly even something like a nutrition shake or something like that that has vitamins in it but that they can easily um that they can easily eat so it's really really sort of dig down on what they're eating and some people have absolutely zero interest in changing their diet um it's just sort of like talking to somebody who's smoking and just you know talking about hey have you ever thought about quitting smoking and they're like no smoking's the only piece so i have my entire day i'm not going to quit i could be dying and on my oxygen and i'm gonna take my oxygen mask off and go to the door and smell them look good you might not say good but i it's you know it's usually not worth sort of fighting with somebody like that you should not smoke um i often meet people where they are and so that's where food is really interesting because not a ton of people ask about what you eat all the time a psychiatrist's job is to be really nosy so it's it doesn't sound really out of left field i'm also i'm not a registered dietitian i went to medical school we learned a lot about biochemistry there's actually a lot of nutrition in biochemistry so when they say oh doctors haven't had any nutrition that's not really true we haven't had nutritional classes like uh rd's would have um but so so i'm not being like oh here is your 1200 calorie meal plan that you're going to be eating today i'm not qualified to do anything like that but i can talk to somebody and say wow you know we're looking at what you ate in the last two days and i don't see any vegetables why is that they're like maybe they don't like vegetables okay you know maybe um well i've talked to people they don't really know how to cook them and they've tried them raw and they don't like them and so we can talk about oh this is how you roast broccoli or steam broccoli you can even uh make very specific interventions just trying to mostly increase the variety of what people are eating um maybe adding maybe making changes say i really like yogurt white chocolate yogurt covered pretzels um and you're saying well you know that's maybe not the healthiest choice do you like dark chocolate covered almonds and that would have a bit of dark chocolate and that almonds you know nuts are actually a pretty decent source of a lot of vitamins and minerals um can you go for more of uh i don't focus a ton on whole grains or grains mostly because i think people eat plenty of grains i think you know i mean cranes are in they're eating corn and they're doritos and they're you know so usually if you start steering people more towards whole foods the the perimeter of the grocery store kind of thing um though personally i think you know if people don't have celiac or a wheat allergy it's fine to see e-glugness not going to kill you um what do you think of uh david permeators you know grain brain theory do you think he there's something there or does he go too far in demonizing grains i think he's one of the so i've never been a serious low carb that that's secure for everything um because i i think you know if you're really talking about if you have a good metabolism um carbs are fine i think it's the process carbs um that are the problem and i think partly because of the sugar aspects of them and then partly because of how they affect the microbiome in causing blooming of some of the bad guys um uh other you know the microbiome is like a jungle and you you have good and bad guys in there and they need to be in a proper balance and there's a lot of evidence that our modern diets kick them out of balance which makes it inflammatory state and like for example you can take the microbiome from a depressed human and give it to a rat not the the rats are raised with germ free basically and you can make the rat depressed so um like they didn't give the rat like a questionnaire but they have some ways to tell their behaviors they're from tasks yes yes um so you know there's that you're basically taking an inflammatory microbiome and depositing it in something else and making them depressed so um i forget what the original question was but well coming back to this your own practice it's just great you you take people where they are right yeah as they come to you and uh if they're more open to dietary changes or less you're able to work with that that's fantastic can you tell us really if they really want a very serious no i want the full diet i want the full nutritional deal i can recommend some nutritionists who um will work with you know what they want like if they want it to be low carb or if they want it to be keto or if they want paleo or whatever it is um um you just have to kind of do some nutritionists to refer to so can you just tell us a few success stories you've had where an intervention whether it be a change in diet or a supplement you saw a significant improvement in in depression or anxiety or psychosis uh so i had a uh a case that this was printed in the new england journal of medicine so i'm not giving away any information that's not already out there and she was known to have celiac disease and also a psychosis and when she was positive for wheat eating she was more psychotic and when she um was not eating any wheat she was actually okay for a long time um and so that was very interesting again it was such an interesting case that it made the new england journal of medicine um but i've had other people that it's pretty clear uh it one with bipolar disorder the probably celiac because it runs in the family um but discovered very early on that eating not eating wheat really kept their mood quite stable so it was not in order to be tested for celiac other than testing the genes you have to be eating gluten um because they do like biopsies of the colon and they can also test for anti-gluten antibodies and this person was not willing to go back on gluten because they didn't want to become psychotic again um which i think is very reasonable so we're presuming that person is celiac and they do quite well um on uh i've not seen wheat avoidance necessarily help with mental health that the person wasn't celiac so in celiac you have an autoimmune reaction to wheat so an inflammatory reaction to wheat right um and that can definitely cause all sorts of delusion psychosis etc so far as other interventions certainly improved matters with certain b vitamins um with uh definitely with iron because low iron is very common i think in women even the U.S. so uh like women 12 to 30 i think like one in four iron deficient at any given time it's super common so what what improvements did you see with the b vitamin or iron supplementation so b vitamin if your b12 is low can directly improve your nerves need b12 to be powered um and so what i'll see someone with a really dragging low energy depression can uh pretty quickly become very improved on it they could just think better and think clearer and they're not dragging and they have more energy iron tends to present sometimes this cognitive dulling because again without iron you can't really power bring oxygen well to your brain um but they tend to have more anxiety because when you have a low iron too if you're walking up the stairs your heart will start to race it's not just because you're out of shape um and they tend to also have and you'll you'll feel like you're running out of oxygen so they'll have you have to breathe heavier and and get out of breath more quickly and so that that feeling is not pleasant and it feels like anxiety and so you will start to have um anxiety just even thinking about that so and you also need iron actually for your nerve transmitters to work well as well and for anti antidepressant medicine to work you need iron and zinc and b12 for all these things to work so all of a sudden you'll find people are having side effects to their meds for the first time they start uh a full aid or or whatever it is there are some very interesting studies now this is it's by the group uh it's now called hardy vitamins in um in uh canada and they're i like that vitamin because most a lot of out uh supplement studies are not done very well um but hardy they actually they send out their meds um uh this this type of vitamins called um uh dietary essential nutrients i think is what their high powered vitamins and their certain families and um other people there's there's running is trying to run a study in main actually using daily essential nutrients is what it is um for bipolar and um there's some very interesting data on that there's a a book called the better brain by julia rutledge that's very interesting it's more about it's not really about dietary intervention it's about this these supplements and vitamins um and they've had a good luck with adhd and um bipolar disorder i think it's been less focused on depression for whatever reason um i think originally the family that originally started using these vitamins they used it in their own family and that's why they decided and it helped they had a strong uh history of bipolar and schizophrenia in that that family and they found that it helped um have you found that um removing simple sugars or processed carbs or going full on ketogenic as in any of your patients have you have you seen those benefits i know i the reports i've read in in uh chris palmer's book it seemed to show that but have you had any experience using ketogenic or you know uh low low carb to help uh moot i've seen in one case bipolar go away with ketogenic diet um i've seen most of the people i have to say most of people who come to me who with dietary control things already discovered that the diet really fixes them and they want a psychiatrist who is understanding of that is not going to be like oh that's ridiculous um so i there are several cases of that i know people online who had depression anxiety from childhood who the minute they went on a ketogenic diet all the sudden it fell away and they were almost completely different person so this is all anecdotal evidence um a lot of people just really aren't interested in trying a ketogenic diet you know it might sort of the general population and i'm not going to hammer on somebody no you have to try you know because there are some people who didn't affect them at all and certainly a lot of people when they go on ketogenic diets i know when i'm in strict ketogenic and it's not just the first two weeks but it really affects my sleep in a very negative way so um i i do much better on sort of more of a it's not exactly low carb but it's what uh oh the four-hour body guy um slow slow carb i'm sorry low carb yes yeah so that's where i kind of live um you know but um so blood sugar control really yeah and there's certainly some cases this has happened multiple times where i've had people wake up like at midnight with anxiety palpitation nightmares and i said okay well what are you eating right before bed and it tended to be there eating you know Doritos or um even something like a low fat potato chip or something like that right before bed and we said well why don't we just try it because maybe so they're eating a lot of carbs a lot of quick digested carbs right before bed and then you know 90 minutes later they get a compensatory bit of a sugar crash i'm not talking about a diabetic or anything like that this can happen normally because you eat high processed carbs and you get a big bolus all at once you respond your pancreas says oh gotta get to work they send out a lot of insulin and that makes that gives you a big change in your blood sugar level they've actually found they did uh comparative studies of like prisoners versus violent prisoners versus the general population and violent prisoners interestingly had in general a higher their uh oral glucose tolerance tests were way more um you know like this than this so mine um personally my uh i can't tolerate high levels of sugar this is probably what was interesting the paleo diet and the stuff in general is even from the age of 18 like i couldn't drink a glass of orange juice because i'd practically you'd have to pull me off the floor 90 minutes later so i've always had to restrict my sugars from the time i was a teenager and i never had diabetes or anything like that but so maybe i'm a violent criminal i don't know anyway it's not always associated with the violence and being aggressive and being in jail but i just thought it was an interesting finding and um i've had people where if they changed that nighttime sugar bolus or carb bolus to let's oh you know we do you like uh protein shakes or maybe an apple and a string cheese instead something that's more uh more fiber more protein more a little maybe a little more fat to smooth out that thing like ice cream will give you a totally different sugar profile than sorbet for example right so uh and all of a sudden they're not waking up in the middle of the night with their panic attacks so you can definitely by smoothing out that blood sugar response and giving more whole foods in general and i'm not necessarily talking about paleo in this case because we're also talking about legumes and whole grains and things like that they're a little bit more like the slow carbs um that people tend as you said have a smoother mood throughout the day and i think a lot of people have had that experience so i don't think it's kind of like you know nobody will argue with the fact that your mood state in your emotional state doesn't affect your physical state because everybody's had a tension headache everybody's had their you know in that nervous situation the rumbling stomach so everyone gets that it can go that way um so that it's the opposite to your physical state um can also affect your mental state people understand that too when you're a lot a lot of pain from a broken leg or whatever it is you're you're generally grumpier and um maybe not particularly happy so um i think the biggest thing when the nutritional psychiatry began was there was idea particularly after all those failed single nutrient studies that i mentioned that food didn't have anything to do with mood i think that was a prevalent idea and it's a ridiculous thing to say a cardiologist would never say that that food has nothing to do with your heart conditions a diet you know an endocrinologist who treats diabetes would never say that food has nothing to do with their diabetes um uh so in some cases it's maybe a virus killed your pink you know caused an autoimmune reaction that killed your eyelid cells and that gave you type one diabetes but um you know it's that's what nutritional psychiatry is about is it yes what you you are what you eat you know yeah and and i think you and you've mentioned this in some of your talks that that 20 years ago this was denied right the standard position was food had nothing to do with psychiatric conditions but i i think you also mentioned that there was a an article a editorial or an article in lancet that finally acknowledged that diet can impact psychology so do you think that the profession is coming around uh not just informally but to formally acknowledge this connection between food and and mental health i i mean i think so and i have to say it's been a while because cobin kind of stopped when my kind of turning in things to go to um and other personal things happened so i've not been doing too many talks recently but every time we went to the apa drew ramsey is a nutritional psychiatrist he's a great instagram and several books um he and i used to present at the american psychiatric association we probably did it six times um every time we had huge rules and it was overflow people are dying to learn about the stuff and how to be helpful um i think people are afraid that they're overstepping what they know i mean i've made it an effort to learn a lot about supplements and different kinds and that that kind of stuff but you again you don't have to be a registered dietitian to say oh maybe add some more fish to your diet or maybe add some you know or and also to be able to recognize some of the symptoms of a b12 deficiency or an iron deficiency so that you don't miss it because it's really ridiculous to give someone pro's act they don't have any iron you know if you haven't even asked about it yeah so how does this work somebody comes to you they're on medication they might want they might they might want to get off or reduce their meds because they're side effects uh food can certainly help there do you have any experience where dietary interventions have helped patients reduce or come off of their psychiatric meds and also how do you handle this kind of from a risk and liability standpoint because that's a that can be a little bit touchy what is your approach to helping people reduce or come off their meds so yeah if people get exercise and diet in shape and lose especially if they lose weight and things people are often able to come off if they're on sort of a minor antidepressant for just a situational depression a lot of people get put on an antidepressant by their primary care doctor and it's been several years and they're not really sure they need it we talk about okay well that stressor that was causing this problem it's not there anymore do you want to try to taper off your med carefully you got to do it slowly and in the meantime we can try all these other things that are known to be helpful and sure you can be very successful i mean someone is with the exception of one celiac case for the most part if people are on mood stabilizers or if they've had suicide attempts or if you've had repeated episodes of depression if you've had two prior episodes you're about 90 likely to have a third doesn't mean that you necessarily need to be medicated um the entire time but you just have to be more careful um and there's certain situations and people and we do a lot of training in this about suicide risk factors so um you just want to be very available so if something goes south they can call you and you can adjust very quickly that's kind of how that works have you had successes though with people reducing or totally yeah i mean all the time sure um especially with like depression or anxiety you have other and it's usually not just diet alone it's usually not so clean so it's hard for me to just sort out a it's usually they're adding diet they're taking better care of themselves in general so they're sleeping better they drop out alcohol um that could be huge tremendous um yeah you mentioned exercise uh yeah it's so adding more activity um or different activity because maybe the activity they were doing before was causing them injuries all the time where they were overworking causing more stress uh so yeah i've also had people this is more controversial and again more people come to me after fixing their problem than before but um a diet's any kind of dietary change can cause an eating disorder so it can make you obsessed with diet and losing weight and counting on your calories can kind of make people really obsessed with food but i've had other people who if they switched from counting calories or whatever it was to just okay well i'm just not going to eat processed foods for the most part except every once in a while i'll have cake at my birthday or whatever it is they think much less about food because they don't have they can just go out and like okay i'm just not going to eat that and all of a sudden there they go from obsessing about food all the time to not obsessing about food really from sometimes from an eating disorder situation to a not eating disorder situation and in general eating disorders they would advise you not to restrict the diets of people with eating disorders um these are people that sort of already figured that out and it's working for them so it's not really risky on my part to continue that um people with the eating disorder is complicated because it can go different people seem to work work very well either with certain restrictions or just eating the same thing every day so they're no longer losing weight but they don't have to think about it all the time again not not the best way maybe to live an entire life but it's better than being in the hospital all the time so uh so yeah so once if people are able to take on new diets or even just change from oh my breakfast was just a Cadbury cream egg or again nothing against the occasional Cadbury cream egg but um you change that to where they weren't eating breakfast at all and they were um then starving at 10 a.m. so they just grab whatever candy that's out at the office or whatever it is and you say okay well what can you do for a quick breakfast and so these little things can make an adjustment and can make a big difference over time and yes I have had success I I've not been running a study on my patients you know so I don't think there are a few cases where you could say oh we just changed this again before dinner snack and that really fixed a lot of things that I talked about with the waking up with nightmares and anxiety um and it doesn't work for everybody who wakes up at midnight with nightmares for anxiety it's not all explained by what they're eating before bed but um so there are some few very clean uh sort of case studies like that but most people their improvement is multifactorial sure but also the psychotherapy side of things so how are your relations I mean I talk I talk about all those things too so um these things work together right yes yeah yeah so um maybe to kind of uh pull this all together can you tell us a little bit about what you're doing these days in terms of writing are you is your blog uh active um are you planning any presentations or any research or is your focus mainly on your practice what's going on um with your your work and your plans with the pandemic and changing everything to online I was having less fun with teaching so I resigned my um Harvard position 2021 um and also this is actually the pandemic too because it was just an interest of mine I'd always been in the 90s I'd read all those virus hunter things and was always just interested in um I had a great aunt die in the flu pandemic in 1919 um and another actually my another great uncle ended up getting the um encephalitis um and was institutionalized after the flu the fatigue encephalitis I think might be able to sort of like the long COVID of the 19 19 flu anyway sorry um so I was really more interested in that um for about two years and then as it has happened sometimes in my lifetime I sort of stopped writing all together for a little while and there are multiple reasons for that um so what I've done recently I've done a couple podcasts recently um this is probably the third one I've done um in the past year and I've been invited for a couple these are more academic presentations so residency programs want to learn a little more about evolutionary psychiatry or nutritional psychiatry I haven't put in any here you have to apply to present at a um convention or whatever it is and I haven't done that recently I think I certainly would be interested in um the next ISNPR which I have to see where it is the the last one I believe there was one in Australia and one in Istanbul or something more recently and I I have gone to the one in London the one when it was in Washington DC or Atlanta I know it was Washington DC and uh if they come closer than Australia next time I think I'll go um well I know your talk your talks at ahs were were very well appreciated and once we start that up again um that might be another venue where yeah that's that's an interesting kind of mixed audience of professionals academics and lay people too I remember I've always really enjoyed ahs and of course I see a ton of friends there so yeah I'd always be welcome I would always be honored to to um to present there on different stuff I have faded back a little bit for various reasons partly partly was the pandemic to sort of put a kibash on everything for several years but then also my kids are kind of teens and so weirdly you kind of need to be around more in the afternoon and so they don't have driver's license yet so I've got to be you know we're driving them around everywhere so it's just been I've just been a little bit more homebound recently and not traveling nearly as much um but yeah it wouldn't be nice to get back in the swing of things um yeah I think my most recent my most recent presentation was that uh it was an LA it was an ancestral event um it was 2020 or 2021 but I don't I haven't done a presentation since then so it was on it was actually interesting it was on um how infectious disease in the history of epidemics affected mental health again and there was more that my focus for a few years with the pandemic so for a few years yeah great well I uh you one thing we'll do is in our in our show notes if you have any links to some of the studies you mentioned that you think would be interesting to viewers we can put those on um it's always good to have that sort of um because I know you've really you've really delved into the studies yeah and I think that's that's pretty interesting um well thank you so much Emily Deans for the conversation today I've enjoyed it learned a lot and I think this is going to be of interest to this audience because we're always looking at how we can be inspired by evolutionary health by the idea of mismatch and and what it is we can do to be inspired by ideas of how our how our early human ancestors evolved not just for yeah not just I have hundreds of articles a lot of them are with food and mood but many of them are about um genes some of them are about you know exercise some of them are about a lot of them are about light management and sleep management so all of those are up at psychology today do just google evolutionary psychiatry psychology today and they're all there um yeah yeah we'll certainly put your your your blog uh up for the readers too yeah yeah and thanks for having me on I could obviously talk about this stuff for hours so I really appreciate it all right well it's been fun thanks again um enjoyed it and uh again Dr. Emily Deans check out her blog on uh an evolutionary psychiatrist psychiatry uh thanks very much thanks for joining us on this episode of ancestral health today we hope you enjoyed our discussion on how evolutionary insights can inform modern health practices be sure to subscribe to our podcast to catch future episodes