 Hi, how's it going? Great. Good. Like he said, my name's Laura Poe. I'm a dietician out of Madison, Wisconsin. I'm in private practice there. And so one of my main focuses in my practice is working with folks with mental health and substance abuse diagnoses. I also do a lot with gut health, which we will get to. So I'll get started. We have such a short period of time. Usually when I give this kind of presentation, it's like 60 or 90 minutes. So if I get a little quick, it's just because I feel rushed. I just want to start saying we're talking about mental health. I am not a mental health practitioner. I'm not a psychiatrist. My focus is using nutrition therapies. But nutrition is not in a vacuum. And it's been so nice to hear some of the other presenters, even just today talking about that there's all these other lifestyle factors that do play into our mental health. And also in the autoimmunity talk, he touched on that as well. So I'm just really happy that that's being talked about because we can't eat a perfect diet and expect that every single thing in our life will be perfect and healthy, right? It's a start. So when I'm implementing these therapies and things that I'm using with my clients, it's always in conjunction with mental health practitioners, mindfulness practices, counseling, and things like that because it definitely goes hand in hand together. So the four main areas we're going to cover nutrition-wise are going to be the gut-brain access, HPA access regulation. Just going to dip my toe in a methylation and then some specific nutrient deficiencies that I'm seeing a lot in my practice with the people who have mental health diagnoses. So the first one is the gut-brain access and the microbiome. I mean, we're all so familiar with this by now, but it's becoming very mainstream, which is actually really nice because people don't, I don't know, think I'm as loony anymore, I guess. So when we're talking about the gut-brain access, so many of the neurotransmitters, the serotonin, and things that make us feel good are based in the gut. And so when we have a lot of inflammation, when we have leaky gut and all these things going on, we're not making the chemicals that make us feel good and happy and maybe we don't need so many SSRIs, but we actually need to help our body make our own serotonin. So the gut-brain are communicating via these neurotransmitters. We've got the vagus nerve that directly connects the two. And so it's not kind of this hypothetical access. There's this direct link. And there's even this emerging kind of field called psychobiotics, where they're specifically using probiotics to treat mental health diagnoses. So it's definitely becoming more mainstream. And so the stress piece as far as the mental health goes just can't be overstated. I would say that in talking about nutrition for mental health, we want to make sure we're kind of separating, and I just saw a great post from Chris Cressor about this, separating that root cause where we want to figure out what's wrong, but also this resiliency. A lot of the people I see have trauma history, and you can't eat your way out of a trauma in your life, or sometimes stress happens, a spouse gets sick, or a child, or something like that. And so when we're talking about mental health and the people I'm seeing, we want to have a healthy diet as this foundation, because we just can't prevent some of these things that happen in life. And so a lot of the people I see who have a trauma diagnosis, we want to focus on healing them. And then for those who don't necessarily, laying a foundation of good health so that we can be resilient when those things inevitably do happen, life is not just going to be perfect just because we live ancestrally, things are going to happen. So that long-term or short-term stress, releasing the inflammatory cytokines, changes the microbiome and causes leaky gut. And a lot of the people I'm seeing have, I'm kind of seeing a triad. Almost every person who has a trauma diagnosis also has IBS diagnosis, also has a fibromyalgia diagnosis. So they're just, and I'm seeing it in almost every person with a trauma diagnosis. So there's definitely a link. So that stress just makes it so our guts are not healthy, not thriving. They don't have a robust microbiome that kind of protects us from these things. And like I said, it's becoming more mainstream. So it's not just the ancestral community. About 95% of the serotonins produced in the GI tract. So when we have that robust microbiome, we're going to set ourselves up for better mental health. And we're going to talk about some of the specific interventions. I'm not going to, because this presentation is pretty short, I don't want to go too far into the specific details of each category, but more head on the interventions. Because as a dietitian, that's more what I'm interested in and when I'm working with people. So to make that robust microbiome that can not only heal us from an impaired guy, but also lay that foundation of resiliency for when stress does happen to us, we're going to add fermented foods, sauerkraut, kefir, yogurt, and I recommend with almost everybody having some with every meal. I do have some people supplement, but as much as possible I want to use food. I try to avoid supplementation almost as much as possible. And adding in those fermented foods is probably the number one. It's also one of the hardest. If you work with a lot of people, if anybody here's a practitioner, to get people who come from the conventional food world to add in fermented foods is pretty darn hard. They're familiar with sauerkraut maybe in a can, but yogurt's definitely the easiest introduction if they can do dairy. It's the one they've heard of. But now they have kombucha at Walmart and the gas station, so we're becoming a little more mainstream. People can, they're like, I've seen that, what is it? So that's a really important one to just add more and more diversity to that microbiome. And with number one and two on here, I know there are certain conditions where we don't necessarily hit these things as hard with GI conditions, but these are just the general recommendations that I'm finding help the people I'm working with a lot. Increasing in those fibers to feed those good bacteria, it doesn't have to be a super high fiber diet, but a lot of the people I'm seeing, they're starting with just white flour, everything. So if they can just increase their fiber intake, they're seeing a lot of improvement. And then that resistance starts to help create the butyrate. Removing refined and processed foods as much as possible, that's of course one of the harder things to do. But my view on all the things I'm gonna be talking about is that what I see over and over is that people are missing a lot of stuff in their diet. It's not necessarily my focus of my practice, and kind of my lens, and maybe it's a personality thing, is not take things out, take things out, take things out. And I know for some people that definitely does work, but what I'm seeing so much of is that people are just starving for nutrients. So what I put people on is kind of what I call regeneration diet instead of an elimination diet. And just really the focus is on lots and lots of nourishment, adding things in, less taking things out. And a lot of people I'm seeing, especially who have someone like the depression and anxiety, it actually works better for them to not focus on what they can't have and focus on what they need to add in. And I'm finding just better results with that as well. So I mean we still wanna take out a lot of the processed foods though, especially the trans fat and high fructose corn syrup and things like that. But that's not the focus when I'm working with folks. The number four is ensuring adequate stomach acid. This is a huge problem and a lot of the people I see are on medications, and sometimes medications are necessary, but I'm seeing a huge number of people on proton pump inhibitors for GERD and heartburn and things like that. So we really wanna work on getting good stomach acid to help with keeping the microbiome healthy and also ensuring that they're absorbing B12 and all that, because as we'll talk about later, I'm seeing a lot of B12 deficiencies too. So using apple cider vinegar, sea salt, taking out the refined sugars and getting all of the fermented foods as well. But the sea salt's a big one. People are always told to take out the salt and maybe not in this crowd, but when people come see a dietician, they're like, I can eat salt? And I'm like, yeah, you need it to make your stomach acid, so maybe that's what's been going on with you. And so getting that in people is really crucial too. And then if they're gonna be eating grains and legumes, nuts and seeds, teaching them how to properly prepare it, I don't necessarily, I don't eat grain-free, which it's fine if people do, but my focus is trying to get people to properly prepare them through soaking, sprouting, and souring, so that they can actually digest them without creating more inflammation and absorb the minerals that are in them. And this doesn't just go for grains and legumes. I will have people come in who try to go grain-free, legume-free, and then they're eating tons of nuts and seeds, but they're not properly preparing those, which are also full of anti-nutrients. So teaching people just that education piece that as we know, no food is ever just that food, not all fat is bad, not all this or that is bad or good. Sometimes it's how it's prepared. So that's a big piece to just lower people's inflammation in their gut. And then adding in collagen-rich foods, bone broth, which we all love, and there's vendors out there selling the collagen supplement, which you could add, but trying to get people to really eat that broth and skin and bones on their animals, their fish, because again, it's what we're missing is those nourishing traditional foods. And then adding in herbs or digestive support, a lot of people, like I said, if they have a substance abuse history, their livers have been compromised, so adding in things like bitters to support liver health and detoxification, things like ginger, cardamom, peppermint, licorice, that are really gonna help calm the inflammation in the digestive tract. And then just a high intake of antioxidants, so that's kind of the theme, is lowering the inflammation in the gut and adding in all these antioxidant-rich foods, you know, all these whole traditional foods, but the broth is a big one. That's also really hard to get people to do. I had someone call me yesterday and they were like, it's like gravy, I can't drink it, because I just did not grow up having broth. So we worked through it. But, you know, these things that people are just not accustomed to having it, and to us, it may be kind of basic, but when I see them add in the broth and the ferments, their gut starts to change so quickly. So in the vein of the gut health being affected by stress, we can just touch on the HPA axis, the endocrine system, you know, the hypothalamic pituitary adrenal axis that's regulating the stress hormones, it's inflammation, all that kind of stuff. So like I said, stress is sometimes inevitable, but how we manage it is gonna be super important, and the body doesn't necessarily distinguish between physical and mental stress, so we can do as much mindfulness and counseling and being in nature and all these kinds of things to kind of curb our chronic long-term stress mentally, but we also wanna make sure that physically we're not putting ourselves under a ton of stress as much as possible. So, you know, going along with the theme of just really, really nourishing ourselves, taking really good care of ourselves, and what I'm seeing a lot is people who just don't have a good routine of self-care that kind of push themselves to the limit, wear themselves thin, and it's not always by choice, you know, socioeconomic status, and things like that can kind of just wear us really thin, so we're not able to have a lot of self-care, but it's gonna have an impact over time on our mental health. So for diet and lifestyle recommendations for this, blood sugar regulation is one of the key, at least with the people that I've been working with, trying to get them to eat regularly is really important. I know a lot of folks here are really in intermittent fasting, and for the people I'm working with, especially who have these specific, like depression, anxiety, schizophrenia, bipolar, things like that, a lot of times they're just not eating, and trying to get them to eat regularly is actually really important just until they can kind of reregulate their HP axis, especially with the women that I'm seeing. I really try to get them to avoid that as much as possible, not that it's not useful, I'm just specifically talking about to get this kind of back in action, avoiding the refined sugars, and for them getting adequate carbohydrates that are complex carbohydrates that actually have some nutrition with them, and at least for this period of time for healing that HP axis, I do try to have them not go super low carb. Of course, I'm not having them just eat a bunch of white flour, but I am finding that is helpful to kind of get that back in balance, and then adequate protein at all meals. This is, I think, the most important for this is that I'm seeing a lot of people who the protein is just not a focus for them, and so getting them to have adequate protein, not just like one egg at their meals so that they actually can keep a steady blood sugar over time, especially adding in collagen, not just having the chicken breast or the super lean hamburger meat to keep that blood sugar steady. Adding in moderate exercise, at least when we're trying to get their kind of stress hormones under control, avoiding overtraining it on the other end, avoiding sedentaryism as well, so getting them more active has been very helpful. That, I would say, is harder than changing the diet. I don't know if any of you are practitioners, but people are way more willing to change their eating habits than their exercise habits, at least I found, because they're going to eat anyway, but they weren't going to exercise anyway. And then adequate sleep, I know we talked about, a lot of people have been talking about sleep. This is one that I do talk about a gentleman earlier, was talking about the kind of two-sleep pattern, and I actually encourage a lot of the people I'm seeing to do that, because a lot of people, it could be because of their mental health or medication side effects or things like that. Sleep is very, very hard for almost everyone that I see, especially with the high anxiety levels. And then what happens when you lay there and think I can't sleep, then you can't sleep some more, and a lot of them will wake up in the middle of the night, and what I tell them is that it's okay, and they're very kind of shocked by that. I'm like, okay, get up. If you've been asleep for a couple hours, but you wake up and can't go back to sleep, get up, make yourself some herbal tea. That's good for your digestion. Read a book, don't look at a screen for goodness sake, but, and then let yourself just be awake for a little bit, and that kind of lowers their anxiety, and then they're actually gonna be getting the adequate sleep they need rather than staring at the ceiling thinking, my God, why can't I sleep? And that actually is really helpful for them to just be allowed to have that natural sleep pattern that they may be having instead of having a doctor give them ambient because they keep waking up at one or two in the morning. Stress management and mindfulness practices, of course, that kind of goes beyond the scope of that, but like I said, this is not in a vacuum, that's gonna be essential. Adding in herbal supplements, especially the adaptogens, when we're seeing just chronic long-term stress or the effects of a trauma. My favorites are ashwagandha and tulsi. I usually like to have them in teas, capsules, tinctures, things like that. But tinctures and teas are what I would probably say are the way I prescribe most of the herbs that I'm using, but those are two that really help the HP access become regulated again, and ashwagandha is a night shade, so if anybody is also on the autoimmune protocol, not using that one, but tulsi's a great one for those folks. And then just adequate nutrient intake, the essential fatty acids, vitamin C is essential for getting the adrenals back, functioning properly, the B vitamins, magnesium, and we're gonna talk about those a little bit later, but just making sure you're not having any nutrient deficiencies, because again, the physical stress of having a nutrient deficiency is just gonna keep contributing to our overall stress load. So we can do as much as we can for mindfulness and calming our kind of external stress, but if you have physical stress from low blood sugar, from inflammation, from having nutrient deficiencies, we're not ever going to be able to kind of calm our overall stress load down. And then limiting stimulants, like caffeine and alcohol is not just possible. Boy, those are hard though. That's ashwagandha in that picture by the way. So I'm just gonna dip into methylation a little bit, I'm not gonna go into the full science or anything like that, but this is one that I've been trying to get more into lately because I've been seeing more people who have gotten tested and have the MDHFR mutation, unsurprisingly, because it's very common. And the implications with inflammation, with histamine in the brain, and kind of the balance between mental rigidity and flexibility that Chris Masterjohn has been talking a lot about lately, and we love him because he nerds out a lot, but that balance because a lot of people I'm seeing either have more the anxiety OCD side or kind of the more depression ADHD side. And getting these methylation nutrients into balance is a key way to make sure that we don't swing too far either way. So the key nutrients that you will need to focus on, especially if you're a healthcare practitioner to make sure we're getting enough of are the kind of well-known ones with methylation or the B12, folate, and then we got the B6, choline, beta-ine, magnesium, calcium, and potassium. So having an overall healthy diet is going to be really important, but some of these, if you have that mutation, especially with the folate, you're gonna have to give extra focus on and the glycine as well. So I emphasize these with everybody who with a mental health diagnosis, but especially if they do have that mutation, getting adequate animal protein that's gonna provide them a thionine, creatine, calcium, and the B12. I just think there's a theme with all of the different interventions that I use, and a lot of it is we have to get back to using a lot of animal foods. I know we're all on board with that, but when people come to see a dietitian, even though I'm integrative and holistic and people know that about me, they're still really surprised when I'm pushing all these animal fats and organ meats and broth and things like that because they've just never been told that they're allowed to. So a lot of the people I'm seeing are, it's a struggle for them. My favorite is when I get to tell people they can eat butter and they just, they're so shocked, but it's kind of a fun job. So adding in the animal protein and adequate amounts, I'm seeing a lot of people who I said before with the balancing that blood sugar, people who are just kind of skimping on the protein and not that they need huge amounts, but finding what's adequate based on their body weight and activity needs. Adding in those collagen-rich foods is gonna be super key for it getting the glycine to balance out the methionine. So bone broth, liver, cuts of meat with the skin and bones, fish, I would say it's also really hard to get people to eat sardines. Maybe it's, we're really into it, but you know, when somebody comes to see me and I'm like, okay, have bone broth and sauerkraut and sardines, they're like, this is not doable. So there are other sources, but it's just fun to see people's face. You want me to eat what? But yeah, the bone broth and the liver once or twice a week, if you have a, and when I go down to Colleen, I'll mention this, if you have an egg allergy or candy eggs for some reason, having an extra serving or two of liver per week. So that's gonna be a great source of glycine with the collagen. You could also use a supplement if they won't or if they won't eat the skin and bones or for some reason, they're averse to bone broth. High intake of mineral-rich, underfied plant foods to help provide all those minerals and B6 that we need. Two or three servings of folate-rich foods a day. And this is when I see a lot that just people do not get enough folate. So I almost have everybody tested for some of the basics. Vitamin D, B12, folate. And I'm seeing a lot of people with B12 and folate deficiencies. And so they might be eating a few servings a week, but especially if they have that mutation where they have increased need for folate, really hitting these foods hard. The liver once or twice a week, again, see it's just so good for us. Those dark leafy greens, and if they are having a gut issue, a lot of times they'll have them cook a lot of their greens. I know the oxalate lady would probably be happy with me for saying that. And then legumes that have been properly prepared. Those are the big three that are sources of folate. And two or three servings a day, so basically one at every meal. So this is, as you can see, it's gonna take a lot of planning if you are trying to create this diet that's having your robust microbiome and good mental health in mind. It does take planning because you need several servings of folate foods a day. You have to have your liver a couple of times a week. You basically need to make a spreadsheet to make sure you get all the foods you need. But it is going to be worth it. And it becomes easier too. It becomes routine to say, oh, on Wednesdays is when I have my liver. And it just becomes easier. Any change is hard to make, but you will get used to it. And then the choline and beading rich foods. So egg yolks, I try to get people to have at least two or three egg yolks or so a day, which is another one that kind of blows their mind. They don't necessarily have to eat the whites if they don't want to, if they have an allergy. But the yolks for sure are such a rich source of choline. Then beets, wheat germ, if they can do wheat, of course we want it in the sprouted or soured form, liver, nuts, and spinach. And so with the choline, if you do, like I said, if you can't have eggs and having an extra serving or two of liver per week. And the liver can be from beef, lamb, a really, some really good lamb liver, paté. You can make chicken or other poultry too. It doesn't just have to be beef. And then again, if you're a practitioner and someone's coming and has a mental health diagnosis, checking for the MTHFR mutation and getting some labs drawn to make sure that if their increased need is there, that you're meeting it. And then there's just some other common nutrient deficiencies that I see and some of them are from food reports. If they're doing a food log and I take a look at it and say there's no way you're getting enough fully. Or sometimes lab testing is necessary. And I do like to work a lot with other practitioners so I can, as a private practice dietician, get more testing than if they were not also seeing a doctor or something. So omega-3s, of course everybody knows about these, but this is one that a lot of people are just not getting especially because they're getting tons of omega-6 if they're eating processed foods. So trying to reduce their omega-6 intake, reduce the polyunsaturated fats, especially the non-polyunsaturated fats. The industrial seed oils as much as possible trying to take out the canola, take out the soybean oil or vegetable oil, and introduce more of the omega-3s. So fatty fish, walnuts, flax seeds, if they can do dairy, the full fat dairy. And pastured meats are gonna have a little bit as well, but especially just keeping that balance in mind with the omega-6 and omega-3s. This is one that I feel like is another mainstream, very mainstream one that people are starting to accept that nutrition can actually affect your mental health. This is kind of a common one that people are like, oh, brain health, memory, take omega-3s. So luckily that's an easier sell than some of the other ones now. And then I just usually recommend having some of those fattier fish two or three times a week. If they absolutely will not eat fish, some people just will not do it, then I'll have them add in a cod liver oil supplement, the extra virgin cod liver oil. Vitamin D, where I live and at this latitude is about the same, almost everyone is vitamin D deficient, it seems like, even in the summer though, because we're inside all day. I'm kind of an hour and a half or so from Mayo Clinic, which is, you know, people think of as a little alternative, not to us, but, and I had somebody, a client go there and I said, okay, have them get you this and this and this test. And they wouldn't even test them for vitamin D. And they said, well, everybody's deficient, so we just don't even test people. And this was at Mayo Clinic, which was supposed to be, you know, like very well known for their care. And I was just, I couldn't believe that they wouldn't even test them for it because they just knew they were deficient, which is probably true. So besides getting people to go outside more, again, just adding in those super nourishing, especially animal foods, the sardines and salmon, and then pastured pork, especially the skin and the fat, go out and get yourself some pork rinds because they're gonna have vitamin D in them, egg yolks, and then the cod liver oil. And not that it's a source that I recommend to most people, but in vitamin D and rich milk is a source, but that's only if every other venue fails because I don't like to do a lot of supplementing. If there's an extreme deficiency, sometimes I will, but usually I try to have it come from the cod liver oil of anything. Magnesium, this is, you know, kind of known as anti-stress nutrient, especially my folks who can't sleep because of anxiety or other mental health things they have going on. This is a big one. If they can't, if they have a really compromised gut, sometimes they will have them do topical, either magnesium oil or Epsom baths, which in Wisconsin in the winter, it's not a hard sell to get somebody to take an Epsom salt bath because it's so cold. But this is a really, really important one, especially for those anxious people, those people who get headaches and can't sleep in that kind of profile of a person. And so we get those in our nuts and seeds, leafy greens, dairy, avocado, seafood for sure. That's the one that, like the shellfish and fish, we're gonna be getting really good ones. And then the broth. Again, with the nuts and seeds, we wanna have those properly prepared or you're not getting much of the magnesium out of them. Iron, I'm not gonna go too much through this. I see a lot of iron deficiency and I know iron is not the only cause of anemia, but I am seeing a lot of this as well. But, okay. I'm seeing that a lot as well. I'm almost out of time, so I'm just gonna breeze through. Getting the proper amino acids, a lot of people, like I said, aren't getting enough protein and we really need these for making all of our neurotransmitters. So again, the liver, the egg yolks, those traditional animal foods are really gonna be emphasized for this. And then, iodine and selenium. There's, at least where I live, there's a really chronic incidence, I guess you would say, of hypothyroidism. And so making sure we're getting the adequate iodine and selenium, the seafood, the seaweed, the prepared nuts and seeds to keep our thyroids really healthy. And then the other lifestyle factors. Like I said, not in a vacuum. Increasing movement, getting tons of outdoor time in nature for earthing for fresh air, for vitamin D from the sun. Some of, I would say these are almost harder for people than the food and exercise as well. Limiting screen time and the exposure to EMFs is a really big one when I'm trying to get folks to prioritize their sleep number five and telling them to turn their screens off. Very, very, very difficult for them. But it's the only way I can calm down. Then we have other problems. Lowering the toxic load, of course, as we know we can't just eat a perfect diet and put a bunch of crazy chemicals on our skin or in our homes. And then mindfulness and mindfulness around eating and other mindfulness practices. And then I'm so glad other people have talked about this. Number seven is finding the community and tribe, avoiding that chronic isolation. A lot of the people I'm seeing are alone all the time. Maybe they go to work or if mental health puts them on disability and then they're home alone all the time and they're never gonna get better just with nutrition alone, they've gotta find that community and avoiding all the isolation. Especially because if they're home alone, they're probably on a screen. I'm just gonna skip through these if you want the PowerPoint, we can talk about them later. But just thinking about, if you are a practitioner and working with people with mental health diagnoses, it's not as simple and cut and dry as some of the other conditions you might be working with and there's just a lot of other things. So getting trauma-informed care and motivational interviewing, training is really important. I would say out of all these things, just to consider. And just working with other providers so that the nutrition can play in with all the other factors as well with mental health. Okay, time for questions. So if you wanna make a line over here by the microphone so we can record a question and ask his answering them. No questions. Okay, thanks so much for your time. Enjoy the rest of the conference.