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Episode 29
The Doctor's Farmacy

Can you beat depression with food?

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

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We’re often told that eating well can prevent diabetes, heart disease, and cancer, but what about the effects of diet on mental health? The correlation is just as strong. What we eat impacts our brains and mental health—food does affect mood. In fact, highly processed foods can lead to a 50 to 100% increased risk for clinical depression and high-glycemic foods pose a significant risk as well. It’s time we stop thinking of the way we eat as relevant to only one piece of our health, it dramatically influences the entire body.

Today’s guest on this week’s episode of The Doctor’s Farmacy is here to talk about the link between diet and mental health. Dr. Drew Ramsey is not your average psychiatrist. A writer, farmer, and doctor who focuses on the connection between mental health and food, he is passionate about nutritional interventions and creative media to share a different way of thinking about the brain and mood. He is an assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and in active clinical practice in New York City. He also spends much of his time with his family, growing their own food, on a 127-acre organic farm.

Throughout our talk, we dig into the powerful relationship between food, depression, and overall mental health. From depression and Parkinsons to ADHD and dementia, nutrition plays a role in how our brains function and our mental state. And while food and mental health are becoming increasingly appreciated in academics for their strong correlation, it hasn’t always been that way. In fact, most medical education programs don’t include nutrition, so many psychiatrists and physicians, in general, aren’t as empowered as they should be to prescribe a healthy diet.

Dr. Drew shares how he’s been able to successfully help patients using the power of real food, along with his top foods for fighting depression and why certain nutrients are key in that process. In an effort to help people access this information, he even published an article on antidepressant foods in the World Journal of Psychiatry after reviewing all the literature and clinical evidence on the topic.

Throughout this episode we also discuss how growing our own food means more than just convenience, the need for a paradigm shift when it comes to nutrition in medicine, and much more. I hope you’ll join us for this powerful podcast episode.

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Drew Ramsey

Dr. Drew Ramsey is not your average psychiatrist. A writer, farmer, and doctor who focuses on the connection between mental health and food, he is passionate about nutritional interventions and creative media to share a different way of thinking about the brain and mood. He is an assistant clinical professor of psychiatry at Columbia University College of Physicians and Surgeons and in active clinical practice in New York City. He also spends much of his time with his family, growing their own food, on a 127-acre organic farm.

Transcript

Mark Hyman (00:04):
Welcome to The Doctor’s Farmacy. That’s F-A-R-M-A-C-Y, a place for conversations that matter and we’re going to talk about something that matters today which is mental health with Dr. Drew Ramsey. And Drew is quite an extraordinary doctor. He’s not the usual guy. He’s a farmer. He’s a writer. He’s a psychiatrist. And he’s breaking ground on talking about issues that nobody really talks about, which is mental health and food.

Drew Ramsey (00:31):
Well, you talk about it Mark.

Mark Hyman (00:32):
I do talk about it.

Drew Ramsey (00:33):
You’re one of the original guys talking about it.

Mark Hyman (00:34):
I was one of the … I was sort of the accidental psychiatrist. You’re the intentional psychiatrist. Now Drew, a little background on Drew. He’s a leading innovator in mental health. He combines clinical excellence, nutritional interventions, and creative media to share a different way of thinking about the brain and the mood and our mental health.

Mark Hyman (00:51):
He’s an Assistant Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons and he’s an active clinical practice in New York City. So Columbia is no slouchy place. That’s pretty good. His work and writing have been featured in the New York Times, Wall Street Journal, Huffington Post, Lancet Psychiatry, NPR which named him a kale evangelist. Not only do you recommend kale but you grow kale which we’ll get into.

Mark Hyman (01:15):
And he’s been on The Today Show. He’s been on BBC. He’s done some TEDx talks, author of three books, Eat Complete: The 21 Nutrients that Fuel Brain Power, Boost Weight Loss, and Transform Your Health, another book called 50 Shades of Kale which sounds kind of racy, The Happiness Diet which I want to eat, and his new course, ecourse, Eat to Beat Depression: Help People Maximize Their Brain Health with Every Single Bite. And he goes between New York City which is kind of the epitome of urban life to one of the most rural places in America, rural Indiana where he lives with his wife and children and parents on his 127-acre organic farm which is amazing. That’s pretty powerful.

Mark Hyman (01:58):
Now, welcome Drew.

Drew Ramsey (02:00):
Thank you Mark. It’s real pleasure to be here with you. It’s fun for me to be here with you because back when I was a little baby psychiatrist, I had this idea for a book and I was thinking, “God, I just finished residency.” We didn’t really talk about food. “Is there anybody thinking about this?” And there was nobody except you. And I got that book. I remember still reading. I remember I was on the plane. I just started cranking through it. And so thank you. I’m here in part because of you.

Mark Hyman (02:26):
Well, I wrote that book. It was for consumers or people who are interested in their health, but actually it was also written with a subtext for doctors, because a lot of stuff I don’t think the average person would understand like methylation and sulfation and fancy biochemistry. But I felt it was important to get it out there because when I started practicing functional medicine, I would take care of people’s physical health and improve their gut function, improve their immune system, optimize their nutritional status, and help them balance their hormones, and all these really simple things. Well, simple through functional medicine. It’s not what typical doctors do.

Mark Hyman (03:03):
And what happened was that people’s mental health got better, their brains got better, And it was, at first, it was kind of confusing to me because I was like, “Wow. How did this happen?” Because there’s this thing called the blood-brain barrier and what happens in your body stays in your body. It’s like Las Vegas but doesn’t turn out that that’s the truth anymore. And that’s really, I jokingly call myself the accident psychiatrist. People with bipolar disease and OCD and ADD and depression, anxiety, all these problems get better. Not only that, but things like Parkinson’s and dementia would also get better, and I was like, “Well, what’s going on here?”

Mark Hyman (03:37):
So I began to really look at the data. And this was 10 years ago, and there was quite a bit even back then. But now I look back and it’s like, “Wow. Those were things that were really in the infancy and nobody was talking about it.” And you start talking about this. But there aren’t many psychiatrists around who are talking about gut flora and mood or the immune system.

Drew Ramsey (03:52):
That’s changing. I mean, that’s one of the exciting things happening now, is food is medicine is becoming more of something that gets embraced and gets understood, is really critical especially to prevention. I think we’re just seeing more. People talk about the microbiome. There’s a randomized clinical trial on for straight-up clinical depression last fall using a probiotic. We have two randomized clinical trials looking at the Mediterranean style diet to treat clinical depression. So it’s an exciting time right now-

Mark Hyman (04:21):
And they showed benefit.

Drew Ramsey (04:22):
And they showed tremendous benefit. I mean, they showed how much benefit, they … I mean, you know if you fail antidepressant treatment right now, you get one of the treatment protocols, we get put on something like Abilify, an atypical antipsychotic. Augmentation strategy, that’s your evidence-based protocol.

Mark Hyman (04:37):
Yeah, that’s a nasty drug. That’s what they used to treat schizophrenia.

Drew Ramsey (04:40):
They used to, and then it crossed over. I like Abilify for what we call a little ego gloom. I mean when you need it, Abilify could be a good medicine. But what’s interesting is the number needed to treat to get that right and find that right patient it works for is about 10. With the Mediterranean style diet what the trial showed is the number to get that right to help one person was four. And compare that in terms-

Mark Hyman (04:59):
So that means you treat 10 people with Abilify, nothing happens … One person gets better.

Drew Ramsey (05:02):
One person gets better.

Mark Hyman (05:03):
And with food you treat four people with food and one gets better.

Drew Ramsey (05:06):
One gets better.

Mark Hyman (05:07):
It’s a much better drug than the drug.

Drew Ramsey (05:08):
I mean, it tastes better, it has fewer side effects, and it’s whether you need Abilify or not, I think the part that concerns me and concerns you is nobody gets food to start with, nobody gets much instruction around food when you get put on medications ranging from, “Hey, this is how long you’re going to be on it,” or, “Hey, there’s a little weight gain. Let’s really dial in your diet.” We don’t mention food. And that’s just … beyond the med, it’s just a huge blind spot both for healthcare in general but really for mental health.

Drew Ramsey (05:43):
Brain consumes more food than any other organ in your body. Every other field of medicine, you go to a cardiologist, we might not agree with the advice that they give, but at least they talk to patients about food. Gastroenterologists.

Mark Hyman (05:53):
They say eat better.

Drew Ramsey (05:54):
Yeah, they say eat better. They say eat better. So it’s, yeah, they say eat better, eat more carbohydrates. Whoops.

Mark Hyman (06:02):
It’s true. I mean, in clinic I joke about this. The head of cardiology there doesn’t agree with this, but on the floor, the diet when you have a heart attack, the heart healthy diet is a low-fat high-carb diet.

Drew Ramsey (06:14):
Of course. My dad had-

Mark Hyman (06:16):
Still today-

Drew Ramsey (06:16):
… quadruple bypass in southern Indiana, amazing small hospital because they didn’t really know how to do it well there. And you look at what they bring right afterwards and it’s like some hydrogenated soybean oil nut butter whip and a roll and some applesauce.

Mark Hyman (06:34):
Yeah, pretty bad. Or pancakes in syrup or bourbon fries to stimulate their appetite.

Drew Ramsey (06:39):
Not what you would want for heart health.

Mark Hyman (06:41):
No. So how did you, a psychiatrist trained in one of the top institutions in the world somehow realized that food was relevant and that the stir we had about mental health wasn’t the real story?

Drew Ramsey (06:57):
Well, I think it’s I’m a psychiatrist, so let’s start with my parents. When I grew up, my parents when I was six moved to really, really rural Indiana. I grew up in Crawford County which is just-

Mark Hyman (07:08):
Were they hippies or something?

Drew Ramsey (07:09):
They were part of that back to the land movement, that original … I mean, they still have their original Rodale copy of organic farming and they got … It’s funny now to think back we’re in this time, there’s so much fear and anxiety politically. And they were in a period like that where people wanted to get away from all of the technology.

Mark Hyman (07:26):
The Vietnam War.

Drew Ramsey (07:26):
Yeah, they wanted to get away from the man and grow their own food and put up solar panels and swim naked in their pond. The things that folks did out in the country. So I grew up out there, and so-

Mark Hyman (07:39):
Well, not the average farmer, how would you say?

Drew Ramsey (07:40):
Well, you and I maybe know some different farmers, but yeah, not that. You get a farmer out on a moonlit night, you never know what happens Mark.

Mark Hyman (07:48):
Okay, all right.

Drew Ramsey (07:49):
So we were way out there in the middle of nowhere and we built our own house with some help and moved in and started growing a lot of our own food. My dad’s a professor and my mom’s a educator and a librarian, and settled into this community. And when you live on a farm like that, it just gets into you, just it was interesting moving to the city where I just missed this whole mount information and just the smell of the forest right now has this kind of sweet smell on the [inaudible 00:08:17], the leaves decay, and it’s the-

Mark Hyman (08:18):
It’s true. Every season has its smell.

Drew Ramsey (08:19):
Oh, so much smells that are just the way the forest just blesses you where you walk out, and I remember the first time that we were harvesting our honey and my buddy Ian who photographer, shot 50 Shades of Kale, but he’s my good friend, we grew up. He’s on the farm down the road. We’re out. We said, “Let’s take a break. Let’s go walk in the woods.” We walk in the woods and there is this huge orange streak going down one of our little streams, and we got closer and it was this big chanterelle bloom.

Mark Hyman (08:46):
Wow.

Drew Ramsey (08:46):
And we just go back with pounds and pounds of these like really …

Mark Hyman (08:48):
Mushrooms.

Drew Ramsey (08:49):
Yeah, really gourmet mushrooms that here in the middle of nowhere just kind of, they’re just there in the forest.

Mark Hyman (08:54):
That cost like $30 a pound in New York City.

Drew Ramsey (08:57):
Yeah, exactly. Right. And so we got like … So I think probably my interest in food came from that. My parents really or my dad’s always been a label reader and a really healthy guy and paid a lot of attention to what he eats, both my mom and dad have. So as I went through med school, I went through training, it was interesting. During that period my life I was a vegetarian, low-fat vegetarian, following the latest advice, real healthy guy.

Mark Hyman (09:19):
Yeah, I was on it that too.

Drew Ramsey (09:20):
Yeah. I mean, I think all of us were. I did exercising a lot and eating lots of [inaudible 00:09:25] cookies, and then trained in Psychiatry Columbia. I mean, that’s a wonderful institution. The guy who wrote the DSM, Bob Spitzer, taught me the Mental Status exam. I mean it’s just … It’s a storied institution for mental health. So it was wonderful to be there and have a foot in that and then also have this other foot that for a long time felt separate. And that was my secret. I’m like from the middle of nowhere. A lot of people call us rednecks or country folk or whatever. And you couldn’t really let that out. And then, it’s been really nice. That’s like changed. I don’t know exactly. Maybe I got a little more confidence, but also I think as people got interested in food and started to respect farms and farmers, all of a sudden this was like an asset.

Drew Ramsey (10:12):
So the fact I could drive a tractor and split wood and grow kale and I just talk about food but lived the reality of trying to grow some of our own food, suddenly that was something that we could talk about. So that’s been really nice for me. My analyst has been happy about that.

Mark Hyman (10:30):
That’s good. So let’s get into the food thing because you’ve written a bunch of books about it. You just published an article in the World Journal of Psychiatry which is an analysis of food and its impact on mental health, was sort of a meta review, all the papers that were written about it. And you come up with some very interesting conclusions looking at both nutrients and foods and how they impact health and mood. Is this something you learn all in psychiatry now or is this just kind of still on the margin?

Drew Ramsey (10:58):
Well, I think we’re learning now. So for the past five years we’ve had a food and mental health workshop at the American Psychiatric Association.

Mark Hyman (11:08):
Oh well.

Drew Ramsey (11:08):
Last year David Bouley came so the chair of our Scientific Committee, Philip-

Mark Hyman (11:12):
You know how he got into all this, right?

Drew Ramsey (11:14):
I wouldn’t doubt. Maybe you had something to do with it. Have you seen his fermentation workshop going on? He’s-

Mark Hyman (11:19):
Amazing. He’s an amazing chef. He’s one of the top chefs in New York. Amazing guy.

Drew Ramsey (11:21):
Well, and he’s like, I would say he’s like one third chef, one third magician, and one third healer because David is … he’s … Chef Bouley is a force to be reckoned with.

Mark Hyman (11:31):
But he close his main restaurant which had been the top restaurant in New York for decades to start a food as medicine program.

Drew Ramsey (11:37):
Yeah. And for research. He’s been spending all this time in Japan researching fermentation. So I think that’s a good example of … People would say we don’t talk a lot about food and we don’t know our training programs yet. And that’s in part because all of medicine, there’s this really slow translation. We have a huge problem and how do we innovate quickly that we have a research finding and how do we quickly begin to adjust our clinical care model to reflect that research, because that’s what evidence-based medicine should be. So you’d think, “Wow, couple of clinical trials, whole lot of correlational data saying food matters for depression.” You’d think every center that’s interested in treating depression would at least have a nutritionist there. And I think some do and we’re seeing more …

Mark Hyman (12:14):
Not so much.

Drew Ramsey (12:15):
Integration. Yeah, I’m trying to …

Mark Hyman (12:18):
You’re fighting the good fight.

Drew Ramsey (12:19):
I’m trying to still cheer but, yeah. I’m inspired by the places like Eskenazi Hospital has a kale farm on their roof. That’s a public hospital. And talking about food and getting … When I see places like that where they start following and they do an intervention and they see that there’s 50 more percent plants being consumed by their staff and they get excited about that, that’s progress. But you’re right. It’s not happening as much as it should and that’s why we’re all talking about it.

Mark Hyman (12:46):
But you know in psychiatry they really, they go, “Oh wait. We know that what your diet is has an impact on your mental health.” Does there like, if you go to a psychiatrist, any psychiatrist in New York or … But they go, “Yeah, I think there is,” or they go [crosstalk 00:12:59]

Drew Ramsey (12:59):
I think there is. It’s funny. I bumped into one of my buddies who’s like a hardcore researcher, Alex Dranovsky. This guy’s like one of these big giant brain MD PhDs and I bumped to him in the park, gosh, two or three years ago as this started to get a little bigger. And I said, “Am I kind of nut to this? Is this … Like am I supported by science?” And he just looked at me and he’s like, “Drew, the idea that people eating well is good for their brain, yeah, I think we’d all agree with that.”

Mark Hyman (13:24):
All right.

Drew Ramsey (13:25):
So I think all psychiatrists would agree with it. I think some wouldn’t feel as empowered as they should to say something, that some of it is complicated, some of it’s cool biochem, but a lot of it eat more leafy greens, eat more rainbow vegetables, the kind of things we do and both eat complete and eat to beat depression of thinking in food categories and thinking in basics. This isn’t rocket science. This is like get rid of refined processed foods, get rid of garbage. I quote you all the time with that eat the food that God made, not the food that man made. That’s one of my … And I don’t … And with your psychiatric license or psychology license or your, wherever you are in the mental healthcare system, to just encourage patients, as we do so many other lifestyle factors, give them that nudge.

Mark Hyman (14:09):
Yeah.

Drew Ramsey (14:10):
To …

Mark Hyman (14:10):
Sleep, stress, exercise.

Drew Ramsey (14:11):
Yeah, exactly.

Mark Hyman (14:12):
I mean exercise they say works better than antidepressants for …

Drew Ramsey (14:15):
Exercise beats Zoloft at 18 months, and it’s one of the things I think which translates. I prescribe a lot of Zoloft and I find it to be helpful medicine for some people, for the right people, but the thing that we don’t do is we don’t say, “Look, I’m also prescribing you exercise. I want a report next week.” And that’s that we’re very good with psychotherapy and with psychopharmacology and with helping people change behavior, but it just, it’s not been something that we have done enough with.

Drew Ramsey (14:44):
Like okay, the most important behaviors that we’d really change are exercise, food, sleep hygiene, and it really makes psychotherapy active in the way that like, “All right, I definitely want to talk about your mom, really interesting, I want to talk about your dreams, super interesting. I want to talk about all your intimate issues, interesting. But, I want to make sure that this week we’re thinking about something that we’ve learned in making a change,” that kind of coaching model of … I have a coach in my office and I’m like a little jealous because her patients, they get like, “We talked about four things and here are your goals.” And I was looking at my patients, thinking, “Man, they’re going to be a little jealous. You leave my office with like some deep thoughts.” But really, I’m activating and making what we call active psychotherapy, making psychotherapy an active engaged process. That’s-

Mark Hyman (15:30):
Now, just tell me more about that.

Drew Ramsey (15:32):
Right. And that’s-

Mark Hyman (15:32):
How did that make you feel?

Drew Ramsey (15:34):
Yeah. I mean there’s a time for that and so we call it … A good psychotherapist understands what’s called surface to depth. And surface is there’s time to get action-oriented, there’s time to really support someone, and depth is when it’s time to get into that really, the nitty-gritty. But what I’ve been struck by as a psychotherapist because I spend, gosh, 20 hours a week at least doing psychotherapy is that knowledge of our deep self. We really have to help patients translate that into action-

Mark Hyman (15:59):
Behavior.

Drew Ramsey (16:00):
In action and behavior. Our knowledge of your unconscious mind in my opinion absolutely critical to your mental health.

Mark Hyman (16:06):
[crosstalk 00:16:06] in psychoanalysis for 20 years.

Drew Ramsey (16:08):
Yeah, I’m one of. I’ve been in psycho … I started in psychoanalysis when I moved to New York, so I’m like a farm boy and there I’m in psychoanalysis. I’ve done a little psychotherapy and I was in med school. And I would say that is actually like my secret power, like I’m well analyzed. And when I think about …

Mark Hyman (16:24):
And does that translate into behavior change for you?

Drew Ramsey (16:26):
It does. It translates to a lot of behavior change. It really translated to a lot of behavior change in my sense of how we as men in the world need to think about our behavior. I think has changed a lot in terms of my … I’m an only child in terms of thinking about what that means, in terms of how I think about peers and how I kind of think about siblings in a certain way. So I find it to be really powerful, supportive, and nuanced idea, knowing ourselves in that way. But it’s got to be like active.

Mark Hyman (16:57):
Well, I always say it’s hard to not be depressed if your thyroid’s not working or your vitamin D is low, if you’re putting weight on too fast. It’s like-

Drew Ramsey (17:03):
Well, it’s impossible. It’s impossible not to be depressed. I mean, that’s the thing that I think so often-

Mark Hyman (17:06):
So I was like, all that stuff’s good. You can work on your beliefs, on your past history, your lineage and all those things really are great, but it’s so much easier if you’re not struggling against the physiological …

Drew Ramsey (17:19):
You actually can’t do that work.

Mark Hyman (17:19):
The system’s making you sick.

Drew Ramsey (17:19):
I would argue that you can’t engage in your mental health if you are nutritionally depleted, if you have really awful sleep hygiene, if you … I mean, you can engage but you’re not … If you’re in a bad mood and irritable or have low energy because your thyroid is off or your B12 is low, we’re going to spend a lot of time talking and theorizing why that might be when actually there is no psychological reason for it.

Mark Hyman (17:42):
Right.

Drew Ramsey (17:43):
Your cells are thirsty and hungry. And that’s when you look at the nutritional insufficiency rates in America, right? What’s a critical brain nutrient?

Mark Hyman (17:49):
Niacin.

Drew Ramsey (17:50):
Zinc. 48% of Americans don’t eat enough every day. Vitamin E, probably one of the most important fat soluble vitamins, 96% of Americans don’t meet the recommended daily allowance, just like …

Mark Hyman (17:59):
Which is found in whole grains.

Drew Ramsey (18:01):
Yeah. You know this. I mean it’s just like what …

Mark Hyman (18:04):
Magnesium, 48%, fish oil, omega-3s 90 plus percent.

Drew Ramsey (18:08):
We don’t even have a recommended daily allowance of long-chain omega-3 fats unlike every other developed country in the world. And so we don’t even have a nutritional deficiency rate because we don’t have a standard. It’s really, it’s alarming especially when increasingly people are distracted, people are pulled into all kinds of strange ideas and diets about nutrition, people are pulled away from farms. I mean, I’ve seen stats like 70% to 80% of all food consumed soon is going to be prepared by somebody else. And I think something about you and I as physicians is that we both have chefs knives and we both-

Mark Hyman (18:42):
Because we’re both farmer chef.

Drew Ramsey (18:43):
Yeah. Well, you prescribe it, you cook it, you grow it. And that’s how you know it, and that’s how you … That is really my mind walking the talk, and …

Mark Hyman (18:53):
So let’s back up here a minute. So if someone’s listening and they have depression, anxiety, mental health issues, what are the ways of eating that actually cause a problem? And then we’ll get into what are the ways of eating that actually can fix the problem.

Drew Ramsey (19:08):
Yeah, that’s …

Mark Hyman (19:09):
Then we’ll get into the subpoint-

Drew Ramsey (19:10):
… such a great question. Let’s start with the problem at the end of year fork before we tell you the solution. And the problem at the end of your fork, a lot of people know those words that everybody knows I’m about to say sugar, everybody knows I’m about to say trans fats, everybody knows I’m about to say processed foods. And so …

Mark Hyman (19:26):
Surprise.

Drew Ramsey (19:27):
Surprise.

Mark Hyman (19:27):
It’s everything that causes cancer, diabetes, Alzheimer’s, and depression.

Drew Ramsey (19:31):
And I think what’s really been striking to me as a psychiatrist interested in behavioral change and as an eater and as a parent, how do you change those from being concepts to being behavioral and action-oriented items in your own life?

Drew Ramsey (19:45):
So what’s causing the problem very simply is not getting enough of the right nutrients. And I would argue for a lot of Americans are missing a set of nutrients. Americans are not getting phytonutrients because they’re not eating plants. Americans are not getting seafood because they eat 14 pounds per year, period, and it’s fish sticks. It’s not the seafood that you would want them to eat. This is not shrimp ceviche and wild salmon.

Drew Ramsey (20:12):
Also, there’s I think a problem that isn’t just around the food choice but is around I would say the missing spirituality of food, and that people, we’ve lost our soul about food. And when you tell people to eat well, there’s a notion that, “Well, that costs too much,” or, “It takes too much time,” or, “I don’t know how to do it.” And I think those are our miss in lives, and I think it’s just … My momma taught me how to cook, and she’s taught me that recipes start with olive oil or butter, garlic and onions.

Mark Hyman (20:45):
Pretty much.

Drew Ramsey (20:46):
And then you add in what, are you putting some vegetables in that?

Mark Hyman (20:48):
It’s fine.

Drew Ramsey (20:48):
And you’re good. Or you put in some meat in that, you’re good.

Mark Hyman (20:52):
It’s pretty much how I cook.

Drew Ramsey (20:54):
Yeah. I mean, I think, and what I’m shocked by things like, “Well, we make our lentil soup,” and, “Oh, we make a lentils carrots celery, and that’s it. We put it in a crock pot. And I love serving that dish and people are like, ‘Wow, what’s in here?'”

Mark Hyman (21:06):
Right.

Drew Ramsey (21:06):
It’s like, “It’s lentils.”

Mark Hyman (21:07):
Food.

Drew Ramsey (21:07):
Yeah, carrot, celery, a little bit of pinch of sea salt. So anyway. Those are what’s on the end of the fork that’s causing the problem is first of all people aren’t eating with a fork, people aren’t taking a deep breath and engaging their digestive system, and people aren’t in any way offering up gratitude or thanks for that, most people, some of you all out there are doing that, but the number of times as we did when we were … We had that wonderful dinner with Well+Good and we sat there, and I’m sitting there next to Gabby Bernstein and I’m thinking like. I’ve been out in the Midwest. Like you don’t eat until you say grace. And I said, “Let’s have a moment,” and everybody’s ready to give thanks and bow their heads for a moment and she said such a wonderful grace to our food for us. So those kind of things.

Drew Ramsey (21:49):
It’s not just that garbage is on the … is not even in your fork, it’s in the packers that you’re eating, or that it’s on the go. It’s that we’ve lost that notion of where it comes from and valuing that and honoring that. And we’re doing a better job as you know honoring the farmers who grow it, who are these silent heroes. Talking about a healthcare crisis. I mean, talk about physicians suicide. I mean, the biggest threat to farmers right now is farmer suicide. I mean, they’re just losing dozens of farmers a day. It’s the number actually came out. There was like a little confusion, like what’s the top risk group for suicide, was it farmers or doctors, and I was like, “Either way it’s just awful.”

Mark Hyman (22:28):
So is there data science proving that sugar and processed foods cause mental illness?

Drew Ramsey (22:35):
Well, let’s talk about the data set that there is. The big data set and there’s controversy about this data set is correlational data. And the controversy is that’s really misguided us with a lot of nutritional policy per smart folks looking at that. I really like the writing of Gary Taubes and Peter Attia who kind of look at the science behind correlational studies and have some serious questions.

Drew Ramsey (22:55):
But if we’re going to think about that data as being useful that data is very clear. When you eat more processed foods which means simple sugars, trans fats and a lot of simple carbs in all those ways, it’s not just sugar folks. It’s fructose syrup. And I love corn syrup solids.

Mark Hyman (23:14):
Right. Now they changed the name of high fructose corn.

Drew Ramsey (23:16):
Right, it was, like sounds like a corn kind of, like corn syrup, yeah, like-

Mark Hyman (23:21):
Corn salad, it’s a vegetable bowl.

Drew Ramsey (23:21):
Maple syrup. Yeah. Those are the things that certainly we want folks to avoid. And what does the data say? If you eat highly processed foods, you have 50% to 100% increased risk of clinical depression.

Mark Hyman (23:37):
Oh.

Drew Ramsey (23:38):
If you eat high glycemic index foods, there’s a great study that came out of a colleague at Columbia looking at high glycemic index foods, so those are foods that just spike your blood sugar more. Those have a significant increased risk, individuals have an increased risk of depression, the Women’s Health Initiative. So big, big study of women ages 45 plus.

Drew Ramsey (24:00):
So there’s that correlational data, and it’s just consistent when you look at the meta analyses of it, it’s consistent, that the food that we’ve created in the last hundred years leads to an increased risk or increased risk in that population of depression. The same data for ADHD. Not as much data for anxiety disorders which is interesting, but certainly feels true to me clinically.

Drew Ramsey (24:22):
Then we move on to randomized controlled trials. And the reason this is of interest is on the molecular side, like in the mouse models. You know this. Not having enough nutrients and putting lots and lots of fuel in any-

Mark Hyman (24:34):
What does a depressed mouse look like?

Drew Ramsey (24:37):
Yeah. I mean, what a depressed mouse looks like. I mean, it’s very clear what depressed mice look like is you stick them in little cages and they don’t try and that you put them into swim, it’s a forced swim test, and when mice are depressed they don’t fight to get out. They just stop swimming.

Mark Hyman (24:51):
They drown?

Drew Ramsey (24:52):
We don’t let them drown, but they would drown if you didn’t fish them out. Whereas non-depressed mice, they’re fighting to get out. That’s what a depressed mouse looks like.

Drew Ramsey (25:01):
So the randomized controlled trials that came out recently are exciting because we can say it makes common sense. We can say on a molecular level it makes lots and lots of sense. We can say it makes sense in the correlational data. But you and I know Mark medicine’s not going to change until we have randomized clinical trials, and that’s where folks like Felice Jacka and Michael Burke and the Food and Mood Centre in Australia, they’re really I would say the leaders in this where they’ve completed a number of trials. Natalie Parletta is also not part of that group, but it’s a part of the leaders in this. And now they’re putting down numerous randomized trials and creating resources for patients with mental health concerns like depression to make sure if it’s part of the equation. And their data looks quite strong.

Drew Ramsey (25:41):
And what I love about this is when the data comes out, it’s funny, one of the big leaders in psychiatry, won’t mention him by name, but been very critical, gets really … It’s funny, there’s a big post about how, and one of these health medicine review websites about how bad the trial was or how small it was or it’s like fighting, and I’m thinking-

Mark Hyman (26:01):
And everybody’s always criticizing each other about the study.

Drew Ramsey (26:04):
And I was like, so when we don’t have data, you say there’s no data, and then when people do a really good trial, you want to pick it apart.

Mark Hyman (26:09):
Yeah.

Drew Ramsey (26:10):
And there’s some feeling that it’s almost like folks have really …

Mark Hyman (26:16):
People don’t like paradigm shifts.

Drew Ramsey (26:17):
Well, I mean is this how bad it’s gotten Mark, that we’re at a paradigm shift? We’re suggesting that our patients, our neighbors, our families eat well for things like when they’re thinking about their brain and their mood and their dementia risk and their depression? Like we’ve gotten so far down the rabbit hole of medicine that that’s a paradigm shift?

Mark Hyman (26:37):
Yeah.

Drew Ramsey (26:37):
Like that’s …

Mark Hyman (26:38):
Yeah, it’s crazy.

Drew Ramsey (26:39):
It is absolutely nuts.

Mark Hyman (26:41):
You’re right. There’s so much data. You might be aware of Hibbeln’s work which was from the NIH-

Drew Ramsey (26:45):
Joe-

Mark Hyman (26:45):
… where he showed the-

Drew Ramsey (26:46):
Captain Joe, Captain Joe Hibbeln is like …

Mark Hyman (26:49):
He’s a pretty cool guy.

Drew Ramsey (26:50):
He’s the leader of the … What he calls himself? He’s the Surgeon General, he’s a soldier in the Surgeon General’s Army.

Mark Hyman (26:55):
There you go. And he did this amazing study looking at the rise of omega-3 … I mean, the rise of omega-6 fats refined oils and the decrease in omega-3 fats leading to violence, homicide, suicide, and that changed behavior. And I remember once coming back from somewhere and I had a letter in my desk in my office, and it was from a prisoner who wrote me a letter, who read my book Culture Metabolism way back when and said, “I was a violent criminal in my life and I realized that when I changed my diet after reading this book in prison,” I don’t know how he did that, that he realized he was a very different person. They’ve done prison studies where they feed prisoners healthy diets and they reduce violent crime by 56%, they feed them multivitamin reduces crime by 80%, in prisons.

Drew Ramsey (27:43):
Yeah. You can just see that the notion that we don’t approach that, what is criminal activity violence. Some of it it’s stuff we don’t understand. Some of it it’s certainly horrible character pathology. But some of it when we think that this is a population that in general does not have good nourishment, in general does not learn a lot of mental health skills, there’s a way that some of what’s going on there is certainly just a result of a broken system of mental health care, and I would say a broken system of our culture.

Drew Ramsey (28:14):
I’ve been really … I’ve been inspired this month by Benjamin, the Benjamin Rush biography, and the reason is that I didn’t know anything about Benjamin Rush. And Benjamin Rush is one of our youngest founding fathers. He is the second youngest signer of the Declaration of Independence and the only, I think the only physician signer. And he is our original American physician. They called him the American Hippocrates back in the day. And he’s also our original psychiatrist. And he founded the first mental hospital and he helped us found this country on a very, very simple principle which is that when we think about mental illness, we can’t put people in asylums and say that they don’t have spirituality or they’re sinners or they’re bad people, that we as physicians are going to treat them as patients and we are going to care for them.

Drew Ramsey (29:01):
And that is just inspired me to really think about what’s happening in our country and how bad our mental health has got and how we all know about it and we’re just finally starting to talk about it. But we were founded as a place where we should have freedom to talk about this. I’ll get you a copy of the Benjamin Rush biography.

Mark Hyman (29:20):
Yeah, it sounds fantastic.

Drew Ramsey (29:21):
It’s like every doctor should read it.

Mark Hyman (29:23):
So Drew, you wrote this paper. It was published September of 2018 in the Psychiatric Journal, and it was really quite detailed in terms of its analysis of the types of foods and nutrients. So help us take this home. What are the things that you learned from there that are the most important nutrients we need and what are the most important foods to help us get those nutrients and just in general to help us …

Drew Ramsey (29:44):
For sure.

Mark Hyman (29:45):
For our mental illness.

Drew Ramsey (29:47):
The paper’s called Antidepressant Foods, and folks can check it out. It’s an open source article. And I do this with my colleague Dr. Laura LaChance, and quite simply it’s arithmetic. It’s bean-counting. And we went through all of the literature, looking at all of the essential nutrients, vitamins and minerals, and did a literature search to say, “Well, which of these have significant evidence that they can help prevent depression and that they can be used to treat depression?” And there are 12 that we have found. And I bet you could name all 12 Mark. They’re the 12 we would expect, omega-3 fats and zinc and B12, vitamin E, magnesium. And then …

Mark Hyman (30:21):
Iron.

Drew Ramsey (30:22):
Iron. So then we looked at just a simple what a nutrient profiling system is, is it just tries, it’s just a system for looking at what foods have the most of those nutrients per calorie. And then what a good nutrient profiling system does and Dr. LaChance and I really wanted to create a good one because oddly there are I think 27 nutrient profiling systems in the world that have been created, and some people have seen ones like the ND or [inaudible 00:30:47]. You know how many have been about mental health?

Mark Hyman (30:49):
None.

Drew Ramsey (30:50):
None. And so what we … A good nutrient profiling system does looks at food categories. So we’re not saying kale, kale, kale, kale, and people say, “Well, I don’t like kale.”

Mark Hyman (31:01):
Can’t eat too much of it. You don’t know [inaudible 00:31:01]

Drew Ramsey (31:01):
Exactly. Oh, no, it’s toxic now, now it’s toxic Mark. But what we say is leafy greens. And so what we did is we scored … We looked at all of the top foods for these nutrients, scored them, and then created a list of the top plant and animal foods.

Drew Ramsey (31:17):
First of all, they’re the foods that topped the list, which I just think are interesting like oysters, clams and mussels are in the top five on the animal side. And the reason we did animal foods is that no nutrient profiling system usually has any meat or any animals in it because it’s all based on calories usually, and plants always have fewer calories. But most people eat meat or seafood, so we wanted to give folks a list of which had the most nutrients.

Mark Hyman (31:41):
And why were the shellfish the top ones?

Drew Ramsey (31:43):
Top ones because think about oysters, why do they top the list? You get 10 to 15 calories per oyster, so let’s just say six oysters 60 calories, and for those 60 calories you’re getting 768 milligrams of long-chain omega-3 fats, you’re getting 340% of your vitamin B12, you’re getting, gosh, at least a third of your iron, you’re getting 500% of your daily need of zinc, I mean and on and on and on, you’re getting in some vitamin C in oysters.

Mark Hyman (32:11):
Okay. Let’s go get some oysters.

Drew Ramsey (32:12):
Yeah, exactly, all that for 60 calories. And that’s just … And on the other side looking at plants like things like watercress topped the list. And why just watercress? Lots of nutrients, no calories or very few calories. So that’s a great example of nutrient density, those foods. The food categories that people should be looking for, things like leafy greens, the rainbow vegetables, more seafood, and if you’re eating meat and red meat to look more towards wild red meats or grass-fed red meats.

Mark Hyman (32:39):
So this is fascinating. So the diet that prevents cancer, heart disease, dementia, depression, and fixes most chronic illness is the same diet.

Drew Ramsey (32:47):
It’s really … Well, it’s where we got off in medicine. We kind of separated out mental health and brain health from the red. Like you’re saying, kind of like somehow the blood-brain barrier was like thou shalt not pass, like we didn’t think that, sure, those same, all those same activities that we think about in terms of our general health and the foods that we want people to eat and the things we want people to do, move their bodies, connect, be part of their community, yeah, that’s key to your brain health and your mental health.

Mark Hyman (33:16):
Yeah. And the trouble with our food supply is that it’s often depleted. Even if you’re eating the best foods. You have an organic farm, the soil matters.

Drew Ramsey (33:27):
It really …

Mark Hyman (33:28):
To what’s in the food.

Drew Ramsey (33:29):
Yeah.

Mark Hyman (33:29):
And if you’re growing in depleted soils, which most of our soils are, more like dust and dirt.

Drew Ramsey (33:35):
Well, they’re just like chemicals in, chemicals out. I mean, it’s really … If you live by the food you grow, you don’t do it the way that a lot of food is grown. And even organic food. It’s funny. As you drive through the produce spell, and I encourage people to do this and you look out, you’ll see organic stuff out there. But it doesn’t look like a healthy farm somehow. It’s got a lot of food on it, but doesn’t smell right, the people working it, I don’t know, they don’t seem happy in a certain way. It’s …

Mark Hyman (34:10):
It’s because of they’re big mono crop organic farms or they’re big-

Drew Ramsey (34:12):
Yeah, yeah, there’s a big monoculture. You look at a big-

Mark Hyman (34:15):
And they till the soil which can produce great soil.

Drew Ramsey (34:18):
There’s a ton of tillage, there’s a ton diesel spent, there’s a ton of compaction. And it’s a real, I think it’s a challenge right now.

Mark Hyman (34:26):
It’s industrial organic is what Michael Pollan calls it.

Drew Ramsey (34:28):
It is. And in a lot of ways, that’s been a huge victory because we have a conversation about organic. It’s better.

Mark Hyman (34:35):
And organic was just found to reduce cancer by 25% people who had it.

Drew Ramsey (34:39):
This French study, right? So there’s something there. So it’s a step in the right direction. But when you think about where I’m from and you drive around, our soil is pretty rough in Crawford County, but boy, you want to … I would say that a lot of places Mark where we live, if you take a lot of Americans, they wouldn’t know they’re in America because it’s just that whole central notion, that central America or middle American notion of a small farm and what that looks like and how that functions, some cows, a couple pigs, not a monoculture, a nice garden for all your food and for sharing with your neighbors, that is diet in a way. And I think-

Mark Hyman (35:25):
Wendell Berry calls it The Unsettling of America.

Drew Ramsey (35:27):
Yeah, and I think that maybe dead is not … That’s on life support and maybe we’re seeing a shift now.

Mark Hyman (35:34):
It seems like it’s coming back. There’s more smaller farms.

Drew Ramsey (35:36):
I hope so. I mean it’s definitely coming back. You see it on the coasts and you see it around urban centers. But there’s still a lot of places that don’t … where it’s not happening. And that kind of combo of I would say agrotourism and interest in food but also just interest in farms. But I’m hopeful.

Mark Hyman (36:00):
So my question was going down the path of, okay, if even organic isn’t the best that it could be, if the foods have been bred in a way that create more starch, a lot of the phytochemicals have been bred out of it, the nutrients aren’t there because the soil, even if it’s the best organic farm. And by the way, Dan Barber and Walter Robb, a former CEO of Whole Foods created a seed company that actually reinvent new seeds to breed them so they have flavor and they have nutrient density and they’re phytochemical rich. It’s a very different idea than breeding them for yield or for pest resistance or water or drought, but they’re doing all that too, but they’re doing both. So the question is if that’s true, then do we need supplements and do you use nutritional supplements in your practice to treat mood disorders?

Drew Ramsey (36:51):
I think even with the food we have today, you can still get all the nutrients you need. It’s actually challenging if you look at all the recommended daily allowance and you think what you would need to eat to meet that, it’s a little challenging. It requires some thinking about it. I almost got to tell people, “No, just eat nutrient-dense food, you’ll be fine,” but if you start scratching your head and adding up, it can be tough.

Mark Hyman (37:14):
Just to stop. I had a patient once who was like, “I don’t want to take supplements.” So I literally looked at the food up and I’m like, okay, selenium, it’s in Brazil nuts. I have two Brazil nuts a day. I have 17 pumpkins seeds.

Drew Ramsey (37:24):
Right, exactly.

Mark Hyman (37:24):
I have two cups of broccoli, or whatever it is. And he was like, “Okay, fine. If you want to do that, go ahead. Let’s check your nutrient levels.”

Drew Ramsey (37:33):
Well, I have that problem where I don’t like the idea of turning a meal into a math equation. I myself, I’m 44 and I stopped taking all supplements probably about maybe 10 or 15 years ago. I guess that’s not entirely true. I’ll take a little omega-3 sometimes and certainly in my practice for non seafood eaters or for individuals who are just kind of eating seafood every now and then, especially for individuals who don’t want to try a medicine and they’ve never, and even for individuals who do, I’ll put them on 1 to 2 grams of fish oil. I mean the trials that … Fish oil is very in the science and the sort of studies of depression is one of these things that has statistical significance, but it’s not able to show clinical significance in the meta-analysis, that you get about a point reduction on a Hamilton Depression rating scale. That said …

Mark Hyman (38:22):
But you can’t take fish oil and be eating like processed oils.

Drew Ramsey (38:25):
Yeah, exactly.

Mark Hyman (38:28):
Which displace it.

Drew Ramsey (38:28):
Exactly.

Mark Hyman (38:28):
And you can’t be eating pounds of sugar. It’s like …

Drew Ramsey (38:31):
And you wonder, a lot of each trial-

Mark Hyman (38:33):
It’s just the way these studies are designed.

Drew Ramsey (38:33):
Well, you wonder, one, do they control for that, and two, we have all these snips now in the longest genes in terms of how we process omega 3 fats.

Mark Hyman (38:42):
What’s a genetic variation.

Drew Ramsey (38:43):
Yeah, I mean there’s that. There’s also that if you have somebody who’s a seafood eater versus not. But the bottom line is I think there are certain supplements that should be tried especially when people are struggling with traditional antidepressant response. Like a lot of people I’ll see, they’ve been on the medicine, it works some like with cheerfulness, with sleep, but they’re not eating well, and for whatever reason they’re not going to start eating well. So that’s a really good example of somebody who a multivitamin or something with zinc or magnesium, certainly anybody who’s low. I mean, I always had the feeling like if you’re low, I definitely like-

Mark Hyman (39:19):
Do you test your patients?

Drew Ramsey (39:20):
Yeah, yeah, yeah. I test. I don’t do is extreme or not, not extreme, maybe is thorough, but I certainly test everybody. I mean, think what you’re saying earlier. I think any mental health clinician who misses, I mean, it is malpractice. If you miss a thyroid problem, a B12 deficiency, syphilis, I mean, there’s a bunch of biological causes of depression, and I think you and I see that get missed sometimes where it’s like this is not even functional medicine. This is just basic medicine.

Mark Hyman (39:47):
Basic medicine, yeah, yeah. It’s all good medicine. Yeah, it’s good medicine. I mean, in my practice I see the common deficiencies. Your testing vitamin D, magnesium, omega-3 fats, sometimes iron, and the B vitamins, particularly around homocysteine and methylation issues which is this cycle of folate, B12, and B6. So I find that giving people a multi and fish oil and vitamin D and maybe low magnesium usually has enormous impact, and …

Drew Ramsey (40:15):
Well, you think that even if you’re going to get them to change their food right away, that takes a little bit, and I-

Mark Hyman (40:21):
But even with changing the food, suddenly I feel like we’re so depleted it’s just …

Drew Ramsey (40:25):
Yeah. And it’s also, it’s really hard when you’re depressed.

Mark Hyman (40:28):
Yeah.

Drew Ramsey (40:28):
So I think, it also gives people something to do.

Mark Hyman (40:30):
You just want to eat that doughnut.

Drew Ramsey (40:32):
Yeah, because you do. I mean, depression causes a lot of carbohydrate craving and a lot of … We eat. We call it comfort food for a reason, because we eat it when we want to be comforted. I mean, I know when I’m in that bad spot, man, I am a mac and cheese guy.

Mark Hyman (40:45):
Yeah, gives you a little serotonin.

Drew Ramsey (40:46):
Yeah, don’t give me any talk about carbs. I need my comfort food. But it’s … I think it’s something else. The other one that’s I think exciting is the L-methylfolate. It’s just exciting in the idea that we’re-

Mark Hyman (40:58):
It’s actually a prescription drug for depression.

Drew Ramsey (40:59):
Well, it’s a-

Mark Hyman (41:00):
It’s called Deplin but it’s like-

Drew Ramsey (41:00):
Yeah, it’s a B vitamin that you got you served by … I’m allowed to say it, it’s a B vitamin that got you served by Big Pharma is a way I think about it, which is you have L-methylfolate which is folate that has a methyl group added on to it and instead of that being five bucks, it’s 200 bucks.

Mark Hyman (41:16):
Yeah, but you can get it for five bucks.

Drew Ramsey (41:17):
You can get it. But the idea that we’re just now because this is going to be the next frontier Mark as you know, which is we’re going to start really getting into precision psychiatry. I mean, that’s my most … My favorite new center at Columbia is the Center for Precision Psychiatry.

Mark Hyman (41:30):
There is that?

Drew Ramsey (41:30):
There’s a center for precision psychiatry. There’s a center for practice innovation. There’s a center for women’s mental health. I mean, there’s going to be, and there’s a new center for media and mental health that’s going online. And precision psychiatry is just that, which is there’s no … I mean, one of the things I think it’s interesting is there’s nobody there’s more critical of psychiatry than ourselves. There’s nobody sits with the …

Mark Hyman (41:50):
And sees the failure.

Drew Ramsey (41:52):
Well, nobody sits with it. Until you sit with getting an antidepressant prescription wrong and then getting it right and knowing that somebody suffered because you didn’t make the right choice. When you sit with that, you want to get it right more than anybody else because that’s your job. And so it’s an exciting time between the new knowledge of the microbiome, the psychiatric genetics which it’s not there yet but man it’s getting close. We’re I hope going to see the tide turn on our mental health epidemic. We are going to see the tide turn on our mental health epidemic Mark. We won’t rest until it does. Do you?

Mark Hyman (42:29):
Oh, no. We can’t. No, it’s … I mean, it’s the food stupid as to paraphrase a former president, but it’s like, people don’t get how powerful it is and how impactful and how quick it works.

Drew Ramsey (42:40):
How do you get people to see it Mark, because I feel like when we tell people, “Hey, eat right, feel right,” they get that. When we say, “Food-

Mark Hyman (42:47):
You know what I do? I just, I think often incrementalism doesn’t work because people don’t see a change. So people eating a crappy diet who just stop the soda but they’re eating like garbage, they’re not going to feel better. So I put people usually as a 10 days, you can do anything. So I put them on a basically elimination diet, I call it the 10 day detox diet for 10 days, and they can experience without me telling them the changes that happened in their body, in their brain, in their mood, their energy, their sleep. And it’s quick.

Mark Hyman (43:17):
So usually can get people to do anything for 10 days and then they go, “Oh, okay.”

Drew Ramsey (43:22):
Well, they have to. I think any good behavioral change, it’s we can’t tell you. You can’t read about it. Study’s not going to help, the soundbite, the science. You have to experience it working. And as soon as you experience that, that extra energy, that better … What I find in fact is the better sleep quality, I’m expecting to hear like more mood, more energy, people like, “You know doc? I’m really sleeping better.” And all those ways that that then makes nothing affects mood I would say like sleep, so it’s …

Mark Hyman (43:52):
Yeah. It’s amazing. Well, if you were able to change psychiatry and you had sort of an autocratic wand that you could wave and …

Drew Ramsey (44:03):
I got to be the Emperor of psychiatry?

Mark Hyman (44:05):
Yeah. And when you throw out the DSM-5 would you say every psychiatrist needs to get trained in functional medicine, nutrition, and …

Drew Ramsey (44:12):
Well, I’d do-

Mark Hyman (44:13):
What would you do?

Drew Ramsey (44:13):
I’d do a few things. One, is that I want America to really meet psychiatry, because I think so often when they think about psychiatrists, they think about Freud, they think about some old white guy with a beard, and they don’t think about our current president, Altha Stewart, the first African-American female president of the American Psychiatric Association, or they don’t think about my colleague Christina Mangurian who’s … She was like one of these stellar. She’s my medical student. Now she’s the Vice-Chair for Health Equality and Diversity UCSF. So these are women who are leading psychiatry and we are diverse and we are desperate to find …

Drew Ramsey (44:51):
Well, we’re desperate for a few things. One, we’re desperate to better … We have a lot of solutions. We have, for example, I just … The number one way to treat schizophrenia or to keep people with schizophrenia really well it’s not an anti-psychotic. That helps for a lot of them with symptoms, but it’s a job. So there’s a program spearheaded by the Office of Mental Health in Lloyd Sederer in New York and in Columbia Center for Practice Innovation that looks at that and now making sure that there are, I think there are 7,000 families in New York who are getting employment support when we have early …

Mark Hyman (45:23):
Basic simple things that aren’t in medical care that are things that happen outside of the hospital.

Drew Ramsey (45:27):
Yeah. So I would want to see more programs like that. I think that there needs to be certainly training and I would say not just nutrition but also in lifestyle and lifestyle modification. I think that gets dumbed down in medicine in general and we don’t know how to do it, and I think a lot of times doctors don’t think they should do it. And maybe that’s true. Maybe it’s not. But what doctors need to do-

Mark Hyman (45:50):
It’s hard. Writing a prescription is easy.

Drew Ramsey (45:51):
Yeah. But even writing prescription for food and exercise. Some systems, that’s all they’re going to do, but building out that capacity. I would want us to … I guess you want to hear my number one change, I guess I’ve come upon this, this week as I’ve been really thinking about innovation in mental health. The number one change I want to see is I want us to stop meeting patients when they’re mentally ill. I want us to start meeting patients and helping them stay mentally well, because the most powerful tool that I have as a psychiatrist is the power of prevention. And no one comes to talk to me or think about talking to me or fights the stigma to talking to me until they’re late in the game. And that’s great. I’m going to get them better. Wherever you meet me, I’m going to help gets you better, but I’m going to help you get yourself better actually is the way to put it.

Drew Ramsey (46:40):
But I hope that what changes and what is changing is that we start having a language to talk about our mental health and recognize that we all have this, that I think people think about folks like you and me. One of things I love about you is you talk about being depressed and people think, “Oh, you’re a brilliant, successful physician, you’re an innovator.” Like, “You don’t have depression.” And it’s like, “No. You do. And you have.” And that’s what I hope is going to change.

Drew Ramsey (47:07):
In terms of the field and the DSM and the diagnostics, I mean, there are smarter guys than me in thinking about that. I think that’s just … Yeah, we’re going to have a reckoning that the way we’ve been doing it has been necessary. Without the DSM, we couldn’t do [crosstalk 00:47:23]

Mark Hyman (47:23):
That’s a way of labeling people based on symptoms for what mental illness they have. It doesn’t tell you why. It doesn’t tell you what.

Drew Ramsey (47:29):
It doesn’t tell you why. It’s a symptom based diagnostic approach because it’s hard. We don’t know why. What I love is now, just now there’s a big idea in psychiatry, not big idea but a new idea, the inflammation has a lot to do with depression.

Mark Hyman (47:41):
Yeah.

Drew Ramsey (47:42):
Now, that’s been an idea in functional medicine and in wellness-

Mark Hyman (47:44):
I wrote about it-

Drew Ramsey (47:45):
… for 15 years. So that’s changing, and I think that we’re going to see more of an integrative model. I think the other thing is I would just hope that we come out of the shadows a little bit and that we’re collaborating and integrating more and more, especially with wellness.

Mark Hyman (48:00):
Yeah, I agree. I think rethinking mental health and then changing our meaning we attach to a lot of it, which isn’t necessarily always psychological, often is but it’s not always, and how do we combine that with a psychological approach, that’s game-changing.

Drew Ramsey (48:14):
That’s the original. The original psychiatry, the model they teach us is the bio psycho social model.

Mark Hyman (48:20):
And except, they usually leave at the bio.

Drew Ramsey (48:22):
Well, the bio is they leave out some of the bio for sure.

Mark Hyman (48:25):
Serotonin, well, let’s give an antidepressant. That’s like …

Drew Ramsey (48:27):
I know. That serotonin’s like the worst [inaudible 00:48:28] that happened for psychiatry.

Mark Hyman (48:29):
Like why the serotonin often gets screwed up is the question.

Drew Ramsey (48:31):
There are hundreds of molecules in the brain. Nobody even knows about BDNF. BDNF is a hormone that makes your brain grow. That’s what we care about. Like that’s what food and exercise and psychotherapy all have in common.

Mark Hyman (48:43):
It’s great.

Drew Ramsey (48:43):
But we’re hung up on serotonin.

Mark Hyman (48:45):
Well, Dr. Ramsey it’s been a pleasure having you on The Doctor’s Farmacy. You’ve all been listening to Dr. Drew Ramsey on The Doctor’s Farmacy, a place for conversations that matter. And if you loved this podcast, please, sign up for listening to it wherever you find your podcasts, share with it your friends and family on social media, and please leave a review. We’d love to hear from you. And if you want to know more about Dr. Ramsey, go to drewramseymd.com, learn about his work, his books, and check it out. See you next time on The Doctor’s Farmacy.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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