This week we have the pleasure of hearing from Dr. Drew Ramsey. In his own words:
“Drew Ramsey, M.D. is an assistant clinical professor of Psychiatry at Columbia University College of Physicians & Surgeons. His clinical work focuses on the treatment of depression and anxiety with a combination of psychotherapy, lifestyle modification, and psychopharmacology. His interests lie in using the modern psychological concepts and the latest brain science to help people live their healthiest, happiest lives.
Dr. Ramsey teaches and supervises Supportive Psychotherapy, Brief Dynamic Psychotherapy, and Psychiatric Evaluation for the Columbia University Adult Psychiatry Residency Program. He also serves as a thesis mentor for graduate students at the Columbia University Institute of Human Nutrition. From 2005 to 2008, he directed the Audubon Continuing Day Treatment Program, a bi-lingual service for the severely mentally ill located in the Washington Heights area of Manhattan; a program of New York State Psychiatric Institute/Columbia Psychiatry.
Regularly providing expert comment on psychiatry-related topics to the news media, he hopes to help bridge the gap between academic medicine and the public. He authored the Great Communicator column for Best Life magazine and has been interviewed by CBS News, The Wall Street Journal, Children’s Health, and Fitness. In 2008, he turned his attention to changes in the American food supply and how the diet of the country’s citizens influences their mental health. His first book, The Happiness Diet, written with Tyler Graham, was published by Rodale in 2011. Follow him on Twitter @DrewRamseyMD for updates on brain health, brain food, and psychiatry.
Dr. Ramsey is a diplomate of the American Board of Psychiatry and Neurology. He completed his specialty training in adult psychiatry at Columbia University/New York State Psychiatric Institute, received an M.D. from Indiana University School of Medicine in 2000 and is a Phi Beta Kappa graduate of Earlham College.
Education and Training:
- Undergraduate: Earlham College, B.A. Biology, Phi Beta Kappa, 1992-1996
- Medical School: Indiana University School of Medicine, M.D., 1996-2000
- Internship: New York Presbyterian Hospital, 2000-2001
- Residency: Columbia University/New York State Psychiatric Institute, 2001-2004
- Board Certifications: Diplomate, American Board of Psychiatry and Neurology
- Clinical Treatment of Depression and Anxiety
- Nutrition and Mental Health
- Alternative and Complimentary Treatments of Mood Disorders
- Psychodynamic Psychotherapy”
The Slim Is Simple.org Non-Profit Nutrition Education Effort
Jonathan: Hey, everyone! Jonathan Bailor back with another bonus Smarter Science of Slim podcast. Thrilled about today’s guest. A man after my own heart. Deep, deep into the science, looking at people’s brains, seeing how it can impact your life in every aspect and he’s doing it in a way which is super accessible because he’s focused on food. He even talks about Farmacies [sic] but with an ‘f’ like farm. He’s out there making differences in people’s lives. He’s bringing it back to the science.
He’s the author of The Happiness Diet of the upcoming or just released depending on when we air this show, Fifty Shades of Kale. He is an assistant clinical professor of psychiatry over at Columbia University College of Physicians and Surgeons. He’s also on the team over at HarperWave so we got to shout out to that. He’s none other than Dr. Drew Ramsey. Welcome, Dr. Drew.
Drew: Jonathan, thank you. It’s great to be here with you.
Jonathan: Well, Dr. Ramsey, I wanted to just jump in because it’s not obvious that the food we eat has as profound impact on our brain neurochemistry as maybe even some drugs and such. Can you talk to us just about how important the food we eat is to our overall mental state and well being?
Drew: For sure. It’s absolutely fundamental and you’re right, we don’t focus enough on it. It makes intuitive sense though, right? Your brain is the most metabolically active organ you have. It burns about 20 percent of all the fuel that you eat. It’s the largest concentration you have of those omega-3 fats that are so important to health and to staying well. Smart eaters are looking out for those. We find a lot of those in the brain. The brain because it’s so metabolically active needs not only a lot of nutrition, but needs a lot of those molecules that kind of buffer the effects of burning fuels so you get all these, the importance now that we’re understanding these phytonutrients, things like sulforaphane and campral.
We clearly have really changed our diet and they’re probably… there are a lot of reasons that we have such an increase in mental health issues but certainly now that anti-depressants are the top class of medication prescribed in America, I think 40 million Americans suffer from anxiety disorders. We’re now starting to really think about diet and the implications it has on our brain health and some subsequent mental health symptoms.
Jonathan: Dr. Ramsey, it seems we’re prone or subjected to a really terrible cycle which is, let’s say that we eat as we are “told to eat” which consist of all these nutrient poor edible products. We eat that way. We start feeling low energy. We start gaining some additional body fat. That certainly doesn’t help our mood that may even contribute in some level to depression because maybe people start treating us differently and then we end up maybe getting some pharmacological help for that and that actually ends up making us gain even more weight and then, we’re on this vicious cycle.
Drew: Yes, and especially think about weight gain and its effects on the brain, particularly how people gain weight these days which a lot of visceral fat. We know visceral fat is really pro-inflammatory. It’s very metabolically active tissue and it’s making all of these signals that are pro-inflammatory, all these cytokines that are pro-inflammatory and we’re thinking now really clearly influence brain health so you’re right. There’s a self-esteem issue that happens with weight gain, there’s also a physiological issue as you to begin to mess around with things like insulin resistance and insulin levels.
Insulin is something that’s quite active in the brain. It’s certainly should be on people’s radar is as you gain weight or as you’re having mood changes, the first place to start in relevant whether you need some Prozac or not, the first place to really start and have a good foundation is getting rid of all that processed food that you mentioned and switching over to a whole foods diet, minimally processed food, none of the sugar and the refined carbohydrates. I really hope and the main goal of my work is to try and get mental health clinicians and health practitioners to think about food as the foundation of building health for patients.
Jonathan: Dr. Ramsey, what – and I ask this because I’ve also had personal experience with it within my own family. It seems with children we get a double whammy here. One, it would seem that children are already a little more subject to – if you give a child a chemical, it’s probably going to affect that child a bit more than if you give it to a larger person, and just with cognitive development and such, and also we live in a country where if you think of childrens food or childrens cereal or a childrens menu, what makes something qualified to be called that?
Drew: It’s horrible. It’s way too colorful and it’s hyper-palatable so it’s easy to get kids hooked on.
Jonathan: You talked about whether or not you need Prozac, it seems we hear about ADHD and all of these behavioral problems in our generation of children and it’s “Oh, it’s the video games.” Well, maybe or maybe their brains are getting broken by what they’re eating. What do you think?
Drew: I think it’s for sure a big factor for a lot of children and the science supports this, is the food. Certainly, we always want to acknowledge there are kids out there who have a really legit ADHD diagnosis and cognitive problem and they benefit from stimulants like Adderall and Concerta. There’s definitely those individuals out there but what always frustrates me is that that’s not the place to start. All of these medications they have issues and side effects is every prescriber and every parent knows so let’s think about what are the connections between food and ADHD, and it’s quite clear.
There’s a very linear correlation between dietary quality and your risk of getting both ADHD and depression as a kid and an adolescent. There’s been a lot of controversy, a lot of up and down science about things like food dyes. My colleague David Chave [07:03] at Columbia actually did the meta-analysis of all the food dyes studies and it’s very clear in his study that there’s a very strong positive trend in the correlation between food dyes and kids getting overly excitable. There’s interesting stuff like if you give adult with attention deficit disorder food dyes, they start to have more epileptic form of waves on their EEGs.
I was kind of take the stance of it’s really hard to prove something in science, especially when it comes to food because there’s so many molecules that are active. When we think about something like development and how much neurobiological activities there is during that period, shouldn’t we feed the brain molecules it knows and is recognizes and it’s always been sustained by? Isn’t that a good thing to do for our kids?
Jonathan: It absolutely is, Drew and the reason I want to celebrate and magnify this science that you share with people is I think so often we have a mental model which is “Oh, Sally is six so she needs energy, so we can give her a Snickers bar because she…” Where we may even want to think the opposite is true like “Sally is six. She more than anyone needs to avoid Snickers bars because her brain and body are literally being built right now.” and if you give someone a crappy bricks while they’re constructing their house, maybe just wait until their house is built or never give them crappy bricks. What do you think?
Drew: No, I agree with you. You’re definitely not giving great bricks. The other thing is that you’re not giving great mortar in the sense of the food habits that someone develop really are very much dictated by the tastes they’re exposed to and what they have observed. If you broke in a house that’s around the dinner table and has a nice piece of fish and some kale and dessert of fruit and yogurt, those are going to be the foods that you incorporate at your own habits and the foods you eat for the rest of your life. If you’re in a house where a Snickers bar is lunch, that’s what you become accustomed to so if it’s both bad bricks but it’s also teaching people and kids the wrong habits about food.
Jonathan: Well, Drew, I know you have a soft spot in your heart as do I for kale and you also mentioned seafood so you’re two for two on my book and I think oftentimes people are very inspired by pursuing the positive in addition to attacking the negative so what are some of the just almost classifiable as therapeutic foods when it comes to brain health and then overall emotional health and why? What are they actually doing in the brain?
Drew: Great. It’s a great question and I also love the notion of let’s talk to people about what to eat because we know what people should eat and I call this a ‘brains food’ or I was trying to put hash tag brain food in my tweets. Let’s start with what should be the foundation. We want people eating a lot of these dark, leafy greens. I’ve clearly gotten a little obsessed with kale. It’s good news a lot of people in America are excited about kale right now. There are lots of leafy greens that are great for you besides kale like bak choy and arugula. All of these cruciferous vegetables are all in the same plant, just different cultivars, are all related to cabbage biogenetically, so any of cruciferous are great.
I love this new campaign of Eat Your Colors. I think the USDA is doing a great job with that because we want to see things like the tomatoes and the purple potatoes and lots of good oranges, sweet potatoes and carrots. What are those foods, those cruciferous vegetables and colorful vegetables doing in the brain? They’re doing a couple of things. One, you’re getting a lot of interesting fat-soluble phytonutrients, which we mentioned a little earlier. I really think this is the reason that we see such a health benefit to vegetables. Those things change gene expression it increased, one in kale called sulforaphane. It rams up your livers own innate detoxification system. That’s a real detox diet.
With all these interesting data emerging about the anthocyanin and quercetin, on top of those are funkier things, you just get good nutrition. You get a lot of fiber that keeps you both full and also feeds your gut. Now, we’re really understanding there’s this clear link between gut health and gut flora and overall health and brain health. Generally, folate comes from the Latin word folium, which is leaf. It’s the way that you’re eating a leaf, you’re getting lots of vitamin B9. Vitamin B9 is essential to do things like make serotonin and dopamine. These important mood-regulating neuro [indiscernible 12:09]. Anytime you eat a leafy green, you getting the plant-based omega-3 fat.
You also need the animal-based omega-3 fat in my opinion, but ALA, the plant-based omega-3 is also quite important and clearly linked to lower rates of diabetes and depression. Those are some of the reasons for plants. We can keep going on. The other top ones clearly are going to be seafood, especially small seafood. I really like to recommend mussels and anchovies and sardines. These are top sources of a longer chained of omega-3s, EPA and DHA. These are supplement forms in psychiatry all the time now as an augmentation strategy. Clear links to low levels of that in depression. DHA is the one of the main structural units of a neuron cell membrane and EPA is broken down to these – we used to make this a eicosanoids, which are these very anti-inflammatory molecules.
Fishes are also a great source of B12, iodine. It regulates thyroid function, very important in the brain and all of these, both the leafy greens and in seafood, example sardines are the top source of calcium. I had no idea. Kale is a very good source of calcium but calcium plays a very important roles in the brain. Then, unlike a lot of position but I also talked about meat because the reality is most people eat meat and we can make better choices, helping people move away from processed meats, deli meats and preserved meats and move over towards things like fresh grass fed beef, pasture raised chicken. You’re going to get more nutrient-density. You’re going to get a better mix of fats for the brain.
I guess I want to throw in the beans, red beans or black beans, any color of beans. Beans are one of the best [indiscernible 14:06], especially dried beans in the grocery store. You soak them, you get some of the gas inside out of there, get some of the phytates out of there and then recently I’ve been pictuing of a lot of fermented foods, things like yogurts and kimchi and pickled vegetables. Again, with the notion of those having some clear data, they helped in gut health. That’s brain food of the top off my head, Jonathan.
Jonathan: Well, I’m sure you have a very healthy brain so I’m sure that list is quite comprehensive. Dr. Ramsey, the thing that I love about going through and really drawing out the power that these foods have is… I used to be in my previous life really into body building and almost a competitive physique achievement and I remember being really plugged in into the supplement world. Really plugged in. I’m talking spending hundreds of dollars a month on supplements. I remember you get this package in the mail or you go to the supplement store and you pick up this jar of powder and the jar would be “It does this. It does this.”
Drew: Right, right.
Jonathan: “It does this.” You’re “Oh my god! Take my money. Here’s my credit card. Just let me all on there. I just want to drink the bottle.” I almost wish and maybe we could do this with your awesome effort which is National Kale Day is if you could literally have a top marketing firm in the world, just be like “Pick something. Kale.” and just say marketed like it was a supplement and it would blow people’s freaking minds because it would kick the crap out of any supplement.
Drew: It would and that’s a big part about The Fifty Shades of Kale in National Kale Day is we really try and think about it like that that it is so full of nutrition so we run through. Just think about one cup of kale, 33 calories, you get a 134 percent of your RDA of Vitamin C, 206 percent of Vitamin A, you get 608 percent of Vitamin K, about 10 percent of your folate, 10 percent of your calcium and 10 percent of your iron, about 20 percent of your manganese. It is so nutrient-dense and I totally agree.
We should be marketing these foods as the key to health because as I’m sure you’ve experienced those supplements have a lot of promises and they cost a lot of money. It always frustrates me when people say “Well, I’m really into physical fitness but I can’t afford to eat right but I can afford all these jars of powder.” I think people build such better physique on real food.
Jonathan: The thing that is so profound also as well if we can attach… because some folks who might be used to eat edible products, if they try to just eat kale because they’re like “Mom said eat your vegetables.” The whole ‘Mom says eat your vegetables’ approach has I think been tried and as many of us can relate to when we were younger, it doesn’t really work but the whole – people will choke down disgusting magic pills and take all these crazy cleanse regimens and they love it, and they pay money for it. If you truly believe that this thing is almost magical in nature, which… folks, one of the most magical things in the world is whole foods. I tell you that right now.
I’m not talking about the store. I’m talking about the actual plants. Once you get that in your mind, that’s what happened for me, I hated vegetables and then I actually did research on to what you’re talking about and I was “If for no other reason, I am just going to drink one green shake per day because once you know this, it’s almost like you can’t live and not do something about it because it’s so easy.” Just blend it up, drink it and for no other reason, it will probably save your life.
Drew: Yeah. The whole food rule is the basic rule. Make sure you’re eating whole foods almost… there’s really not anything mother nature has been put on the planet is bad for you, even honey. Studies of honey, honey comes with a 181 bioactive compounds in it; minerals, phytonutrients. It’s incredible. Sure, it’s a source of sugar and sweetness. You actually can’t find sweetness in the natural world without other important nutritional molecules. It is a message that we want to spread. I love the idea of “Let’s tell people what to do. Let’s help them make those better choices.”
Jonathan: I think when people also they understand how, I think – actually you’re a great person, I’m going to ask you as a mental doctor, I know that’s not the proper term for this. It’s the best I can come up with right now. As a clinical professor of psychiatry… there we go.
Drew: Brain doctor. Let’s say brain.
Jonathan: Brain doctor. There we go. Brain doc. As a brain doc, if I want to feel good – that’s really what we’re all after. The reason we want to lose weight is ultimately because we think it will make us feel a certain way. Let’s say I’m not clinically anything. I’m just a normal person. I do not have a need for pharmaceutical intervention right now. What would you say are the top three things I could do to feel better?
Drew: Alright. The top three things that I usually recommending to people are the incorporate more variety of seafood into their diet, moving beyond wild salmon and tuna, and moving on to things like the smaller fatty fish, anchovies. Trying to get them to eat more bivalves like mussels and oysters. Those are both good for the environment and the food supply and also they have the essential things that you need: Vitamin B12, Vitamin D, the omega-3 fat, DHA, and a fair amount of zinc. I’m sorry, [indiscernible 20:15]. These things that you get from anything meaty. I talked to a lot of people about eggs. There’s a lot of confusion about eggs but the data on eggs is good. Eggs are a great way to start the day several times a week.
A lot of people move away from eggs and egg yolks, and there’s just a lot of confusion about dietary cholesterol. I actually been both compelled by the data and I’ve been loving, reading Peter Attia’s blog, The War on Insulin, just to give him a shout out. He’s super math whiz doctor/surgeon. He’s got a great 10 part series on understanding cholesterol. I’ve always felt that dietary cholesterol is fine but you always want some back up and he and Gary Taubes, I think you’ve interviewed, do a great job talking about that.
I’m really try and move people – I’m try and identify the sort of problems in someone’s diet like snacking, let’s say, and help them come up with the good whole foods solution. A lot of my patients will end up or just regular people I talked to about food end up having their brain food kit of some almonds and walnuts and maybe a little bit of dark chocolates so they always have some food with them and then helping figure out the leafy greens.
It’s amazing. I have people keep food journals for me. They come with a whole week of food. They say “I really try to do well, Doc.” I looked through it and you could see they’re trying hard and you won’t see a single leafy green in the entire week or they’ll have a salad in the afternoon and it will be romaine or iceberg or with some grilled chicken breast. Getting people to eat those dark leafy greens, kales, bok choy, brussels sprouts, arugula, that in more lentils and beans. You ask for three but those are the main four or five that I generally feel everybody can have a better relationship with.
Jonathan: Well Drew, I so appreciate you sharing that with me and with the listeners because oftentimes food is used as a drug. It’s used as a way to make ourselves feel bad or not to feel – well actually, Freudian slip there – often it does make us feel bad but…
Drew: Well, I think you’re really right, Jonathan where a lot of people don’t think food is torture because they’re doing a crazy math of the equation. That’s why I’m so excited with your book The Calorie Myth, this is coming out later on this year because people that turn on meal… as I’ve been saying turning meal into a math equation and that’s no fun. It’s no fun to sit there and think “Wow! I just made a lot of bad choices but this taste is so good so I must be getting fat.” That’s horrible way to think about food. You’re right.
I think it’s an appropriate Freudian slip being someone disciple of Freud myself that a lot of people do use food to make themselves feel bad and I think what’s really changing in our messaging and how we want to talk to people about food is let’s think about all the ways that food can make you feel awesome and great. One of the motivation for Fifty Shades of Kale was to have fun. I think one of our original taglines was “Slim your waistline and entice your taste buds.” Recognizing that people will go to great lengths to lose weight and to feel better. Here are some simple ways.
Jennifer Iserloh, who did all the recipes for this, is an amazing chef. She’s cooked for top celebrities all around the country. She’s written lots of cookbook. She’s amazing and she has this great sense of how do you make something so good and never, ever have to worry about calories. She always gives a calorie count which I think people want to see and appreciate even though I think you and I feel “Yeah, don’t worry about the calories.” but people want to know. Her calorie counts are always – everything in Fifty Shades of Kale are under 400 calories. It’s amazing to me, all the synergies and flavors and all these crazy colors that she brings out and pairs with the kale, all these great Asians noodle dishes, with these purple kale leaves and these kamome red kale leaves are just – I was so blessed and happy to work with her and partner with her. It’s just a beautiful book and a beautiful way to think about kale more than just this green.
Jonathan: Dr. Ramsey, there’s two levels of enjoyment that you bring to the table when it comes to food, which I think is so important and so empowering for people. One is the one you just talk to and your wonderful recipe plus book. I said recipe plus because there’s a lot more than just recipes in there, Fifty Shades of Kale which is we all just sometimes need to eat something that’s delicious. We can’t always be eating strategically, for lack of better terms, one that’s delicious and we can do that. To be very clear, you can do that and absolutely be healthy and then you’ll feel good for the next five hours not just the next five minutes but what you also offer is…
When we talk about feeling good, oftentimes when we think about food, we just think about “I just ate some chocolates so I feel… my mouth feel…” yada-yada-yada. But what you show and what you demonstrate clinically is it will actually make you feel good by changing your brain chemistry. There’s two levels. There’s the visceral mouth stomach level but then there’s the freaking neurological level and when you can do both, if you want to eat to feel good, which I think we all do, there really is no debating the matter. The best way to feel the best from food is what we’re talking about here.
Drew: Yeah, and you’re completely right. Especially when we think about in the context of the new neuroscience. When I went to med school, and it was 15 years ago, you already got handed a couple hundred billion neurons, hundred billion, that’s it. Good luck. What we really learned in the last eight to ten years is there are these what we call neurotrophic or hormones in the brain that the brain produces and actually a lot of cells in the body produce. One example is BDNF, Brain-Derived Neurotrophic Factor. It’s literally something that causes neurons to sprout. They reach out with these chemicals and connect to other brain cells. We had no idea about this but we know that you can give birth to new brain cells in the hippocampus where you form memories.
You can actually form new brain cells and the level of BDNF in your body and in your brain is really a way influenced by what you eat. That’s the very cool part is that we’ve got good epidemiologically. Women who eat, for example, more processed food have about a 40 percent increased chance of getting depressed over five years. We’ve correlated things like trans-fats very clearly, which is a signal proxy policy go for processed foods to you’re a risk of depression. We’ve shown that the Mediterranean diet can decrease your risk for depression and anxiety so in the epidemiological data and then we have this very, very cool mechanistic, physiological data saying “Look at what food does to brain chemistry?” and you get both more neuro transmitters if you eat right, and you get more of these neurotrophins to grow the brain. For me, somebody who likes to both help people and also have that be science backed. It’s a really satisfying time to be thinking about this right now because there’s so much great science coming out.
Jonathan: It’s such an empowering time too because everything we’re talking about here, we’re not saying you need to be hungry. We’re not saying you need to go spend hours doing something you don’t want to go do. We’re saying just eat more delicious whole foods.
Drew: If you’re talking about health food, a minute ago I’m thinking “I can’t remember the last time I haven’t eaten something delicious. All I do all day is eat, eat delicious food and I think that’s where… in the Happiness Diet, Heather Graham and I, we created a 100 reasons not to take a supplements in place of food and then a 100 reasons not to eat processed foods. One of the ideas in that is that processed food, they give bad data to your brain and they shift your palate. For example, just coffee with milk. I used to always take my coffee just two sugars with milk, and over time, when we messed off that sugar, probably about five years ago and now, whenever I have milk in my sugar which is basically every morning, there’s a little sweetness to it because lactose is a sugar and is naturally a little bit sweet.
If you’re getting just natural sources of sweetness in your diet, you can still enjoy sweet things. You don’t get skewed so real food taste delicious. This is why I tell people, Look anti-depressants take a month to work, real food I think you feel some of the benefits in just a couple of days. The real benefit especially if you think about this as building a better brain, the real benefit takes several weeks because you’re coaxing new brain connection, birth of new brain cells, a real shift state for your brain.
Jonathan: Well, Dr. Ramsey, this is a very inspirational topic. It’s an exciting time to be alive and we’ve got a bunch of great resources we can learn more about you. We got your new book Fifty Shades of Kale. We’ve got The Happiness Diet. Folks, you can go over to DrewRamseyMD.com. Hey, you can even check out his blog The Pharmacy Blog over at Psychology Today. Drew, just to finish up, what’s next for you?
Drew: I’m really excited to connect with people over Fifty Shades of Kale and spread that message. Jennifer Iserloh and I started this initiative National Kale Day, that’s October second this year. We got a petition in to President Obama at Love. Everybody listening to go over. Check out NationalKaleDay.org and sign our petition. That’s really, really exciting and then, I’m working on a third book which is about the connections between my background and my belief in farm fresh food. I come from an and help manage my family’s 127-acre organic farm in Indiana and so I’m getting an opportunity to write about that and the connection to how I practiced in my office as a psychiatrist in New York City. That and having another child. So that’s next six months.
Jonathan: Well, it sounds like you’ve got a busy six months. Folks, it sounds like if we want some science showing us just how we can feel, look and all up be better tomorrow or even today, check out The Happiness Diet. Check out Fifty Shades of Kale. Check out NationalKaleDay.org. Check out DrewRamseyMD.com. Dr. Drew Ramsey, thank you so much for joining us today. It’s been an absolute pleasure.
Drew: Jonathan, what fun. Thank you so much for having me on and I’m sure everybody listening is very excited about your upcoming book, too. I’m really looking forward to seeing that.
Jonathan: Well, thanks so much, Drew. I appreciate it. Listeners, I hope you enjoyed today’s chat as much as I did and please remember this week and every week after, eat smarter, exercise smarter and live better. Talk with you soon.
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