Okay good afternoon everybody, and thank you very much rod and Jeff. for inviting me to talk it’s an honor to be here can everybody hear me? okay little louder? So I am at least financially unconflicted Many people think of health when they think of health they think of physical health However studies have shown conclusively that the head is part of the body So If you are crippled with panic attacks or have debilitating depression you are not healthy If this gingerbread man were to describe himself as healthy we would call him delusional So, I am a psychiatrist I’ve been a psychiatrist for 17 years for the past 12 years in college mental health for the first Six or seven of those at Harvard and now at Smith College a women’s college in Western, Massachusetts And what we’re noticing across the country in college mental health is really disturbing trend You know the first year students 18 years old arriving on campus more and more of them each year arriving on campus already taking 2, 3 4 psychiatric medications students coming in for crisis visits every day panic attacks self-injurious behaviors suicidal ideation professors and Dean’s walking students over on a regular basis worried about manic behavior or psychosis or anorexia so what in the world is going on and What does this mean about our future? So it turns out the trend is actually global. It’s not just about college mental health And It’s not just the United States Now these numbers are likely underestimates because it’s actually very challenging to count people with mental illness around the world So about three hundred and twenty-two million people are estimated to have Depression that’s about the same number of people that live in the United States. That’s up 18% in the roughly the past decade then now the number one cause of disability in the world 800,000 people die per year from suicide and that number, now the number 2 cause of death among young people worldwide Anxiety disorders also up about 18 percent in the roughly the past decade and Dementia the numbers are expected to triple by 2050 Why why is this happening? What is driving these trends and colleges and all around the world Do we know anything about the root causes so is there anything we can do about this? Or is this just how it’s supposed to be Well there are some theories that have been around a long time About what causes these mental health problems the neurotransmitter deficit theory stress Trauma and of course your mother So what about this modern atrocity might this have a little of something to do with it You know we have learned the hard way as many other speakers have just told you about How dangerous this diet is this modern diet for our physical health so it stands to reason you know? Why should the brain be any different? You know so if we could prevent? Psychiatry from going the same way. That would be wonderful psychiatry as a field is in its infancy nutritional psychiatry, so hopefully we can go in a different direction and learn from others mistakes But I believe that the decline in mental health around the world has a lot to do with the decline of The in the quality of our diet over the past 75 years, and I think that’s catching up with us And I believe that it may be one of the primary driving factors behind many mental illnesses So can we look to the Past to guide us going forward into the future We do know that Psychosis was exceedingly rare in traditional cultures compared to Western their Western westernized counterparts So what is it about westernization? Diet was one factor, but there of course were others. I believe diet was a very strong factor And I hope to convince you of that today. I actually believe that there are two dietary patterns on the rise around the world One because we are told it’s healthy and the other despite the fact that we know very well. It is not healthy The one we know is not healthy for us is the standard American diet or what? I’m gonna. Call the sad diet this diet used to be called the Western diet, but it is now exported around the world and And What distinguishes the sad Western diet from other diets is The presence of refined and processed carbohydrates and the presence of refined and processed fats Not the presence of saturated fat meat or cholesterol Refined and processed carbs up 32 percent Calories from sweeteners around the world between 1962 and 2000 and refined and processed fats up 3 to 6 times Around the world between 1985 and 2010 so We know from epidemiological studies Which is usually the first step in trying to understand? What’s going on that many mental health conditions are associated with the standard sort of sad Western diet? But these are just associations. We don’t know anything about causality. This is just a hypothesis So what did the randomized control trials tell us so just sit back and relax? And I’m gonna walk you through every randomized controlled trial there has been about diet and aggression All two of them So Both of these studies were done in the past year and both in Australia the SMILES trial and HELFIMED trial these the researchers chose to compare a modified Mediterranean diet with a the sad Western diet and they did find That there was some modest improvement in depression symptoms in the people who switched to the Mediterranean diet Now this is compared to the sad Western diet, so it doesn’t necessarily mean that the Mediterranean diet is the best diet for the brain? It just means that it’s better, but of course. What diet isn’t better than the standard diet uh you know, but I do believe that there are many good things about the Mediterranean diet I Define it for myself as a post agricultural whole foods diet It’s very low in processed foods low and refined oils low and refined carbohydrates So we don’t know although many people believe that it has something to do with magical ingredients in the Mediterranean diet like olive oil or nuts or wine That it is really May have more to do with what’s not in it rather than what is in it, so? In terms of the Signature ingredients in the standard American diet the sad diet. They really are the refined carbohydrates and the refined oils So what do we know already about how those affect the brain? We actually know a lot? So both of those ingredients are very powerful promoters of inflammation and oxidation All of these mental health disorders are strongly linked to inflammation oxidation, just like so many other illnesses are So the way sugar causes inflammation and oxidation one way any way is that it floods your chemical pathways and Overwhelms your natural internal antioxidants tilting your system too far towards oxidation and away from anti oxidation the way that Refined seed oils do this the way they cause inflammation is by competing with anti-inflammatory omega-3 fatty acid particularly one called EPA so if you eat Soybean oils for example which are very high in omega-6 linoleic acid Then what you’ve done is you tilted the scales because these compete with each other You’re now tilting your whole system too far towards inflammation and too far away from healing There have been many trials attempting to use EPA supplements fish oil supplements and such in various mental health conditions Unfortunately the results are rather unimpressive except perhaps when it comes to delaying the onset of psychosis most of these trials are underwhelming There’s another way a second way in which refined foods particularly Carbohydrates destabilize brain chemistry, and that’s through this invisible internal hormonal roller coaster So when the average? person probably not in this room You know eat sugary meals three four five six times a day with flour sugar cereals juice etc And so they get a nice big glucose spike And they get a nice insulin spike on its tail and that brings the blood sugar back down, so what’s the problem? the problem Is that insulin is not just a blood sugar regulator? Insulin is a powerful master hormone of growth that Regulates lots of other hormones in the body including the sex hormones and the stress hormones So what you get is as the blood sugar is coming down if it’s coming down too quickly The body will perceive that as an emergency and release stress hormones like cortisol and adrenaline and these are your fight-or-flight hormones particularly adrenaline and some people are quite sensitive to this to the release of these hormones and can experience some very uncomfortable symptoms You know in between meals? Panic attacks insomnia if it happens in the middle of the night You know intense cravings for carbohydrates irritability all kinds of things So is it any wonder that these conditions are on the rise around the world if most people are eating this way now And if you’re wondering you know what’s the degree of this of this problem? Just take a look at what happens to teenage boys who drink sugar sweetened beverages compared to a sugar-free Cola drink? That’s their adrenaline level spiking to nearly five times its baseline about four or five hours later So this is not subtle and for most people this is happening again. Three four five six times a day Now the third way that That the modern American diet standard to diet is damaging the brain is through insulin resistance, so We know that people with depression are a little bit more likely to have type 2 diabetes Which is just an end-state form of insulin resistance? we know that people with bipolar disorder schizophrenia are at very high risk compared to the average population of type 2 diabetes and People with Alzheimer’s disease a staggering 80% of them have either insulin resistance or type 2 diabetes But these are just associations, so this doesn’t mean anything about Causality we do have some interesting a few studies, which give us clues that perhaps insulin resistance inflammation Etc are playing are more than just associated that they actually may be playing a role in how severe the some of the symptoms some-somebody symptoms might be So here is an interesting study about bipolar disorder took a group of people with bipolar disorder tested them for insulin resistance and diabetes the rates were actually quite high and They discovered that in people who with bipolar disorder who had insulin resistance or type-2 diabetes They were more likely to have chronic symptoms They were more likely to be rapid cycling, and they were less likely to respond to the mood stabiliser lithium Now and that’s very interesting is it’s just that insulin resistance may actually playing a role in the in the disease process With Alzheimer’s disease You know I said psychiatry is a field nutritional second its infancy Alzheimer’s disease is a very mature field a scientific field right now in terms of understanding how insulin resistance affects the brain So we know many of us call Alzheimer’s disease type 3 diabetes and the reason for that is that it seems as though there gives multiple lines of high-quality evidence indicating that Insulin resistance is not just associated with Alzheimer’s insulin is resistant seems to be a primary driving force causing most cases of garden-variety Alzheimer’s disease and this could be an entire talking of itself and it has been But just a one key point is that insulin resistance the way it affects the brain is that the blood-brain barrier? Itself becomes resistant to insulin not to glucose glucose can flow right in questions asked Plenty of glucose gets into the brain even if you have type 2 diabetes severe insulin resistance the problem is that insulin has a difficult time getting into the brain, and that’s a problem because The brain is an energy hog it needs a constant supply. It’s an electrical organ It’s very busy So it needs a constant supply of high-quality energy and it often prefers glucose but can also use ketones, so you know if insulin can’t get in to burn glucose insulin is actually required for cells to turn glucose into energy and if you don’t get out of insulin in the cells will begin to sputter and Suffer energy deficits and this can be especially problematic for the hippocampus the memory center of the brain Because then that’s an especially active area that it’s very sensitive to insulin deficits So We have some handful of interesting studies of these drugs called PPAR gamma agonists And these are these are medications, which not only reduce insulin resistance, they’re called insulin sensitizers, but they also have Anti-inflammatory properties so and these are not antidepressants But if you give them to people with severe depression bipolar depression treatment-resistant depression They actually seem to help which is very interesting and it’s sort of proof of concept that inflammation and insulin resistance Are playing a role again in driving the disease process It’s all very early research We also see that these medications can be helpful perhaps with psychosis and in cognitive deficits and early dementia So when it comes to diet and mental health? You know if insulin resistance is an issue well, how about a ketogenic diet we know that that helps with other other? Insulin resistance related conditions. Well of course we have a wealth of information going back over a hundred years now indicating that ketogenic diets specially formulated low carbohydrate diets can be very remarkably power powerfully healing in serious neurological conditions including epilepsy and so Why should the brain be any different into this in terms of psychiatric disorders? This dotted line that you see down the middle of the slide is the imaginary line between neurology and psychiatry really doesn’t exist So what works for neurological conditions that would stand to reason that it should work for psychiatric conditions and there have been a handful of case reports and very very small preliminary studies On this topic that you can read about more if you like The other diet that I’m very worried about as a psychiatrist That’s on the rise around the world is the plant-based diet so the plant-based diets of vegan and vegetarian diets These are really there’s a movement afoot This is a really Germany takes the lead 44% of Germans now described himself as eating a low meat diet That’s up from 26%. Just three years ago and in the United States there’s been a 50% increase in vegetarians and vegans in the United States in the past ten years alone and veganism in particular has increased to six percent of Americans That’s up 500% in the past three years, so What’s interesting if you look around the world is that there are actually 1.5 billion vegetarians estimated to live on the planet? But the vast majority of them are not vegetarian by choice They’re vegetarian because they can’t access nutritious animal foods They’re about 5% are by choice. I call it voluntary vegetarianism tends to trend with affluence and education So how can I stand here and tell you that I’m worried about this plant-based diet being unhealthy for the brain when we have actual real-life clinical trials showing us That plant-based diets can be helpful truly helpful in Metabolic disorders such as obesity diabetes and heart disease. I can tell you that confidently because They did not simply remove animal foods from these No What they did was they removed almost all of the fat? they manipulated multiple other lifestyle variables often stress smoking etc and Lo and behold they removed the refined carbohydrates So how in the world are we supposed to know? What is responsible for the benefits of these diets? It may have had nothing to do with plant fullness or animal lessness You know in given what we understand about how refined carbohydrates affect metabolism my money is on the sugar lessness We don’t yet have to the best of my knowledge any randomized controlled trials comparing a Whole Foods Plant-based diet to a Whole Foods animal-based diet. That would be a fair fight, and I’d be very interested to see what that would show So simply removing animal foods from the diet is an untested intervention But what about mental health do we have any studies of mental health and plant-based diets Well, we have a few epidemiological studies. They’re weak. They’re mixed. They’re poorly conducted They often don’t control for refined carbohydrates. That’s just a problem that keeps happening and And there aren’t any meaningful clinical trials so We don’t really have a lot to go on in that regard so But I would argue that we don’t need more studies Because we already know so much about what the brain needs we know what it’s made of we know how it operates We’ve been studying it for a long time. We don’t know everything about it of course But we know what it’s made of so one of the mistakes that keeps happening in nutritional research is that researchers will Choose their pet diet and then test it out on people with various conditions and see what happens and they’re always comparing whatever their pet diet is to the sad Western diet and of course it’s always going to do better and Then they can say that their diet is great So you know I I don’t think we need any more studies in order to make scientifically sound recommendations about brain food so when you study it that way when you pick your diet and apply it you’re studying nutrition from the outside in I Prefer to study it from the inside out What does the brain need how do we get it there? So you know when I was in psychiatry residency for four years of psychiatry residency After medical school were not a word about diet in four years of course you know I left with the impression that the brain was just a bag of neurotransmitters designed to be manipulated with medications and And I did that for a while Until I became interested nutrition and but of course the brain is so much more than that it’s this beautiful sophisticated Electrical Oregon lined with these special fats, and it’s just amazing and if billions and billions of beautiful cells And if everything isn’t constructed properly. It’s not going to work It doesn’t matter how many drugs you throw at it, or how well neurotransmitters are working So what is the brain made of let’s start there so? The brain is two thirds fat and a full 20% of that is this amazing Essential omega-3 fatty acid called DHA The brain has a lot of protein in it of course every organ needs protine to build you know essential components Neurotransmitters and the like the brain is loaded with cholesterol 20% of your body’s cholesterol is housed in the brain and that despite the fact that the rain only represents 2% of your body weight and The brain again an energy hog needs a constant supply of glucose and ketones to keep it running and in order to extract energy from those molecules it needs lots of vitamins and minerals to run those chemical reactions I’d like to introduce you a little bit more to DHA So DHA is a really incredible molecule it’s been conserved over evolution for more than 500 million years in vertebrates So vertebrates have used it as is for that length of time and you’ll find it enriched in all of these special places in the body from mitochondrial member – synapses and and even to the photoreceptor in the retina, it’s responsible for helping to maintain the integrity of the blood-brain barrier as well, so interestingly DHA is really critical for the Proper development of the frontal cortex in humans, and if that doesn’t go well Problems can ensue So what is so special about this molecule? Well it turns out that the configuration of it is has quantum mechanical properties and that just means that And I’m not a physicist, but my understanding is that it interacts with electrons in a very special way In a couple of important ways one is as In the retina in the photoreceptor it can actually transform sunlight into electricity and In synapses and other places in the body it actually functions as a semiconductor buffering electron flow It’s really quite amazing So people much smarter than I am have hypothesized that without DHA consciousness symbolic thinking intelligence impossible and You know according to this research your DHA plays a unique and indispensable role in the neural signaling essential for higher intelligence So Here’s the rub plant foods contain absolutely no DHA whatsoever They contain ala which is an omega-3 fatty acid, but it is widely agreed That it is extremely difficult If not impossible to transform ala from plant foods in the body into the DHA that the brain needs This may help to explain why? vegetarians and vegans have lower DHA levels than omnivores Another powerful argument for including animal foods in the diet if you care about your brain is the micronutrient access argument So here are some nutrients of interest Actually every single nutrient that the body needs can be found in animal foods and what’s more in the most highly bioavailable form possible Compare that to plant foods, which not only are lacking certain key nutrients such as b12 vitamin k2 EPA and DHA But some of the forms of nutrients that they contain are harder for us to use iron for example So the to make matters even worse Plants also contain something animal foods. Do not contain anti-nutrients So anti nutrients are chemicals natural chemicals in plants that are there for their own purposes But many of them interfere with our ability to utilize nutrients Not only from the plant foods that we eat, but from the animal foods that we eat along with those plant foods And I want to call your attention to a couple of them you know Soy, which is an important staple protein food for people who choose a plant-based diet Interferes with iodine of utilization and that can impact thyroid function and thyroid function is very important for the brain And then the Greens beans nuts and seeds Which are really important crucial elements of a plant-based diet because they do contain protein? They are rich in phytic acid and phytic acid as a mineral magnet That interferes with minerals like iron zinc calcium and magnesium so Why is this important? it’s important because again remember the brain needs more nutrients than many other parts of the body because of its activity and And these nutrients are really key to brain function if you are deficient in these your brain may not be working at top speed So how how bad is this phytic acid problem? Here’s an example? If you eat zinc rich oysters with black beans you will absorb less than half of the same from those oysters If you eat those same oysters with corn tortillas you absorb virtually none of the zinc from the oysters so through robbing your brain of these minerals and This may help to explain. Why vegans are more likely to be inadequate in zink than omnivores Note that omnivores are also at risk because they do eat some of these seafoods iron deficiency is rampant and You know people think of iron deficiency In women in particular people think of iron deficiency as a blood problem, but iron deficiency If you have it you also have a brain problem So it’s another reason why I think that meat belongs in a healthy brain healthy diet But it doesn’t have to be red meat by meat I mean animal foods. It could be the meat of any animal and so for example Duck is richer in iron than red meat and oysters even more so and when it comes to Iron and b12 oysters are a powerhouse, and if you’re if you’re looking for liver is as well. It’s less palatable to many people But if you’re looking for DHA really seafood is where it’s at and you know if you look at this chart Salmon is included there, and it just kind of blows everybody else out of the water So The people that I’m most concerned about when it comes to low meat or plant-based diet in terms of accessing critical brain nutrients are women So because women are more likely to be culturally averse to eating meat and fat that May help to explain why? three-quarters of vegans are female in the United States They’re more likely to Prioritize weight and appearance over health they’re more likely to prioritize animal and planet health over their own personal health for compassionate reasons and This is not just a problem for the women that we care about in our lives It is also a problem for the future Generations because women literally feed the brains build the brains of the next generation through their food choices So What happens if you don’t get enough DHA early in life these are again just associations we can’t be sure but children with autism are more likely to have lower levels of DHA for example and omega-3 sub doesn’t seem to help very much The the critical window for obtaining DHA and in young life is the third trimester to age 2? once that window closes if We may not be able to undo a lot of that damage With ADHD we know that children more likely to be obese or overweight twice as likely Than their age match counterparts, but we don’t know if there’s a cause-and-effect relationship There but we do know that they tend to be deficient in Omega-3s particularly, DHA EPA and zinc and iron again zinc and iron much easier to get from animal foods than from plant foods there’s been some very interesting elimination diet studies with ADHD putting children on a What looks mostly like a whole foods diet they threw in some margarine and some apple juice too, but just a few foods diet And a little misguided But they but these studies show remarkable results they’re flawed they’re flawed States but there are quite a few of them, and they all point in the same direction and So why not try that what would be the harm? So which diet do I think offers the most hope for Humanity I? advocate For a pre-agricultural whole foods diet why? Because it contains animal foods Which are rich in nutrients so it maximizes your nutrient availability? And it’s lower in anti nutrients than a post agricultural Whole Foods Diet which will like the Mediterranean diet Which will be a contain a lot of grains and legumes which and the phytic acid and so forth? So I think it’s a I think it’s an excellent diet and it it makes sense right? I mean why should this be a radical suggestion I mean I can’t understand why people think this is such a strange idea So what we’re up against as we kind of wrap up here what we’re up against when I try to employ this in clinical practice is It’s not as easy as it sounds to get people to switch to this diet. We’re up against something I call the psychology of subtraction Which is nobody wants to take anything out of their diet? They just want to add things to it? It feels better to do that feels positive and empowering active If you take something away that feels bad and negative and depriving So you know one of my students said to me once? But I you know she’s how can I? Fix how can I help myself my mental health my depression my anxiety without medication and their all-natural way, and I said well Let’s took a little take a look at trying to get that additional amount of sugar down in your diet she looked at me like had three heads and she said but but dr. Ede I deserved chocolate and He was just dripping with addiction. You know nobody says about kale, so It’s a and you know the other problem we’re up against is that as marketing Nobody gets rich telling people to take things out of their diet believe me. I am proof positive of that and so There’s all this marketing superfoods and marketing supplements and people really thought in is it such an appealing it’s such an appealing concept So it’s it’s a hard sell But again so I really do think that we have all the scientific information. We need to make a common-sense recommendation Scientifically sound about what foods what dietary patterns would be better for the brain? I don’t think we need more studies to be able to begin to act is my point and it would be great to have more studies But we can act now, I think we need a revolution you Know in the way that women feed themselves in the way that parents feed their children the way that schools Feed their students the way hospitals feed their patients and the way senior centers feed their residents. Thank you