Stretch The Real Mental Health: Eating for Your Brain Certain foods are better for your brain. Doctor, farmer, and author Drew Ramsey shares with us what they are, and how to use them. By Amanda Kohr Photo by Helena Yankovska See Dr. Ramsey at our inaugural wellness conference, Wellspring in Palm Springs October 26–28. It was a tough week for mental health last week. The loss of Kate Spade and Anthony Bourdain triggered a national dialogue surrounding suicide and mental health. Both individuals were beloved mentors to so many, shaping their respective industries with wisdom and innovation. It was surprisingly to many that these two successful and cultural icons would be in such a dark place—but mental health has little to do with perceived happiness. Suicide rates have increased by nearly 30 percent in the last 20 years. We can spin our wheels attempting to understand the “why”, but perhaps our attention might be better focused on the importance of understanding and – mental health disorders. Depression is as much of a disease as the flu, and yet, for some reason, is it often taken far less seriously. Last week, I had plans to speak with Dr. Ramsey, a psychiatrist, author, and farmer dedicated to aiding those with mental health problems, but he was called on multiple media opportunities to discuss and create a dialogue regarding suicide and depression. (You can listen to a recent interview featuring Dr. Ramsey discussing these topics with NPR here.) He was able to get back to me, but our conversation took on a different tone. We weren’t just talking about brain food, we were talking about the value of making mental health part of a national dialogue. Dr. Ramsey’s unique perspective sheds a positive light during this dark time by reminding us to care for ourselves and for others. Read our conversation below. WL: The news of Anthony Bourdain’s suicide came shortly after the news of Kate Spade. These tragic losses stimulated a national dialogue surrounding suicide and depression. What would you say are important things to consider in this discussion? DR: Treatment works. It’s hard to make that point in the wake of so much tragedy. The suicide rate in the US is up 28 percent since 2000. All suicides are a tragedy and the recent highly publicized deaths by suicide should remind us there are 123 suicides every day in the US. When we hear that, of the 2.8 million people with severe suicidal thoughts last year, only half got treatment. I emphasize risk factors, namely a mood disorder, substance or alcohol abuse disorder, and prior suicide attempts along with access to a firearm. Know the warning signs, like worsening alcohol use, talk of death, and reluctance to make future plans. Those factors help reduce risk. Don’t be scared to ask about suicide if you are worried. Stigma and lack of access to quality care are driving this epidemic. But we all wonder what else? The rise of social media which fuels suicide contagion? Easy access to firearms (80 percent of suicides)? The polarized political climate? The misperception that mental health treatment is just medication are all pieces that are driving this epidemic. Some people question if psychiatric medications are effective or safe, which concerns me as a physician who prescribes psychiatric medications. After the FDA put Black Box Warning on anti-depressant medications regarding rare increased suicide thoughts in teens, the prescription rates dropped. Suicides in teens then went up. So what can we do? Let’s all talk more. Be curious about someone’s inner life. Talk about mental wellness… And struggles. Hug more. Help people find a greater sense of belonging. Get more treatment for those in need. Advocate for more funding for NIMH and mental health services. All of this plus less judgement and stigma. You’re a doctor—and a farmer. Those seem like disparate career paths. Explain the connection and crossover between the two. They are both about growing and nurturing growth. That’s what good doctors and good farmers strive to do. I’m not sure that a profession in medicine or as a farmer are careers that you really choose. I was raised on a farm and so my views about health and food are informed by that. Nothing makes you feel like walking in a forest or putting your hands in the dirt. Nothing makes you humble like trying to grow food. Nothing makes you feel like helping a patient get better. It seems like magic every time we plant seeds and a few weeks later you have food. I’m writing this in June and our plants are heavy with flowers: pumpkins, cucumbers, and of course tomatoes (we are in Indiana). Our farmers have so much wisdom about health and healing, and so many of my colleagues in medicine could use a week on the farm! Part of the burnout in medicine today is we have completely separated our concept of health from nature. Being from a farm and living for 20 years in New York City also has taught me about stigma. We are finally starting to really talk about mental health and stigma. We focus a lot in the wellness movement about how there is a disconnection from the natural roots of health such as real food, restorative sleep, and satisfying movement. But we don’t often frame wellness in terms of mental health explicitly. That’s changing and I am grateful for it. There can be a lot of stigma that gets promoted in the wellness world. Try being a bipolar yogi who needs lithium and Zoloft. Many of my patients in this situation don’t feel supported and we all need to examine our own bias and stigma. First in The Happiness Diet and recently in Eat Complete, you discuss the connection between food and brain health. Can you give us a quick rundown as to how certain foods can affect our mental health? All foods affect our mental health, just like they do our physical health. And that’s the first shift we ask people to make: Your mental health is rooted in brain health. As I started talking about food with all my patients and prescribing food, it struck me how surprised people are by the connection between food and how we feel. We know that when we nourish ourselves well we fell our best. We know that when we eat garbage, we feel like garbage. But somehow, food and health are mostly connected to concerns about obesity, diabetes, and heart disease instead of depression, anxiety, and dementia. Certain food categories contain more nutrients that are critical to brain function, like long-chained omega-3 fats, zinc, folate and vitamin B-12. These are the building blocks of the brain, and so when you eat a kale salad with wild salmon, you build a better brain. Then there are the foods we have people stop eating, taking the messages of about sugar, processed foods and fats and helping folks make a realistic plan based on their preferences. People are so confused right now about what to eat. My new e-course Eat To Beat Depression helps people transform how they view food and make a joyful, and effective, plan. The fact that foods can grow new brain cells sounds like sci-fi. Is this true? How does it happen, and are the brain cells related to the type of food? Yes. Your adult brain can grow a bit and can produce new brain cells. Food influences the production of a neurohormone called Brain Derived Neurotrophic Factor (BDNF). It is really important we move conversation about mental health and brain health beyond serotonin and to think about neuroplasticity, brain growth, and BDNF. Certain nutrients and a few phytonutrients promote more BDNF expression. We love your book, 50 Shades of Kale. Kale is definitely having a moment right now; but in world where so many healthy foods exist, why did you choose to focus on this vegetable? Why did you help to found National Kale Day? Kale chose me. I remain in her service. She is ancient. She is nutrient dense. She is versatile. Unlike other “healthy foods,” she feels no competition. For example people keep saying “cauliflower is the new kale,” but Kale tells me that she’s always been a fan of cauliflower “just being cauliflower.” National Kale Day is a nutritional psychiatry public health intervention we planned. More kale in the US diet means healthier brains. When we started, consumption was 2 cups per person per year. We’ve partnered with the largest public school systems in the US, the US Department of Defense and kale farmers to celebrate kale and her many benefits. We quickly learned that people love to adorn themselves with fresh kale and dance. Celebrate this year on October 3, 2018… You know what to do. (Hint—eat and dance.) What are some of your other favorite “brain-boosting” foods and what makes them so darn special? These days I am loving sunflower sprouts, though with some guilt as this is like the veal of the plant world. All sprouts and greens are awesome for their nutrient density and a bevy of phytonutrients. I like eggs as a great, easy protein source with lots of choline and one of the few foods with both folate and vitamin B12. Pepitas, cashews, and almonds are my go to snacks. Good dose of minerals in these, plus a nice mix of fats, protein, and carbs. Seafood is the category people struggle with the most. I prescribe a lot of bivalves, mussels, clams, and oysters, and fatty fish like wild salmon and anchovies. Growing up in the midwest, I have a lot of empathy for the seafood struggle! I think we can agree that some of the most fun comes with incorporating healthy foods into nourishing, delicious meals—and we yogis need that kind of grounding. Any recipes you’d like to share that could help augment a meditation practice? In a randomized clinical trial of the Brain Truffles in Eat Complete, yogis who received the brain truffles, compared to those yogis getting placebo truffles, reported 29 percent more enlightenment. For those yogis who did not respond to the brain truffles aka “enlightenment resistant,” we added on the marinated kale salad and are currently massaging the kale in hopes of publication in a major medical journal. — Amanda Kohr is the editor at Wanderlust. You can find her exploring new highways, drinking diner coffee, and on Instagram.