Today, I am delighted to reconnect with Dr. Uma Naidoo, who joined me once before for episode 173.
Dr. Naidoo is an awarded and board-certified Harvard nutritional psychiatrist, professional chef, and nutritional biologist. She is the Founder and Director of the first-ever hospital-based nutritional and metabolic psychiatry service in the United States at Massachusetts General Hospital and the Director of Nutritional Psychiatry at the MGH Academy.
In our enlightening conversation, Dr. Naidoo talks about her latest book, Calm Your Mind With Food, and we dive into the impact of anxiety during the pandemic. We explore how anxiety influences our susceptibility to metabolic diseases, autoimmunity, and Alzheimer's, and the difference between processed foods and homemade meals. Dr. Naidoo emphasizes the pivotal role of nutrition in mental health, particularly the interplay between the enteric nervous system, the vagus nerve, and brain function. Our discussion also covers the scientific underpinnings of the gut microbiome, the pitfalls of non-nutritive sweeteners and sugars, and the critical roles of neurotransmitters and neuroinflammation. She also elucidates the concept of leptin and its resistance, critiques nutritional trends like the low-fat craze, and clarifies the nuanced impacts of carbohydrates, fiber, and plant-based versus omnivorous diets.
I am sure you will find this conversation with Dr. Uma Naidoo as valuable and enjoyable as I did.
IN THIS EPISODE YOU WILL LEARN:
Some of the mental health and anxiety trends Dr. Naidoo continues to see four years after the pandemic
How cooking at home improves your food choices and health
The link between gut health and mental wellbeing
How older artificial sweeteners, like aspartame, can lead to cravings and weight gain
How stress and poor diet impact brain function
How hormones like leptin can cause anxiety and depression
The importance of understanding your individual nutritional needs based on your genetics, physiology, and environment
Dr. Naidoo advises moderation when consuming fruit and processed foods
Why many individuals struggle to consume enough fiber
How to increase your fiber intake
The benefits of including whole, unprocessed foods like eggs, avocado, and sourdough bread in your breakfast
The thing to catch here is that the moment metabolism is tipped over towards being unhealthy, it can actually set off things like anxiety and mood symptoms.
-Dr. Uma Naidoo
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Connect with Dr. Uma Naidoo
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today I had the honor of reconnecting with Dr. Uma Naidoo. She last joined me on Episode 173 and she is an awarded board-certified Harvard nutritional psychiatrist, professional chef, and nutritional biologist. She is the Founder and Director of the first hospital-based nutritional and metabolic psychiatry service in the United States at Mass General. She also serves as the Director of Nutritional Psychiatry at MGH Academy. Today, she joined me for her most recent book called, Calm Your Mind With Food.
[00:01:01] Today, we spoke at length about the impact of anxiety on the pandemic, how anxiety drives our risk for metabolic disease, autoimmunity, and Alzheimer's, the impact of the processed food industry versus home-cooked meals, the role of nutrition and mental health, specifically the bidirectional relationship between the enteric nervous system, vagus nerve and our brains, the science surrounding the gut microbiome, short and long-term affects, the problem with non-nutritional sweeteners as well as sugar, the impact of neurotransmitters and neuroinflammation, she helped define leptin and what drives leptin resistance and lastly, the impact of nutrition, including the low-fat craze, the poorly understood role of carbohydrates and fiber, and plant-based versus omnivorous diets. I know you will enjoy this conversation as much as I did recording it.
[00:02:01] Well, Dr. Naidoo, such a pleasure to have you back on the podcast. I really enjoyed reading your most recent book.
Dr. Uma Naidoo: [00:02:07] Thank you so much, Cynthia. It's always great to talk with you and thanks for inviting me back.
Cynthia Thurlow: [00:02:11] Of course, of course. You know, it goes without saying that over the course of the last four years, there is no one listening that hasn't had more stress and anxiety than they had previously. Obviously, the impact of the pandemic has been quite profound and clinically, as a psychiatrist, what are some of the trends that you are still seeing at this point four years later in terms of mental health and anxiety?
Dr. Uma Naidoo: [00:02:39] I think that's a really great question, because one of the things that people don't realize is anxiety disorder has always been the most common mental illness in the world, even prior to the pandemic. But after COVID-19, anxiety disorders grew from about 298 million people to about 374 million people, which actually showed an increase of about 25%. And this was published in a highly reputable journal called Lancet. So, it turns out that not only is the data backing up what our human experiences of our friends, family, colleagues, coworkers, perhaps everyone that we're interacting with, but it's quite significant. And I think that the concerning thing, Cynthia, is that we also know that globally, more than 70% of people with mental illness, they never receive treatment from mental health staff or even healthcare staff. So, there is a huge gap in the number of practitioners available for this type of work and then the increase of this disorder worldwide. So, I think that disconnect needs to be somehow dealt with, and certainly starting with simple things like how we are adjusting our diet for a healthier way of eating become important.
Cynthia Thurlow: [00:04:00] And it's interesting for me, we were speaking before we started recording, and I said, even in this day and age, with emerging information authors like yourself, clinicians, the concept of nutritional psychiatry is still not as well known as I hope it will be moving forward. And so, helping your patients and our listeners understand the complex interrelationship between the foods that we eat, which can either foster the health of our gut and producing healthy neurotransmitters, which do impact mood quite significantly. But the other piece of this that I think is quite significant is that we know that anxiety in and of itself, can put us at greater risk for other types of physical ailments, disorders, metabolic disease in particular. Can we speak to this just a little bit? Because I think that this, in and of itself, is a very important concept for listeners to understand as they are navigating, getting help for themselves, their loved ones, or family or friends.
Dr. Uma Naidoo: [00:05:08] Some data shows, Cynthia, that about 88% of Americans have some abnormal metabolic symptom or factor. That doesn't mean full metabolic syndrome, but some sort of issue. And part of it is our food system, our level of stress, environment, so many different things. But I think when it comes to metabolism and anxiety, one of the things we need to start to understand is that mental health and our metabolic health shown and being shown to really be inextricably linked. So, if we're eating a diet that is high in, say, the standard American diet called SAD for a reason, which actually has a lot of highly processed, ultra-processed foods and high in fast food, junk foods, but also high in sugar, an ingredient either through high fructose corn syrup or other natural or unnatural sugars found in our foods, we are just naturally eating a diet that is pushing us towards type 2 diabetes, insulin resistance.
[00:06:12] The thing to catch here is that the moment metabolism is tipped over towards being unhealthy, it can actually set off things like anxiety and mood symptoms. And I often see these in conjunction. So, anything that we can do to clean up our diet. So, taking it in a simple way, just taking one food that you know is not the healthiest option, can you swap that out with a healthier version? Can you give it up or cut back on it in a way that doesn't make you feel deprived, but you're eating a healthier version of it? Let's just take something like, say you love store-bought chicken nuggets, right? May not be that much chicken in them and a lot of highly processed ingredients doesn't mean you have to give them up. Can you make a healthier version at home in your air fryer? Can you try to do it in a different way? Can you maybe omit the breadcrumbs and find a crispy way to eat the chicken? Or maybe it's tofu that you like and some sort of dish that you eat at a restaurant. But, you know, when you look up a recipe or you ask, then there's a lot of sugar added to that to make that flavorful, spicy taste. But I think it's about finding the healthier swaps and starting there becomes important.
Cynthia Thurlow: [00:07:27] Well, and it's interesting, I've come to find that if we meet our patients where they are, we oftentimes have much greater success. And so, I love that you're starting with something that I think most Americans have probably consumed, if not once or twice or more often, like chicken nuggets. And just saying, “I'm not telling you not to eat chicken nuggets. Let's just find the healthiest version of that food that you crave or you're interested in consuming. And I think for a lot of individuals, they assume that when they’re in a restaurant or in the grocery store, if unless you’re reading food labels, you may not even realize how unhealthy some of the foods are that are in our food supply without even going down the kind of proverbial rabbit hole about subsidized foods. And as you mentioned appropriately, there’s a lot of excess sugar throughout the ultra-processed food industry. And I think as people start realizing what's in their food, that greater awareness will help with making better food choices.
Dr. Uma Naidoo: [00:08:27] You're absolutely right, Cynthia. One of the things I want to kind of underline for people here is that we are up against food marketing and the food companies who market those foods in a way to us to make us think that they're healthy. And that doesn't go for every single food across the board, but it goes for many foods. And we just need to be a little bit more savvy about looking at those food labels and discerning for ourselves. Is that truly healthy? Because it has this label? So, I think understanding what is a healthy version of a food, let me just mention, cauliflower, broccoli, cruciferous vegetables, some of my favorites are having a moment. They're in pizza crusts, to nuggets to, you can get any version of them. Doesn't mean that they're healthy. Look at the ingredient list and may just be worth your while buying those vegetables, even frozen, because flash frozen in this country are actually pretty healthy options for us. And making something at home that's a healthy version of that.
Cynthia Thurlow: [00:09:26] What do you think contributes to many of our patients lack of understanding on how to do basic cooking skills? I think if we encourage our patients to cook at home, they're like, “First of all, I never learned how to cook food at all.” I have been largely dependent on just going to the grocery store or ordering takeout because food prep at home is hard. It doesn't need to be. What are some of the largest impediments that you find when you're talking to your patients about cooking at home, which we know is one of the best ways to help support making better choices?
Dr. Uma Naidoo: [00:10:00] You're absolutely right on that. And it's been shown in large database studies as well, that we eat healthy and consume fewer calories and even may lose weight when we cook our meals at home. One of the biggest impediments is, I think, that people feel it's too hard, it's too difficult to do something. And for that reason, in both my books, Calm Your Mind with Food is my second book. In my first book, This Is Your Brain On Food, the last chapter is always recipes. And I go in the most simple way to help people be encouraged to even use a microwave if they have to, to make a scrambled egg in a mug. Now, do I like microwave cooking all the time? No. But if you're really stuck and you know that you arrive at work with five minutes to spare and you don't generally get to make your breakfast ahead, this is the solution for you. Or same for dinner or lunch, whatever that meal might be. They think it's too difficult and they think it's a skill set that is above where they're at.
[00:11:00] But you can start very simply by just buying your favorite vegetables and chopping them up. You can start very simply by cooking something that you enjoy. Say you like eggs, or say you like those chicken nuggets, or say you like tofu, whatever it is that you might enjoy, maybe look up a simple recipe, WhatsApp it and doing it online and realize that, influencers on Instagram and chefs and all of that, they do this for a living. So, their skill and expertise is going to look beautiful and look very easy. But you can start somewhere. I know this because as a child, I grew up in a family where everyone cooked. So, I had grandmothers, aunts, older cousins that prepared the food. And I really could mostly be spoiled and just enjoy the food. So, I started cooking late and I had to learn those skills. Granted, I enjoy cooking, so I went to it just as, I was willing to get by any bad dishes that I started with. But you have to start somewhere. So just get a chopping board, choose a knife that you can work with. These are not expensive. You can even get these at your supermarket and kind of get cooking with something simple.
Cynthia Thurlow: [00:12:05] Yeah. And I think you so appropriately mentioned the social media influencers, because if we just view our nutritional intake based on what we see others doing, an Instagram worthy photo has probably-- that meal has probably been duplicated 50 times to find the right photo, the right angle, the right lighting.
Dr. Uma Naidoo: [00:12:27] You're correct.
Cynthia Thurlow: [00:12:27] And I oftentimes will say to my husband, I'm less concerned about presentation, I'm more concerned about taste.
Dr. Uma Naidoo: [00:12:31] Yes.
Cynthia Thurlow: [00:12:33] And so helping everyone understand, as an example, on days where I am very busy, like in between podcasting, I sometimes will cook up two pounds of ground bison not to eat in one serving. My teenagers could do that. And some days it may be hamburger salad, it may be, I put some greens down, I put the cooked bison or beef on top of it, maybe I add some dressing, maybe I don't. I add some vegetables. It doesn't look like an Instagram worthy meal, but it's delicious, it's clean, I've made it home--
Dr. Uma Naidoo: [00:13:02] And it’s clean [crosstalk] and it's nutritious. I think that's such an excellent point because we are so influenced by the things we see, and I think we just need to be comfortable with the fact that to your point, it just needs to be nutritious, healthy, actual food, not a store-bought version of it that's frozen and has gone through multiple machines to be made, just actual food where you know what's in it. And some easy tips are things like buying frozen vegetables and frozen berries. Like I said, they're flash frozen these are easy. So, you don't have to clean the whole cauliflower. You don't have to clean all of the broccoli, canned beans, legumes, canned seafood. This is also specially affordability issue. Wild-caught salmon is not within your price range or your budget. Wild-caught canned salmon or canned beans. I'm referring to things like lentils and actually not so much lentils, but more chickpeas and black beans, for example rinse them out and use them. These are cost effective and nutritious for you and ways that you can even over greens or a big salad that you literally don't have to cook or just throw together. Easy additions.
Cynthia Thurlow: [00:14:12] Yeah. I'm a huge fan of keeping things really simple. Let's speak to the impact of nutrition and mental health. Let's talk about the physiology between the brain and the gut, this whole concept of the enteric brain, all the neurons that I found this fascinating as I was navigating your book, this bidirectional relationship between the gut and the brain, and why it's so important. It's not just, yes, it is important to eat healthy food, but understanding there's a lot that goes on behind the scenes, if you will, in terms of the interrelationship between the gut and the brain and mental health.
Dr. Uma Naidoo: [00:14:49] I think the biggest issue is people don't make that connection. They are always associating how we eat with, often weight gain, or maybe a family history of some type of medical condition that whether their food has been or nutrition plan has been suggested, like say type 2 diabetes or hypertension. The gut and brain originate from the exact same cell line in the human embryo. They divide apart. They form these two separate organs, but they're not really separate because, A, they originated from the same place and B, they remain connected by the 10th cranial nerve, which is the vagus nerve. And what that does is it is a two-way messaging system for chemical neurotransmitters that are happening all of the time. And so, I like people to realize that the serotonin receptors and other neurotransmitter receptors are many parts of the body, including the brain. But 90% to 95% of serotonin receptors are in the gut. We call serotonin our happiness hormone. It's definitely associated with anxiety and mood.
[00:15:55] So when you consume food, anything that you eat is being digested in your, let’s day, digestive tract. There are trillions of microbes in the large intestine mostly, and they are helping with this digestive process. So, when you are eating the healthy salad you mentioned, the microbes are happy, they nourish, they're getting fiber, they're getting vitamins, nutrients, mineral, protein, everything that you need, healthy carbs, and they are thriving, they're helping you. So, when they help to break down the food, not only are they interacting in the same environment as the neurotransmitters, they are forming healthy products called short-chain fatty acids, which really fend off inflammation, fend off oxidative stress, and are healthy for your body. So, you're fending off inflammation in your gut. On the other hand, if what you're eating is fast food every day, a lot of candy, ice cream and chocolate, and more of a sweet tooth, but also more processed, ultra-processed foods, then the microbes in the gut that are going to thrive are the negative ones. The ones that drive inflammation, cause problems, and cause dysbiosis in the gut and when that happens, it tips over the balance. It leads to overtime conditions like leaky gut, because it damages this delicate cell lining of the gut and enters your circulatory system. And inflammation in the gut leads to inflammation in the brain. And these two are connected. So, your eating is not just infecting the waistline, it's affecting your brain, it's affecting your neurons, it's affecting many parts of your body, but it is specifically impacting your mental wellbeing.
Cynthia Thurlow: [00:17:36] And in terms of working with women that are navigating perimenopause and menopause, do you see an uptick in reported symptoms of anxiety? We speak a lot on the podcast about the changes that occur with the poor ovarian reserve as we're navigating the transition from perimenopause to menopause and how progesterone in particular, if it's not at appropriate levels, can exacerbate underlying anxiety. But in your clinical experience, what are some of the common concerns that women, at this stage of life, in particular, will express to you?
Dr. Uma Naidoo: [00:18:11] For one thing, there's just anxiety about approaching perimenopause. Perhaps they had a mother or sister or cousin that had uncomfortable symptoms and perhaps wasn't able to get the best advice and suffered through that. So, they might be angst related to that. They may be angst related to the changes in our body that happened over perimenopause, menopause. And the things that come with it that, that we have heard are not that cool and not that fun. So, there's a lot of preconceived ideas about it, but what they tend to complain about is really feeling uncomfortable in their body, feeling more for moodiness, poor sleep, not only because of some of the physical symptoms, like hot flashes, but also really an uptick of anxiety. And some of that is the natural hormonal changes that they're undergoing.
[00:19:05] Plus, they worry about these symptoms. But it could also be because as they're going through some of these changes in their body, they tend to be craving or feeling like eating certain foods which feel like a source of comfort for them. But often those foods are not the healthiest, and they are discomfort for the brain. So guiding them towards, “Well, how you're feeling. What can we do again?” To swap, to clean up, to cut back, not give up something. Not saying give up something you really enjoy, just eat less of it or find a healthy swap. And I can help you do that. That's part of the way that just creating recipes or alternates for people can make them feel less deprived. But anxiety is huge and often associated with those problems with sleep.
Cynthia Thurlow: [00:19:50] Yeah. And it's interesting to me just, when I started as a nurse practitioner in my 20s, and I saw so many women in their 40s really struggling and not yet having enough of a profound appreciation for what they were experiencing. Now, being on the other side, I think, “Oh, my goodness. Now I understand so many of those women were struggling because there really was this lack of understanding about how impacted--” And it's so bio-individual that's the other thing. You can take 10 women and they could all have a very different experience navigating perimenopause into menopause. And so I, at that time, lived in an area of the country, there was a lot of traffic, people were involved in very stressful jobs, and almost every single woman in that vulnerable time period of perimenopause, sleep apnea, insomnia, on multiple medications to help them navigate some of the changes they were experiencing. So, thank you for speaking to that. I love to pivot and talk about the gut microbiome. I think that this is an area of medical research and information that when both of us were training, there was no information.
Dr. Uma Naidoo: [00:20:57] Yeah.
Cynthia Thurlow: [00:20:57] Now there's been an explosion over the past, gosh, 17 years. Let's talk about why the microbiota is so important and how current research is helping navigate changes around how we can best support this part of our microbiome.
Dr. Uma Naidoo: [00:21:15] I think that one of the things people don't realize is that the science is evolving very rapidly between about 2012 and 2017, there were like 12,000 articles on the gut microbiome, just in that timeframe. And so, once the research started, it really took off. And we know much more than we did about mental health and the microbiome. For example, one of the things we touch on is anxiety. We know that GABA is an inhibitory neurotransmitter. And when GABA levels are low, the parts of the brain like the amygdala can be more reactive and respond to stress differently. So, GABA is actually shown to be produced by certain gut microbes, and the species is called Bifidobacterium adolescentis. So, any imbalance in the gut, say you're eating poorly and you’re eating those fast foods, that gut imbalance can lead to a shortage of this species. And a shortage of the species means less GABA in the gut and the brain, and therefore an increased level of anxiety.
[00:22:19] There are fascinating things that have been studied in not only different groups of microbes, but their impact on actual neurotransmitters. So, I think that becomes important for us to understand. But along with that is the fact the food we eat is impacting these microbes in different ways, and therefore impacting our mental health in now a little bit more specific ways of targeting these different microbial groups, or bifidobacterium, or lactobacillus, and we’re therefore understanding much more. So, while it's not prescriptive, we do understand that there are healthier principles that will help support those gut microbes and overall help our mental health. And then now we also understand more specifics as well.
Cynthia Thurlow: [00:23:10] I think one of the things that I have found so fascinating about the gut microbiome and the research is that something like jet lag can change the gut microbiome quite profoundly and significantly. And so, when people are traveling overseas or as an example, I'm going to be in LA tomorrow, I will be 3 hours behind and I'm someone that does fine when I go east and I struggle when I go west. It's just the way that my body works. But understanding that even kind of acute things, individuals that work shift work, how many healthcare practitioners, healthcare providers, or cops, or EMS, ambulance, or even people that do construction in overnight hours, understanding that that degree of hormetic stress, brief, potentially beneficial stress can have a large net impact on the gut microbiome. And I would love touch on sugar, which we know sugar exacerbates underlying anxiety. But now there's the advent of all these non-nutritive sweeteners, sucralose, aspartame. What are your thoughts on how this impacts the gut microbiome? I know some of the research is suggesting it can impact insulin sensitivity, metabolic health, but what have you seen clinically with your own patients?
Dr. Uma Naidoo: [00:24:25] Clinically, I find that the foods that are marked sugar free and the older sweeteners, like the ones you mentioned are problematic. Personally, they're non-nutritive and so they trick our bodies into thinking that food is coming. And sometimes people don't realize that they actually gain weight when they starting to eat these so-called sugar-free foods or drinking a lot of diet soda. And part of that is the way that they work. They are ultra sweet. They trick the body into thinking that sugar is on its way because it activates the taste receptors, but then sugar doesn't come. You feel hypoglycemic, you have a sugar crash, and then you want to eat more. So it's an interesting, one of the different mechanisms that's been looked at. I think that overall, these older artificial sweeteners that are in many of our foods actually are problematic because they disruptive to the gut, and they drive these types of cravings. They may cause us to gain weight. I see this a lot.
[00:25:26] So I generally guide people towards some of the newer sweeteners, but very little. And the example I like to use is sweeteners, yes, they exist as options for baking, but that's not a good idea because you're using a lot more, a very highly sweet sweetener into your baking. So, I'd much rather you just-- I can always give you alternatives for what you're trying to make. But that's an example where I think that it'd be providing a solution, but not one that's ultimately healthy for people. Even if that particular sweetener in a little bit in your tea or coffee or is okay, I'm just saying don't have it 15, 10 times a day. And I'm also saying don't drink those diet sodas and diet drinks because they are pumped up with those artificial sweeteners. But if you need to sweeten your tea, there are some newer ones which are less problematic in terms of insulin resistance.
[00:26:21] You know, erythritol, certainly stevia has not been as problematic. But again, stevia is a bit complicated because stevia can worsen anxiety, even though it's natural, and yet it can be okay in small amounts for some people. So, it's always, you mentioned bio-individuality, and that's so key to what we're talking about. So, a little bit a newer sweetener, don't use it all the time and try to maybe do with less of it. And most certainly don't be buying all the sugar free products with it, because that's just going to be super disruptive to your gut.
Cynthia Thurlow: [00:26:56] Yeah. And it's interesting, and how many times I have gone to events and either listened to colleagues speak or been asked this question, “What's the best sugar substitute?” Because I think many people, whether it's just the sensitization of our palates, given the processed food industry, and how sugar has infiltrated every condiment, everything that we eat, with very few exceptions, if we don't make it at home, has probably been touched by some type of sugar, alcohol, or sugar product. And so many people are looking for the next best thing. The non-nutritive sweeteners seem pretty benign. And I would agree with you and echo what you're saying, that they themselves can become problematic and can impact the gut microbiome in profound and significant ways.
[00:27:43] When we're talking about neuroinflammation and we're dovetailing into this conversation, because I think that this is very interesting to me, the changes that are going on with the gut microbiome, this bidirectional relationship with our brain. But helping listeners understand the concept of neuroinflammation, how stress plays a role in that, and what is going on physiologically in the brain when it is inflamed. Because this will help people identify some of the symptoms that they are experiencing that they may want to discuss with their healthcare provider.
Dr. Uma Naidoo: [00:28:19] The way that neuroinflammation can show up clinically, one of the ways that it starts is your level of stress. Perhaps you are feeling stressed and therefore you are eating poorly. We know that stress precipitates habit circles in the brain. So, it is actually true if you are stressed and you're starting to order fast foods every day for all of your meals, because it just becomes easier because you're stressed and worried, or maybe work is tough right now, you start craving it and you want more of it. There's a lot of engineering that goes into our food. There's a lot of research and development to actually perpetuate those cravings. So be aware of that. So, you're feeling stressed, your cortisol levels go through the roof, your HPA axis is thrown off. And where you're at is you sort of craving these less healthy foods. Let's face it, no one's eating broccoli when they stressed, and no one's rushing to that great leafy green salad. Mostly it's the candy, the chocolates, whatever it is, the ice cream.
[00:29:18] So, realize that we have to kind of step back from that cycle. But the moment that we talked early on about this gut-brain connection, the moment that inflammation starts to be set up in the gut, the inflammation in the gut will reach the brain. Once there's damage to the single cell lining of the gut, it's very delicate. And once that is permeated, the dysbiosis, the toxic breakdown products that the negative microbes, which are not forming short-chain fatty acids, they are forming more toxic polysaccharides. Those leak into the circulatory system and guess what? Reaches all parts of your body, but it reaches your brain. And so, when you start to develop neuroinflammation, what I will see clinically, if I were to trace back someone's diet, is an uptick of symptoms worsened anxiety, new anxiety in person who's not had anxiety before, saw a lot of that in a pandemic with less healthy.
[00:30:13] Some people thrive during the pandemic and started exercising more quickly at home. And there was another group, a larger group, that struggled more. So, with some of those individuals, they will naturally just experience almost new symptoms when they haven't really been so overtly anxious before, they've been able to manage it. Same thing with mood, so there's definitely a connection. This is where food is a pillar, but even things like breathwork exercise and mindfulness practice that appeals to you. You know, outdoor time, simple things, working out, just being more active, these are all part of the same puzzle. It's an integrated and holistic approach. Well, whereas food is the pillar, and I think it's the one that we most overlook. Things like sleep and exercise and getting into the best routine also become important. Also, things like hydration, because if someone's dehydrated, they can feel very anxious and not realize it.
Cynthia Thurlow: [00:31:08] No, I love that you are thinking about this from a very comprehensive lens as I'm watching you drink water all the way from dehydration, driving anxiety to the food choices that we're making and understanding what's going on physiologically when we're stressed. I always tell people you're going to crave salt or sugar or maybe both. And appropriately, you don't crave chicken and broccoli. You're probably going to crave the bag of chips, the ice cream. But understanding that there is a physiologic drive to do that, your body is looking for a way to increase serotonin. Sometimes I find this fascinating that,-
Dr. Uma Naidoo: [00:31:46] Yes.
Cynthia Thurlow: [00:31:4] -when I was still getting a menstrual cycle, there was a time in my cycle where I would always crave chocolate and I would say to myself, “I need more magnesium,” because that was always my indicator or my sign. And so, for people listening, understanding that what's going on in our personal lives can directly impact what's going on in terms of our stress. And to your point as well, talking about new-onset anxiety could be a clue that something else is going on. Maybe you were traveling, you picked up a parasite, or maybe you have a new underlying food sensitivity that is driving some of these leaky gut symptoms. Now, when I think about the brain and I think about hormones and I think about cravings, one of the big hormones that I know we’ve talked about quite a bit on the podcast that is relevant to our conversation is talking about leptin, this very, very important hormone. Can we speak to how it impacts food cravings, can impact anxiety levels, and also understanding that there are some gender differences as well, that men and women may have more or less leptin circulating just based on our gender roles.
Dr. Uma Naidoo: [00:32:55] True. So, it's often overlooked. But leptin is the hormone that helps tell us that we're satiated. I like to tell people that when you're eating, it's the hormone that kind of reminds you that, I've had a plate of food, I've enjoyed my dinner, and now it's time to move on, take a walk or whatever your next activity is, or however, maybe you have some berries to help with that sweet tooth. But when we're eating in a way that is leading to leptin resistance, meaning that it won't be able to create the correct signals, and we are behaving in a way, and that behavior may be the stress that gets set up that we talked about. It might be the cravings that have gotten set up that's leading you to just eat poorly. We can actually really set off or allow without meaning to, that we start to develop leptin resistance.
[00:33:54] And when that hormone does not remind us to shut off our eating, we eat more. We continue, we get that second plate of food. We then reach for more berries than we need, because berries are healthy, but they do contain sugar. So, eating a ton of them in one sitting or one day is not the healthiest. It's all about the balance and bio-individuality. I think understanding that these are delicate hormone systems that get impacted by how we eat is really key to helping us step back from things like anxiety and helping us almost rebalance our physiology and our metabolism to help calm ourselves. And it's something that works if we pay attention.
Cynthia Thurlow: [00:34:37] Yeah. And even in the book, you talk about when leptin is properly functioning, it can have a calming effect on the brain. So, if you're leptin signaling or your leptin levels are optimized, you are less likely to experience anxiety. So that was a big takeaway that more often than not, when things are balanced, and I hate the word balance because balance is elusive.
Dr. Uma Naidoo: [00:35:00] It’s true.
Cynthia Thurlow: [00:35:01] But for the context of our conversation, helping people understand that when we are satiated, when we have the appropriate amount of circulating leptin, we are going to be able to push that meal, push ourselves away from the table, feel satiated, we're not thinking about a candy bar or the ice cream. We're able to go about our day. And then the opposite is true. That for some individuals, when they have a lot of cravings, when they are feeling very anxious and depressed, or even in the book, you talk about OCD, obsessive compulsiveness, it can be a sign that your leptin levels are not optimized. Now, I know a lot of our focus today is talking about the interrelationship between nutrition and mood and how we feel. But I would love to talk about the misappropriation of fats. You and I both trained in a time when fats were effectively bastardized. We were told fat is bad. Let's talk about healthy fats, the fats that you like to encourage your patients to consume and then the fats to avoid.
Dr. Uma Naidoo: [00:36:00] Right. This relates back to the food industry, food labeling, food marketing and phases in this country, right? There was a phase when mothers were buying low-fat milk and skimmed milk and low fat, everything from cheese to anything that could be low fat, and finding all sorts of substitutes for things like butter, including things like margarine that were used extensively. So, what the food industry did is because the so-called low-fat craze happened. They took out the fat, but they put in carbohydrates or sugars to increase the flavor, because fat is also flavor if you cook, you know that. And so, it was something that was incredibly unhealthy for us, because while it was labeled low fat, the calories were coming in through other sources, like carbohydrates and different forms of sugar.
[00:36:54] And as time evolved, there have been different phases and crazes. But I was very interested in a study that was published actually in 2020. Now, granted, many phases of the rethinking around fat have happened, but this particular study was published in the JACC and was one of the most cited, if not the most cited that year. And they looked at almost a reworking and relooking at saturated fats. So, it used to be that you told people, “Go towards lean poultry and lean meats and don't eat beef or red meats,” I should say. And the issue is that a certain amount of saturated fat is completely okay for you. It's not going to kill you. And I'm not saying you should eat beef every day, but I'm saying well sourced red meat is completely okay.
[00:37:47] And this may not be something that your cardiologist tells you. I often talk to my colleagues and they're not in agreement with it. So, I think it's about bio-individuality, creating the right sort of formula for what works for your body, and understanding that these food rules that have marketing behind them and food companies behind them are not the best for us. So, we've got to look at the world. We've got to learn a little bit about how to read food labels. We've got to become savvy about what's a healthy version of something. Those broccoli nuggets are not quite the healthiest version. Just get the broccoli, eat the broccoli. And that small amount of, I say small amount, Cynthia, simply because I don't want people to sway in the other direction and say, “Sure, butter is great, I'm going to cook everything in butter.” And that's fine if you're metabolically healthy, but many of us are not.
[00:38:37] So, when you are metabolically healthy and metabolically flexible, so you're at a good, healthy weight, you are exercising, you have all of these different things that you're doing, and your body is perfect, but you are in pretty, let's say, you're in good shape overall. Then if you ate a lot of red meat or ate a lot of butter, your body can take it because you're exercising, you're metabolically fit. When you exercise, you burn off that fat, so you can take it. But for many of us that 88%, that's why I speak about eating it in moderation. It’s not that you have to demonize it or never eat it again, but just have good sauces if you can afford it, eat it in moderation and same thing with butter. So, the facts that I like are things like extra virgin olive oil for my salad dressings, avocado oil, for say, I'm roasting vegetables. I love using an air fryer, in which case you don't need any fat to be added, and a touch of coconut oil, I love ghee, which is clarified butter, and actually a little lob of butter if I'm cooking something that I want the flavor in. But because I have to watch my health, I don't put a ton of butter in everything. And so, it's about that creating what works for you.
Cynthia Thurlow: [00:39:51] Yeah. I think that's such a beautiful explanation. And I will remind patients when we're looking like calories matter to a point, it's not the whole picture.
Dr. Uma Naidoo: [00:40:00] Yes. It's not the whole picture.
Cynthia Thurlow: [00:40:01] Helping people understand that protein and carbohydrates are 4 calories per gram and fat is 9. So, fat tends to be much more calorically dense. You appropriately said, “It's what drives flavor. It's very pleasing to the palate.” So sometimes being conscientious about portions, for many of us and myself included, I have to be mindful of my portions of healthy fats. I can generally do fine with protein and carbohydrates. Now, I also feel like carbs have gotten a bad rap. And I say this about the healthy carbs, that there are some people who are now paranoid to eat a piece of fruit. They demonize the vegetables, helping your patients and listeners understand that there are healthy carbohydrates, and these are the ones we want to consume. And then there are the unhealthy, processed variety that we want to limit as much as possible. You mentioned the chicken nuggets. Eat the chicken, avoid the breading. But helping people understand that there are high quality carbohydrates. There's this glycemic index that you do talk about in the book. So, let's differentiate, give listeners some examples of low glycemic index and higher glycemic index foods to help them understand.
Dr. Uma Naidoo: [00:41:12] Sure. So, let's start off with carbohydrates, because I think that one of the things people don't understand is that things like cauliflower can be classified and not classified as a carbohydrate, but they are a more complex, healthy carbohydrate compared to a doughnut, which is largely sugar and highly processed flour that makes doughnut, and then there's a ton of sugar. So, we just want to be careful about understanding that our bodies need sugar. Our bodies need carbohydrates. We are bio-individuals so what you eat and I eat may need to be different based on our genetics, physiology, environment, so many things, gut microbiome, etc. But I think when people get a little bit misguided, is don't ever eat fruit because fruit contains sugar. Yes, fruit contains sugar, fruit contains fiber and multiple nutrients and vitamins. Eating fruit in moderation, a quarter cup of berries, a piece of apple, a clementine, these are good ways and good foods that your body needs, and they balance your gut.
[00:42:14] They help with the fiber content. They are healthy for us and we should be eating a certain number of servings of fruit in a day, not fruit juice. That's a totally different product. And not dumping a ton of berries into a smoothie all the time, by all means, put a few berries in your smoothie, make it sweet that way, totally fine. But sometimes we go to stores. If you go to places that sell these breakfast bowls with multiple different types of fruit and frozen yogurt, it's actually a sugar bomb. And just understand eating it in moderation becomes important. And understanding that if you have a doughnut, they say to people, “Why do they tend to sell donuts and like the little special, we have these two donuts with this cup of coffee or whatever it is, because you usually want that second donut. You eat the doughnut; it's gone through your system so fast that you need a second one. That is the nature of simple carbohydrates. They break down very fast. They cause a blood sugar spike. You are not satiated. You want another doughnut or you want something else to eat, because if you've chosen that for breakfast, you're not full, and you remain hungry.
[00:43:24] Very different if you had eggs with spinach in them or maybe you had scrambled tofu with lots of veggies in them. And you maybe had a piece of avocado for healthy fat with that, whatever it was. That's a little bit more wholesome than what you ate. When it comes to higher glycemic products, it's the processed, ultra-processed flours that we use in our store-bought bread, the ones that are shelf stable and are highly processed and tend to be what a lot of people use for sandwiches. These are less healthy for us, and it's hard to step away from a habit that we have which is finding healthier versions. Maybe there's a bakery that makes sourdough bread that you can find in your neighborhood or maybe there is a recipe you can find for a more-- I've seen recipes that are pretty easy for, like a cracker, but made from nuts and seeds. And so, you're not adding a ton of ultra-processed flours, because the ultra-processed flours have almost no fiber or actual wheat left. They're really stripped off their nutrients. So, I think that just finding those choices for ourselves become really important.
Cynthia Thurlow: [00:44:38] Yeah. And I think again, you really do a beautiful job of meeting patients where they are identifying that there are these fun foods, like the doughnut, the bread, and finding healthier alternatives. Why do you think so many of us struggle with getting enough fiber in our diet? And why is fiber so important for our gut microbiome and our mental health?
Dr. Uma Naidoo: [00:45:02] Many of us struggle to get fiber because of the standard American diet, which is not rich in fiber. Ultra-processed and processed foods tend not to contain that much fiber in them. And so, we have to be conscious of where we get our fiber. Fiber is easily obtained from vegetables, beans, nuts, seeds, legumes, healthy whole grains, not from animal or seafood protein. So fiber, just having adequate vegetables in your diet in some way, shape, or form becomes important for obtaining the fiber that your body needs. Why does your body need it? Because our gut microbes thrive on fiber that they’re fond off. That's what they eat. So, if you want to take care of your gut microbiome, tap into a diversity of different vegetables, different colors, different textures, have fun with it, start expanding your palate. Add in proteins from beans and nuts and seeds, because that brings you fiber. But I think that where people get waylaid is tending to eat a less healthy diet, and it is high in processed ingredients and sugars that is not high in the type of fiber that our body needs. But it's easy to fix because we just have to lean into more salads and vegetables every day as part of whatever else you eat.
Cynthia Thurlow: [00:46:20] Yeah, I know. I had Dr. Robynne Chutkan on last year, and she was encouraging listeners to have 30 plants per week,-
Dr. Uma Naidoo: [00:46:27] Yes. I love that-- [crosstalk]
Cynthia Thurlow: [00:46:29] -and that could be herbs, spices. So understanding that you could have a salad with eight different elements and you could knock eight out just like that. And I think understanding that fiber plays this role as, like, the fertilizer for the microbes in the gut is super helpful. And if anyone's listening and saying, “Well, I tried to have a cup of brussels sprouts, and it made me bloated and gassy.” Sometimes it's dosage dependent, sometimes it is that you need to start with half a cup or maybe half a cup or a quarter cup of a particular vegetable until your body kind of gets acclimated.
[00:47:01] Now, I want to make sure that we at least touch on a very popular subject. You talk about it in the book as well, the rise of plant-based protein. In the book, you talk about how veganism is increased 600% from 2014 to 2018, and that plant-based labeling has increased to 87% in the past 10 years.
[00:47:23] And what I loved is that you are looking for balance. We talk about balance being elusive, but you even speak to the fact that there's no definitive evidence for either veganism or omnivorous diets in terms of anxiety. So, for everyone that's listening, depending on which side of that you fall on, which argument, what works best for you, it's really figuring out that bio-individuality piece. But for you, as a clinician, as you've been witnessing the rise of plant-based focused proteins, etc. Have you seen any differences within your patient population depending on which direction they go in for their protein, whether it's animal, plant-based, a combination of both.
Dr. Uma Naidoo: [00:48:05] I really think that what I've learned in my practice over time is bio-individuality is so much where it's at. I think we knowing that now, we're understanding that precision and personalized medicine, that a nutritional, lifestyle, and metabolic, psychiatry treatment plan has got to be suited to that individual. But one of the things I want to point out to both sides of this argument are, so I'm vegetarian just from birth. I was born into a vegetarian family. So, that was decided for me, and it never bothered me, because as a chef, I cook anything and members of my family eat anything. But one of the things I remember years ago when I visited, I was so excited because of these new vegan restaurants in New York, and this is not recent, they've much improved since then, everything was deep fried. Every type of vegetable in this vegan restaurant was deep fried.
[00:48:56] And I remember thinking, “I wanted the vegetables, but is this really the best way for me to eat them?” And of course, I knew they were not. So, I think we've come a long way from that. I think that there are many more restaurants and options and recipes and people who can teach you how to eat a healthy plant-based diet. An individual needs to do what's best for their body, that is the bottom line. And some of my patients have needed to switch away from eating as much meat and build in more of those plants, the diversity for the gut microbiome. Others have actually wanted to eat more of a vegetarian diet. But if we're doing that, we got to make sure that it has balance in other ways. And that if they say giving up red meat and chicken, that they're getting adequate protein in other sources, because not many people know how to do that well.
[00:49:46] And I think that the kind of fads we go through where there's a rush towards protein is the most important thing, or this is what you should be doing, confuse people the most. And that's where we just throw off all of that balance. So, I think whatever the diet is, whether you’re a pescatarian, vegan, or just vegetarian, and maybe you do consume things like a touch of honey or some dairy. If you eat dairy, there's a way to find that balance. And I think the more we can embrace that, the healthier, happy, and less anxious we will be as a country and I mean that. Because the more that we fall into-- Cynthia, you should never eat that bison, you need to be giving it up. Well, you eat it, you enjoy it, you're thriving, your family's doing well with it. That's a choice. I think we really just need to be more inclusive with food. And I think giving hard and fast food rules to individuals, whether you're carnivore or vegan, it's the same thing on different sides. And I think when people feel split that way, I see my patients and people in my practice really struggle.
Cynthia Thurlow: [00:50:57] Such a beautiful message. I can't thank you enough for our conversation today. Please let listeners know how to connect with you on social media, how to get access to your new book.
Dr. Uma Naidoo: [00:51:07] Thank you. Thanks, Cynthia. Thanks for having me. So, the best way is to go to my website, umanaidoomd.com, where you'll see a ton of fun stuff actually, you'll see my books, you'll see a link for my course that helps other clinicians, practitioners, or just if you're a listener wanting to be healthier, learn more about nutritional uses in your mental health. I have a new meal delivery service with the daily dose meals. It's called Mood Food Meals and you will find that link on my website as well. It's freshly delivered food for three to five days of the week based on my recipes, using my spices and ideas for sort of a balanced meal for that, for whether it's lunch, dinner, or your breakfast. And check me out on social media @drumanadioo. And I have a new-- I'm an instructor at Masterclass, so we have a new Brain Health MasterClass that was just released about around Father's Day. Check that out as well if you want to dive deep into brain health and mental health.
Cynthia Thurlow: [00:52:08] Wonderful. Thank you again for your time today.
Dr. Uma Naidoo: [00:52:10] Thanks so much, Cynthia. It was lovely to talk to you.
Cynthia Thurlow: [00:52:14] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
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