karppaus.infon arkistoitu foorumi

Litteraatti


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I'm very pleased to introduce Georgia Eid again psychiatrist um from the US who has done a lot of this written a
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book so Georgia inform us please thank you very
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[Applause] much good morning uh nice to be back
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with all of you again today uh so there have been some really interesting presentations and discussions about how
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diet affects physical and mental health over the past couple of days uh we have
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considered some very important questions things like how much carbohydrate should we eat how much fat should we eat how
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many calories should we eat how often should we eat what things should we not eat but one of the things that we really
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haven't talked very much about it all is what should we eat uh how do Foods the
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individual food choices that we make within our preferred dietary patterns how do those affect our risk for future
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mental health conditions and the course of of any existing mental health conditions we may already have so um and
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this was you food actually the brain actually cares a lot about your food choices uh and that's not something that
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I would have thought about when I was in medical school or residency as I think most women do I thought really of my
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food choices as purely a way of controlling my weight uh and and it
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wasn't brought up in in medical school residency this relationship uh but of course food does matter to the brain
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uh uh we were taught um the What's called the bioc psychosocial model of
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causes root causes of mental illness meaning that mental illnesses are thought to have psychosocial causes uh
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such as stress trauma of course your mother um and those kinds of stresses we
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were taught to address with Psychotherapy and we were taught that the bi the biological root causes of
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mental illnesses were largely neurot transmitter imbalances chemical imbalances in the brain this is a theory
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that's been uh dominant for the past 75 years and really the biological uh uh
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track and Psychiatry has has changed very very little over that period of time now it's not that uh
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neurotransmitter balances don't matter they do uh and it's not that the medications that address these
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neurotransmitter imbalances can't help sometimes they certainly can help sometimes it's just that they don't they
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really fail most people um they do help some people excuse me they do help some
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people but the price that people pay for the relief that they will sometimes get from these medications is often a a lot
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of U um physical health especially metabolic Health disturbances for example um within minutes to hours of
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the first dose of taking an anti-yo medication blood sugar and insulin levels can begin to rise so there are a
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lot of trade-offs here so and this is very interesting because I've been thinking about this week when it comes to the convers is we've we've talked a
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lot about obesity and type 2 diabetes and uh we actually have For Better or
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For Worse we have some medications that can help us with obesity and type 2 diabetes they actually work and uh if
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you can access them and tolerate them we really don't have for most people uh any
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good medication solutions for mental illnesses and this makes nutrition uh prioritizing good nutrition and finding
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alternative Solutions uh all the more important so medications are important I still use
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them in my practice even though I'm a nutritional and metabolic psychiatrist they have a really important place to
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play to play uh a role to play but uh you know I've become convinced uh very
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strongly that the most powerful way to change brain chemistry is through food
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because that's where the brain chemicals come from in the first place and I think all of us would agree that food must
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play some role uh we may also uh agree that this so so called sad diet the S
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standard American diet which is very high in ultr processed foods is probably not very good for the brain it certainly
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hazardous for the rest of the body why should the brain be any different but I think where we might uh come to some uh
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heated disagreements and uh passionate discussion is uh what should we eat instead of the standard American diet
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which dietary changes are most worth making and why there's no consensus
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around that question we have lots of opinions we have uh um so for example
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there are two uh relatively new uh sub Specialties within the field of
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psychiatry in the past 10 years or so the field of modern nutritional Psychiatry uh nutritional Psychiatry is
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a um a field established uh this term was coined by uh Dr Feliz Jacka a
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nutritional psych psychology researcher at the univers uh daon University in Australia and the the thought leaders
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most of the thought leaders in in the field of nutritional Psychiatry um uh recommend the Mediterranean diet over
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the standard American diet uh now I consider myself a nutritional psychiatrist because nutritional
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psychiatrists believe that uh the uh the decline in uh our Global mental health
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is largely related to the decline and the deter the decline and the quality of the modern diet so I absolutely 100%
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agree with that so uh nutritional psychiatrists for the most part a focus
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on the Mediterranean diet and with good reason there is actually excellent data on the Mediterranean diet particularly
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for clinical depression there are several randomized control trials now showing that if you switch from a
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standard American diet to the Mediterranean diet you can significantly improve uh symptoms of
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depression but just because the Mediterranean diet is better than the standard American diet for the brain
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does not necessarily mean that it's the best diet for the brain and there is uh
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there are several reasons uh to to think that it may not be now there's an even newer branch of
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uh Psychiatry uh called metabolic Psychiatry and this was a a term coined by Dr Shabani SEI who's here this week
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from Stanford metabolic psychiatrists are interested uh Less in the nutritional quality of the diet and more
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in the metabolic quality of the diet meaning that we are and I also consider myself a metabolic psychiatrist we are
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interested in the metabolic roots of mental illness uh in other words how does uh how does the diet that people
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are eating provide the brain with energy UHC and and we are primarily interested
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in the ketogenic diet because it energizes the brain so differently from every other diet and somehow we've
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gotten away I don't know how how this happened we've escaped uh defining what a ketogenic diet is it's already
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Wednesday conference is almost over uh but uh let me just Rectify that so uh I
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think a good definition is any way of eating uh that lowers insulin levels
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enough to turn on fat burning and generate clinically meaningful levels of
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ketones in the blood most people would say that that begins at around .5 Millo beta beta hydroxy mate now it doesn't
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have to be a low carb diet uh you can get intermittently into ketosis using intermittent fasting you can uh get into
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ketosis using a very low calorie diet even if it's high in carbohydrate uh but
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a ketogenic diet allows you to stay in ketosis without fasting and without uh
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Cal caloric restriction so typically is very low in carbohydrate uh moderate in
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protein not excessive in protein uh and obtains most of its uh calories from fat
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as opposed to carbohydrate so these are two very different diets and I and I hope that if
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you were here on Monday you were you were convinced or at least intrigued by the the what I think is the remarkable
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therapeutic potential of the ketogenic diet to improve uh even quite serious mental illnesses so how can both of
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these two very different diets one which is based in carbohydrate starches and Grains and the other which contains
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almost no carbohydrate at all how can both of those diets be good for the brain and is one of them better than the
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other I mean patients are very very confused about this so I think that whenever we're
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thinking about any diet uh I mean there are lots of other dietary patterns we could talk about you know low fat and
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vegan other kinds of diets how do we know which one is best for the brain and I think the only way we can really even
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begin to think about this question is to take a step back and instead of you know asking you know what your favorite diet
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how how your favorite diet whether it's the best for the brain is to ask what does a brain healthy diet need to
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accomplish and that way we can establish some maybe some uh logical criteria by which we could then uh you know compare
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our favorite diets too kind of as a as a yard stick as an objective yard stick so I hope these won't be too uh I I hope
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that we can gather some consensus around these uh I don't think there's a controversial a brain healthy diet
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should nourish the brain it should provide the brain with all essential nutrients it should protect the brain by
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excluding any ingredients that we are fairly certain damage the
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brain and it should energize the brain in ways that support healthy brain
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metabolism over the lifespan so um I think those are those are fairly not
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should be non-controversial uh so when whenever we're making any food Choice within whatever dietary
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pattern you wish we could be asking ourselves this question how does this food nourish protect and energize my
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brain is this doing anything for me or is this mostly doing something against me uh and so which foods are best at
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nourishing the brain now Whole Foods are certainly better at nourishing the brain than other foods but not all whole foods
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are created equal and it is just it it is inescapable this truth this biological
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truth that if you are trying to nourish your brain entirely with plant foods not with supplements or Ultra processed
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foods that have been fortified you you you cannot do this without including some animal food in
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your diet it's it's just a fact a biological fact uh this um uh this slide
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uh shows you the nutrient deficiencies uh for which uh people who are choosing a vegan diet uh this this
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were deficient in more likely to be deficient in than people who are eating other diets this was a study just
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published in uh 2022 conducted in the Netherlands very nicely written study so
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these are you know nutrients like vitamin B12 iron zinc iodine omega-3 fatty acids all of those nutrients are
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much more difficult if not impossible to obtain from plant Foods uh and uh and
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are are very easy to obtain from animal Foods so I want to give an example
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example of why even if a plant food contains a nutrient that you might not be able to access it and this is a little known nutrition secret uh so for
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example the grains and the glooms that form the the foundation of the Mediterranean diet are actually extraordinarily poor sources of
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micronutrients uh and they also contain antinutrients and so there are a variety
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of these listed here we're just going to focus on one for the sake of example which is phytic acid uh phytic acid
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exists in all grains beans nuts and seeds and it's a powerful mineral magnet designed to hold on to the mineral for
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the sake of the sprouting plant it certainly does not want you to uh to to uh obtain to access its
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minerals so phytic acid interferes with our ability to absorb iron calcium
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magnesium and zinc uh and I I use this slide in many presentations forgive me if you've already seen it but it's just
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a helpful uh example so oysters are the uh the food the whole food uh that is
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richest in zinc uh in the world so so if you eat oysters your zinc level will
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rise very nicely in the blood if you eat that those oysters with uh black beans
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then you will absorb less than half of the zinc from those oysters if you eat those oysters with corn tortillas you
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absorb virtually none of the zinc from those oysters this is not a subtle effect and minerals are very important
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for the brain um you know for many many uh many uh functions in the brain
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including uh affecting our neurotransmitter systems which drugs are trying to help us improve the function
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of excuse me so iron is a lovely example too because you know we take for granted
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that 20% of women around the world are iron deficient this is just really absurd that we would accept this because
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if you have iron deficiency you don't just have a blood problem you have a brain problem an iron is required for
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neurotransmitter synthesis and it is it is a an essential part of the electron
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transport chain inside mitoch contri where brain energy is generated not enough iron not enough brain
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energy so uh nourishing your brain requires that you include at least some animal food in the
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diet which foods do you need to exclude to protect your
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brain uh so of course the ultra processed foods that would be a great place to start um and a hearty
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congratulations to the UK because now more than 50% of your diet is no longer food it is now ultr processed
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ingredients um and second only to the United States uh where uh it is more than 60% of our
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foods and so when we're talking about what makes the standard American diet so dangerous for the body and for the brain
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it's not red meat and saturated fat those are ancient ingredients it's the modern ingredients that are so novel to
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our bodies these started as Whole Foods uh we're talking about refined carbohydrates and refin Seed oils these
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are the signature ingredients of all modern unhealthy diets so regardless of
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what pattern you eat you want to exclude refined carbohydrates and vegetabl O as much as you
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can so um these uh uh um so even if
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you're eating lots of healthy Whole Foods throughout the week and on the weekends you take a break and you treat yourself to something Ultra processed if
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you're eating too many of these ultr processed foods you've taken this beautiful brain that you've worked so hard to build during the week and you
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have dropped it into a very unhealthy environment of inflammation oxidative
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stress and insulin resistance these are the more recently discovered uh drivers of
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all kinds of uh Neuropsychiatric conditions and and physical conditions as well so how to refine carbohydrates
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and refine seed oils lead to excessive inflammation oxidative stress and
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insulin resistance and what are these things anyway we've talked a lot about insulin resistance but not so much with
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respect to the brain so inflammation and oxidation are normal part the normal first phase of
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our immune system they're healthy normal responses to to any threat so if you're eating a diet that's too high in refined
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carbohydrates uh your blood sugar levels will Spike too frequently and your brain sugar levels will Spike too frequently
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as well uh and uh that excess sugar in the brain's environment will literally
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stick to proteins and lipids and uh nucleic acids and other cell components
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and create these um crippled dysfunctional carmalized molecules
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called Advanced glycation end products and to prevent these from accumulating the brain mounts an immune response uh
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to begin to neutralize the clear away these ages uh and and and then is supposed to
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return the brain supposed to heal the brain and return it to normal that first phase of the immune
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response is uh brain cells releasing uh inflammatory cyto kindes to deliberately
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create inflammation and uh oxygen-free radicals to deliberately create oxidative stress these are the important
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first steps of the immune response but then they're supposed to be followed by a healing phase now uh this is supposed
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to be controlled temporary targeted but if you are eating foods containing
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refined carbohydrates three four five six times a day which is not at all
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unusual uh this process never has a chance to let up so what you've got is
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uncontrolled chronic inflammation and oxidative stress very dangerous for the
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brain we we are only beginning to uh understand how um how the toxic
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vegetable oils that Nina telz has done such a beautiful job on covering the dangers of uh in her book Big Fat
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Surprise in all of her research um we're only only beginning to understand how these affect the brain so vegetable oils
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are exceedingly unnaturally high in linolic acid a very fragile uh uh fatty
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acid um uh polyunsaturated fatty acid um
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what I understand so far about these which I researched for the book is that the brain absorbs linolic acid quite
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well but it really doesn't know what to do with it it it it what it does with it
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unfortunately instead of turning it into you know arachadonic acid which is an important uh U Omega important omega-6
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fatty acid for the brain or turning into something else useful almost all the linolic acid absorbs it burns for energy
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that's not what you want the brain is not supposed to burn fat F acids for energy when it burns fatty acids for
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energy it creates a lot of inflammation and oxidative stress and the brain is much better at Burning uh glucose
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ketones and other small molecules uh so how do excessive
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inflammation and oxidative stress regardless of what causes them because diet's not the only cause you know smoking uh alcohol consumption other
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types of things can cause inflammation and oxidative stress but so how do inflammation and oxidative stress
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contribute to m mental health problems one way is by creating neurotransmitter
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imbalances the very same neuro neurotransmitter imbalances that psychiatric medications are designed to
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Target so this is just one prime example of this is a a pathway in the brain called the kerine pathway so you can see
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on the left um the molecule tryptophan it's an amino acid an essential amino acid from dietary protein normally under
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normal circumstances as you see here we'll call this the Zen State um this is
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a the tryptophan a small amount will go down to make serotonin and melatonin
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important neurotransmitters but most of it even under normal circumstances will go to the right uh down this curine
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pathway where it's used to regulate the balance between two other neurotransmitters major
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neurotransmitters in the brain widespread Gaba and glutamate so you can
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think of Gaba as sort of the brain's brake pedal and glutamate as the brain's
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gas pedal uh Gab is the brain's primary inhibitory neurotransmitter and glutamate is the brain's primary
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excitatory excitatory neurotransmitter so the balance between these two Gaba
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and glutamate at any given moment essentially determines the brain's activity level at any given point in
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time uh so uh so what happens under the influence of excessive inflammation or
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oxidative stress is this something called the tryptophan steel where even
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less tryptophan goes down to make serotonin and melatonin and almost all of it goes down the bottom branch of the
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ainan pathway the neuro inflammatory pathway uh uh where so as a result what
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you get of this shift is you get less serotonin less melatonin more dopamine
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less Gaba and significantly more glutamate up to 100 times Baseline and
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if this state persists or occurs too often uh you it can lead to a a
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situation called glutamate excitotoxicity this is uh associated with many different psychiatric
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conditions are known to uh to be associated with glutamate ex cytotoxicity glut high levels of
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glutamate are very dangerous for the brain they directly physically damage
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proteins lipids nucleic nucleic acids which means that they can injure
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mitochondria weaken the bloodb brain barrier uh kill cells of the hippocampus and cause the hippocampus the brain's
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learning and memory Center to shrink so you do not want to spend too much time
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in this state of mind so uh how do you best energize the
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brain so we we understand that to nourish it you you should include some animal foods and stick primarily to
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Whole Foods uh um and and reduce the the amounts of foods that have antinutrients
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in them we know that uh to protect it you want to really avoid those refined carbohydrates and Seed oils that there
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are other things you want to do as well but this this is what we have time for today how do you best energize the brain
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it's really this simple what you want to do is keep your blood sugar and insulin levels under good control and so part of
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that of course is avoiding refined carbohydrates that there's two reasons then to do that um so how does the brain
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uh normally get energy uh so uh when glucose is traveling through the bloodstream um uh the the uh the amount
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of glucose inside the brain is always mirrors the amount traveling in the bloodstream it's proportional it's much
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lower inside the brain than in the blood but it's proportional so the higher the blood sugar the higher the brain sugar
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um so even people with severe insulin resistance or type 2 diabetes which is an end stage form of insulin resistance
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never need to worry about low brain glucose what they need to worry about people with insulin resistance which is
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now the vast majority of us uh is lowb brain insulin because when somebody
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develops insulin resistance uh if becomes harder and harder for insulin to cross into the brain glucose still
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waltzes in no questions asked but this uh if your insulin levels are running
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too high too often the uh insulin receptors on the bloodb brain barrier become resistant to insulin and uh those
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insulin receptors are needed to escort insulin into the brain so now you've got a problem on your
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hands so this is a paradox so the more refined carbohydrate you eat the higher
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your blood sugar levels will be uh but the higher insulin levels will be so
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high blood sugar high Blain sugar but over time paradoxically the higher the blood insulin the lower the brain
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insulin this is a serious problem because the brain cannot turn glucose
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into energy or anything else um efficiently to maximal capacity without
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adequate insulin and that leads to a situation uh called cerebral glucose
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hypometabolism which is just a fancy expression for SL sluggish brain glucose processing uh you're not processing
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glucose at full capacity if you have insulin resistance uh so essentially the brain can be swimming in a sea of
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glucose and still be starving to death that is a very serious problem and that
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is one of the driving forces behind Alzheimer's disease as we heard from Dr Steven Cain earlier this week um and as
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I was explaining on Monday uh the um all of the conditions on this slide all the
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psychiatric conditions on this slide are known to be associated with insulin resistance and or cerebral gluc glucose
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hypometabolism so obviously prevention is best right so once you have insulin
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resistance especially if it's more advanced uh you already have some compromise in your brain's ability to
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use glucose for energy so you want to prevent that situation because it's actually very
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difficult if not impossible to reverse that situation um once you're in that situation you're going to need an
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alternative fuel source so prevention is best uh and I think we really need to expand the
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narrative uh we think I mean again was I when I was in medical school and rency I I was not thinking about the health of
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any of my organs I was just thinking about how to control my weight and I think a lot of people do still and that's it's something people really care
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about but we need to expand the narrative Beyond obesity Beyond type 2 diabetes um to to brain health and you
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know under teaching people how important it is to protect their metabolic Health
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before it's too late because once it's too late you you often have to go to some measures that you might not want to
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go to to re-energize your brain and and Revitalize your um Revitalize your
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metabolism so what diet is best for prevention is one question what diet is best for treatment is another
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question so let's take some of the principles that we uh have just U gone through through today to uh translate
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those into some some basic brain food rules now there are others but we don't they don't have time for it but but
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these are your fundamentals to nourish your brain you want to include some animal food in the diet you want to
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avoid grains and legums if you can to protect the brain you want to
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avoid refined carbohydrates and uh vegetable oils and Ultra processed foods to energize your brain you want to
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avoid refined carbohydrate and you want to tailor your whole food sources of
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carbohydrates by which I mean fruits and vegetables fruits and starchy vegetables to your personal metabolic tolerance you
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may not need a ketogenic diet you may only need to understand what your
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personal carbohydrate threshold is it's a little different for everyone so um I'm going to come back to
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the Mediterranean diet because I I alluded to the my I said something a
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little provocative and I want to clean it up which is i' said that just because the mediterran Mediterranean diet is
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better for the brain uh than the standard American diet I mean really what diet isn't um uh doesn't mean it's
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necessarily the best diet for the brain uh so and I said that there are some good reasons to think that it may not be
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so what did I mean by that well let's use our new yard stick of nourish uh protect energize how well does the
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Mediterranean diet nourish the brain uh well it is grounded and it's found Foundation is nutrient po grains and
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legumes that are high in anti-nutrients that doesn't make a lot of sense to me I think you could choose a better
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Foundation how well does it protect the brain well it does discourage certain types of refined carbohydrates such as
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sweets sugar things like that but it also explicitly encourages other types
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of refined grains such as Breads and pasta so it's it's not it doesn't do as
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good a job as it could and it EXP explicitly encourages red wine consumption which as a psychiatrist I
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think that's just malpractice I if any patient comes to me and says oh Dr E you know a lot of trouble concentrating my
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memory is not what it used to be I'm so depressed I am not going to say to them you're not drinking enough red wine this
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is the problem go home drink more red wine come back next week I am sure you'll be feeling
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better so you know red wine is a all alcohol very uh potent promoter of
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oxidative stress a root cause of mental health conditions that we are trying to avoid by improving our diet uh so that
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doesn't make any sense at all um how well does it energize the
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brain it's simply too high in carbohydrate of all types refined and otherwise for the majority of us who now
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have insulin resistance and those of you wearing a glucose monitor can can check this out for yourself a lot of people
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think of a nice big bowl of oatmeal topped with blueberries as brain healthy watch your glucose monitor when you have
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that that uh that that for breakfast and see what happens so uh unfortunately the the
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Mediterranean diet while it is nutritionally better higher quality uh and healthier than the standard American
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diet pays almost no attention to metabolic quality uh so when I'm recommending a
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place to begin for the you know somebody who's trying to improve their diet I I recommend starting with a paleo diet
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instead of a Mediterranean diet because it it it it includes animal Foods as does the Mediterranean diet the
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Mediterranean diet does include animal Foods it's not a quote unquote plant-based
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diet uh but the the paleo diet explicitly excludes grains and legumes
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it also explicitly excludes all refined carbohydrates uh refined seed oils ultr
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processed foods and dairy but we won't talk about that today um and uh and but
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but what about energizing the brain the paleo diet May energize your brain beautifully if you have a healthy
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carbohydrate metabolism if you're you're lucky enough to still have that you might be able to tolerate you know all
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the fruits and starchy vegetables you wish I mean we were designed to do that as human beings but if you have insulin
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resistance it may uh contain too much carbohydrate even from fruits and vegetables for for you to be healthy
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only you can figure that out so um you may need to lower your carbohydrate intake uh you may need even
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to uh to uh go to a ketogenic diet so on a ketogenic diet so let's say let's say you have insulin resistance and it's
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severe enough that a paleo diet is not good enough for you um your brain glucose levels are still going to be
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spiking too high after you eat carbohydrate Rich meals uh your um and and your your brain insulin is going to
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be too low so your brain glucose is going to processing is going to be sluggish so you're going to need to go
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on a ketogenic diet to get some ketones uh rising in the blood which will cross easily over the through the bloodb brain
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barrier and and bridge that energy gap you know take up the slack that's been
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um uh uh that's been left by insulin resistance so it's a wonderful uh really
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a godsent for the insulin resistant insulin deficient brain but if you're eating a ketogenic
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diet please also be mindful of nutritional quality ketones are not all
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the brain needs the brain also needs nutrients and it needs to be protected so both metabolic and nutritional
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quality matter so I wrote this book to help explain many of these very
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controversial things that I'm recommending and and and others um I didn't write this book to try to control
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what people eat I'm I'm nutritionally pro-choice um I work with lots of people who eat uh so-called plant-based diets I
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and I will help people optimize the brain health of any diet they choose I
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want everyone to have a seat at the table when it comes to improving brain health there are lots of things you can do with your diet that will improve its
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brain healthiness uh even without uh including animal Foods or going uh on a
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ketogenic diet um but the reason I wrote this book is because it really breaks my
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heart to meet people every day they have tried so many medications they have
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tried so many diets they have tried meditation they have tried mindfulness
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they have tried psycho they've been in Psychotherapy for 10 years and they think they've tried everything and they
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think they're doing everything right the problem is they don't have the information about food and the reason
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why we don't have the right information about food is because as Nina telz and Gary tobs and so many other people have
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told you the science uh the science is is is wrong uh there the the there is no
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science behind the nutrition guidelines and headlines most of what we see uh so
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people have the wrong information and so what I want people to know is that you haven't tried everything there's so much
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more you can do if you have the right information and then it's your choice to decide whether or not you want to do
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that so I just want to tell people out there if they're listening and are struggling with these issues and think
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that there's nothing else left to try that hope is still on the menu thank
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[Applause]
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[Music]
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