The Key to Mental and Cognitive Health Is Diet — This Diet

It's official - it's a food intervention. Psychiatrist Drew Ramsey is going to be supportive, but he's also going to tell you to clean up your diet, and eat right for brain health.

Drew Ramsey: We know that brain health depends on proper nutrition. And so when we see people who have nutritional deficiencies, maybe, for example, having not enough vitamin B12 or missing certain fats like the omega-3 fats in their diet, we see that there's a vastly increased risk of illnesses like depression and anxiety. We also know that in clinical trials we can use those nutrients to actually treat brain illnesses like depression and dementia.

So every good psychiatric evaluation involves some lab testing just to make sure that the basic physiology, things like your thyroid, your B vitamin levels, the amount of potassium and sodium in your body that those are normal. And for a lot of people they are but for some people they aren't. And those are instantly reversible deficiencies. For example, if you have an iron deficiency you're going to be sluggish; you're going to have a brain fog. You're not going to feel well. It's interesting that we sort of start with evaluation in labs when really part of my work has been how do we get food into the conversation. And so I can assess you with a lab test, but, for example, if you never eat wild salmon or mussels or any good fatty fish that are a good source of those long chained omega-3 fats, we know that your levels are going to be low. So really we can learn a lot about someone's nutritional status just by asking them simple questions. It doesn't require expensive testings. In our clinic we simply ask people what they eat for breakfast lunch and dinner.

And that's really the goal of my book. Eat Complete is helping people - walking them through a nutritional assessment; it's called a Simple Food Assessment just because it's simple. And thinking about what are your challenges at every meal and what are the nutrients in the foods, most importantly the foods that are missing? We know that there are these very important nutrient-dense foods, the foods that have more nutrients for your brain per calorie. And we want those nutrients because you use them to make everything in your brain. If you think about it, every molecule in your brain starts at the end of your fork. And so really what I love about food in clinical practice - I'm a psychiatrist - is that it gives us an intervention that really you can focus on and employ every day and it's a way that we can help patients and people in general take care of themselves, really employee self-care with every bite. So that's the idea behind nutritional psychiatry, as it's being called.

So, a lot of times we focus on super foods or singular foods. I focused a lot of my work on kale. But really how we want to think is in food categories. And what I see in clinical practice over and over again is these same food categories are missing in people's diets. When we look at the eater landscape in America what we see is that people are really missing some of these key nutrients. They're eating very - I call it the beige diet or the 12-year-old boy diet, like lots of highly processed foods, not a lot of colors. We want to get people having more of those rainbows on their plate. So the food categories that I really love to see people put back into their diet when it comes to eating for brain health, we love to see the leafy greens. So things like kale, I've got some watercress right here that I particularly like; very, very dense green.

And nutrient dense, that's a very important concept, it's much more important than calories. Calories really only help us calculate nutrient density. And nutrient density is the bang for your buck. Something like this watercress it's going to be under 30 calories for a whole cup. And with this or any other leafy green you're going to get so much vitamin K, vitamin C, vitamin A. You're going to get fiber and you're going to get these phytonutrients. Those are molecules in plants that we understand - they're much more powerful than just antioxidants. So leafy greens and crunchy vegetables, or we call them the rainbow vegetables; you want to look at your plate and see colors. You want to see greens and reds and oranges because each of those colors represent a different phytonutrient, a different pallet of medicine, as it were. A lot of those powerful phytonutrients, they're what color a plant. And so we know everything with red like that red pepper has lycopene just like a tomato and watermelon. So colorful fruits and vegetables and leafy greens.

And then the category that so many people are missing is seafood. So we want to get more wild fish and particularly small fish like anchovies and sardines and there's all kinds of really fun creative ways to do this. I love to prescribe ceviche because it's a no-cook way of doing food. Something like a scallop or shrimp just in lime juice. So in terms of the nutrients, what are we trying to get into people's diets when we get to eat more of these leafy greens and seafood? And we're getting much more of these long-chained omega-3 fats. Those are very critical for brain health. The longest DHA is actually what brain cells are made of. And then others EPA, for example, is a very interesting fat that helps kind of thin the blood. Imagine that your blood is kind of silky smooth and that's obviously very important in terms of delivering oxygen to the brain and also preventing vascular disease as you age.

Other nutrients that we want to see a lot of in people's diets, we want to see more fiber, more plants because as we understand the connection between the gut and the brain you can't have a healthy brain without a healthy gut. I mean everybody just knows that I think a little intuitively, when you don't feel well down here you don't feel well up here. We also understand there's a lot of cross talk between the brain and the gut, just literally hundreds of thousands of neurons, nerve cells that communicate back and forth between the brain and the gut. And we know the gut has certain bacteria living in it, the bacteria that really get fostered and are promoted to grow when you eat more plants, more crunchy plants and more fermented foods.

That's one of the key nutrients that often gets left out of the conversation - fiber, because gut health is so key. So omega-3 fats, the B vitamins, vitamin B12 - which the food category for that are going to be mussels, clams and oysters - just find very high concentrations of both B12 and other minerals that are important for the brain, like zinc is one of my favorites. And so the idea behind nutritional psychiatry and behind Eat Complete is how do we look at what nutrients are missing and then translate that into food? So instead of telling people: 'Hey, you should eat more iron', we say 'Hey, you know what a surprising food is that's full of iron? Clams'. Or another great source of iron are these cashews, they're one of my favorites. Because along with leafy greens and seafood you want to get a lot of nuts, so almonds, cashews - here's a nice almond for vitamin E. And then these are some of my favorite medicines in my clinic, these are pumpkin seeds. And pumpkin seeds are pepitas, are great for three nutrients: zinc, magnesium and then tryptophan. Tryptophan is the amino acid that we use to make serotonin and dopamine. These are very, very important mood-regulating and learning-regulating neurotransmitters or chemicals in the brain. And so the idea is to give people a core set of foods. You know, again, with every bite you're getting all the nutrients that your brain needs.

Like the rest of the human body, our brain depends on good nutrition. In fact, it’s where everything starts and from where everything flows. Lack of certain vitamins can lead to drops of mood, cognitive ability and physical functionality. For these reasons, when getting a psychiatric evaluation it makes sense to call a nutrition intervention to make sure slumps in vitamin and nutrition levels aren’t the cause of common mental diagnoses such as depression and anxiety.

Drew Ramsey, MD and author of Eat Complete and co-author of 50 Shades of Kale, wants to make sure people know about the links between wellbeing and nutrition. A well-balanced diet is firmly linked to a person’s wellbeing. Without enough iron, as he points out, a person will feel sluggish, cloudy, and at the bottom of their game.

Most of us don’t consider every vitamin when we think up our meals. We may know that fish is a good source of protein, but we’ll stick to what we know, choosing to get our protein from steak or poultry of tofu. What a person might overlook is that fish such as salmon and tuna, and especially the smaller, oilier, and more sustainable fish like sardines and anchovies, are not just good sources of protein, but also a major haul of omega-3 fatty acids that are a critical brain booster. Omega-3 are long-chained acids, and a type called DHA is actually what brain cells are made of. So raise a sardine on toast in the air and say cheers to a more robust brain.

In Drew Ramsey’s clinical practice, checking to make sure people are getting all the vitamins and nutrients they need doesn’t necessarily require expensive and expansive testing – sometimes it just requires a few questions, such as do you eat fish, mussels, clams? How about cashews?

That’s what Ramsey considered while he was writing his book Eat Complete, and designing the assessment practice in it. Ramsay is on a mission to translate nutrients that are hard to quantify into more practical food categories, to help people know what they’re missing and how they can fill in their nutritional gaps. Eat Complete looks at phytonutrients, and how to recognize them. As Ramsey describes, phytonutrients are often leafy greens and colorful fruits and vegetables with nutritional benefits beyond their widely known antioxidants. Ramsey reminds us what we should instinctively know: when looking down at a plate, if you see a wide variety of colors (natural ones, not M&Ms;), you’re doing it right. From red tomatoes to green kale and orange carrots to purple cabbage, each color literally represents a nutrient content that is shared in other vegetables of its color. So mix it up to reach far and wide across the nutrient spectrum.

Armed with more workable knowledge of which foods will do what, your wellbeing could improve across all facets. You’ll feel more energetic, have more cognitive clarity, your blood quality will be smoother (yes smoother, it prevents vascular disease and helps oxygen get delivered efficiently around the body), and your gut health, which is being increasingly linked to mental health, will also rocket upwards. Interestingly, self-congratulatory pats on the back have also been known to increase.

Drew Ramsey's book is Eat Complete.

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Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

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Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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