Elizabeth Stein 00:00
Hi, everyone. I'm Elizabeth Stein, founder, and CEO of Purely Elizabeth. And this is Live Purely with Elizabeth, featuring candid conversations about how to thrive on your wellness journey.

This week's guest is Dr. Uma Naidoo, what Michelin star Chef David Bouley calls the world's first triple threat in the food and medicine space. A Harvard-trained psychiatrist, a professional chef graduating with culinary school's most coveted award, and a nutrition specialist. Dr. Naidoo founded and directed the first hospital-based nutritional psychiatry service in the United States. She's the director of nutritional and lifestyle psychiatry at Mass General Hospital and director of nutritional psychiatry at Mass General Hospital. While serving on the faculty at Harvard Medical School, she was considered a Harvard food mood expert and has been featured in The Wall Street Journal. D. Naidoo is also the National Best Selling Author of This Is Your Brain on Food, which you can hear more about in an earlier Live Purely episode, and Her most recent book, Calm Your Mind with Food which comes out next week. In this episode, we talk about the global rise of anxiety disorders driven by the COVID-19 pandemic and nutrition's role in mental health. Dr. Uma Naidoo shares her approach to relieving anxiety. The latest research on how anxiety is rooted in the brain, gut, immune system, and metabolism and how to effectively use food and nutrition to calm the mind and enhance overall mental well-being. We also discussed the impact of children's diets on their health and anxiety and her approach to managing symptoms. Lastly, we talked about her favorite foods and tools for mental well-being, her flexible approach to creating healthier habits, and how to be more mindful while eating. Dr. Uma Naidoo is such a wealth of knowledge keep listening to learn more.

It's officially oatmeal season and I'm so excited to share that you can find our Purely Elizabeth oatmeal products at select Walmart stores, just in time to get cozy with a warming breakfast. You can find our blueberry flax, oatmeal multipacks, and dark chocolate chunk oatmeal cups in the cereal aisle. Out gluten-free instant oatmeals are made with organic oats combined with five super food grades and seeds for delicious taste and texture. Our packs and cups make for an easy breakfast, snack, or dessert. And they're also perfect to take on the go. Click the Store Locator in the show notes to find a Walmart store near you. Happy oatmeal season and happy shopping.
Dr. Uma Naidoo, welcome back to the podcast. It is an absolute honor to have you back and huge congratulations to you on your latest book.

Dr. Uma Naidoo 03:02
Thank you so much, Elizabeth. I'm always happy to speak with you. We always have such fun conversations. So, I'm looking forward to it.

Elizabeth Stein 03:09
Well, I thought we would just dive right in and start with a question to summarize the book. What is the one thing that you want readers to take away from reading your new book, Calm Your Mind With Food if you could only pick one?

Dr. Uma Naidoo 03:26
I would pick one thing it is that we do have the power at the end of our fork to impact the level of anxiety. It's a gap that most people are overlooking, turning to pose two very important forms of therapy and other means. But food is also something that is within our power. And I want people to understand that first and foremost.

Elizabeth Stein 03:50
I love that. Certainly, the mission of the book resonated with me. I know it'll resonate with our community. And as the last couple of years where anxiety has just been on the rise since COVID and we have this mental health epidemic, I would love just to kind of ground us in. Where are we today? What are some of those kind of stats on anxiety? And probably all of that spurned to, I'm sure, inspired you to write the book.

Dr. Uma Naidoo 04:23
So true. Anxiety disorders are the most common mental illness in the world and this has consistently been shown in research. After the COVID-19 pandemic, the level of anxiety disorders has grown from about 298 million people affected to 374 million people, which was in rise of about 25% which is just a huge marker and understandable that when we turn left or right in anyone in our lives, everyone's experience something of a tinge of anxiety with a small, medium, or large, so to speak. But there's a lot to it, as well as that the American Psychological Association shows that three-quarters of adults report symptoms of stress. And this was before COVID. So, they were already reporting that many people are just reporting symptoms of stress. So we can only imagine that has also increased, right? But I also was concerned that about 70% of people, and this has been shown in research with mental illness, have no treatment from an actual healthcare provider, and don't have access, so perhaps the stigma associated with it, but they're not necessarily getting treatment. I think this is where tools like food and nutrition become additional tools in their toolkit to help us through what we know has become, a mental health crisis, but anxiety has become its epidemic of sorts.

Elizabeth Stein 06:01
And would you say that even if you're someone who has identified that you have anxiety, and you are taking medications, or seeing someone eating the wrong foods, I'd imagine, isn't helping and is deterring from perhaps the other path that you're going down with medications and things like that?

Dr. Uma Naidoo 06:26
Absolutely correct. You've heard the expression you can't exercise out of a bad diet. Similarly, it's great you're seeing a provider, and you're taking medication for anxiety. But if you're eating unhealthy foods 100% of the rest of the time, you are not helping yourself. Because what you're doing is you may be taking medication, but the foods that you're eating bring inflammation to your body, especially your gut and your brain, and just setting you up to fail. So cleaning up your diet, no matter what, whether you may be seeing a therapist, or maybe you're taking medication and seeing a therapist, whatever it might be, and the food can always only enhance and improve upon what you're already doing. And it's also, in some cases, a solo treatment, along with more of a holistic and integrated model of care, like exercise, movement, meditation, mindfulness, fresh air, hydration, and that type of thing. So, it's also meant to be something that you can do in combination with other things as well.

Elizabeth Stein 07:33
Now, how do we define anxiety? Is there a great definition that you can share? Sometimes I wonder if am I stressed. Is this anxiety? What is this?

Dr. Uma Naidoo 07:46
Right. Anxiety usually comes out of nowhere. Sometimes when you're stressed, we often may know the source, we are having a difficult workday, or we have a difficult project, or something is going on at home that's stressing us out. But within society, very many people will report just that it comes out of nowhere. It's a feeling of waking up. Of course, there's a clinical definition, as kind of outlined in DSM-5-TR, which is the Diagnostic and Statistical Manual, but I'll give you a working explanation, that people can identify. You wake up with a feeling in your stomach, wake up with a feeling of worry, not even sure what the worry is about. But every day they just wake up worried. Having an increased heart rate, sweaty palms, just feeling so overwhelmingly worried and stressed about something. Very often my patients will say that they can't take a sock lead to something specific, it just comes on. Then of course it’s things like panic, which can be very frightening. The feeling of your heart racing, sweaty palms, just feeling sometimes dizzy, sometimes nauseous. It feels like a physical, physiological change in your body. So I feel that one of the things I want people to know is when you are slowly and steadily working on the nutritional psychiatry plan to clean up your diet and improve, it doesn’t have to be 100% perfect. None of us are perfect. But for the most part, adding in those healthy foods and those gutrich foods that are healthy, that have fiber that is helping nurture your gut microbes, when you're adding in the foods that are helping you, you are fending off oxidative stress and inflammation. So, you are going to be supporting yourself in many more ways, not just in one way. So it's about finding that balance for every one of us.

Elizabeth Stein 09:46
You mentioned an inflammation. In the book, you talk about how anxiety is rooted, and they're all interconnected in our brain, our gut, our immune system, and metabolism. I thought I was familiar with the brain, the gut, the immune system, and the metabolism was an interesting add-on to that, I'd love to dive into each of those, perhaps we start with our gut, and how our gut health and anxiety are connected.

Dr. Uma Naidoo 10:14
Sure. We know that the guts in the brain are connected. And we know that the gut and brain are connected in the embryo. What I mean by that the gut and brain arise with the same cells in the human embryo, then divide apart to form two separate organs, which remain connected by the 10th cranial nerve, the vagus nerve, and that acts as a messaging system, especially for neurotransmitters between these two organs bidirectionally and also allows for that communication that goes on. So the food that we eat, and oftentimes what I'll say to people, what happens when you have a headache? Headache is usually perceived somewhere in your brain or your head, what do you do? And they'll often say, “Wel,l I hope I have a Tylenol in hand, and I take the water, and I swallow. And I sit down.” And I say that then, “Well, what happens? Did you ever think about the fact that you’re just swallowing the pill, but it's working on your neural tissue because it's reducing some pain or whatever the cause of that pain is? In a very similar way, just that simple example is meant to take us to the fact that when we eat food, food is something that may be chewed, swallowed, we digested in our gut, but it also has effects on other parts of the body. One of those parts is the brain and the evolution of the science around the gut microbiome, the gut-brain connection, especially over the last few decades, has helped us understand that. So the foods that we eat are broken down into more positive substances, like short-chain fatty acids, which reduce inflammation and have antioxidant properties. Or if we are choosing water or fast food, processed, ultra-processed diet, those breakdown products are more toxic to the gut, and they feed the negative microbes, and then those microbes thrive, they set up for inflammation and dysbiosis in the gut that leads to damage of the gut lining. So once the gut planning is damaged, these toxins into the circulatory system, and they also reach the brain. It's an ecosystem that we want to understand and has been one of the bases for just improving our mental health or worsening our mental health. We have control over that through the choices we make when we eat. And that's one way to understand how the gut and the brain are connected.

Elizabeth Stein 12:43
What I thought was important in this conversation about the gut is understanding that it's not just the foods that we eat, that are affecting our gut. And therefore, if we have an imbalanced gut, that could lead to anxiety. But on the other side of it, anxiety can lead to poor gut health, right? So it's like a vicious cycle. Am I understanding that correctly?

Dr. Uma Naidoo 13:12
It is a vicious circle because what I often find is, say we don't know the chicken and the egg story. People come to me and they say, “I'm so anxious that all I do is I turn to these ultra-processed foods all the time, I turn to these junk foods and only eat fast food because that's the only thing that suits me.” One of the things to understand is that in the short term, those types of meals may suit someone because they allow for some conversion of serotonin in the brain. But it's a very short-term effect.

Unfortunately, since it also increases sugar in the bloodstream and allows for insulin to be involved, the long-term effects are not very good, not only on our metabolism but also on brain cells. So you're right, if I also have people who are unable to control even a glass of wine or other foods that they are craving, often sugar-laden foods, the added sugars from those foods, because they want to feel calmer, they want to calm themselves and they want to soothe themselves, unfortunately, that's just driving the symptoms in the wrong direction.

Elizabeth Stein 14:23
It's fascinating. And also, I just had some gut issues. I had SIBO I was just diagnosed with which was super surprising to me. I'm a very health-conscious eater. So it just made me think if I'm having these issues, how many other people have some unknown gut issue that we don't know about that is perhaps really affecting them mentally? And there's just so much to learn and discover through that.

Dr. Uma Naidoo 15:01
That's exactly right. I'm sorry that you're dealing with that. But you make such an excellent point many of us are walking around with possibly undiagnosed symptoms or an undiagnosed condition. But so much can be worked on through healing the gut because it involves so many conditions. Those gut microbes, the trillions of microbes that reside in the gut microbiome, they take care of many different things. They take care of our immunity, they take care of infection control, they deal with sleep, and circadian rhythm, which is our internal body clock, they deal with vitamin production and hormone production, and mental health. So they have multiple functions that they're involved in. And some of the time, we may unknowingly have a condition that's affecting the gut, which therefore may be affecting other parts of our body. So it's important to check in with the doctor and make sure that we are asking the right questions and getting the right tests done so that we understand what might be going on.

Elizabeth Stein 16:01
For sure, I will say I've been completely gluten-free and dairy-free now for two and a half months. And I have no symptoms, I had bloating symptoms that I didn't realize. And after three weeks, I felt completely better.

Dr. Uma Naidoo 16:20
That's impressive. Good to know that those might have been causing such inflammation for you.

Elizabeth Stein 16:25
Absolutely. So when you think about or when you hear patients coming to you, what are some of the biggest food offenders that you often hear? Particularly, my mind goes to kids. As we think about the rise of kids having anxiety, there are a million external factors, social media, and all of this, but I'm sure there's also the influence of the kids' diets today. They're loaded with sugars and refined flours and lots of gluten and then all those other things. So, what do you see are the biggest offenders when it comes to food anxiety and kids today?

Dr. Uma Naidoo 17:09
I think that for kids, probably the leading one is going to be those added sugars that we don't even realize. Sometimes unsavory foods like pasta sauces, ketchup, or even salad dressings, or just something, the stuff that they're consuming, the cookies, candies, the snack foods. Sometimes savory snack foods also have added sugar for flavoring because a lot of food companies will add bad sugar. They spend a lot of research and development adding sugar to french fries from fast food restaurants that are engineered to be a particular way to tap into our cravings for food. Children are a very vulnerable age group because they reach out for food or go to a vending machine. I know some schools have vending machines, so they are reaching out the snack foods that are just not best for them. It's also ultra-processed industrialized seed oils. Artificial sweeteners are some things labeled low sugar and people think of it as a healthy choice, but they may be loaded with the wrong types of the older artificial sweeteners or some newer ones that have better evidence related to them. And then the wrong types of fats. The trans fats, the hydrogenated fats are often found in those shelf stable cookies and pastries and things that they may be junk for. One of the things to be aware of is eating poorly. Not only is driving anxiety of amping up the sugar in their body, but the amping up the sugar leads to inflammation in the body, gut issues, and inflammation in the brain. But the other thing is that they're not eating just for the 80-20. One of the pillars of nutritional psychiatry is finding consistency and balance. 80% of the time, if they're not trying to or eating more whole foods, they also are setting themselves up for nutritional deficiencies. And it turns out that iron deficiency is pretty common in children. Iron deficiency especially in children and infants, children, teenagers, and adolescents is associated with anxiety. One of the ways that gets set up is if you're just not eating proper foods. Because you get iron from beans, legumes, and healthy whole grains. You can also get it from animal proteins and things like that, altogether from leafy greens and spinach and foods like that. You get iron in a lot of places. But if you're mostly eating a diet of processed foods, you're just not getting those basic nutrients that your body needs. Even with things like magnesium, many of us may be deficient in magnesium, but again, if we are just rushing out for processed foods, that's a problem and they Increase inflammation in the body without even realizing it.

Elizabeth Stein 20:05
So those foods that you just mentioned for kids, I'm sure are also the top foods to avoid for adults as well for anxiety. As you mentioned some of those nutrients, what are some of the if any supplements that you recommend for adults whether helping to strengthen your gut or to supplement if you are someone who has anxiety?

Dr. Uma Naidoo 20:28
Some supplements that I think are worth looking into and discussing with your doctor include things like ashwagandha because there's a good amount of evidence associated with anxiety. It's been used in Ayurvedic traditions for eons. It's bitter tasting so it's better in a pill form and worth speaking to your doctor about something like that. Saffron, while we cook with saffron, it's an expensive spice and we'll use very little when we cook with it. Although it's delicious and worth using, one has a good amount of evidence and clinical trials with supplemental saffron and it helps mood and anxiety. In the supplemental formula, you get enough saffron in that capsule or that supplement. So, that's worth talking to your doctor about. Other ones include vitamin D. In the northeast, a lot of people may be deficient in vitamin D, because of the level of sunshine, worth checking in with your doctor.

Elizabeth Stein 21:24
How much vitamin D do you usually recommend to take?

Dr. Uma Naidoo 21:28
My easy hack for vitamin D is spending 10 minutes outdoor time in daylight, without sunblock or sunscreen, which gives you 80% of your vitamin D for that day. I think every one of us should be doing that. And then of course, apply sunscreen, and use sunblock after the 10 minutes, but not through a window, really spending 10 to 15 minutes outside. But I always go to food first. With the vitamin doses, they usually recommended doses of vitamin D for different age groups. So obviously check it if you're worried about the symptoms, once you have a blood test. The doctor can help you supplement with the right form and the right dosage. My easy hack is food first and also outdoor time.

Elizabeth Stein 22:21
So let's get into food. We know that there's not one approach for everybody. But overall, what is the best diet approach that you recommend to your clients and to the community to manage symptoms of anxiety? And then we'll get into a few of your favorite kinds of all-stars.

Dr. Uma Naidoo 22:43
It's funny because I like to make it easy for people. In the book, I go through an anxiety shopping list. I go through a food protocol and make it actionable after unpacking the science with people. How can they put it to use and why is it that we should pay attention to micronutrients and macronutrients? But rather than give everyone too much information, I have an acronym that I developed called CCCALMS. And what I did is I pulled from the book what I think people should have on their fingertips so that these are things that they're kind of always thinking about, then there are many more foods that they can fall in. So the C is for colors. And by the colors, I mean all those different colors of food, fruits, and vegetables, they bring those different plant polyphenols, which nurture the gut microbes. They bring fiber and carotenoids. They have these different nutrients that are great, and we should be eating them. The other C is vitamin C, and the third C is chocolate. By chocolate, I don't mean candy bars. But I'd like people to know that they can eat extra dark natural chocolate because it's rich by the way, in a plant-based source of iron and very rich in things like magnesium and even serotonin. So really nutrient-dense. Dark chocolate has been shown in studies to improve mood. We know that mood and anxiety run together all the time. So just worth getting into the colors, the dark chocolate, and the vitamin C. Then the A is for anthocyanins and ashwagandha. Anthocyanins bring out a beautiful hue in blueberries but are great for the gut, anti-inflammatory, and antioxidant properties. And then ashwagandha we touched on already, when people remember that there's a choice. And then the L is for your liquids. And by that I mean add your teas. People often overlook the fact that things like lavender tea, passionflower tea, chamomile, and things with turmeric and a pinch of black pepper, all are calming to the mind and shouldn't be forgotten. But before anything, I want people to be hydrating adequately, because when we are dehydrated, we can experience anxiety. So the liquids are about remembering the water and remembering that you can lean into these very calming teas that can help you. I love to make a little infusion of dried lavender and add fresh mint to a slice of lemon. It's just great for me, it's a very big pick-me-up, so I have coffee in the morning. But in the afternoon, I reach for something like that, which kind of sets me up for a little bit of energy, but also not a buzz that’s gonna get me anxious. It offers calming as well. The M is for more omega. Omega three fatty acids have a significant amount of evidence for anxiety disorders and they're worth adding in. Many people get their biggest omega-3 three fatty acids from fatty fish like salmon. But you can also get it from chia seeds, flax seeds, and walnuts, so plant-based sources as well. And then the S is for spices. So turmeric with the pinch of black pepper, oregano, and capsaicin, many of the spices have good properties and qualities that can help us and they're just worth adding. I want people to remember that there are different types of foods from different food groups, keep them at their fingertips, and try to eat them as much as possible. As you know, there are hundreds more foods in the book. But you also want to be able to go into the world with a few ideas that you can turn to all the time.

Elizabeth Stein 26:35
That’s a great tip and a good one to remember. As you think about it, I love that you have the 80-20 approach to your diet suggestions. That's 100% how I live as well, really having that balance. So as you work with clients who are coming to you with anxiety issues, and maybe they're coming to you and they're eating a lot of sugar and processed foods, how do you approach making the changes in their diet and lifestyle? It's certainly not easy going from eating 100% that way to being at 80-20 that way.

Dr. Uma Naidoo 27:12
That's such a great question. Because I think that part of my protocols evolved as I did more and more clinical work and research. I realized that giving people a list of things to do is very overwhelming. So to your point, Elizabeth, we want people to make slow and steady changes. And now I use the expression, it's a marathon and not a sprint. So let's start with the one thing that you have started to do that is we know it's not helping. And often I'll tell you, it's a great conversation starter for this type of work. Because someone will be worried about one food, it might even be a glass of wine that they began drinking during COVID. Or it might be the cookies that they stocked up on during COVID. It might be something that evolved during this phase of the pandemic. They often want to change it, but they're not quite sure how, and they know that they like it, and they look for it, and they crave it. So how do they work with it? So often, it's about first identifying it, and then what we can swap out, can we make a healthy version of that food, that beverage, that snack that they're looking for? And can they start to change that most nights of the week? If they can't give it up completely, can they start by doing this every other night? So swapping out that for a fruit with a piece of dark chocolate, one of my favorites is dark chocolate with a clementine. Can we do that instead of the bowl of ice cream? What I noticed is you take one habit like that that's top of mind for the person, and you can work with them to switch out just that habit. The moment that they start to feel better, that they start to notice they’re sleeping better, they feel calmer, something is changing, they want to do more. That's really when one can accelerate the plan to say, let's try these three things. So in addition to one habit, let's try two more things that you do. And you can slowly build it up from there. What has happened is the person now understands the link between changing how they eat and the impact and how they feel. And that's very powerful. Once we get there and that happens, if someone's following the plan, it happens for most people. And then we build up a nutritional psychiatry plate from there, using those guiding principles. Because if someone is only eating at a fast food restaurant every day, we can't just put this nutritional psychiatry plan in front of them and say, “Do this.”

Because there's not going to be something they want to eat. They're going to have to build towards it. So, I find that that's a good way to work it out with someone.

Elizabeth Stein 29:52
That's a great tip and I think for anyone whether they're seeing a professional or not being able to self-identify and write down a list of all of those items that you're having issues giving up or swapping and start at the top of the biggest offenders and go one by one to give you that confidence. How long would you say you typically see with your patients that it takes for, maybe two questions, one to make that change, but then secondly, to really start to feel the effects of eating better, therefore helping to lower their anxiety?

Dr. Uma Naidoo 30:36
The effects can be as short as a few days to a week and as long as three weeks. Usually, by about two to three weeks, someone is noticing a change if they've been consistent, meaning that they made the effort. You can't do this once a week and then go, “Dr. Naidoo, why am I not feeling calmer?” You got to try it out once and do it today and do it next Monday and it's gonna work. It has to be consistent most days of the week. So there's a range of that and remembering that our gut microbiome is like a pumpkin. It's pretty individual response for each person. But in terms of how they implement this, they have to leave my evaluation, an action plan related to what it is we want to tackle first. So say I've started to eat a bowl of ice cream, this is a pretty common one. A bowl of ice cream, and different flavors every single night, we started this as a family tradition during the pandemic. I've heard this a lot. So what are we going to do now? Well, can we cut down on portion size? That's one thing. Can we have one scoop instead of three? And every other night, can we switch that out from a recipe that I wrote in This Is Your Brain on Food, my first book, and that's made from bananas? And you can even make it a chocolate flavor with extra dark, natural cacao. Again, all of these ingredients are helping you