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The Mediterranean Diet and Rethinking Meat

A number of studies have linked the Mediterranean diet (high in fish oils, nuts, and grains and including maybe a little red wine) with advantageous effects on neurologic and mental health. People followed the Mediterranean dietary pattern the closest over 4.4 years had a significantly reduced risk of developing depression (40% to 60%).


Which two dietary patterns are associated with higher rates of anxiety during pregnancy?

Answer: Vegetarian and high-sugar diets.

The Best Foods for the Brain

Seafood: Seafood is packed with brain-healthy omega-3 fatty acids. These healthy fats are also abundant in plants like chia and flax, but plant-based sources aren’t as efficiently converted to docosahexaenoic acid (DHA), an important structural component of neuronal membranes. DHA also influences the expression of brain-derived neurotrophic factor (BDNF), which can benefit people who have mood and anxiety disorders. Bivalves like mussels, oysters, and clams are the top source of vitamin B12 as well as zinc: six oysters (only about 10 calories each) provide 240% of our recommended daily B12 intake and 500% of our recommended zinc intake! Seafood is also a leading dietary source of vitamin D (we don’t get it all from the sun) as well as iodine and chromium. Although many people worry about mercury in fish, Dr. Ramsey provided an easy way around the concern: eat small fish like sardines, anchovies, and herring, which typically don’t accumulate toxic levels.

Leafy greens: A great base for a brain-food diet, leafy greens are a good source of fiber, folate (derived from the word “foliage”), magnesium, and vitamin K. Perhaps surprising, kale, mustard greens, and bok choy provide the most absorbable form of calcium on the planet, more so than milk. Greens also provide flavanols and carotenoids that have beneficial epigenetic influences (eg, including upping hepatic toxin processing). One cup of kale provides 600% of daily vitamin K, 200% of vitamin A, and over 100% of vitamin C — all for only 33 calories. For those who are greens-phobic, Dr. Ramsey ran through a list of preparation methods to make them more appetizing: sauté them with olive oil and garlic; put them in a smoothie; bake some kale chips.

Nuts: Nuts had a bad rap for a while because of their high fat content. But, “There’s great news here. We’ve overestimated the caloric content of nuts. Anytime you look at the calories in nuts, take off 25%.” Nuts are packed with healthy monounsaturated fats. They help keep us full and also aid in absorbing fat-soluble nutrients. Nuts also provide fiber as well as minerals like manganese and selenium. A serving of 22 almonds (just 162 calories) contains 33% of our recommended vitamin E, plenty of protein, and minerals, including iron. One study from 2013 found that the Mediterranean diet augmented with nuts is associated with significantly higher BDNF levels in patients with depression.

Legumes:  Acknowledge that many people are eating far too much and the wrong types of meat, and that nuts and legumes are a great alternative source of protein and nutrients. Small red beans in particular are the top antioxidant-containing food, while just 1 cup of lentils contains 18 g of protein and 90% of the recommended daily folate intake.

6 Food Questions Answered

Following the talk, the packed room had lots of questions. Below are the highlights.

Question 1: What’s Healthier: Raw Food or Cooked Food?

“What could be more human than a cooking fire, right?” asked Dr Deans rhetorically. She explained that cooking tends to increase nutrient availability and decrease toxins, and that many grains as well as potatoes are actually poisonous raw. “I’m not a huge fan of this raw-food movement,” she said, “but some foods—greens especially—can be healthier raw because cooking breaks down nutrients.” Dr. Ramsey then chimed in: “I recommend a mix of cooked and raw foods to my patients. But we invented fire and started cooking for a reason.

Question 2: Should we worry about recommending too many high-cholesterol foods like oysters, particularly in people with high cholesterol?

“Dietary cholesterol really doesn’t affect blood levels of cholesterol that much,” responded Dr. Ramsey, “One of the main drivers of heart disease is high triglycerides, which come heavily from eating glucose and fructose.” But he did caution that if patients have high cholesterol or an abnormal cardiovascular condition, then it’s important to get a patient’s primary care doctor or cardiologist involved.

Question 3: We hear a lot about certain spices being healthy. Can you comment on this?

“That’s a great point,” answered Dr. Ramsey, “You can’t just tell people to eat grass-fed beef; spicing is important both for flavor and possibly health.” Evidence suggests that curcumin, an ingredient in turmeric, increases BDNF. Other research has found that populations that eat more curry have a decreased risk for dementia, while rosemary extract may help prevent cognitive impairment. “Many spices seem to have healing properties,” Dr. Ramsey commented.

Question 4: Is coffee and tea consumption healthy?

The data on coffee are very good. “I had a patient who was drinking nine Diet Cokes a day,” recalled Dr. Ramsey. “I switched him over to coffee. It’s still a low-calorie drink, but now he’s getting healthy flavonoids. And tea is one of my favorite ways to try to get people off of soda; there are so many teas available with antioxidant properties.” Earlier this year, a study out of Japan reported that higher consumption of green tea is associated with a lower risk for dementia or mild cognitive impairment.

“Most coffee data have been positive, even with high intake,” commented Dr. Ramsey, though, as he pointed out, transient increases in blood pressure and anxiety can occur.

Question 5: Is milk healthy for the brain?

“Milk consumption is an interesting adaptation in the human race since the advent of agriculture,” explained Dr Deans, “and lactase persistence in adults — meaning you can digest lactose into adulthood — has evolved six separate times over the past 6000 years. Clearly there’s an evolutionary population advantage to it.” Milk consumption may help explain why modern humans are so much taller than other hominids.

Dr Ramsey then mentioned the fact that people started avoiding dairy in part as reaction to the “China study,” a large epidemiologic study that reported a correlation between dairy and cancer. “But this is one of those cases where we take a correlational study and go crazy with it,” he said. “The data have also been called into question.” Dr Ramsey explained that milk is reasonably nutrient dense and that he’s not pro- or anti-dairy.

Question 6: What about fasting?

Although the “Food and the Brain” session at the American Psychiatric Association annual meeting focused on what to eat in the interest of brain health, intermittent fasting might also be beneficial for the brain. In addition to helping maintain a healthy weight, fasting induces ketosis. Ketone metabolism has been shown to be beneficial for the brain and improve cognition in patients with mild cognitive impairment or Alzheimer disease. Keep in mind that fasting can come with risks for some people, particularly diabetics, and should be discussed with a healthcare provider.

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