← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Mental Fitness Secrets for Women: Seafood, Greens & Oxytocin with Dr. Drew Ramsey
01:17:03
Dive into mental fitness with Dr. Drew Ramsey! Explore the vital links between nutrition, physical wellness, and mental well-being. Perfect for women navigating perimenopause and beyond. Tune into self-awareness, nutrition, and community for an abundant life! Watch the full episode at https://youtu.be/ugrqirHagxM
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- [00:00]
A
You and your community probably know why are women taking so many antidepressants and anti anxiety medications? Because the struggle is quite real that when you're caring for kids, for parents, for siblings who are struggling, so many women are just in service to a large community, the matriarchs I call them in, where it's just, it's a lot. We are in an era where women taking care of their brain health can understand risks, can understand benefits, can speak to a variety of experts, can look at randomized trials and boy like we have got a lot of research and a lot of science about the female brain in a way that we just haven't had before.
- [00:38]
B
It isn't about being perfect, it's about being better. Hello, My name is Dr. Stephanie Stima and I host expert discussions with thought leaders in all facets of health, including nutrition, fitness, hormones, stress management, performance recovery, longevity, healthspan and energy production. On this show we discuss complex science, but then we also alchemize it into actionable everyday living. The ultimate goal with the show is to assist you in making informed decisions about your health and to catapult you into being the hero in your own Life. Hey Betty's. Welcome back to another episode of Better with Dr. Stephanie. It is me, your host, Dr. Stephanie Estima. Today I am joined by Dr. Drew Ramsey and we are talking all about not only physical fitness but mental fitness and why you need to be integrating this into your life. If you don't know who Dr. Drew is, he is a leading board certified integrative psychiatrist, a best selling author and leading proponent of nutritional psychiatry and mental fitness. He served as an assistant clinical professor of psychiatry at Columbia University and the Vagelos College of Physicians and surgeons for 20 years and founded the Brain Food Clinic in New York City and Spruce Mental Health in Jackson, Wyoming. So today what we talk about is what are some of the pillars for a healthy mental fitness. Of course we talk about nutrition, of course we talk about fitness and what in each of those categories we need to be thinking about. And we also talk about self awareness, we talk about connection, we talk about grounding engagement, unburdening the trauma that has been and finding our purpose. And we dive deep into each of those categories. Now I think that this is something that is often over overlooked when we're trying a new fitness program or we're trying, you know, for in midlife and we are noticing that the joy might be draining from our everyday life. Dr. Drew actually before we got started recording the show said that perimenopause and menopause is one of his favorite patient cohorts to work with because of some of these things that we're going to be talking about. So are we going to get into specifics of nutrition and fitness? Absolutely. And in my humble opinion, I think some of the more important tenants of mental fitness, which is this idea of being engaged, being connected, being in a community, and letting go of what was to make room for what is. I think this is a fantastic episode for anyone. If you are in perimenopause menopause or just you yourself are looking to develop a wholesome mental fitness regimen. This is going to be helpful for you and your friends. 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In addition to that, lactoferrin, one of the main proteins in Colostrum, has been shown to prevent the colonization of haemophilus influenza, a common cause of ear and respiratory tract infections. And the best part is you only need one scoop a day. You can add it to coffee. I add one scoop and I shake it along with my prime protein or my grass fed collagen. You can also mix it in with yogurt or add it to your favorite baked goods recipe. Head over to equipfoods.com better and use code better at checkout to save 20% off of your order of core colostrum. That's equipfoods.com better and Use code better at checkout. Okay, Dr. Drew, welcome to the Better podcast. I'm thrilled to welcome you today.
- [06:14]
A
It's such a treat to be with you. Dr. Stephanie. Thank you. Hi everybody. It's great to be with you all.
- [06:19]
B
Awesome. We are going to be talking about your new book, which I've read, Healing the Modern Brain. And I wanted to start with a stat that jumped out to me as I was preparing for our conversation, which was today, almost 14% of adults in the United States take an antidepressant medication, including 1 in 4 women over the age of 60 years old. So this is a shocking stat and we can open the floor with what is driving 25% of our beautiful women over 60 to be taking an antidepressant.
- [06:56]
A
I like to start with the idea that maybe they're brilliant, maybe they're the only population that's really taking care of their mental health. I appreciate that. That feels shocking and looks like a lot of people taking medication. But when we see that SSRI and antidepressant medications are used for anxiety, for depression, for a lot of symptoms of perimenopause, you know, sometimes appropriately, sometimes not, but just they're very handy medications for a lot of women. And so I see people who have been really helped by these who suffer with tremendous stigma because as you say, it feels shocking. And then I see people who've been on these medicines for a long time and really haven't had a, let's say, full attention to their mental health. And of course, we know there's incredible controversy around the chemical imbalance theory around medications in general for mental health, around, you know, how are we a little different than other countries when it comes to these? The way I try to understand it is what we want to have. And what I think mental fitness, like a real mental health care and mental fitness system would provide us with is the notion that we have a lot of options and we are in an era where women taking care of their brain health can understand risk and understand benefits, can speak to a variety of experts, can look at randomized trials and boy, like we have got a lot of research and a lot of science about the female brain in a way that we just haven't had before. So I don't really want to be on the side of defending anything other than women's right to have access to all types of research evidence based on care such as SSRIs. Obviously you and your community probably know why are women taking so many antidepressants and anti anxiety medications? Because the struggle is quite real that when you're carrying, as a lot of women in my practice are for kids, for parents, for siblings who are struggling. So many women are just in service to a large community, the matriarchs, I call them in my practice, where it's just, it's a lot. And some of these women just do a lot better taking SSRI medications.
- [08:57]
B
Yeah, and I appreciate that nuance. I think that there can be a stigma for sure taking any medication. I mean, the only ones where I think there's no real stigma is if you are sick and you go to the doctor and like, oh, you need a, you have a bacterial infection, here's an antibiotic. Like no one's like, I'm so ashamed that I have to take an antibiotic. I do think when it comes to, you know, the mental fitness, mental health, there certainly are stigmas around taking medication. And I appreciate what you said insofar as sometimes it can go unchecked for a long period of time and we're not really developing this robust mental fitness program that we're going to talk about with you today. And then sometimes it's, it's a crutch, it's a necessary thing to kind of get you through a certain period in your life. Maybe you've, you know, there's been big life changes or maybe just there's been an accumulation of, you know, the hard knocks of life and you just need some support while things feel a little destitute. So I love that there's more of a, there's a little bit more color that we're giving that you're giving rather than just all of us. Like the monoamine, you know, the monoamine hypothesis is not a valid one and we should never give antidepressants. I do think that there's a time and place for all of them. In context.
- [10:04]
A
Of course in context. I mean, thank you so much. I mean, it's also, I'm a psychiatrist. And so people should understand. After medical school, I did four years of specialty training in psychotherapy and medication prescribing. I've been doing this for 21 years. And so I'm glad you hear the nuance because I think in addition to those two scenarios you said, there are also people where it just works as a treatment just like it's supposed to. And I think that that gets missed sometimes. So, you know, and the hope with all of this, as somebody who does prescribe and as somebody who does a lot of psychotherapy on the couch, was to. To take the things that I really see in my practice, what's working, where we can all kind of agree these principles, these tenets are true, that in the face of the isolation epidemic, we need a plan to form more connection in our lives. And we, we all know when we feel more connected. And I share a lot of brain science in the book. But again, it's just one of those things we know, feeling more connected and supported, boy, more robust mental health, more mental fitness. And so that was I. I guess the hope for the book is that I, I see so much conversation and you know, I appreciate it around medications, but it's such a individual thing as I've seen in my practice. I mean, it's just when you're a prescriber, like I am, and you have two molecules that are literally like the left and the right hand version, like Celexa and Lexapro, like almost the same thing, and you see people have a starkly different response, you get this like, humbling appreciation for how complex our brains are and how, I mean, the idea that the human brain can detect what is really just the mirror, you know, how a molecule reflects light in an antimer. I mean, something that's so subtle and have a profound difference in how you think or feel. It just, it gives me an appreciation for how complex things are.
- [11:46]
B
Yes. And I, like you, don't think I will ever stop having that reverence for the human body and brain. I think that it's incredible. And we are eternal learners as practitioners, for sure. Let's dive into your book a little bit before. You've outlined beautifully some core tenets that I want to explore with you today. But I just want to start off by. When we're thinking about mental fitness, so we know physical fitness, we sort of, we can understand that movement, some type of movement. There's cardio, there's resistance training. But what are some of the barriers that you've seen? Some clinical patterns that you've been able to tease out over your tenure as a clinician in terms of what are some of the barriers to adopting a healthy mental fitness regimen?
- [12:28]
A
Well, I think first is that people having gotten some of the new science of how exciting this is, you know, part of up leveling your knowledge base and how you think about the human mind and depression, anxiety and the potential that your mind has. So thinking about things like neuroplasticity and inflammation, you know, things that get thrown around sometimes almost as buzzwords really I think important for people to hang on to new science motivation, that amidst all the controversy, it's super cool and everybody agrees your brain continues to grow and repair itself in adult life and there's stuff you can do to help it do more of that. So I think that is, you know, one of the barriers I see is people having kind of up leveled their knowledge. I think a second barrier that I often see are things that the modern world has put in place, whether it's our screen, you know, allowing us all to be much more efficient. You know, I'm in touch with more people, I'm posting more, I'm responding more. I'm probably a better, more present clinician to my patients in lots of ways because of my phone. It's also always with me. So, you know, along with things like all of the ultra processed foods that we're eating and the artificial light and the noise pollution, I go into some of these in detail around kind of urban living, which as we see in the trends and how people in the United States are living, we're going to have more and more urban dwellers. And part of the book takes people on the journey a bit of. For most of my life I've been in New York City, psychiatrist living in Manhattan. And then I moved to our family farm in very rural Indiana and then moved again to a very isolated small town in Wyoming. And so I've kind of gotten a first person view of a lot of this data thinking about things like nature and its effect on our health. And so again, part of that barrier is some of how the modern world is wonderful, comfortable, filled with lattes and great experiences and lots of urban living. That said, there's some things that we then start to miss, like a natural circadian rhythm, like clean air, like community and collaboration. And so, you know, those are some of the major barriers. The other two that I just see right now is still a lot of stigma around mental health changing more than ever. You know, more than ever. I see particularly like young men talking about their Feelings and sharing and supporting number one another. I mean, it's really kind of like wonderful in a lot of ways, but there's also still just a lot of stigma and a lot of misinformation around mental health, mental health care, and kind of what we can do. So I'm, I'm grateful everybody's here listening and I really appreciate the conversation.
- [15:04]
B
Wonderful. So let's move into self awareness, perhaps, which is one of the first tenets that you talk about in the book, maybe one of the most elusive, I would gather, and I would love your input here, but it's sort of essential to get us in the race, right, to get at the starting line, to have self awareness. And in the book, I forget her name now, but you were talking about this mother who didn't really drink wine, but then Covid happened and then she was homeschooling her children, and then she was working from home, and then everybody was. And all of a sudden she went from the occasional drink to downing a bottle of wine, you know, every night during dinner preparation. So how can we, how can we first improve? How do we sort of read the label of the jar that we're in? I guess is my first question. And then moving into how can we begin to become aware in our everyday lives? As you mentioned, you know, as a practitioner, a clinician in New York City, it's a very busy, loud, noisy, sensorial overload type of environment. So how can we, when we're constantly looking outside of ourselves, you know, friend or foe, friend or foe, how can we. We sort of get inside of our own bodies to become aware of habits and patterns and schemas and filters and the things that we might, that might be sort of operating just beyond our conscious awareness.
- [16:23]
A
I love that, Dr. Stephanie, that. That really, I mean, what you just listed off there speaks to it. I like this idea of how do we understand that the jar that we're in? And I think the first is to really have an appreciation that your unique nervous system and your development, right, the milieu or the environment in which you were in, how you were loved and cared for or ways that you fit in or not, traumas that you've had, big little, you know, whatever size t it is, you know, any good therapy or therapy experience where people grow in their self awareness is thinking through usually some aspects of their development and some aspects of your relational pattern. If you're constantly having problems at work in the same way, you know, people who transcend that gain self awareness of what they're contributing to the problem. So in healing the modern brain, I take a few very specific techniques from my psychotherapy room that I found to be very useful. And the first one I think everyone listening can see in their everyday life, especially with this audience, because I hear this a lot out of my female patients, which is they'll tell me a lot of what they know about something and just, you know, kind of the best list in some ways, as you just did, right. You just gave this really beautiful list of what does it take to get more self aware? But then I often I'll hear, well, you know, I don't know, Doctor, what do you think? Something like that. And for me, over time, I've sort of heard this as almost a cue that you've really listed all the things that, you know, you might be unclear what to do about it, or you might not have a clarity in terms of your next step, but you certainly have profound knowledge. And so I think first is kind of sitting and grappling with some of the truth of what you know. You mentioned Charlotte was the name, and I changed the details about my patients to protect their anonymity. But this book is really from wonderful moments with patients over the years, really my greatest privilege in this life to get to take care of people and get to be their psychiatrist and their therapist. And you just see it, and this happened with Charlotte, of her just gaining a real clear awareness. Right. And it sounds kind of obvious, right. But just she was coping with drinking and it started out as kind of normal Covid coping, normal pandemic coping. And then I think for so many people in their 30s and 40s, it really starts to take quite a toll on sleep, on cognition, on gut health. We normalize a lot of excessive drinking. And so some of what I get into, and when you asked earlier about barriers to mental fitness, some of that are some of the habits and some of the patterns we've gotten into as a modern culture. We like to overeat and overindulge. There's usually a lot of alcohol involved. There are a lot of gummies, powders, tinctures, salves, all kinds of stuff ranging from legal to illegal to supplemental to psychedelic floating around these days that people are kind of fiddling with, let's say, and experimenting with. And so again, one of the things we want to do with self awareness is have people maybe take a step back from all of the experimenting and think through what you're actually in a clear way after. What are the major challenges, as I think about clinically with patients, you triage a little bit. If there's something on fire, we're going to put that out first and then we're going to think about dealing with that and then we're going to think about of course, where'd this fire come from so it doesn't get started again. But there's that kind of sequencing. And so self awareness is asking you to really do that thing we all say as clinicians, right? What do we do? We try and meet you where you are. Well, it's really asking you to take this from the clinical room into your life. Meet yourself where you are, right? If you're drinking every day, it's like a toss himself awareness. I really appreciate that. And before you get into self, you know, kind of loathing or goals or just first to just see that, how's that happening? How did that start happening? So those are some of why again, self awareness is that first really important step, right? That we begin to think about ourselves as empowered, in control. And the last one, that's very hard, responsible that the only person who really at the end of the day truly is going to care about this in the most meaningful way is, you know, and that that might sound a little selfish. One of my patients asked me, it's like, isn't that selfish? You know, maybe this book is asking people to be selfish in a bit of a different way. If selfish is around creating boundaries by which you engage in more self care, more self awareness, I think that leads to, whenever you're engaging with the rest of us, a much like more powerful, more potent version of yourself, you're in what we call a better stance. So if that's selfish, okay, a little bit of that's probably good for some people, that's fantastic.
- [20:55]
B
And I, I've spoken about this on the show before where I've contrasted the idea of being selfish versus selfless. You know, when you are selfless, you are just giving without regard for yourself. And I think selfish in sort of the modern context in which it's used often a derogatory term. So we tend to shy away. We and women, we don't want to be selfish. We don't want to be seen as the, you know, the snob or the person who's only this sort of, you know, I don't want to use the word narcissist but sort of self consumed person who doesn't have any regard for anybody around her. But I do think that, and I would say this is true at least and this might be a bias because I tend to speak to more perimenopausal women. But we are very much nurturers and caregivers by nature, and we often don't make our own to do lists. Right. Like, we have all these other people and all these other things that we're trying to achieve and help and support, and we often forget about ourselves. So I really love what you just said around, like, is it selfish? Like, okay, you know, can we be a little bit selfish in the context of setting boundaries for ourselves and say, this is what I'm willing to do and this is what I'm not willing to do, and I'm not going to be a martyr and be selflessly giving so that, you know, it's like the airplane is like always, you know, put your own air mask or put your mask on first and then help the people around you. I think that that's usually. I think it's a longer lesson. I'll say it that way. I think it takes. At least I've seen. And in my own life and my own personal end of one, I've seen that as well. It's harder for me to put myself first versus putting, you know, my children or, you know, the other people that I sort of hold in high regard and I love, you know, more than anything.
- [22:28]
A
Well, and it's also such a comfortable setting, I think, for women of being of service in that way, of being a caregiver. So many accolades for that. It's sort of like for me as a man, you know, like having a job and earnings. It's like that's what you do, you know, it's. It's like some home projects maybe. And so I think that notion of like the compass on, you know, selflessness as you're talking, or the. The compass on what is selfish and what isn't, feel very skewed to me because so much of identity for perimental puzzle women is about being a caregiver, taking care of others or. And so the switch or this. What I think is very exciting culturally, this. This kind of turn that's happening into what has been described to me by my patients and by, I think, a lot of people in the space kind of this phase of life of no fucks left to give, and not that people don't care about others, but that there's this notion of having been of incredible service and now needing to be involved in dynamics that are a little bit more interesting and complex. And so it's coming out, I think, in this very sexual way right now, which is, you know, I think a Fun. Fun. I'm curious what you think about that, because it feels like suddenly perimenopausal women is like the hottest, kind of spiciest focus of attention.
- [23:40]
B
Mommies now. Yeah.
- [23:41]
A
I know. If I'm allowed to say that it's kind of. I. I kind of. I blush a little bit, but it's. I think it's really wonderful. It's always maybe been kind of where my attention or preference has been. Maybe just. But. But also it feels there's something really invigorating because it speaks to a power of kind of sensuality and sexuality that revolves around self knowledge, self awareness, and again, being in more kind of interesting, more complex dynamics than just being of service.
- [24:07]
B
Yeah. And kind of knowing who you are and who you aren't. I think that I can speak for myself and say that I spent a lot of my 20s and 30s, like, trying to be everything to everyone. And sometimes I really succeeded, and sometimes I fell flat on my face. And I feel now in my 40s, I really do understand what I'm really great at and what I'm not great at. So I can take on the things that I'm great at with vigor and excitement and passion and the things that I'm not. I can set a boundary and say, hey, you know, I'm not. Like, this is not. This is not my strength. So I think that there's also, you know, maybe to your point, around that sort of sensual. It's sort of understanding who you are, and there's confidence in that. And I think that we've all, you know, culturally, and I can. You know, people are confident. It's not a look. It's not. It's not like a certain bag or pair of jeans that makes you confident. It's how you actually feel in your own skin. And when you know who you are and you can sort of show up fully in. In that space, I think that that's really. I think that's maybe what you're touching on, is that sort of, you know, really, it's exciting. I'll say that it's. It feels exciting for a woman to kind of come into her own skin and say, yeah, like, this is who I am and this is how I want to show up, and this is what I want to be doing.
- [25:18]
A
I love that. And I think it's also a much nicer way of thinking about development. You know, so often, I think, especially for women, it's like, you know, the 20s and 30s are supposed to be where it's at and I think so often for women there's such a striving around, identity around, you know, as you're saying that clarity you have of, hey, there's things I'm just not very good at, not that interested in and there are things I'm great at. I want to focus more on those, you know, not that you're going to not be a well rounded person, but again, more clarity and identity that I think helps us feel confident and engage more effectively. And it's a really nice way to think about this era because I think so often in generations before us, right, like you and I are both done. You're like, I'm in my 50s, you're in your 40s. It's like the best of our years are behind us. Like I'm no longer strong and potent and I just, I don't think that's true at all if you play your cards right. I mean, that's not been my experience of it at all and it doesn't sound like yours either.
- [26:10]
B
There was something else that you said that I wanted to just underline and double click this idea of responsibility. I have said maybe and people maybe don't like it, but it's like no one's come to save you. You know, this idea of the prince riding up on their.
- [26:24]
A
None of us like that. I don't like that. I want the prince to come and save me. Like, who the fuck. I just want the prince to come save them. Like it's a great idea. I mean I'd like. It's just. Yeah, you're right. It's not, not going to happen.
- [26:35]
B
It's not going to happen. So, you know, the person who's going to save you is you. And so I talk a lot about weightlifting and resistance training for women and technique and range of motion. You know, my background as a chiropractor really understand like joint mechanics and body mechanics, et cetera. And so often I'll have people, well, you know, like it's this or it's that and it's like, all right, but you can't get upset for the results that you're not having for, with the effort you're not putting in. And so this comes back a little bit to responsibility because no one's coming to save you, no one's going to lift the weights for you, no one's going to build the plate for you, no one's going to set boundaries with your mother for you. You know, you have to do a those things and so it can be hard to hear. But I just wanted to just maybe marinate in that for a moment and have you expand on this idea of responsibility. Because I think it is important for women to hear probably on this podcast ad nauseam a little bit. But I would love to hear it from you as well.
- [27:29]
A
I want you to hear responsible but not alone. As you say. It is up to you to set boundaries with mom or to go to the class. But. But you're not alone in that. You can get help from someone like me to talk through it and to think about strategies. You can do something. Like the favorite perimenopausal woman in my life who has started going to orange theory classes and is like stronger is my wife is like stronger than she's ever been. Like I think she's a little stronger than I am now. It's like very hot, very fun. But you know, not the kind of thing that happened without like a group context, some challenges and, and so. But yes, I like the idea of us taking responsibility. I think it's also, it's very hard when you're struggling, right? Anyone listening right now who's really struggling with symptoms of depression, anxiety, perimenopause, insomnia, itchy skin, brain fog, you know, this idea that like hey, it's all on you. Like I can appreciate that can come across and sound overwhelming. Part of where I wanted to give the tenets of the book was to really help people direct their attention towards what works. What works in the kind of biology and neurobiology of the brain and the kind of new science of the brain and how even things like taking responsibility, right? Like what's an easy, quick, free thing if you can't afford therapy, I'd want you to journal. There's some journaling prompts in the book. Why? Because studies show that journaling increases the functionality of our prefrontal cortex. This is the part of our brain that basically works. Does executive functioning, working memory, like we call it gsd. Get shit done. So that's frontal lobes. You have more activity in that part of your brain when you journal regularly. Like wow, that's very cool. And over time for people who are in more self reflective activities, whether it's journaling or therapy, there's some studies that show like a 14 to 15% increase in gray matter. There's actually those are neurons so it's just like more brain cells. And so again what I hope people see in the book is stories like the story of Charlotte and several other of people I've worked with over the years. And how their lives change sometimes in unexpected ways. But there's deep science behind it in terms of how these activities affect our brain. Sort of where we want to take responsibility in a new way because we have new knowledge, because we have new challenges from the modern world.
- [29:46]
B
Well, let's jump to two of the other tenants. I think this is a great place for them. I was going to follow them in order, but just based on what you said, I love the let's talk about connection and engagement. And again, another story that you had shared in the book. Again, I can't recall her name, but she was sort of going to work. Everything was shades of gray and beige and nothing was really colorful for her. And then through her work with you, she ended up, I think, going to a poetry class. And you know, she seemed, she was going to this poetry class. She didn't want to share poetry, but she was an avid reader, an avid writer. And then all of a sudden as she started becoming engaged in this community of I think it was poetry slam or something. I could be getting the details wrong here, but she started writing and writing poems and reading books and all the things that really lit her up before she had moved away from the family and moved away and sort of started this, this work and was feeling really invigorated. And I think it was like six months later she ended up reading one of her poems in front of this group. Foot mechanics affect every aspect of your fitness and your movement patterning. When we are wearing shoes with a built in arch support, lots of cushioning, we are affecting the mechanics of the entire lower limb and spine. These types of shoes will shorten the Achilles tendon. They will limit ankle dorsiflexion. They cause more arch collapse. They limit toe flexion and abduction, which causes bunions. They affect your ability to squat properly and your ankle and knees have to take up the slack of a foot that isn't moving the way it should. I have recently swapped my running shoes and have been wearing Paluva shoes as my day shoe. Still training barefoot and I've loved it. Paluva helps to restore foot mechanics, giving your feet the room to move, which improves posture, your gait, your natural body movement. And for me it's helping my squat. Go to paluva.comforward/drstephanie to get 10% off of your entire order. That's P E l u v a.com d r s T E P H A N I e to save 10%, let's talk a little bit about why you Know, you said responsible but not alone. So let's talk about this in the vein of community and connection and why that's so important. And then the. And then the other piece that I think really works well, here is the other tenant that you talk about, which is engagement. So engagement may be in a community or in something that really lights you up. Why are these two things so important for a mental fitness regimen? And why do we need to be conscious, like, actively working towards that?
- [32:19]
A
Well, I think Everybody listening and Dr. Stephanie, you know, because many of these things have eroded for us, whether it's the pandemic or modern life or the screen or that you've moved that there's so much that that has shifted in how we socialize and how we connect. And that's also caused us to just be, I find, in my practice, a little less engaged. You know, there's a little bit more kind of dopamine waiting in our phone than ever before. And that just kind of meaning that, you know, kind of this notion of dopamine getting us attached to things and wanting to pursue them. And. And so if, you know, your biggest dopamine is your, you know, community softball game on Tuesday night, you know, something you look forward to, it's a certain, you know, kind of piece of your structure and your schedule. So. And I really appreciate you highlighting the stories in the book, because I want people to see mental fitness and mental health as something that all of us have questions about. And I wanted this book to really, in some ways, the. I want to kind of plan a flag saying, we gotta shift. I'm so. I love meeting people in crisis. I really do. I. I'm. I'm helpful and handy in a mental health crisis. And as a physician, I enjoy being in that role. I do wonder sometimes. This happens a lot to me as I'm sitting with someone and I'm hearing the story. I just wonder how close we were to meeting earlier. Was there ever a time that, like, I don't know, we were, like, walking past each other in the street, or was there a time that they almost called me? This happened recently. Someone called me, and then they called me. We had a talk, and then exactly a year later, they called and they came in. And that sort of notion of what. What can we do to create a framework where we're not waiting until the last minute of rock bottom or so symptomatic to think about building our mental and emotional health? I know I've been very functional my whole life. I've also had lots and lots of work to do. All types of things to recover from, to sort through, to understand. All kinds of probably just like you, some thoughts that make sense and some thoughts and feelings, you kind of wonder what they're doing up there. And so I'll just say mental fitness is really getting into this proactive role, right of we can be pretty isolated and pretty unengaged with our hobbies, enjoying Netflix, not really engaging Internet dating for a long time before it really saps our mental health. And so connection and engagement are two tenets that are really important to me for personal reasons and professional reasons, both connection is just one that for me and my own personal journey, mental health is just very, very important. Also, during writing of this book, I moved from being connected up in the mental health community in New York to very rural Indiana during the pandemic and then to a new town in Wyoming. Slightly different culture. So how you kind of build up and think of community was really near and dear to my heart writing this book. And I remember moments where weird things like the pumpkin sale at the elementary school, I get like a little misty eyed, like looking around and like, oh, I know a lot of these mommies and daddies, like, I recognize these kids, like, this is our community and you like feel it. And it's like, oh, it's like, I don't know, it's like, it's like this letdown of like you belong somewhere. It's like that thing we're looking for. And so connection is really important to me. And when I meet patients often, especially in New York, I'd meet people who'd moved there for work. Then you really start to crump in your mental health. Right? New York can quickly become an island of work, alcohol, great dinner and alcohol and more work. And, and so how people connect up to things like, you know, a sports league, it's like so many fun places to play sports in Manhattan or connect up to something that helps them get out of the city or explore the city. The ones that are coming to mind are kind of exercise based, but it's certainly not always that. I had a patient who got involved with a kind of philosophical society and they get together and debate and it was like so cool to hear about her exploration and kind of, you know, going from very shy and anxious to kind of going and talking and sharing or the patient that you mentioned who really was able to kind of look back of what had interested her in college. And instead of being in that stance of like, ugh, not really living my dream of being A writer think about ways she could engage with that creative process. And as someone who writes and likes to write books, it was really always fun for me to work with people who are writers or creators or artists, thinking, how do you like liberate that, honor that, get that going? And again, so often it involves having connection, right? So you have a space or this word. I use a lot of framework and then, and then that kind of allowing you more engagement because you have more structure, you have more accountability. Again, you have this framework idea, right? If you have painting class every Wednesday night, seven to nine, you know, you're there, you're missing class, those are your only two. And if you're there, you're painting. And so there's a way that for a lot of my clinical work, there's the, you know, it's kind of like putting a little puzzle together of how do you get more connection, how do you get more engagement? And again, how do you have that like set up like mental fitness? I talk about being, you know, a set of its knowledge, its skills, its patterns and its habits. Right. And so, you know, how do you set these up so there's more of a pattern, especially like if we're not feeling so well. Like again, in this painting class analogy, you wake up on Wednesday, you get your class at 7pm Even if you're not feeling great, you're still painting. What's a. I bet, I bet after a couple hours of being with your classmate, you feel differently, you feel connected, you're working something, might not feel great, might still feel, feel down, but you're engaged with that emotion, you're not isolated with it. So just again, an example of where that structure really helps people with connection and engagement.
- [38:17]
B
And I think if you're listening and you're in your city dweller, it can, as you mentioned, it can be very quickly work and great dinner and alcohol. And you can go for years without knowing your neighbor. You know, you can get the flyers for the local pumpkin fair and never go because you don't know anybody there. And so I think if you were living in an urban location, it is even that much more important for you to be actively seeking out this connection and this engagement. And it's. And I can say too, I live in a large city and I every Sunday I go to my martial arts. I have a martial arts class that I take and it's an all women's class and it's just, just fantastic. Like the women are so supportive with each other and we just had a huge snowstorm at the time of this recording as a huge snowstorm. So I wasn't able to get to it on Sunday because all the classes were closed and I was so bummed. I was like, man, I miss those women. I miss the, you know, the class. So I think it's important if you're someone who lives in a city to be actively looking for some of the things that really do bring you that joy and that connection where if you can find that Venn diagram of like things you enjoy doing in a community setting, you know, or maybe it's not Venn, but it's just two overlapping circles.
- [39:29]
A
No, no, I like this idea. You're talking about the stacking of the tenets and I think it's really important that people hear this because otherwise it's like oh, nine things plus all the vegetables, plus the seafood, plus the saunas. Like, ah, like enough of you honest people like it. So they're, they're very. What you're talking about is the stacking, right? That, that again you give a great example where martial arts class, like that's not something traditionally that like, you know, women go and do together on a Sunday afternoon. But as you talk about that's an amazing mental health information, you know, intervention, mental fitness intervention where you're increasing a sense of security and strength, you're getting in touch with your bodies in certain ways. You're together as women, right? So you're sharing, you're able to talk and process stuff together. You have lessons, usually your sensei and a, in a, you know, a dojo comes and you know, there's a theme or an idea around which you're, you're learning. So which again, all really potent stuff. When we think about again what our brains love do, we love to learn together. And so just a way that again having it just be like a self defense karate class, it's like doesn't really again, think of all of the ways that there are tenants of mental fitness involved in what you're doing and that stacking, right? So if you're. I'm out here in Wyoming, in Jackson. So for me a lot of times I get a lot of connection through my clinical work, the groups I get to work with and talk with, doing podcasts like this. But when I'm doing a lot of clinical work, you know, it's kind of isolating. I'm in a certain stance. So getting into big nature for me and doing that with a friend or with a, or pet, really important or I'm again moving my body in some way, usually hiking or skiing. I'm interacting and engaging in a kind of looser way than I am clinically. And then being out in nature, ideally, where, again, that that's. And probably have a little healthy snack, like some dark chocolate and a kombucha. So again, trying to think about many tenants all together at one. So in that hour, boy, I think about it with patients, like, it's just a lot of points on the board. Yeah. Whether it's. It can say, oh, let's talk about the science of how my kombucha is like, helping my microbiome. Or how the phyticides, these trees in the forest, emit certain chemicals that they've now shown are kind of part of that, like, calming response. And there's even a little bit of data that they can trigger some brain growth. So that I just love that idea that I like it because when I walk into a forest, I grew up on a farm and we have a big forest. And so the forest is a really calming space for me always. I just kind of instantly settle down and feel part of the natural world. I don't know if other people listening have that. I'm sure many of you do. And it's always just really struck me, kind of like going to the ocean and then you learn there's like biology behind that, that. That in the forest, the feticides are. Are these molecules that we're inhaling that the trees make. And same thing like on the. Or by the beach. There are these negative ions from where the water molecules are splitting. And a lot of people have a little bit of almost like a euphoria response to negative ions. So, you know, it's fun to learn. There's a lot of, again, we can use this knowledge, hopefully not to burden anybody. Right. But more to liberate us, to empower us. Right. There's a lot in our everyday life that we can do to take care of our brain health, et cetera. Maybe not as complicated as sometimes people make us think.
- [42:44]
B
Right. And instead of rolling your eyes, being like, oh, grounding, okay, that's just some hippie nonsense. Like, well, there's these phytocides and here's some science behind it for those of us that want to know more. And I think that it bridges this gap between intuition, what your body naturally craves and naturally wants, which is being outside barefoot, listening to the leaves rustle or listening to the birds chirp or whatever. And some of the, you know, the modern science or some of the, you know, we'll say discoveries that science can apply to the natural world to help us understand it a little bit better.
- [43:18]
A
I hope that's how the book works for people and helps people of both. Some inspiring stories, some real science, and then just real straightforward actionables. You know, some things that, you know, I wouldn't say it's common sense, but people know. Prior to mental fitness, my work has really been in nutritional psychiatry. And so I both, you know, we're clinically here, but my book before this was Eat to Beat Depression and Anxiety and, and you know, a lot of times I had the experience of. I don't think people were very surprised when I talk about anchovies and sardines and fatty fish or when I talk about rainbow vegetables or fermented foods. You know, most of the people listening, most of folks who are kind of in the know a little bit in the wellness space, you know, have, have a sense of what to eat. What I think was cool and what motivates people and it sort of surprised me is folks hadn't kind of connected what they eat. Like literally what's on the end of your fork, right? If I take a swig of this kombucha, I'm like ingesting like millions of live bacterial organisms, right? So that what is on your end of the fork or in your glass directly affects brain structure and function. Like when you're 60, if you eat more whole foods versus processed foods, the researchers can see the change in brain size. Your brain shrinks faster on ultra processed foods. And so it is as you said, like, I think a really fun time because there's more motivation and for me, a little bit more, you know, I'm a science guy. So with more evidence, there's more truth. And I found that to be helpful like lentils, pistachios, kale, wild salmon, journaling, holding hands with my wife, going on a walk in the mountains with one of my buddies and talking about our families. You know, just stuff that like usually works for us, usually feels good and lo and behold, yeah, it's really good for us. And the science backs it up.
- [45:06]
B
I was reading this is a little off topic, but I was on my own little like geeky magic carpet ride on A. In PubMed, I was on some, in some rabbit hole and I was reading about oxytocin and which is often, you know, people know it as the love hormone. It's, you know, secreted during orgasm, of course, breastfeeding and bonding with your partner. But it's also seems to be also involved in muscle repair and muscle stimulation, which I thought was really exciting too. So for women in perimenopause, of course, we often focus on like the decline of sex hormones and the change in our metabolic hormones, et cetera. But oxytocin also declines as we age. And so it is even more important just to sort of back up some of the, you know, the science with what we're talking about here today with the grounding and the connection and the engagement. It's also important for us to be thinking about maybe an oxytocin rich diet so that we can not only keep our brain healthy and to keep us connected to the people and the things that we love and our fur babies and our pets and things, but also from a. If we can just get you at aesthetics, it's going to help with your muscle, it's going to help with muscle protein synthesis, is going to help with muscle turnover, it's going to help with, you know, hypertrophy, which I thought was like super interesting as well. I don't know if you've read anything like that. I mean, currently we give oxytocin to laboring women and you know, there's been some promising research in the elderly for depression and anxiety for giving them some oxytocin. But I was like, oh, this is really cool for, from a physical perspective as well. Right. And we often separate the mind and the body. It's like, well, what's good for the mind is good for the mind and what's good for, for the body, you know, but it's really just one and the same structure just separated by, you know, the brain barrier. But I thought that was really interesting and maybe a little bit of a deviation, but I wanted to just share it with you as we're kind of talking a little bit about nutrition and wading into nutrition and movement a little bit that, you know, this bonding love hormone, which we, you know, sort of looked at as like a neurotransmitter that keeps us connected socially, is also really important for our physical attributes and recovery as well, which I thought was cool.
- [47:11]
A
I love the oxytocin tangent. I don't think of it so much of a tangent, I think because speaking around menopause and perimenopause is certainly one. It's something I've seen where there's just a little bit less connectivity. I find husbands and spouses and kids for some women just get more, let's say, burdensome, a little less connected innately and intuitively during kind of perimenopause not, not all, but I've certainly seen that. I think it's a lot of, there's a lot of shame involved with that. But I like your notion and it reminds me of that kind of, you know, if you don't use it, you lose it. And I think oxytocin is one of those things that it's a great way to conceptualize and think about some of the benefits for you, but it really needs to kind of go from that awareness to action, right? It means that when my wife comes home from orange theory, I need to cuddle her up a little bit more. And I even noticed that, you know, especially people in longer term relationships, that attention to the small moments of affection, right? Whether it's just a minute or two in the morning, whether it's more hugging, whether it's just kind of keeping that going. I hear from so many couples, one, how important that is to everybody. I mean, it just, it just means the world to folks when you have this consistent interest and kind of affection. But then as you're noting how powerful it is with it. I didn't know the muscle repair data, that's very interesting. But, you know, this notion again of what, what signals, does more connection. And then I also want to say, you know, I don't. We always make oxytocin. It's just like kids, babies, breastfeeding and orgasms. And it's like, you know, it's like, that's some good oxytocin right there, all those things. But I also think that there is oxytocin when you sing in the community choir, I think there's oxytocin when you hug your buddy. So I, you know, I think that there's a lot of ways for us to tap into these neurobiological mechanisms. And again, the hope is for people to hear, boy, a lot of new science, a lot of new science around mental health and mental fitness. Here's some truths, here's some things that I see work for patients. And, you know, I hope people feel my encouragement. You know, I really want you to take on mental fitness just like you do your physical fitness, you know, because I find so many, so many folks, especially, you know, these days, you know, they're focused on lifting, resistance training, which kind of like, awesome, very good for your mental health. But we don't have that same equivalent in our relational life. We don't have that same equivalent in like building our mental fitness. And I kind of want to push everybody right now, like, you've got to, you Should. And here's my idea of a framework that really, I think, works. It's worked for me, it's worked for my patients, and I hope, I hope people find the science compelling to try it and see how it works for them.
- [49:51]
B
So let's talk a little bit about diet. I think you've mentioned already Omega 3 rich foods. You've mentioned some polyphenols and the green leafy vegetables and the lentils and all and all of that. And I think that nutrition is where so many people can get tripped up. There's so many Zealands and there's so many, like, this is the only way. So. And a lot of people will talk. I think that a lot of people will try to focus on, like, what's the best diet for humankind, may be conflating that with their own personal results. And of course, you've already mentioned this before. There's a lot of bio individuality. You know, there can be two, you know, two molecules that we give and radically different, you know, responses to those drugs, let's say. And the same, of course, can be true for nutrition. So what are some of your, we'll say, clinical pearls in diet modification that you found to be easy to adopt and again, building on this, like, innate wisdom. So, you know, people say, oh, I don't know what to eat. It's like, maybe you do. Like, you know, let's, let's try and pull out a little bit.
- [50:51]
A
You do.
- [50:52]
B
Yeah, I bet you do. Like, you know, you probably need to, probably need to drink some water, probably need to have some fiber, like, you know, so let's talk a little bit about. What are some of the things that you've been able to pull out that are easy modifications for people to adopt and then not just adopt for like a short delta, but maybe over a longer period of time where they can adhere to. To it.
- [51:09]
A
Yeah, for sure. So everybody, I'm a nutritional psychiatrist. I'm really one of the first other handful of us, and we got interested maybe about 20 years ago in the simple fact that when we think about mental health, we weren't thinking about food and nutrition as augmenting or helping us in our strategies to get people better. And, you know, for some patients, even though we know, right, vitamin B9, folate, vitamin B12, iron, magnesium, there's a host of nutrients that when you're low in them, you're just much more prone to depression and anxiety. We've never done a good job of kind of taking a clear history. You know, we measure blood Levels, but, you know, taking a history of, hey, are you getting those things in your diet? So a couple really, I think big key concepts that people, I want people to hear. One is this idea of nutrient density. I mean, a lot of people who count calories, and there's only one reason that you should count calories, which is to calculate nutrient density. A can of Coke and a kale salad, small kale salad, they have the same number of calories, about 140 calories. Coke's not really bringing any nutrition to the table. A little sugar, a little salt, you know, Whereas the kale salad, boy, for the same number of calories, you're getting like 800 of your vitamin A and vitamin K. You're getting folate and fiber and all the phytonutrients and the quercetin type things and on and on and on, right? Long lots and lots of nutrition. So nutrient density is the number of nutrients you're getting per calorie. And so one way I think about this as being an efficient eater, that with each bite, you're getting lots of nutrition for your brain. The second idea, nutritional psychiatry, is to think about food categories. There are certain nutrients like folate, magnesium, zinc, omega 3 fats. And most of us don't know what foods we find those in. When I ask the average person, like, hey, you know, you should eat more vitamin B12, you know, most of us don't know, like, clams, bam, clams have like 1200% of your daily B12 in just 3 ounces. Or when we think about magnesium, that instant, like, hey, those are beans and greens. And so in all of my work, I've really tried to focus on food and better understanding where we find some of these really important and rare, sometimes nutrients and focusing on food categories. So not just thinking about, hey, more wild salmon, but what are we after there? With wild salmon, we're after a sustainable, inexpensive source of long chain omega 3 fats. And then the benefits we get from seafood, things like selenium, iodine. Like, with any meat, we're gonna get a complete protein. It's not just wild salmon. Right? That's a great place to start, but I hope you'd think about some other food like anchovies and sardines. Right? They were getting probably a little bit more value, a little stronger flavor, easier to store. But for a lot of us, boy, I had to learn, like, pasta con sardi that, like, took me a little while to find my sardine recipe where it's, like, really dialed in and delicious. I have a little rhyme. Dr. Sevy, seafood, greens, nuts and beans and a little dark chocolate. And that rhyme kind of comes from where I see a lot of people needing displacement. Where do I start? And. And so when I'm looking through a menu at a restaurant or I'm thinking about my day, you know, I'm thinking about some macronutrients. Like, for me, protein in the morning is really important, as I think it is for most of us. But I'm also thinking about these food categories. Have a. When was the last time I had some, you know, good wild salmon or sardine meal? Okay. If I can't think of it in the last few days, it's time to really get that on the menu. Same thing with fermented foods. That's not my little rhyme, but. And then you mentioned polyphenols. You know, that's where this eat the rainbow advice is great. When we're eating the rainbow, we're kind of killing two birds with one stone in the sense that we all need more plants, or most of us do. About 90% of Americans don't get the recommended daily allowance of fruits and vegetables. So, you know, what do we do about that? Well, if you look at your plate and you see natural colors, right? Red pepper, cucumber, carrot, red onion, you know, you're seeing a whole array of phytonutrients. I think about them like a little bit like a medicine chest. And so I really like that campaign, eat your colors. I think it's a good one. I think it's a great way to shop. And so those are, you know, some of the nutrition real quickly. Why, like, what's different? Again, healing. The modern brain kind of picks up on eat depression and anxiety, saying there's new knowledge, right? Neuroplasticity, inflammation and the microbiome. Just these like new ways you think about mental health. And so part of what we're hoping to achieve with nutritional psychiatry is can you have better evidence? And so it's really quite cool. A Mediterranean style diet's been shown in clinical treatment. In the Smiles trial by Felice Jack, of 32.3% of patients who had depression were in treatment went into full remission. That trial then gets repeated with the Healthy Med trial, which is a group intervention where they're doing a Mediterranean style cooking class and they have huge reductions in depression scores. And then another trial actually just came out of Australia a couple years ago. The AMEND trial looked at young men, gave them two nutritional counseling sessions, 36%, and they all have depression 36% of them go into full remission from their depression. And what, what were they eating? Was it all this like amazing food? It was funny. I talked to the researcher, Jessica Bayes and she said, you know, it was basically telling, asking them what plants they like, what vegetables and getting them to eat more of those. Not really like trying to push too many weird things, getting them to eat more legumes, like things like hummus and just giving them kind of plant based protein alternatives. And, and those were kind of the main. And oh, and more olive oil. They just started using more olive oil. And in doing that they radically shifted their Mediterranean dietary pattern score. And for many of them, over a third of them had a drastic improvement in their mood. So you know, again, in terms of nutritional psychiatry, there's both the foods to eat. I think there's the kind of new science of how we think about food and mental health. I think there's the important part that you mentioned. Boy, there's a lot of chatter. It's easy to like suddenly feel like you should be a vegan or a carnivore or, or do something kind of radical. And this is again where that first tenet is self awareness. I have patients who are eating a keto diet, I have patients who are exploring high protein diets. I have patients who are die hard adherence to the Mediterranean diet. And I have patients who are trying to get by doing the best they can. And I see my job is to help and encourage, share new science and again have people not feel overwhelmed. Oh, you ate this thing. Of course you ruined your brain. That's not how this works works. But for people to feel empowered. There's no better time in history than now to have a human brain when it comes to understanding what's going wrong with it and what can go right with it.
- [57:58]
B
If you want to feel like Wonder Woman the next time that you go to lift weights, then you are going to want to get your hands on some ketone IQ from hvmn. Ketones are a natural source of fuel for your body. They're often created when your stored carbohydrates are depleted, which is going to trigger various processes in the body to trigger your body to convert fat into ketones for fuel. And ketones, unlike fat, cross the blood brain barrier. And when we compare ketone bodies to other sources of energy like glucose, ketones are much more efficient in terms of producing more power and using less oxygen sort of unit for unit. I love ketones because there's a wide variety of advantages of Using ketones going to help you with your energy. This is very true for me when I'm working out at six in the morning and I've just woken up and I will say that it's ketone esters which is what this product is used to taste so awful. And HVMN has done just a superb job at making this feel very palatable. If you are looking to try ketones and to level up your training, your recovery, your mental focus, just visit ketone.comstephanie to get 30% off your first subscription order. And I think that the, the best diet for anyone listening is the one that you can stick to over time. Right?
- [59:18]
A
That's what all the data says. All the data says if you look especially at weight loss, hard to interrupt. It's just like what matters is you sticking to it and you, it's satiating you. And that's really. And, and it's a great point. I mean that data I think is quite clear. I, I want to hear some of your favorite brain foods. I mean you mentioned some of mine that I've said lentils and white beans in particular too just to say them. I really.
- [59:40]
B
And I drink the juice from my. I have sauerkraut every day and I will keep the juice and I. So you were mentioning that you drink. Was it kombucha? I will keep the brine and I will drink it like a little shot. I love sauerkraut juice.
- [59:55]
A
That's really good. It's funny, my daughter creeps pickles all the time. I mean I think it's just one of these things that you know what a refreshing and healthy and micro biome boosting beverage. It's interesting think we drink and eat these live bacteria. So it's funny as a doctor because it's, you know we've always been very proud of our ability to like give antibiotics and kill bacteria. So this idea now that we're having people eat more fermented foods and that being a category a lot of us can explore. What's really fascinating to me, everybody is when you eat like so this is full of like Lactobacillus and Bifidobacter, the good bugs, right? So you drink this and they travel down to your gut. That's not what you grow more of. What's really fascinating in the studies is the diversity increases but it's like a diversity of other organisms that are probably already down there. And so you know, it's, and then I was talking to a buddy, I've got a gastroenterology buddy Julian, and he was talking to me about the. The secondary metabolites that, like all of the bile salts that then get also processed by the microbiome. So it was this, like, incredible interaction that again, I could definitely end up down those PubMed rabbit holes like you're talking about. But I think with the microbiome, the. The advice is pretty straightforward for most people, which is gently add in more fermented foods. Really moving towards eating fermented foods every day, if you tolerate them, because some people have a little reaction, but most people tolerate them and eating more plants, right? And that's just, you know, and. And making sure you count them. Like. Like probably one of the plants I eat the most of is onions. I don't know how many onions I go through in a week. A lot I try and probably eat a onion, I don't know, a day and onion every. I think just great, great vegetable, great food. Easy. Makes everything delicious. A sauteed onion. So, you know, again, thinking of the ones that you like, they're easy. That, and then expanding a little bit. And that seafood, greens, nuts and beans is a nice place to start. And as I think everyone hears my message, it's also probably about keeping it a little simple, thinking about what works for you.
- [61:55]
B
The other thing I would love to touch on with you is this idea of habit modification, because I think that it can feel really overwhelming, particularly with food. You know, it's something that we have to deal with every day. We have to eat all the time. And sometimes when I've counseled patients, you know, who've come to me and they're maybe drinking like 12 cans of, you know, Diet Coke a day, sometimes it's not like, okay, you're gonna go from 12 to nothing, but you're gonna go from like 12 to 8, and then you're gonna go from 8 to 6, you know, but we spread that out, so it feels painless. And so you said something there which I think is really important, which is like, how. What is easy for you? And I think that habit modification, we often just think of the outcome that we want. We think, I wanna lose 10 pounds or I want to eat healthier, I wanna have more plants. And we can get really extreme in our application of how we reach that outcome. But the behavioral goal can be just a little softer, right? So if you're. Let's say the 12 cans. I remember once, you know, I had a patient, she's like, I'm drinking 12 cans. It's diet Coke, you know, so it's no calories or zero calorie, whatever it was. So we went from 12 to 8, and we did that for a couple weeks. And she was like, I don't even feel like this is so easy. No problem. What else you got from your doc? And I was like, all right, let's bring it down to six. So in like a month and a half, we'd effectively brought down her, you know, soda consumption by 50%. But it was so low and slow that it was. It was very easy for her. So I just wanted to maybe throw that to you to see if. If you have found that habit modification maybe at the beginning of the path is a little. Maybe it feels a bit overwhelming for the patient or it feels like this huge mountain that they have to ascend. But if we sort of break it up into these really small, digestible little, little bits, kind of taking a chapter from like, BJ Fogg and like, you know, tiny habits, what have you found is the most effective for habit modification? Because I think that the tendency, especially for really driven those perimenopausal back to those perimenopausal overachievers is this really like, okay, I'm going to do it and I'm going to do it 100%. It's like, you can do that for a couple weeks and then you're going to. And then it's going to be very overwhelming because you're not like, if you. If you rush, you know, you're not ready yet. Do you know what I'm trying to say?
- [64:08]
A
I do. I think that there's something you're speaking about, which is how people set themselves up for failure a little bit by engaging in extreme behavior modification. I think that what you're describing is a little bit of exposure, right? So a little less soda each day or each week works for a lot of people. I think for some things that are more, let's say, addictive or have it forming than diet soda, like cigarettes or alcohol.
- [64:33]
B
Right?
- [64:33]
A
Yeah, that works to an extent for some people, and for others, not so much. I think that's also where that kind of, excuse me, fantasy of the cold turkey comes in. I'm going to put it down, I'm going to fight through it, and then, you know, if I. If I hold that long enough, I won't ever pick it up again. And, you know, that. That certainly happens for some things, but it takes a while. I stopped drinking about three and a half years ago. Alcohol and. And, you know, it's really strange to go from, you know, being something I really enjoyed and consumed regularly to something that just really isn't on my mind at all, very rarely. And I think that's a good example of brain change over time, that there's a real shift from three months to six months to two years in terms of just really not being something your brain is engaged in, not the ordering above it, not the thinking about it, not the craving it. And so you know what you're talking about, which is that slowly graduated change, I think is part of, in some ways, any change process. And I'm not sure we can make all change, you know, completely painless, especially around substances, but for some, when it's like eating healthier. Yeah, I think you can do a lot, you know, satiation comes from protein, fat and fiber. If you're thoughtful about that and going to bed on time, I think you can avoid a lot of carbohydrate craving in the process. I think a lot of people, a lot of women I work with and men have a whole lot of options now when it comes to the GLP1 medications and weight loss. And you know, one of the great things about being in clinical practice is I get to see people exercising their options and making choices according to their values and then get to take care of them. And so I've seen people have great responses. I've seen people have some pretty scary side effects. I've seen people, you know, really shift their life. It's been very interesting for me to see some of them and what you're talking about, like getting back into the gym, seen that happen in a number of people where it really part of the GLP1 journey in the weight loss is adopting a lot more consistent, healthy behavior. So it, it's, you know, I hope what everybody is hearing again is a lot of options, a lot of encouragement and yeah, I, I love the idea of a little bit every day. Clear. There have been some studies more in ocd, but looking at exposure therapy. Exposure therapy, let's say you're scared of snakes, right? You come in and we talk about snakes. And then I'll hold the snake and then eventually you'll hold the snake. So classic exposure. If you do that like once a week and regular therapy really doesn't work very well if you do it every day, works quite well. And so again, thinking about those daily habits and how to not have them be, as you're noting, like, you know, so kind of overly ambitious that it's hard for us to be consistent. But, you know, just some disciplined Practical, responsible steps that you can take.
- [67:27]
B
Beautiful.
- [67:28]
A
More cuddling. Like you said, Dr. Daily Cuddles. Like, daily cuddles. I was like, that's what I want you to call this episode, Dr. Ramsey Mental Fitness. Daily cuddles.
- [67:38]
B
Daily Cuddles for muscle gains.
- [67:40]
A
Exactly. Boost your oxytocin with Dr. Drew Ramsey. It's like, I'm just about the cuddling my cuddles. I journal about it.
- [67:48]
B
Yeah, Love it. Tell me a little bit about your movement practices. What are some things that you find really enriching in your own life? And then how are you counseling your patients in terms of minimum or, like, goalposts that we want to be achieving or aiming for when it comes to.
- [68:05]
A
A fitness regimen, I think we should move every day. I mean, I think that it's very easy to pull. Get pulled into this sedentary lifestyle. I'm a psychiatrist. I mean, the more successful and busy I am, the more I just sit, literally. And in psychiatry, the better you are, the stiller you sit. I mean, I could sit really still at this point. It feels like, so that's very dangerous for my health. And so I really think it's something we want to do every day. You want to engage in with your body every day. I went to a yoga class last night, candlelight yoga class, and the instructors did something about maybe this was the first time that you're checking in with your body today, you know, and it was one of those moments I had, like, oh, my gosh, it's so embarrassing. Like, how is it that I've gone all day and I just haven't checked in with my breath or stretched a little bit? So I really encourage daily engagement with your body. Movement is absolutely essential. It's essential to your brain and your brain health. We just look at the data. You know, when it thinks about clinical depression, like, regular exercise, right. Is equal to the antidepressant Zoloft at 18 months. And as I tell my patients who are really struggling with depression and maybe haven't tried a medicine, like, why don't we do both, like, really get you exercising, really get this treated. For me, I like movement, especially as I've gotten older, that incorporates some balance. And so I've moved to a mountain town. And so I got introduced to skinning up the mountain, where you don't just ride the lift, but you put these little, like, pieces of. It's almost like Astroturf on the bottom of your skis and you skin up. And so I have a little. What's called a Split board that there's this like Japanese sect called the Yamabushi. And the Yamabushi find spiritual enlightenment and then eventually develop superpowers as they spend more time on the mountain. And I found that to be a little bit true. Dr. Stephanie I find something happens as I'm out on the mountain. I'm in the elements. It's really invigorating. It doesn't exactly feel like exercise to me. It feels like movement, Alpine skiing that you're doing. This is. Yeah, I'm a snowboarder, so, you know, I mean skiers. Yeah. But I'm just to say it, just to say it. But they make these great split boards. There have been a number of people, Jimmy Jones is one of them. There's a. My guru here is a guy, a guy named Brendan Burns. And split boarding is where you, you take your snowboard apart. It's a split in half. You put your skins on, you go up, you put your board back together and then you ride down. And it allows you to access parts of the mountain where there's really no one else. It allows you to be out in the elements in a way that's really invigorating. So that's a little bit maybe esoteric. I said the other ones that are really important or if you've been following me on Instagram, I've had a big journey with a horse over the past five years. And so horseback riding's always. It's been something I found a little later in life, really. I don't know how to describe that. Like, wow, that movement really did some deep healing into my psyche. Other things that I found really important, like stretching, especially my hips, that's like a weird thing for a middle aged man in Andropause to say, but I just find like the hip, opening, them getting.
- [71:12]
B
There's a lot of energy stuck there. There's a lot of energy stuck in the hips.
- [71:15]
A
Yeah, it's all changing down there for guys at my age. And so it's good to just, just stretch it out and, and so those are ones that I find. And then as you said, the weightlifting, I find myself, I'm one of these guys. Like I have a couple 40 pound dumbbells I just like have around and I just try and lift them like whenever I can over my head, do some curls. Just the idea that as I'm getting older, really keeping my muscle mass up and keeping my flexibility up and then working on kind of the longer endurance where I'm finding myself trying to get out for, for longer periods of time and almost a little bit more of a meditative way. So those are some things working for me with movement. I think the, the part I encourage in the book and I tell some stories in the book of movement, tell the story of a great tango dancer. I didn't know she was a tango dancer when I started treating her, but taught me a lot about movement woman. I was recommending exercise too, kind of ad nauseam and, and she started definitely hate me as her therapist and, and then we had this amazing encounter. I share in the book about it where she comes in just beaming and she's picked up tango dancing again. Of course I'd never asked her like, oh, you know, what kind of movement, what kind of things do you like to do? I'd said I just asked her about exercise and she'd give me that kind of guilty response we all have when we're not like, ah, you know, I know I should be doing more right. So. But thanks for asking.
- [72:33]
B
Patients are our greatest teachers, aren't they? Our patients are always our greatest teachers. They always.
- [72:37]
A
I find I love being a clinician. I find it really to be in medicine, particularly one of the. Being a psychiatrist and psychotherapist. It's one of the last places where you get to spend a lot of time with people. I'm really blessed and I get a lot of longitudinal care so people I've known for years and years. You get to see family systems develop and shift and heal. And so yeah, you learn all the good stuff in the practice of medicine. I definitely have a couple of patients in their 70s who really, really inspire me. I've got a woman I work with who's in New York and she's getting in, she's a, she's gotten into big lifter. At one point she had like a, like she'd never done a pull up and it was her goal. I think eventually she did 10 pull ups in a row in her 70s.
- [73:21]
B
Good girl. Nicely done. Yes. Yeah, there's something too about, I mean we could also nerd out, I'm sure on like Myokines and bdnf. Like I'm so enamored with this idea that you could have a, you know, a cytokine released from the muscle that can cross the blood brain barrier and like positively affect mood that can positively affect. You know, they've nicknamed it the molecules of hope. Right. I think that that is just incredible. And I always know that when I'm feeling anxious or when I'm feeling sad or When I'm feeling frustrated or something, doesn't feel like it's like just, you know, melding the way that it should. I go for a walk, I go for a lift session and I always feel better afterwards. I like 100% of the time I feel like I've even in not thinking about it, in focusing on the squat or the bicep curl or the pull up or whatever it is that I'm doing, I sort of am solving the problem, even though I'm not. It's somewhere in my, I don't know if you want to use the word subconscious, but it's not in my, it's not at the forefront of my thinking. And then when I'm finished, the lift session, I have new ideas, I have new approaches that I can take to it. My emotionality or my neutrality around how I can solve it feels a little bit more aligned with a way to solve the problem than it did maybe before the session. So I think there's something, sarcopenia and all that stuff, like good for muscle, lean mass and like preventing sarcopenia and all that. But it's also very, very cool about. You can have these molecules that are released from the muscle just through the art of squeezing them and like moving them through a range of motion that can positively influence your problem solving ability, your emotional regulation and, you know, systemic inflammation.
- [75:04]
A
No, I, I love all that biology. I completely agree in the sense that it's new, it's exciting. And then also what you're describing, which is a way that I think psychotherapy and lifting weights are better than psychedelics, what you're describing is a shift in focus and that by being present with your body, by pushing against those weights, by squeezing the muscles, you're both activating a tremendous amount of neuroplastic biology. And we're going to make this brain grow and repair more. But you're also pulling the mind into a different space and almost freeing it up to think about problems differently. You know, we all know that kind of ruminative loop, right, where we're like, can't quite solve it, can't quite solve it, still thinking about it. And so a lot of times we talk about its distraction and I don't think that's totally true. To me it feels like it's a of, it's allowing of a different set of focus, right, Approaching it from a sense for you of more strength, more calm, more empowerment, more an ability to achieve things. You're kind of sitting in that emotional state now and as you say, It's a little bit in the back of your mind. Maybe it pops in occasionally. But when you leave that lifting session, you feel the good mood from the endocannabinoids and endorphins and all that stuff. You have the knowledge where. I do think the knowledge helps everybody that, that you know, when you're ending and you're thinking about your brain being filled with brain growth factors and that no matter what problem you're grinding on, you know you get put points on the board for your brain and your mental health and mental fitness. Yeah. I just think it does wonders for us. It's again, this idea that there's a lot within our control to be able to state, shift, feel better, explore ourselves. And again, that notion that you're talking about, whether it's working out or talking in psychotherapy or engaging in some breath work, our ability to shift states, reconsider problems, get new perspectives, is really within our control.
- [76:55]
B
Beautiful. So we have Healing the Modern Brain. It is gonna, at the time of when we release this, it'll be out for purchase. What are some final thoughts that you want? Everybody, if they are picking up the book, what is the. Your dream for the reader? So someone goes and buys this book, they pick it up. What is your dream for them after they've finished reading it?
- [77:15]
A
Oh, boy. My dream is you're going to feel empowered with a sense of new science, but also hopeful. I hope that the stories of my patients will stay with you. I hope some of these studies will stay with you. Like, you're never going to think about French fries the same after you read this book and some of the solutions to French fries. I. I hope that people feel a framework like that when it's Tuesday and you're looking at your schedule, that there are things in there that you've been intentional about or for your mental fitness. I really hope that people will, for the first time in their lives, have a mental fitness plan. Right. If you ask me. What's your mental fitness plan, Ramsey? I'm going to tell you about a variety of different things, ranging from my journal to my sauna to my snuggly bernadoodle to my oxytocin cuddles with my wife that Dr. Stephanie just prescribed. There's intentionality and engagement, whether it's in my parenting or in my work. Right. There's. There's a framework. So no matter how I'm feeling, there are certain things that I'm. I'm engaging in. Because we all know we can't just engage in things because we want to or we feel great about them. Like, that's not how motivation works. Exercise is a great example. People who exercise consistently, they don't do it because they always feel like doing it. They do it because they always do it. It's like a discipline thing. And as a consequence, they almost always feel better, you know, 90 plus percent of the time after they do it. And I think it's where people get kind of confused that, oh, once you get in the habit, you know, you want to do it, you want to journal, you want to exercise. And like some of the time I'm in that stage right now with journaling. It's like when I, it's like almost like a drug. Like when I sit down, it just feels like it's really healing. It's really good. If I don't do it for a few days, I'm missing it. It wasn't always that way for me. And so again, this, this, to answer your question concisely, I hope that when people finish the book, you'll have a warm smile on your face. You'll feel a tremendous sense of being seen, heard and encouraged. And you'll have a sense of some areas and arenas in your life where effort simply pays off. And amidst all the controversy and stigma and misinformation, you can feel a framework for your modern mental health. That's my hope.
- [79:29]
B
That's wonderful. And thank you for writing the book and spending your time with, with us today. If people want to find more about you, we'll obviously have all of these, like the link for the book to purchase in the show notes. But where can people find you? Can I, where can I send them to?
- [79:43]
A
I only meet people on the top of the mountain. Dr. Stephanie I'll be there. We're going to skin up everybody. I'm easy to find them. Drew Ramsey, MD. I'm on Instagram is where I'm most active, but you can find me on Facebook, LinkedIn. My webpage is Drew Ramsey md.com We've got an E course version of the book that's up if you want to spend a little more time with me. And lots of information about mental fitness, mental health, Some of my favorite research, some free downloads. So please check it out. Please sign up. We've got a great freeze newsletter and I just appreciate everyone's time and attention today. But mostly, you know, the thing that'll make the big difference for me besides all the social media and posting and ordering, I hope for all of that, but it's just if, if this conversation causes you to do some things for your mental fitness that causes a shift and a change for the good in your life. That. That would be the most meaningful thing for me.
- [80:35]
B
Thank you so much. I think you have to change your handle to Split Border md. But we'll. We'll put it through.
- [80:41]
A
Such a dream. Okay, I'm ready.
- [80:43]
B
Just gotta. Just gotta drop it. I love that. Thank you so much for your time and your focus and your energy today.
- [80:48]
A
Thanks so much. Take care.
- [80:50]
B
All right. All right. I hope you enjoyed today's episode and I'm must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, chiropractic or any other primary health care provider's advice, treatment or care in the consumption of this podcast. There is no doctor, patient, patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care diagnosis or treatment. In other words, guys, be smart about this. Take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor and these conversations are meant for educational purposes only.