Latest / Radically Genuine / 132. Change your diet, Change your mind w/ Dr. Georgia Ede

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132. Change your diet, Change your mind w/ Dr. Georgia Ede · Radically Genuine

• elcome to the Radically Genuine Podcast. I am Dr. Roger McFillin. Sean, it's become more and more clear that if you follow what is standard, standard American diet, standard health recommendations, standard mental health treatment, standard nutritional guidelines, you will become the standard, which is metabolically sick on multiple pharmaceuticals, unhappy and seeking out more pills. What is yet mainstream? But a burgeoning field based on strong science, and honestly, a lot of common sense, is nutritional psychology and nutritional psychiatry. Where physicians, originally trained as standard psychiatrists, have shifted course with powerful health interventions with extraordinary results. People are waking up to the problems within the allopathic model of healthcare, where new drug after new drug, to manage symptoms without addressing root causes of health. is destroying our culture. And how can it not? Life expectancy is decreasing. Nearly 60% of Americans have at least one chronic illness. 66% are in at least one prescription drug with more than 20% of Americans on at least one psychiatric drug. We are waking up and the Radically Genuine podcast is committed to creating a new standard with conversations that challenge the status quo. as we pull back the curtain revealed decades of industry corruption and financial conflicts that really have eroded our trust in major institutions, which is why I like to have these conversations, especially when it comes to mental well-being. Today, I'd like to introduce Dr. Georgia Ede, an internationally recognized expert in nutritional and metabolic psychiatry. I've been following her for quite some time. Her 25 years of clinical experience include 12 years at Smith College and Harvard University Health Services, where she was the first to offer students nutrition-based approaches as an alternative to psychiatric medication. Dr. Ede co-authored the first inpatient study of the ketogenic diet for treatment resistant mental illness, developed the first medically accredited course in ketogenic diets for mental health practitioners and was Sean (02:24.864) honored to be named the recipient of the Bazooka Brain Research Fund's first annual Metabolic Mind Award. Her new book, Change Your Diet, Change Your Mind was released on January 30th, 2024. Dr. Georgia Eade, thank you for coming on to the radically genuine podcast. Dr. Georgia Ede (02:46.942) Thank you very much for having me, Dr. Roger MacMillan. Sean (02:50.464) Well, let's start with this. I am interested in first why you originally chose to become a psychiatrist and what were you exposed to as kind of conventional psychiatry education? Dr. Georgia Ede (03:04.722) So why did I originally become, I wanted to become a psychiatrist. I actually was very torn. In medical school, I was torn between two, it's maybe surprising to some people perhaps, torn between two very, very different specialties of medicine, to the extent that I actually took a year off to try to figure out which direction to go. And they were psychiatry and pathology. And pathology is almost the opposite of psychiatry in every way you can imagine. Psychiatrists spend their time talking to people and much of what they do is not really grounded in measurement-based science. Whereas pathologists spend most of their time not talking to people. You're looking at pieces of tissue under the microscope and that sort of thing. And so I think really what that was about was my struggling to figure out how I could... how I could satisfy two things I'm really interested in. One is the brain and people, and the other is science and objective ways of understanding the brain. And so I ultimately did decide to go into psychiatry because I really didn't think that I could enjoy work if I wasn't working with patients, working with people, and you probably can relate to that. And so, but I was hoping that... by studying psychiatry, I would learn something about the brain, that I would learn something about how the brain works, about where emotions come from, why do we think and feel the way we do. It was a big mystery to me. And unfortunately, even after four years of psychiatry residency, it remained a mystery to me because so little of what we were taught had to do with the brain. It was largely about psychotherapy, which is a very valuable skill that I still use, and medications. which I also still use in my practice, but less and less so. So I ultimately had to sort of find my own path in psychiatry after I'd practiced for a while. Dr. Georgia Ede (05:15.41) so that now I think all the time about how the brain works, brain chemistry, where brain chemicals come from, brain metabolism, where brain energy comes from. And that's a very satisfying way of working that sort of satisfies both sides of my personality. So. Sean (05:33.516) wondering if you were exposed to what I have been exposed to in my career that if I followed kind of the standard treatments within my field so that would be some psychiatric medication and cognitive behavioral therapy and I am board certified in behavioral and cognitive psychology I unfortunately what I experienced was that professional patients were being created that we weren't necessarily making the changes that were going to lead to long-term So what was your exposure within standard treatments, conventional psychiatry, and tell me why you reversed course or how you took the steps to be able to educate yourself and learn about these new innovative treatments. Dr. Georgia Ede (06:20.666) Yeah, so as much as I loved my work, it was painfully obvious to me after, I don't know, five, 10 years, that most of my patients, no matter how hard I worked, no matter which medications I tried, no matter how many conferences I went to, most of my patients simply weren't getting that much better. And... And this was not just true in my practice. You might think, well, you know, I was an early career psychiatrist. Maybe I just didn't have enough skill, you know, to be able to help people. But it was true for all of my colleagues and some of my colleagues and mentors who had been in practice for decades. It was just, we were taught to think of mental illnesses as chronic and mysterious and incurable. And my job really became writing refills and trial and error medications, trying to help people with depression, anxiety, and so on. illness is improved without any real tools to understand what was causing those problems. I mean, no blood tests, no genetic tests. You know, even in 2024, there are no reliable ways for us to test people for these chemical imbalances that we're told cause mental health disorders. So, and there's no reliable way for me to predict what medication is going to be the best one for me to prescribe for you. So, it, we really, were practicing in the dark and people were not getting that much better. So that was heartbreaking and frustrating for both for me and for all of the people who came to see me for care. So I wouldn't have changed course if it hadn't been for my own health concerns that kind of woke me up to the fact that most of what we're told about nutrition is incorrect. Dr. Georgia Ede (08:22.406) and that the brain cares a great deal about what we eat. And it was just never a topic of conversation in medical school or residency. We didn't talk about food in the brain once. So it really was. I wouldn't have changed course unless I had started thinking about these things for my own selfish purposes. Sean (08:45.176) Yeah, I mean, that's insane for me to consider in a medical education system that you would not be exposed to nutrition and food as medicine, given how important our diet and lifestyle is in maintaining our health. I just wanna get your thoughts on why that is. Why do you think the medical curriculum is the way it is and why you would not be exposed to such critical information around health when you're going to be in this. powerful and important position as a physician. Dr. Georgia Ede (09:17.81) Ah, well, nobody gets rich telling people what not to eat. I think that's thing number one. I'm living proof of that. And so that's thing number one. Thing number two is, I think that, and I was guilty of this myself. As a medical student, as an aspiring medical student, and then as a medical student, I sort of thought of the definition of being a real doctor, sort of was gonna separate me from people who are doing other kinds of care-oriented work, that. the ability to write prescriptions and do procedures was going to be what separated me from other types of practitioners. And there's a certain arrogance and status that goes along with that. And that I think a lot of people seek and I'm sure that I was one of them. I mean, to some extent anyway. But I think, so I think there was no profit motive in teaching nutrition, but also there was no curiosity about it. And I think that's really... Dr. Georgia Ede (10:23.27) Medical school, and I hope this is starting to change, wasn't really about understanding healthy bodies and how to keep them healthy. It was about... when something goes wrong, we're going to figure out the most interesting way to try to fix it. And it's either going to be some fascinating chemical, some molecule that someone has devised in a laboratory that only you have the power to prescribe, or it's gonna be some fancy surgical procedure that costs tens of thousands of dollars that only you are going to be allowed to perform. So there was this sort of exceptionalism that comes along with medical school. It's not really that, I think a lot of medical students and physicians would think of nutrition as beneath them. Just not interesting, just not sexy or scientific enough or, boy, you don't really need any special kind of certification to talk to people about food, right? So. So why would I need $160,000 degree to do it? So lots of things, lots of pieces there. But the other piece is just, I think the, you know, we did, when I look back on it, we actually spent a good deal of time talking about the chemical pathways, the biochemical pathways that... that we use, that the brain uses to make neurotransmitters, that the brain uses to generate energy, that the brain uses to protect itself. We talked about all of those things, but. Dr. Georgia Ede (12:00.194) isolate, but in sort of separated out from everything else. So for example, anybody who's even had a biology class in high school or college will know that there are these pathways like the Krebs cycle, sometimes called the TCA cycle, the citric acid cycle, or there's the electron transport chain inside mitochondria, or there are these different pathways that we memorized. spent hours and hours memorizing that we never connected to food. We never connected to the diet. We never put it all together in the context of a healthy human being. I'm not even sure now why we learned about it. I wasn't sure why we needed to learn about it, but now I use it every day in my work because cellular metabolism and keeping cellular metabolism healthy is the foundation of total health. So, but we weren't taught that. I'm not really sure why we were learning about these pathways at the time, just part of the curriculum, which was divorced from everyday experience. Sean (13:00.336) Mm. Sean (13:08.548) It's a fascinating perspective to assume that a physician would see nutrition as beneath them, because I read Dr. Palmer's book Brain Energy, I read your book, to me that there's a, you know, there's a complex science that drives a lot of the work that you're doing that most people aren't aware of, we'll get into some of that today. And with most of psychiatric drugs being prescribed by general practitioners, they at least have the ability to run various tests and to be investigative in being able to identify underlying pathways that are leading to poor health and then recommend specific interventions. However, it seems to me that the field is corrupt. I mean, how else would one... When you go and see your cardiologist or when you go see your GP and they're prescribing a heart healthy diet and in that heart healthy diet, they are recommending food choices that from what I understand and from what I've learned and what I think you would advocate for are actually going to make them sick. So let's just open it up to what you've learned. And I think it intersects with understanding industrial kind of corruption of scientific research and their influence on mainstream doctors. So what are you learning? And this education, how is it now informing your own treatment of... typical presenting mental health presentations, which anxiety and depression, mood-related problems I think are what is most common as far as presentations. But there's also some more severe mental illness that are also being targeted with some of this understanding. Let's open it up to what you have learned and how you're applying it. Dr. Georgia Ede (14:58.834) Well, you know, for many years I was taught that mental health problems had psychosocial roots and biological roots. So I was taught to, you know, psychosocial roots, things like, you know, stress and trauma and your mother, you know, and I was taught to address those problems with psychotherapy. And I had very good training in psychotherapy in my program as it happens. It was one of the programs that emphasizes psychotherapy more than many others do. And I was taught that mental health problems also have biological root causes, chemical imbalances, genetic vulnerabilities that could lead to mental illness. If it runs in your family, if you're under a certain amount of stress or something that sort of wakes up this vulnerability and... and then I was taught to address those with medications. But I wasn't taught to think about what causes those chemical imbalances in the first place or whether there was anything else people could do biologically to address them. And so that was very unsatisfying. And of course the medications fail most people. I mean, they do have their place. We still need them for emergency situations. They can be in certain cases, life-saving. So I've definitely seen them help people. But most people honestly do not respond very well to medications. And so what I thankfully came to understand after years of studying it for my own purposes, I came to understand that the most powerful way to change brain chemistry, though medications can change brain chemistry, the most powerful way to change your brain chemistry is with food because that's where brain chemicals come from in the first place. That's where every element of the brain comes from, every molecule, every cell, every membrane. And so what I came to understand was that... Dr. Georgia Ede (17:12.854) mental health problems are largely, not entirely, but largely, sort of very, very strongly influenced by environment and not just environment writ large because we know we are taught for, we've been taught for a long time that certain elements of the environment, things like stress and the quality of your relationships and things like exercise and things like that can influence your brain, but food. And the way we eat, it turns out, and I just really enjoyed discovering this because it's such an empowering thought, is that so many of the actual root causes of mental health problems, which we now understand really over the past 10 or 15 years has become very clear, the root causes aren't necessarily chemical imbalances. I mean, chemical imbalances play a role, but... if you go deeper to sort of what might cause those chemicals to become a balance in the first place, are inflammation of the brain, oxidative stress, which is... why we're told we're supposed to eat lots of antioxidant rich foods, and insulin resistance or pre-diabetes, you know, sort of high blood sugar and insulin levels. All of these, you need to look no further than the modern diet to find ingredients that directly and powerfully promote those three. root causes not just of mental health problems, but of just about every physical and mental health problem we fear and face as a society. So why not start there? Sean (18:54.836) Yeah, such a good point. And the problem that exists is there's so much misconceptions about food, that people don't know what to believe anymore. And this is the challenge of me in clinical practice. So if I'm working with someone who might be anorexic, or bulimic, and I do believe in the power of the diet to restore health, many of them are actually believing the foods that they are eating are healthy. And that could be like eating oatmeal in the morning and eating a lot of foods that are like fruits and vegetables and so forth, which they're told healthy grains. And I'm noticing that there's like this blood sugar roller coaster that they're going on and it's potentially predicting a later binge and a purge. And it's never discussed in those terms. The idea of incorporating more red meat, high protein, is something that they're scared of, obviously, because for decades, there's been conditioning about those type of foods as contributing to cancer and heart disease and a number of things, especially weight gain if you're involved with an eating disorder. So what are some of those misconceptions about, you know, these quote unquote brain foods that we've been told and how are you then making changes with your patients? Dr. Georgia Ede (20:15.442) Yes, and the reason I wrote the book is because if you have the right information about food, which most people do not, if you have the right information about food, changing your diet can be a powerful intervention, therapeutic intervention, even for very serious chronic mental illnesses. Even for people who have been... struggling with schizophrenia or with bipolar disorder for decades, who have tried every medication under the sun, even for people in those situations, with the right information, you can see in some cases dramatic improvement in symptoms, and sometimes even full remission, complete recovery from these conditions. Dr. Georgia Ede (21:08.914) For example, the ketogenic diet, which is one of the cornerstone of my practice, I use many different types of diets in my work. But the ketogenic diet is a particularly powerful intervention and is the one that has so much science behind it and mounting evidence in terms of published evidence, in terms of its potential, its ability to heal people in ways that no medication can. So, but if I'm going to recommend a ketogenic diet to somebody, I'm going to have to then deal with the 10 to 20 questions that follow. Well... okay, this is a high fat diet, isn't fat bad for me? This diet doesn't have any whole grains in it. Isn't that going to be bad for my digestive system? This diet doesn't contain the full rainbow of fruits and vegetables. Am I going to get cancer? I mean, this diet, the foods that are easiest to incorporate in this diet and most nutritious are the animal foods, things like meat and seafood and poultry. Aren't I supposed to be leaning in a more plant-based direction? All of these myths about nutrition, which are so ingrained in our psyche over decades, stand in the way of people being able to readily accept these diets, not just people, but the clinicians that take care of them or are trying to help them. stand in the way of people's good mental health. Because when you eat the wrong way, the brain will not work properly. You know, so if you were, I was thinking about this the other day, it's a koala, right, that eats eucalyptus all day. If you change the diet of a koala, instead of eating eucalyptus, say you're going to eat dandelions for the next 10 years, I'm sure that koala would not thrive. Dr. Georgia Ede (23:00.634) And perhaps the call may even come down with severe depression or anxiety. I don't know what happened to the call, but something bad is going to happen because, because your body cares very much about, about getting its needs met. If you're not eating the right way, then you cannot expect to function. You cannot expect optimal function. In fact, it would be strange to expect yourself to function optimally. if you're not feeding yourself optimally. Sean (23:31.76) So, Dr. Eade, you said the most powerful way to change brain chemistry is with food. How would the average person who may say, like, I feel okay, but maybe I don't feel optimal, like, how do we know if maybe our brain isn't functioning 100% because of inflammation or just oxidative stress? Like, we may not be schizophrenic, but maybe we can improve. Like, what are some of the other indicators of that? Dr. Georgia Ede (23:57.17) Yeah, I love this question, Sean, because most people are walking around with sub optimal mental health without really realizing it. We've come to expect, we've come to expect very little of ourselves and we've come to expect our brains and bodies to deteriorate over time, that that's just supposed to be normal. We expect to crumble under stress and perhaps never recover again, if we go through a trauma or a serious loss, which, which most of us face significant stresses and losses throughout our lifetimes. That's part of the human experience. But so resilience, right? So what are the markers of good mental health, robust mental health? Resilience, the ability to tolerate stress and tolerate frustration without falling apart. the ability to recover from stress and serious losses, the ability to navigate challenges and even embrace them in certain cases, the ability to navigate relationships without overreacting to criticism or to disappointment, just sort of a robust internal stability. You know, having enough energy to get through the day, mental energy, being able to get things done, being effective in your life, accomplishing what you set out to accomplish, feeling, you know, and I think a thing that, there's a phrase now that's used so often that we think of it as normal, it's brain fog. You know, so a lot of people say, well, you know, it's brain fog. Well, what is that? Sean (25:33.786) Mm-hmm. Dr. Georgia Ede (25:38.618) And I've been asked in numerous podcasts, like what causes brain fog? Well, you know, we don't formally study brain fog. It's not an official diagnosis, but it's a real thing that most people are experiencing at least on some semi-regular basis. Well, if the brain is inflamed, perhaps it can't work as well. If the brain is under constant attack from oxygen-free radicals, from excessive oxidative stress, from eating the wrong way, from eating... Too many refined carbohydrates and vegetable oils and things like this that attack the brain from within. Maybe then the brain's not going to think clearly. Insulin resistance, pre-diabetes, which is now rampant. It's pandemic level around the world. More than half, depending on which study you look at. anywhere between 52% and 93% of us have at least some degree of insulin resistance or what's sometimes called pre-diabetes. The problem with insulin resistance, I like to tell my patients, if you have pre-diabetes or diabetes, you don't just have a blood sugar problem, you have a brain sugar problem because the more insulin resistant you are and the longer you've been insulin resistant, the harder it becomes for your brain to turn glucose or blood sugar into energy. Sean (27:00.452) Doc, you bring up insulin resistance. Can you define that for our audience? And how do you determine if you'd be insulin resistant? So there's certain biomarkers that can be identified with a healthcare professional. Dr. Georgia Ede (27:13.934) Yes, so this is, I'm so glad you asked this because I can give your listeners right now the tools that they need to test themselves for insulin resistance. And it's actually very easy to do. Some of these you can do at home without ever seeing a health practitioner, so they don't cost you anything. And others are very inexpensive, readily available blood tests that might cost you $10 or $20. And so very simple. So right now, the way it is right now, if you go, let's say you go to your doctor for your annual physical and for them to evaluate your metabolic health. what they will usually do is they will test a fasting blood glucose or fasting blood sugar. And that's your blood sugar level after you've not eaten for at least 12 hours overnight. So it's of course going to be at its lowest point. And then they're going to test you your hemoglobin A1C. So hemoglobin A1C is just a measure of, it sort of gives you an average of your blood sugar over the past three months. So if your hemoglobin A1c is too high or your fasting blood glucose is too high, they're gonna say, oh, you have a problem. You're either on your way to diabetes, you're already there, and you may need to take medication or you may need to exercise or change your diet. But these tests are really excellent at detecting type 2 diabetes once it already has developed. The type 2 diabetes develops over, it can take up to 20 years for type 2 diabetes to develop. what's happening over that 20 year time span is, yeah, your fasting glucose is gonna stay nice and normal, but what's keeping it normal is increasing levels of insulin that your body is having to pump out to manage all of that excess glucose that's coming into the diet. So you don't wanna know what your blood sugar is first thing in the morning. Dr. Georgia Ede (29:12.53) when it's at its lowest anyway. You wanna know how much insulin is your body needing to produce to keep your blood sugar in a normal range until it can't do it anymore. So that's called pre-diabetes or insulin resistance. So lots of names for it. So we wanna know what your fasting insulin level is. How high is your insulin when you wake up in the morning? And the reason why is because when your insulin level is running too high, The body will naturally, cells throughout the brain and body naturally will try to protect themselves from being overstimulated, bombarded by too much insulin, insulin is a hormone. All cells will protect themselves when hormone levels are too high. They will tone down their response to that hormone. That's called insulin resistance. So insulin is trying to send messages to cells, really important messages to cells, and the cells are going, you know, enough, you've been kind of screaming at me all day long, I just need to tune you out a little bit so that I can take a break. That's insulin resistance. And so the higher your insulin levels run, over the course of your life, the more insulin resistant you'll become. And that's not good because cells need to be able to pay attention to and respond to insulin's messages. It's not just about regulating blood sugar. Insulin is not just a blood sugar regulating hormone, which is what I was taught in medical school. Insulin is a master metabolic hormone. It's a master growth hormone. It is controlling, is regulating, orchestrating the metabolism of every cell in the brain and body. And so if cells can't respond properly to it, cells will not work properly. So this is a very, very serious problem. Sean (31:05.252) Sean, you mentioned before that, you know, you, how do people know? Like let's say that they don't have bipolar disorder, they don't have schizophrenia. Or even with Dr. Ken Berry, because he was on talking about the carnivore diet. And I said, hey, you know, I feel fine. I eat whole foods, I have vegetables, I eat some rice, and I feel great. Like my brother and I, we have the same parents, like why are we different? And he said, You don't know you don't feel great. Go on a carnivore diet for 30 days. Just see how you feel. Cut out all the other junk and just focus on something and see how your body adjusts. I just feel like we've normalized sickness to a degree. So on Saturday night, I went to a friend's house and for the first time in a real long time, I had lasagna. And with that, I had some wine and there was dessert. There was like a piece of cake. Dr. Georgia Ede (31:52.097) I'm sorry. Sean (31:58.848) And I'm still recovering from that. Like the next day, which was yesterday, my body ached. I felt stiff and a little bit fatigued. And growing up, our father probably would have said, this is what happens when you get old. Yeah. So what is actually happening to my body, Georgia, whether I felt that way yesterday, I'm just recovering today. I mean, I had liver today. I had eggs. Dr. Georgia Ede (32:01.194) Hahaha. Dr. Georgia Ede (32:27.734) I'm going to go to bed. Sean (32:28.06) and I had some avocados and I'm going just full keto diet for definitely the rest of the week. But what's happening in my body yesterday that it had this profound impact on me. Dr. Georgia Ede (32:39.034) Yeah, so it really is, I mean, so many of the things you just pointed to are about inflammation, right? So you felt physically uncomfortable, you know, achy and fatigued. And so these are, there are many different signs of inflammation, but pain and fatigue and difficulty concentrating, sometimes even depression, these are some of the hallmarks of inflammation. And so a lot of people feel sleepy and achy after they eat the wrong way. And it's been shown in a number of elegant studies that when your blood sugar and insulin levels rise too high, then that can trigger cascade waves of inflammation and oxidative stress throughout the brain and body. So for example, so lasagna is a complicated food because not only is it high in refined carbohydrates because it's made of flour, but it also contains wheat. And wheat is a really common culprit for a lot of people. And it's one of those, it can cause a lot of inflammation in the digestive tract and throughout the rest of the body. But since most people eat it every day, and they've been eating it every day since they were really young. they don't necessarily connect that food to how they feel. So they just think, oh, I have chronic pain or I have fibromyalgia or I have chronic fatigue or I just, this runs in my family, whatever it is. Unless you do those experiments, like you were just saying, you don't know how much better you can feel until you eat properly. So if you want to, if there's somebody listening who's trying to figure out, well, Dr. Georgia Ede (34:27.884) have too much carbohydrate in it for me for my personal metabolism? How do I know? You know, if I need to change my diet in terms of insulin resistance, high glucose, high insulin levels, there are lots of simple things you can do now to figure this out for yourself. So you could wear, for example, a continuous glucose monitor, and those are going to be available over the counter in the United States this summer. Thank goodness, without a prescription. You could go to your doctor, you could order online a fasting insulin level, and if it's higher than single digits, then you have some degree of insulin resistance, you could look back at a previous cholesterol panel you had done or get a new one done. They're very inexpensive and most insurances will cover these, and look at your triglyceride level and see are my triglycerides over 100 milligrams per deciliter, that's a sign you're eating too much carbohydrate for your metabolism. You can measure your waist circumference around your belly and if your waist circumference is more than half your height then you very likely have insulin resistance. So there are lots of things you can do to assess yourself and the more of these things that are out of the normal range, the greater the degree of insulin resistance that you have. But the good news is you can turn these numbers around within a matter of weeks by changing your diet. Your metabolism will respond robustly and quite gratefully. If you feed yourself properly, you can bring your blood sugar down within days, your triglycerides down within weeks. It is amazing what you can see when you have the right information. Sean (36:01.54) So you co-authored the first inpatient study for the ketogenic diet for the treatment of what's called treatment resistant mental illness. So, you know, I have a issue with that because often the treatments themselves are harmful. What were your insights from that study? Dr. Georgia Ede (36:21.566) This study that I helped to publish, the work was, the clinical work was done by my friend and colleague, Dr. Albert Dana. He's a psychiatrist, has been practicing psychiatry in Toulouse, France for more than 35 years now. And he, after witnessing a member of his extended family, improved within a number of weeks on a ketogenic diet in terms of both epilepsy, seizures and autism symptoms. He thought, well, maybe this diet seems to be good for the brain. Maybe this diet could help some of my patients who, no matter what I've tried over the years, they haven't gotten better. So that's what is meant by treatment resistance. But I agree with you. I don't like the term because... it implies that we're giving people effective treatments and that they're failing them. But these treatments are by and large not very effective. And so it's really, it's not the conditions fault and it's not the patient's fault that they're not getting better. In any case, he invited 31 of his patients who weren't getting better over many years. These were people with schizophrenia, bipolar disorder and severe major depression. These were patients who had been ill for an average of 10 years, some as long as 30 years, most of them under the care of this very same psychiatrist that entire time. And these were patients who were taking an average of five psychiatric medications at the time that they came into the hospital. And that's not at all, as you know, not at all unusual in chronic mental illness. And so these were people who... were ready, willing, and able, and eager to try something new because nothing had worked for them. And these people had been in the hospital before, often multiple times in this very same hospital. So he invited them to come into the hospital to try a mildly ketogenic diet, Whole Foods ketogenic diet prepared by the hospital staff to see if it would help them. And 28 of those 31 people, Dr. Georgia Ede (38:37.062) were able to stay on the diet for two weeks or longer, which is what you need to do to start to see response, and all 28 of those patients improved. All 28 of them substantially, and 43 percent of them achieved clinical remission. 64 percent of them left the hospital taking less psychiatric medication than when they came in. And so this was, and also all of their metabolic, their markers of metabolic health improved, triglycerides, fasting, blood sugar, weight. All but I think one of these patients, almost every one of these patients was taking at least one antipsychotic medication. Your medications like Cyprexa and Risperdal and Syruqual, the medicines that are notorious for causing significant metabolic dysfunction, high blood sugar levels, type two diabetes, obesity. high triglycerides, and even though they were still taking those medications while they were following the ketogenic diet, all those metabolic markers improved, including a significant amount of weight loss. And so it's almost impossible, as I'm sure you know, to lose weight if you're taking an antipsychotic medication. So this is a really powerful intervention. We're not talking instead of medication, we're talking in addition to medication, even those people were taking medications that in some, in metabolically working against them. You added this really simple ketogenic diet, whole foods ketogenic diet to their plan, and they were able to tolerate and feel better and be healthier on their medication. So it's not always about replacing medication, because I know some people are worried about my saying that. necessarily have to, it doesn't have to be an either or. You can use these two strategies together if you choose to do that. So this was, you know, the first, this was the first time this had ever been shown in a hospital setting. And these, I mean, I really think that what's so remarkable about the work that he did is that it offers tremendous hope to everyone. Dr. Georgia Ede (40:53.194) who has been diagnosed with a so-called serious chronic mental illness and who has been told that, you know, this is, you're gonna have this for the rest of your life. And the only answer is to take medication for the rest of your life. So even people who've been ill for many, many years were able to achieve remission. And that's, as you know, we do not see results like that in conventional inpatient psychiatric care. Sean (41:23.18) Dr. Ede, um, we started off this conversation talking about how there's very little money that could be made with nutritional intervention. So I'm curious when it comes to these clinical studies, who's funding the research. Dr. Georgia Ede (41:34.95) Yeah, so that has changed quite a bit in the past several years, because it had been historically extremely difficult to get funding for studies like this, and now it's become much easier, thanks in no small part to the Bazooka Brain Research Fund. And that's a philanthropic organization, a wonderful philanthropic organization, which was founded by Jan Ellison Bazooki and her husband David Bazooki. And the reason why they were inspired to launch this organization was because their own son, Matt Bazooki had his college studies interrupted by serious mental illness, bipolar disorder with psychotic features, intermittently on the streets, intermittently disconnected from his parents. and very, very ill. And he had tried, I can't remember exactly how many, I think 29 different medications. He'd been out of the hospital. His parents, of course, had all the resources you could want. And he saw every specialist, tried every treatment. The only thing that helped him completely recover, completely recover, now I think it's about three years now. from this very serious mental illness, which would have surely otherwise led to either homelessness or death, was the ketogenic diet. Sean (43:02.084) Wow. Um, you know, I'm sorry, I do remember you did bring up that name. Maybe I just overheard it very quickly. Are you excited about any other clinical studies that are maybe currently undergoing right now or nutritional interventions are the primary intervention being used? Dr. Georgia Ede (43:19.886) Yes, so there are now studies having been launched around the world across a wide variety of psychiatric conditions, everything from major depression, anxiety disorders, PTSD, ADHD, bipolar disorder, schizophrenia, really, oh, even weight restored anorexia. So people who are still suffering with eating disorder thinking. There's Dr. Guido Franck at the University of California, San Diego, who is launching a study to look at the ketogenic diet in terms of its potential to be able to be helpful in those conditions because there have been a number of case reports that have been published showing that can be useful. So really just about any psychiatric condition you can imagine, we're starting to look at in the scientific research, and there were two beautiful studies just published in the past few months. bipolar disorder and schizophrenia. So if your listeners are not already aware of the work of Dr. Ian Campbell, he is a remarkable scientist and human being who put his own bipolar disorder into full sustained remission more than seven years ago on a ketogenic diet. In fact, he had started the Anakans diet to try to lose weight, simply to try to lose weight. And three days later, his bipolar depression disappeared. And he thought, that's interesting. And so he went back to school to become a scientist. And now he's one of the world's leading researchers in this field. And he published a study, a pilot study just a few months ago, where he asked people with bipolar disorder if they would follow a ketogenic diet. This was really to figure out whether or not people with serious mental illnesses like bipolar disorder could even follow this diet. Could they follow the diet? Could they measure their ketones? And what would happen? Would it be safe for them to do so? And they passed with flying colors. So they were easily able to, I don't know about easily, but they were able to reliably maintain excellent ketone levels and measure their ketones every day. And not only that, but the higher their ketone levels were, the better they felt. Dr. Georgia Ede (45:35.91) in terms of their mood, their energy, their irritability, and so forth. And so that was a wonderful pilot study. He's now looking at doing a randomized control trial. And then Dr. Shabani Sethi at Stanford University, just last week, published a pilot study of the ketogenic diet, four month study, ketogenic diet for people with bipolar disorder and schizophrenia. And the people who were most adherent to the diet, 100% of them improved, meaning clinically meaningful improvement in their symptoms. And across the board, whether they were adherent or semi-adherent to the diet, 79% of them, clinically meaningful improvement in their symptoms. So it's a really powerful and hopeful intervention. Sean (46:25.792) This is fascinating science. Everyone who comes on to our podcast, who's an expert in terms of nutrition, I always ask the same question, like, I want to know, is there such thing as an optimal human diet? And I look for like, really clear recommendations if we were going to be perfect in the way we were eating. And I'm gonna ask you that same question. I'm gonna ask you the same question. But first, I want to know, like what are common nutrient deficiencies? Because I think this leads us into this question, too, because we have to target those nutrient deficiencies with the right foods. Dr. Georgia Ede (46:43.386) I'm not sure. Sean (46:54.948) But what are the most common nutrient deficiencies that you're seeing in clinical practice? And then how do they present themselves with psychiatric symptoms? Dr. Georgia Ede (47:02.534) Yeah, so this is a great question because nutrient deficiencies are quite common, which is strange, right? Because we have all the food, at least in the United States, we've got all the food in the world, right? We've got, we have access to every kind of fruit and vegetable all year round. We have access to all kinds of animal foods. We have, you know, we're surrounded by food. And yet we are, many of us, nutrient deficient. And one of the best examples of a nutrient deficiency that should not exist, but yet we take for granted as normal, especially among women of reproductive age, is iron deficiency. So iron deficiency, 20% of women worldwide have iron deficiency. And we think of this as normal. We think of the, well, of course women will have iron deficiency because, you know, they have menstrual cycles. Well, no, who would design a species to become nutrient deficient? I mean, that doesn't make any sense at all. And what's actually happening is that we have the wrong information about nutrition. And so we need to know which foods contain iron, and which women need to eat more of, and which foods interfere with our ability to absorb iron and actually rob our bodies of iron. And so, and this is a perfect example of how the standard dietary guidelines not just fail us in terms of like they're not being useful, but they actually harm us. And so the foods that are rich, it's an iron surprise, things like red meat and shellfish and, uh, you know, uh, even, even duck and that sort of darker poultry meats. Um, the animal foods are where, are we're not talking about dairy or eggs. Unfortunately, they're actually very poor sources of iron. We're talking about meat, seafood and poultry, richest sources of iron, bioavailable iron. So. Dr. Georgia Ede (49:03.834) Women are told, oh, you shouldn't eat much red meat. You should just eat giant salads. You should eat grains and beans all day long, grains and nuts and seeds. The problem with the Mediterranean diet pyramid or the dietary recommendations, the foundation of our dietary guidelines, we've seen it, everybody can picture this, right? That pyramid, that grain heavy triangle that's full of beans and rice and pasta and bread and whole grains. those foods, that foundation of the diet, it's not just that they have too much carbohydrate in them because some people do quite well with a certain amount of carbohydrate in the diet. Others don't, those of us with insulin resistance no longer do. But if you've got a healthy metabolism, you may be able to handle a decent amount of carbohydrate. It's not just that they're just essentially sources of starch, they're really low in nutrients, so low in nutrients that when you buy a cereal product or a bag of flour or a box of pasta, they have to add, they're fortified, they're fortified with nutrients because they don't contain enough on their own to be worth eating. And so A, they're very nutrient poor and B, they're loaded with, naturally loaded because the plants are designed this way. Uh, to plants are designed, especially the grains, beans, nuts, and seeds to guard those, uh, nutrients such as iron for themselves. So they contain molecules like phytic acid, which a very powerful mineral magnet that doesn't just hold on to the minerals, um, you know, interfere with your ability to absorb the minerals from those foods, but also interfere with your ability to absorb minerals from foods you've eaten along with those foods. Sean (50:53.241) Mm-hmm. Dr. Georgia Ede (50:53.698) So, and this is not widely known. So I think that, you know, just because a plant food, the label on a plant food says it contains iron doesn't necessarily mean you can access it. And I think this is, there's so much, there's so much wrong with our nutrition advice. But this, so iron deficiency, you asked, okay, well, what's that going to cause in clinical practice? We think of iron deficiency as a blood problem. But similar to the blood sugar issue we were talking about before, if you have iron deficiency, you don't just have a blood problem, you have a brain problem because iron is critical to a brain's ability to generate energy in the mitochondria, which mitochondria do many things, but one of the things they're famous for is generating energy. You can't do that without iron. You can't build neurotransmitters like dopamine or norepinephrine without iron. And the brain is more sensitive to iron deficiency than the bloodstream is, because the brain uses more iron. So it is really, really important to brain development, as well as maintenance and optimal function of the brain throughout life. Where we really see problems with iron deficiency in terms of how it clinically manifests itself is early in life, and iron deficiency is very, very common in pregnant women and very common in infants and young children. And perhaps no surprise because not eating enough animal foods and eating too many of the wrong plant foods. And so iron deficiency can manifest itself, for example, in problems like attention issues and intellectual capacity. So you'll see lower IQ. You may see more, you're more, maybe more likely to see ADHD. and other forms of developmental problems because iron is critical to brain development during that first thousand days of life. That's just one example of a nutrient and most nutrient deficiencies, most of the common nutrient deficiencies in pregnant women and in the general population are deficiencies of nutrients that are very difficult, if not impossible, to obtain from plant foods. Dr. Georgia Ede (53:11.778) and easiest to obtain from animal foods. Sean (53:16.052) I read a study where I guess about 50% of Americans were magnesium deficient. And additionally, I think everyone's aware of how vitamin D impacts mood. And I think our primary care physicians do a decent job of identifying that and recommending vitamin D supplements. But then one of the things that I'm observing is even though they're taking vitamin D supplements, they're still low vitamin D. So can you address those two issues with? magnesium deficiency and how that may present. And then if someone is low vitamin D taking supplements and their vitamin D is not improving, what's that about? Dr. Georgia Ede (53:55.19) So we'll start with magnesium, and if I forget to say vitamin D, remind me. So we're going to start with magnesium. So magnesium, because sometimes if there's two questions at once, I get very interested in the first one and forget the second one. So magnesium is a mineral, just like iron, it's a mineral. Sean (53:58.864) Okay. Dr. Georgia Ede (54:10.954) extremely important, responsible for hundreds of reactions, critical to hundreds of different types of reactions in our biochemical pathways of ourselves. So metabolically critical. So magnesium, one of the interesting things magnesium does is it buffers the brain against glutamate, something called glutamate excitotoxicity. So... Glutamate is a, for your listeners who aren't familiar, it's a neurotransmitter that's widespread throughout the brain. And it's gotten a lot more attention recently, but when I was in medical school and residency back in the late 90s and early 2000s, I hadn't ever heard of it, except when I started learning about Alzheimer's drugs. But the, so glutamate is a mineral that the brain uses for many things, but one of the things it does is it sits, it literally sits like a little cork. inside of the glutamate receptor. And so glutamate is an excitatory neurotransmitter. You can think of it as the brain's gas pedal. And the level of glutamate, sort of the balance between glutamate and GABA in the brain, GABA is the brain's calming neurotransmitter. It's sort of the brain's gas, a brake pedal, and glutamate is sort of the brain's gas pedal. And so the balance between glutamate and GABA. determines the brain's overall activity level at any given point in time. So what magnesium does is it protects the brain from being overstimulated by glutamate. and it takes a significant amount of glutamate to pop that magnesium out of that spot and allow the glutamate to flow through and excite the cells beyond. So if you if you're deficient in magnesium it's easier for you to for the brain to become overstimulated or dysregulated in terms of its glutamate and GABA balance and this is why so many practitioners and so many individuals find that magnesium has a calming effect. Dr. Georgia Ede (56:08.71) It might help them fall asleep or it might help reduce their anxiety levels. But we want to understand, first of all, why are they magnesium deficient in the first place? And second of all, why are they anxious and why can't they sleep? And what might be causing those glutamate levels to be so... Why is their magnesium so low and why are their glutamate levels so high? There are actually lots of studies going back over decades... showing that quite a few of the mental health conditions that we diagnose are associated with high glutamate levels inside the brain. Bipolar disorder, for example. Glutamate levels are too high. And in Dr. Ian Campbell's pilot study, one of the brilliant and fascinating things that he did was he measured glutamate levels in the brain using magnetic resonance spectroscopy. And he found that on a ketogenic diet, that the glutamate levels, he was able to document the largest ever recorded drop in brain glutamate that's ever been accomplished in a study. So there have been many studies over the years that looked at different kinds of medications and other kinds of interventions for bipolar disorder that have tried to lower glutamate, but no one has ever lowered it as much as this ketogenic diet did in these patients. So this is really cutting edge research and kind of helps people maybe put some of the puzzle pieces together. Everything's connected, you know? So... Yes, you can help yourself feel calmer with magnesium, or yes, but why do you have a magnesium deficiency in the first place? And are your requirements for magnesium artificially high because you're being bombarded with too much glutamate? So magnesium is a mineral that's found in all kinds of foods, but again, that phytic acid, that mineral magnet. Dr. Georgia Ede (58:01.446) affects our ability, strongly affects our ability to absorb magnesium from foods. And phytic acid is found again in the grains, beans, nuts, and seeds and certain other plant foods. It's not found in animal foods. And so again, just one of those other pieces of the puzzle that fits into this nutrition that sort of helps us understand the problem with the nutrition mythology that we're taught. I mean, why do we, do we really need supplements? And you know, I think some people actually do need and benefit from supplements for a variety of important reasons, but most of us shouldn't need supplements. If you're eating properly, you should be able to get the nutrients, the molecules, the components that you need from your food if you know which foods are the right ones to eat. Sean (58:49.016) That was such a good description because I threw magnesium into my smoothie just because I know that it might be a calming thing and maybe helping sleep, but I'd never really understood what I was trying to correct. Um, just so I understand what could cause glutamate levels to be high. Dr. Georgia Ede (59:04.258) Ah, thank you for asking. So eating too much sugar or eating vegetable oil. So refined carbohydrates. So sugar meaning any kind of naked carbohydrate. So, oh, is that your drug of choice? Well, no. Sean (59:07.864) Oh. Sean (59:13.764) So no more pixie sticks for me. He's joking. I'm joking. I would never do that. No, no, no. Well, that makes sense. Okay. Dr. Georgia Ede (59:25.918) Yeah, so refined carbohydrates like sugar, flour, cereals, fruit juices, all the things that kids eat all day long and most adults now too. Sugar flour, all these naked carbohydrates, they turn instantly into glucose, too much glucose in the bloodstream. And so you get this tsunami of glucose molecules that would be unnaturally, it would be impossible to do this to yourself if you're eating whole foods. You get the tsunami of glucose molecules and then you need a tsunami of insulin to deal with it. spike in blood sugar you also get a spike in brain sugar right so and so the higher the blood sugar the higher the brain sugar what's the problem with high brain sugar doesn't the brain love to burn sugar for energy well the brain does need some glucose at all times blood sugar is glucose the brain does need some blood glucose at all times but it doesn't need much and B if you give it too much woe to you because what happens is that excess glucose The brain has no capacity. It doesn't know really what to do with it. It piles up in the brain and literally sticks, sticks to proteins, nucleic acids that make up our DNA, lipids that make the, the member, the fats that make up membranes and myelin and mitochondrial membranes and the blood brain barrier. And it, it cripples them into these, this dysfunctional caramelized clusters that won't work anymore. So you get these are called advanced glycation end products. So these are these sticky dysfunctional clumps. And so when the brain sees these clumps accumulating, it needs to do something about them because if they're allowed to accumulate, they will interfere with cell signaling and you will have a huge problem on your hands. But the brain doesn't take it lying down. It has an immune system and it says, okay, sound the alarm. We're gonna need to deal with these AGEs, these advanced glycation end products. They're also abbreviated AGEs, which is apt because they're known to accelerate the aging process, cause premature aging of tissues throughout the body, including the brain, like the skin. So we had to get rid of these AGEs. So the brain's cells deliberately release inflammatory cytokines and oxygen-free radicals to deliberately create inflammation and oxidative stress. Dr. Georgia Ede (01:01:49.342) because that's step one of the immune response to any kind of threat, whether it's an injury or an infection or too much sugar in the brain. So the brain becomes inflamed and generates oxygen-free radicals as the first step in dealing with these things. Now, and then they're supposed to be cleared away and then there's supposed to be healing phase, right? So everything goes back to normal. But what if you're eating this way, like most people are? six times a day, every meal, every snack, your brain never gets a chance to quiet down. So now what you've got instead of this targeted, controlled, healthy, appropriate inflammation and oxidative stress, you've got chronic, uncontrolled inflammation and oxidative stress. And so what you had asked is, how do we get too much glutamate? When you have too much oxidative stress or too much inflammation, It throws off the balance of this pathway in the brain called the kynurenine pathway that's regulating the balance of all kinds of neurotransmitters, including glutamate. So glutamate is an excitatory neurotransmitter. And so when glutamate responds, it springs into action because what you've got is an emergency on your, you've got a crisis on your hands. So you want to stimulate the brain to deal with this problem. That's what glutamate is trying to do. But you don't want it to be high all the time. If glutamate levels, and you can over-stimulate this pathway to the point that your glutamate levels rise to 100 times their usual baseline. And so now you've got this situation called glutamate excitotoxicity. And too much glutamate is physically damaging to everything in the brain, every structure in the brain. the blood brain barrier, the hippocampus, the mitochondria, DNA molecules, everything, the brain is literally under attack from within. And so that's how your glutamate levels can go up, simply by eating the wrong way. Sean (01:03:49.316) So, um, sorry. Um, you said, uh, the glutamate is kind of like the, the gas pedal. So is it your brain's response is then like it's increased so much and you're excited, is that because the brain wants you to burn off all that sugar so you can bring your levels back down? Is that what it's trying to do? Dr. Georgia Ede (01:03:54.986) Yes. Dr. Georgia Ede (01:04:06.69) That's an interesting question. I never thought about it like that before. I don't think so, but don't quote me on that because I've never looked at it, but I don't think that's what's happening. This pathway, this kynurenine pathway regulates a lot of different things, and it regulates the balance between neurotransmitters in response to its environment. So if you're under psychological stress or physical stress or if you've got an injury or an infection or too much sugar in your brain, all of those, smoking, alcohol, all these things can increase oxidative stress or inflammation in the brain. No matter what the source of the stress, the glutamate level is going to go up, even if it has nothing to do with high glucose levels in the brain. Sean (01:04:49.44) I want to circle back to vitamin D. So I'm assuming that I'm going to know a little bit about your answer that if there are some nutrient deficiencies, that's going to impact how that supplement is metabolized. So those clients who are taking vitamin D supplements and their vitamin D is not improving, what would you recommend? Dr. Georgia Ede (01:05:08.615) Uh-huh. So thank you for reminding me to see. I forgot about vitamin D. I knew I was gonna forget about vitamin D. Okay, so vitamin D is fascinating because it's a hormone and it's a fat-soluble hormone. And we really don't, we don't really need to get it from our diet. We're supposed to get it from the sun. But you know, now we're all scared to be in the sun and we're using sunscreen and hats and covering ourselves. And we've become too sensitive to the sun for lots of interesting reasons. But anyway. Sean (01:05:11.536) Hehehe Dr. Georgia Ede (01:05:36.926) We're supposed to get it from the sun. If you're gonna try to get it from food, you're gonna need to eat animal foods because the type of vitamin D, first of all, there's no vitamin D of any kind in plants. There is a certain type of vitamin D called vitamin D2, which is in the fungi like mushrooms, but those aren't technically plants. And it's the wrong form of vitamin D. It's the less useful form of vitamin D. It's not stored as easily and it's not metabolized as easily as vitamin D3, which you can make from the sun or you can get from animal vats. So vitamin D deficiency is really common. And one of vitamin D's many purposes in the body, it's kind of famous for helping with bone maintenance and helping you absorb calcium and maintaining bone structure. But in the brain, one of its chief responsibilities is to fight inflammation and oxidative stress. And so it's really an antioxidant in the brain. And so if you don't have enough, well, on hold, you could again end up with all kinds of damage as we were talking about before. So it plays very, very important roles in brain development. So... Why are so many people deficient in vitamin D? Two reasons. One is that we're not exposed to enough sun and many of us live in places where the angle of the sun is too weak for a good part of the year that it's not useful to be in the sun. And the second reason is, and we used to think, we used to think that this relationship went one way, but we actually now figure out that it goes the other way. It's a very tight relationship between vitamin D deficiency and insulin resistance. If you have insulin resistance or pre-diabetes, which means your insulin levels are running too high too often because you're eating too many of the wrong carbohydrates too often, if you have insulin resistance, which more than half of us now do, you're much more likely to be vitamin D deficient. So why would that be? So we used to think that vitamin D deficiency caused insulin resistance, but actually it seems to be the other way around. That if you have insulin resistance, it is much harder to convert Dr. Georgia Ede (01:07:48.746) vitamin D into its active form, and it's much harder for receptors to respond to vitamin D properly. So even if you restore people's level of vitamin D to the normal level, it may not be working properly. And this is why I think we often see in studies that vitamin D supplements don't help as much as you should think they would. You can replace someone's vitamin D, but it doesn't necessarily help with their depression or their anxiety or whatever it is you're trying to treat. So because you also have to deal with the metabolic soup that the vitamin D is in and if you're metabolically unhealthy and your pathways aren't working properly and your receptors aren't working properly and you're not able to convert vitamin D to its active form all the vitamin D in the world isn't going to help you. So you have to not just correct the vitamin D deficiency you also have to correct the metabolic dysfunction by changing your diet and there's just no way around it. Sean (01:08:44.8) Yeah, make sense. So I just want to bring something up because I think we had a conversation, it was the biohacking nutrition. And we talked about vitamin D. And on that episode was just Roger and I, I talked about how button mushrooms are something that is being studied for a potential source of dietary vitamin D. And you know, we're in Pennsylvania, so really close to Dr. Georgia Ede (01:09:06.581) Mm-hmm. Sean (01:09:10.048) mushroom country and I just kind of like pulled that out as a random thing and they talked about the way that Mushrooms because they're exposed to sunlight natural light They were processing vitamin D in a way that it could be a diet or dietary supplement So you said that it only could really come from the animal source So from a mushroom standpoint, is that not a valid way of getting your vitamin D? Dr. Georgia Ede (01:09:34.002) You can, it's just not as good. And this is true for lots of nutrients. When you compare really almost any nutrient, there are very few exceptions to this. Almost any nutrient, if you look to an animal food and you will find not only that it's easier in most cases to find that nutrient in the animal food, but it's also the most bioavailable form in many cases of that nutrient. So for example, we talked about iron deficiency before. Sean (01:09:35.907) Okay. Dr. Georgia Ede (01:10:03.082) there are two kinds of iron in the world. There's heme iron and non-heme iron. And, you know, animal foods contain a mixture of heme iron and non-heme iron, but plants only contain non-heme iron, which is much harder for us to absorb and utilize. So... Again, just because a plant contains a nutrient doesn't necessarily mean you're going to have full access to it. So it's suboptimal to get your vitamin D from food in general. I mean, it's better to get from the sun. But it's suboptimal to get vitamin D2 is inferior to vitamin D3. So vitamin D in terms of how we absorb and utilize it and store it. Non-absorb, we absorb them both well. But So vitamin D2 from mushrooms is not going to be quite as good as vitamin D3 from animal foods. Sean (01:10:48.336) Okay. All right, Doc, I know that you're respectful of people's ethics and beliefs. So I know that just reading your book that you do advocate to, you know, regardless of what a person's lifestyle is, you're trying to help them make improvements where they can. But I'm going to try to nail you down on the optimal human diet. So if you have a very motivated patient who has a history of mood dysregulation and mental health conditions, and they are just looking to to do and adhere to whatever you tell them that would be optimal. What foods are you recommending that they ingest and how would you support the manner in which they eat those foods as far as like time restricted feeding or things of that nature? Dr. Georgia Ede (01:11:36.634) Yeah, so I lay out a path, a roadmap in the book for to answer exactly this question. And I will summarize it for you now for people who won't read the book because I want people to know what this plan needs to look like. So I've got a little picture in the book. It almost looks like a planet, you know, it's got a core and then it's got, you know, rings around the edge, so maybe layers of an onion or however you want to describe it. And so the core of the diet needs to be, again, optimal. So as you hinted, I'm nutritionally pro-choice. So I want people to feel good about the foods they're eating and to feel that they can kind of square that, square their diet with their emotions and their ethics and their goals. Right? So I will help anybody regardless of you know what their diet of choice is to make that diet as healthy as possible for their metabolic health and their mental health. And so there are lots of things people can do if they choose not to eat animal foods. There are lots of other changes they can make to their diet without adding animal foods that will help tremendously in improving their brain health. But if you're seeking optimal brain health, meaning fully and adequately and easily nourishing your brain with all essential nutrients, protecting the brain from damaging ingredients, and energizing the brain safely in ways that will support healthy brain metabolism over the lifespan, if that's what you want, if optimal brain health is what you seek, the core of the diet needs to be, in my opinion, non-dairy animal foods. And then the next layer, when you move outside of that core, are the fruits and vegetables that you tolerate in terms of your food sensitivities and your digestion, but more importantly, your carbohydrate tolerance. So some people are going to be able to enjoy and tolerate safely a wide variety of fruits and vegetables, including the starchy vegetables like potatoes and the very sweet tropical fruits. So... Dr. Georgia Ede (01:13:53.63) But for those of us with insulin resistance, we may need to cut back even on the amount of fruits and starchy vegetables that we eat, even those are the healthiest sources of carbohydrates, those whole foods. But this is all a matter of your personal metabolic health and they help people show them in the book how they can figure out like where their so-called sweet spot is, their personal sweet spot. So non-dairy animal foods in the middle, outside of that next layer is fruits and vegetables to your personal tolerances and likes and dislikes and metabolic health. And then everything else beyond that becomes risky. So when you move outside that layer, the next layer are really the nuts and dairy products. So nuts and dairy are higher, they're good sources of protein in a lot of cases. So they're nutritious, but they're risky because nuts are really hard to digest, for example, and they have a lot of antinutrients in them because they're technically seeds, so they guard a lot of their nutrients. And then dairy, metabolically pretty complicated food group that can cause a lot of, it's a very, very common culprit in terms of inflammatory syndromes, weight gain, cravings. skin issues, digestive issues, lots of problems there. So the further you go out from that core, the more precarious you get. So again, better than processed dairy, but still, ideally, this is again, you asked me for my opinion. And my opinion is no dairy is best. Sean (01:15:22.104) What about raw dairy? Sean (01:15:36.76) Yeah, I mean, this is the part of the conversation. You know, I've had both you and Carnivore MD, Dr. Ken Berry. Yeah, and he said the same thing, and that's the one part I'm disappointed with because I love Derry. You love Derry, yeah. He just wants to hear somebody tell him and give him permission to do what he wants to do. But this is where I hear mixed, you know, I hear some mixed things on Derry. So I understand the problem with Dr. Georgia Ede (01:15:54.132) hahahaha Dr. Georgia Ede (01:15:58.814) Ha ha ha. Sean (01:16:04.804) pasteurized dairy and what it does to key bacteria. So I'm also focusing on gut health. I tend to handle dairy very well. And the raw dairy gives me these vitamins and really this diversity of bacteria for my gut health and mito microbiome, I'm sorry, that I just, in my research, I thought, ah, this is something that I really need in my life. But then, unfortunately, I have these conversations with some other docs and they disagree. Dr. Georgia Ede (01:16:35.09) Well, there is a really complicated food group, the most complicated food group on the planet. And so one of the things I've done in the book, which I hope people will find useful, is I really try. I try in the book to give people information that they can then use to make their own decisions. So there are chapters in the book that are about the different food groups. So there's a whole chapter on meat. There's a whole chapter on dairy and eggs. There's a whole chapter on fruits and vegetables. There's a whole chapter on greens, beans, nuts, and seeds. And so people can understand, okay, what are these foods actually? And what are the pros and cons of each one of these food groups? Truly, what are they? Not what you hear typically. But What is in these foods that's working for me and against me? What are the risks and benefits of eating these food groups, right? So that people can make their own choices. And in the dairy chapter, I explain that dairy is the most complicated food group on earth because it is a species specific growth formula designed for, you know, I mean, most people are drinking cow dairy and dairy, cow dairy products. So we'll think about cows, but it could be goats or sheep or anything else. It's designed to grow a very tiny baby cow into a much larger cow. And then the cow is supposed to graduate to solid food. Humans same. So we are designed to drink mother's milk for a certain number of years. It's controversial. Two years, three years, four years, whatever. Anyway. early life, then we're supposed to graduate to solid food. Why? Why are we drinking the milk and eating the products of another, the growth formula of another species? And now you can, you can, some people tolerate it better than others. Dr. Georgia Ede (01:18:27.478) And so this and this is why I encourage people to do their own experiments. I encourage everybody Unless you love exactly if you feel absolutely perfect right now, and you don't think anything could possibly any better Maybe you don't want to go down this road But I think it's always worth it to be curious about these things To take it out for a month and see if you notice any difference because most people will notice a difference and how much of a difference will help you figure out, okay, how important is this food group to me? How often do I want to eat it? What are the risks and benefits for me personally? But I've had so many patients who haven't been able to lose weight despite being in ketosis or are struggling with food cravings or have skin issues or digestive problems or aches and pains. I have people in my practice who You know, they, you know, their back is killing them as they're standing up and getting out of bed in the morning. You know, they feel like they're 50 years older than they are. And they take the dairy out and lo and behold, they don't have back pain. They don't have the body of a 90-year-old. They are, they just had inflammation. And dairy is a really, really common cause of inflammation. So... that can have widespread effects on the body. So I really just encourage people to explore and be curious, but I also encourage people to, after they've figured out how foods affect them, to really find the diet that's the broadest diet that they can tolerate, that they can enjoy. safely while maintaining good physical and mental health. For some people that's going to be a much narrower list of foods than for others and so if you tolerate dairy well it makes you happy and it makes it makes you feel like your diet is worth eating and enjoyable. I mean you know you don't want to let the perfect be the enemy of the good right you want you know you don't necessarily uh need to do what's optimal every minute of the day. Dr. Georgia Ede (01:20:34.154) But I think it's important to know how it's affecting you so that you understand that when you are having some, what its effect is on you. And then you can decide how much you wanna eat it. So I think from a biological and evolutionary standpoint, it makes no sense to consume dairy, but that doesn't mean that you can't get away with it. You know what I mean? So, Sean (01:20:56.984) Fair, fair. I have one question. I don't know if you have another one. And I know we're short on time. So I just wanted to ask the role of fasting. And, you know, diet aside, do you think fasting and putting our body into that state for cells to kind of replenish and become new is something we should be incorporating into our lifestyle? Dr. Georgia Ede (01:21:07.519) Oh yeah. Dr. Georgia Ede (01:21:20.114) Yeah, so it depends what you mean by fasting. And so I'm a huge fan of not eating all the time. A huge fan of giving your body a regular break, ideally on a daily basis, a break from food processing. Because, and I explain a lot of this in the book, sort of more of the science behind it, but your body really kind of has two major operating modes. It's got the, okay, we just ate, so let's absorb and process and build and grow in store mode. That's called the post-absorptive state. So you're food processing, right? You're building things, you're growing new cells, you're storing extra energy. Your insulin levels are higher after you've just eaten and insulin is telling your cells, okay, build, grow, store. Then you've got this other operating system, which is, rest, recover, recycle, rejuvenate. And that mode, can only operate when your insulin levels are low. So it's like taking your foot off the metabolic gas pedal, right? So insulin is kind of firing everything up to build and grow in store, take your foot off that insulin and which means eating less or stopping eating, giving yourself a break from food processing. Now you've allowed all these other functions to turn on. healing, repairing, rejuvenating, recycling, this process called autophagy, where you're destroying the old, making way for the new, right? So you're healing and clearing things out. If you don't spend a time on a regular basis in that healing mode, that's your recipe for chronic disease. you're not going to be able to, you know, you've got to clean up every once in a while. Right. And then the other thing is that when you everything you eat, we were talking about inflammation and oxidative stress, inflammation and oxidative stress is normal. It's oxidative stress in particular is a normal part of food processing. So there's no biological way to turn food into energy without creating some oxidative stress. Sean (01:23:09.68) Mm-hmm. Dr. Georgia Ede (01:23:33.862) it's just part of the process. You have to break oxygen molecules in half to do it and if you want to get all the energy out of that glucose or those ketones or those fat molecules, you have to use oxygen, which means oxidative stress. But Mother Nature knows this. She's like, okay, we understand your oxidative stress happens. So she arms us with very powerful, our own very powerful antioxidants inside our own cells to mop up those oxygen-free radicals as we're processing food. But if you are, I mean, she was really no match though. Our own antioxidant system is no match for the modern food environment because we are flooding ourselves six times a day, sometimes more with too many food molecules at once, glucose, not just glucose, but also fats, whatever you're eating is gonna generate some oxy of stress. So you don't want to be in that mode all the time. And so, sometimes when people after they eat, they feel kind of sluggish or sore, sometimes because they've eaten the wrong things, but sometimes it's just because they're eating too much and too frequently. And so if you never give your insulin levels a chance to come down into that fat burning range, into that fasting range, into that healing range, uh, you are not going to be well. And, and so you need to, you need to eat in a way. This is the way I look at it. You need to eat in a way that doesn't make you want to eat all the time. Sean (01:25:09.264) Mm hmm. Yep. Well said. One final question for you, Doc. I am really curious about how your colleagues, the more conventional psychiatrists out there are responding to your work. And this comes in the heels of a recent article that was published by Dr. Roy Perlis, who I think he's out of Harvard, who is arguing that the time has come... Dr. Georgia Ede (01:25:14.774) Sure. Sean (01:25:37.008) for antidepressant drugs, SSRIs, to be over-the-counter drugs and just widely accessible. I did find that as a not an evidence-based comment and one that would be quite, quite dangerous. So I just wanna kinda get your thoughts on that as well as how conventional psychiatry is responding to you. Dr. Georgia Ede (01:25:59.113) Ugh. oh so many things I could say to this so let me gather my thoughts. The first thing I want to say is that have we really are we really at the point where we believe that most of us cannot function without antidepressants to the extent that we want to make them available over the counter so that everybody can have access to them because they're that important that critical to our well-being. What kind of a world are we living in, number one. Number two, I've been prescribing anti, even ostensibly, a lot of people would argue, well, the antidepressants, they're the simplest types of psychiatric medications. We're not talking about antipsychotics. We're not talking about anticonvulsants. We're not talking about benzodiazepines or stimulants. We're talking about plain old antidepressants. Well, Butrin and Prozac and Celexa and Zoloft, right? So. What's the big deal? Well, I've been prescribing these medications for 25 years. I've prescribed them to thousands and thousands of people. These are not simple medications. These are not easy to use. These are not easy to figure out the safe dose. They are not easy to stop. They are really complicated chemicals. And I have seen horrific things happen to people when they take too much or they don't follow instructions or they forget them on the weekend when they're on vacation. I mean, very, very serious. You can, if you have undiagnosed bipolar disorder, which so many people with depression actually do and don't realize it, you could take an antidepressant over the counter and within days become dangerously manic. Dr. Georgia Ede (01:27:59.978) and end up in the hospital or lose your relationship or lose your job and you know you could hurt yourself or somebody else. These medications are powerful and they are not to be there. I mean I've got a healthy respect for these medications even these so-called simpler ones. Sean (01:28:17.996) Yeah, I've been spending probably the last five years of my career really going into the data and the safety and efficacy around antidepressants. And I would add that mania is actually a side effect to these drugs, very clearly identified in the clinical trials, not necessarily related to an underlying bipolar disorder, just that it there's a portion of the population that is going to respond with like an activation syndrome related to SSRIs. So they're quite dangerous drugs. They certainly, there's been drug regulatory agencies throughout the world who have identified them as, you know, culprits in violence. There's been, you know, a number of lawsuits against the pharmaceutical companies for violent acts and actions. And so although there are maybe potentially a small portion of people who do respond to these drugs, at least for a period of time, I don't know if we can really say with any, you know, strong sense of... of validity that these drugs are quote unquote antidepressant in nature. And so a comment like that, I think was extremely dangerous, but it does represent some of the conflicting evidence that we're getting from the medical establishment. And when you talk to different doctors, you know, there'll be doctors who will come in here on this podcast and, you know, agree with my conclusions about the poor efficacy and the safety problems with SSRIs and They're now advocating for new approaches to understanding our mental health, very similar to kind of what you're describing today and how we have this powerful science base that should be foundational in our work with clients. That in fact, they should be frontline treatments. When you talk about the sophistication in which you did today about various nutrient deficiencies, about the impact of metabolic illness on our mood, on our behavior, on our lifestyle. Well, then that should be the first step that we should take when we are in our evaluation process. Because drugs have significant side effects, significant problems, they should not be frontline interventions. And unfortunately, that's just where we are in, are kind of our healthcare centers for various reasons, a lot of them financial unfortunately, because we're not taking the time. Sean (01:30:38.852) to investigate this. But I do really appreciate everything you've shared today. I could nerd out on this for another 30 minutes, but we want to be really, really respectful of your time. Where can listeners learn more about this? And how can they get access to your work? Dr. Georgia Ede (01:30:45.284) I love you too. Dr. Georgia Ede (01:30:56.49) The best place to start would be with my website which is called diagnosisdiet.com or people can just put my name which is Georgia Ede into the search engine and it'll come up. And there's information about the book there, Change Your Diet, Change Your Mind, information about the book there, but there's also information about my clinician training program for clinicians out there who want to learn how to use ketogenic diets to treat people with mental health conditions safely, especially in combination with medications. And then there's also information there. There's a free clinician directory where if you're looking for somebody, it's really important to let your listeners know if they're considering any kind of low carbohydrate diet, whether it's ketogenic or carnivore or what have you, that they learn more about it and seek professional support before they begin because it can be dangerous in combination, especially in the setting of certain health problems or medications a person might be taking. and in terms of adjusting to the diet. So to make it safe and comfortable and to set yourself up for success, you wanna work with somebody who knows what they're doing. And so there's a free clinician directory that's searchable on the website. There's a tab to clinician directory. And it's international and you can search either by service like psychopharmacology of medication prescribing or you can search by location. So lots of information there for people that I hope will be useful. And then I also, I wanted to say something about what you were just saying about medications because I think that just the very last little thing. You had said, you know, why not start there? Like, why start with medications when that's, you know, that's what we're really trained to do, right? But as prescribers anyway, why not food first? Why not, what I like to say in my training program is every person with a mental health condition deserves a metabolic evaluation. Dr. Georgia Ede (01:32:58.094) measure insulin levels, measure triglycerides, look at the, not just the fasting blood sugar, but these other measures that we were talking about, and have a conversation with people about if you've detected any signs of insulin resistance, how that is slowly robbing your brain of energy and laying the foundation for all kinds of mental health problems, including certainly not least, dementia. And so, first do no harm. Let's first shore up the nutritional and metabolic foundation of the brain and then see how is that person doing. Like maybe that's all you need to do. And in a lot of cases I find that is often all you need to do. So why not start there? Sean (01:33:49.68) Yeah, it only makes sense to me that the most safest and efficacious treatments should be first, frontline. And if somebody's lifestyle, if somebody's health needs to be that target, that should be first. Can we should be able to measure that response to that treatment. And when we, now that we know what we know with all this burgeoning research, it has to be a frontline intervention. And I'm also spoke speaking to the therapists out there and the psychologists out there. that you are often on the front lines and you are gonna be doing these evaluations and you can't assume that every presentation is related to some psychosocial factor. You have to understand it's their lifestyle that could be leading to the marital problems that they're having. You know, everything is so much harder when you're not sleeping well, when you don't feel well, when you're irritable, when you're depressed. It's hard to love somebody. It's hard to be interpersonally effective. It's hard to be good at your job. And that's the problem with my side of the field, with therapists and psychologists. They're going to see that as the point of intervention and not asking them what they're eating, how they're living, how they're sleeping, all these critical factors. And that's why, you know, in my idea of what is the safest and most effective mental health care, it is... a nutritional psychiatrist who's working in this manner, combined with a type of therapy that's gonna help target some of the problems that exist for a person's life. Could that be sometimes replaying the past? If the past is what's impacting their future and they have to get through that, whether it's trauma or other things, sure. But most of the time, it's valuing that we have to live right now. We only can live in the now. And that's what's... most important for so many people is to get out of their heads, to get out of their past, to get out of their heads about the future, and to get healthy and to live fully in their lives, in the moments that they have, which is only the eternal now. And I think I wish that was going to be our, you know, kind of like a takeaway point today is when we get in these extreme arguments about what is biological and what is social, it makes no sense to me because, you know, two ideas can exist at the same time. Sean (01:36:13.744) right, but our how are we going to target our biology? Are we gonna do it with sleep interventions and nutritional interventions and sun exposure and exercise, all these powerful interventions that change our mood, that change our behavior. That just seems like it's going to be the most effective way to approach the mental health crisis. You know, that probably combined with phone dependence. You know? If we're going to really make some profound changes that we want to do in our culture, I think those are the things you can do first. Dr. Georgia Ede (01:36:45.114) I mean, doing this kind of work, I just want to piggyback what you just said, because it's so important. Doing this kind of work where you're helping people improve their metabolic health, their lifestyle, their exercise, their eating habits, it takes every clinical skill you have, you know, we're not just talking about, I'm not, I, I often do not do this work by myself. And I, because I need really good therapists, really good counselors, really good dieticians and coaches, people to help behavior change is not easy. And, you know, it really takes every psychotherapy skill you have in order to help people along this road. And so a lot of people who take my training program are not prescribers. These are people who are trying to help people get healthier in their minds. And I've had so many patients that, you know, Oh, you changed my diet. You know, how's that going to fix my marriage or how is that going to change my childhood or this or deal with this horrible loss or trauma that I've had is, of course, it's not going to, you know, your environment, your environment is not going to change externally. You're going to change your internal environment. And so whatever is going on around you, you're going to be able to deal with it better, you're going to feel stronger, more resilient. You're going to. start to see more options open up, it's going to feel different to you. It's not going to be right here in front of you all the time. You'll be able to push it aside and function. And so, you know, if you're if you're unbalanced on the inside, even if everything on the outside is perfect, you might still be really suffering. And so, I mean, how many times have I heard that? Like, everything's good. Why do I want to die? Well, something on the inside isn't right. And so. Being being a really good. therapist is 90% of this. And so I'm really, really glad you mentioned that. Sean (01:38:35.504) Well said. Well, we've taken a lot of your time. I know you got some work to do. We really do appreciate it. It was a fascinating conversation. Like I said, these things are important resources for us here, even at my center. We often direct a lot of our patients and, you know, family members to listen to some of these podcasts just to be able to be aware of that science and alternative perspectives on this. So Dr. Georgia Ead, I want to thank you for a radically genuine conversation. Dr. Georgia Ede (01:39:05.246) Thank you very much. It's really been a lot of fun talking to you. Thank you.