New to the idea of Evolutionary Psychiatry? We recently had a popular symposium at the APA 2014 Annual Meeting, and there might be some new folks arriving with many questions. While I can’t condense four years of blog articles and ideas into one post, I can distill the main principles. Some of these phrases and ideas will be borrowed directly from my co-presenters, Drew Ramsey MD and Georgia Ede, MD, and also some of the folks I met at the APA, including microbiome and nutritional psychiatry researcher Alan Davis. So buckle up and hang on, here comes some unadulterated nutritional psychiatry and paleo wisdom experience (you will have to search the blog for most of the references):
Full house at the Food Brain Workshop
1) Eat Real Food: People’s definition of real food may vary, but my favorite part of the “paleo” diet is the appreciation for whole, recognizable foods without need for consulting a biochemistry textbook to understand the ingredients. Low-hanging fruit for food sensitivities include wheat and dairy, so it is reasonable to do a 90 day trial clean of either or both of these. Additional folks may be sensitive to eggs (particularly the whites), nightshades, and/or shellfish and tree nuts. Most people will get 90% of the benefit from avoiding processed/refined carbohydrates and vegetable oil added fats and soy, which encompasses 95% of processed convenience food.
An ideal meal happens 2-3 times a day, and involves a palm-sized protein (meat, fish, eggs) surrounded by a pile of vegetables (leafy greens, cucumbers, onions, okra, etc.), with starchy veggies such as tubers or winter squash once or twice a day, and whole fruits one to three times a day. Add up to a tablespoon of olive oil, coconut oil, or pasture butter depending upon the fattiness of the protein to make everything taste great and the fat-soluble vitamins and minerals readily absorbable.
There is nothing special or magical about a “paleo” style diet. By focusing on unprocessed foods, you avoid empty calories (that is, energy without the accompanying vitamins and nutrients that enables those calories to be processed cleanly and efficiently). You will also clear out the low-hanging fruit of some inflammatory proteins, particularly gluten and dairy. In addition, you supply the especially energy hungry human brain with all the nutrients and building blocks it needs to function at optimal performance. But many can tolerate gluten, and more dairy, so it is important to try to add them back in (unless you have allergy or celiac disease) to make sure the overall diet is as flexible as possible. It doesn’t take any nutrition degrees to get these sorts of diets correct.
2) Specialty Diets: Eating “Real Food” will get you most of the way to optimal, and will be 100X better than the Western Diet. So most Vegan, Zone, Weight Watchers (tm to all of the above) etc. will be superior to the Western Diet. Most of these diets will be slow carb or low carb compared to the sugary Western Diet. I am carbohydrate agnostic…healthy metabolisms are characterized by metabolic flexibility, and I’ve met plenty of people happy on a low carb diet and high carb diets. Certain genetics and pathologies will also be in play (high amylase, poor betahydroxybutryate metabolism, diabetes) that will influence the ability to process carbohydrate or fat. Beyond cleaning the diet of processed foods and empty calories (including large amounts of alcohol), there can be additional benefits from trying ketogenic diets (low carb, low protein, high fat) in situations of dementia, bipolar disorder, schizophrenia, autism, traumatic brain injury, etc. Ketogenic diets are far more restricted, are more like a pharmacologic intervention, and need some study and care or you will be inviting some risk of nutrient deficiency, kidney stones, etc. However, by adding some MCT oil/coconut oil you can have a far more flexible ketogenic diet than is sustainable for long periods if necessary.
3) But what about the fat/cholesterol/egg yolks/animal foods/fear from the last 40 years of shortsighted and ridiculous nutrition advice? Your brain needs cholesterol. Vegetarian diets aren’t good for mental health. Even if they are good for cardiovascular health, which is questionable, what does that matter if you are suicidal or clinically depressed? There is no health without mental health. The brain should be first and foremost, a protected organ, not an aftersight. Now I believe what is good for the brain is good for the body, but I’ve worked for many years on the front lines of hospitals, emergency rooms, and in cancer consultations. Quality trumps quantity, especially in this day and age.
4) Diet isn’t the only answer. “Let food be your medicine” is a nice enough concept, but without proper activity and sleep, you are wasting your time. Moving the body, exposure to green spaces, and use of blue blockers and appropriate sleep are vital to modern mental health. Sleep is the holy grail of modern health, a guard against anxiety, depression, obesity, autoimmune conditions…you are wasting your time chasing health if you can’t prioritize sleep.
5) The mircobiome and parasites are important. Most modern chronic diseases are related to inflammation and immunity. The microbiome and parasites co-evolved with our immune systems, and if we aren’t on good immunologic terms with these creatures, our immune system isn’t working up to par. That has ramifications in all human disease, including GI disturbance, major depression, anxiety, autism, schizophrenia, autoimmune disease, atherosclerosis, and cancer surveillance. Probiotics work in a similar anti-inflammatory way to antidepressants. Helminths may be more anti-inflammatory in the correct context, but there is a lot we still have to learn. Without a happy microbiome and chronic exposure to eukariotic parasites at the right place and time, we are missing a part of our immune system, leaving us vulnerable to cancer, autoimmunity, and infection.
6) We are all going to die. A pioneer of ancestral health and a paleo-style life died suddenly in late April. A low carb guru died suddenly this year as well. Some of my friends on the front lines have reported patients coming in with late stage cancers, wondering how it could happen, because he or she “ate paleo.” Sooner or later, death waits for us all, whether from accident or chronic disease. If it is your great pleasure to spend your life worrying about the minutia of diet and paleo living, more power to you. For many people, there is more to living a good life, and more power to them as well. If tomorrow were your last day on earth, would you be satisfied with what you were able to accomplish? We should all be at peace with that question, even if we will never reach all of our exalted goals.
Keep all of those ideas in mind as you pursue optimal health. Don’t be blinded by mortality, or carbohydrate counting, or shift work. Do the best you can, nobody is perfect. And at the end of the road is resilience, not guarantees.
Copyright Emily Deans, MD
Personal images of NYC, our APA presentation