Untangling the relationship between the gut and mental health is a bit like trying to sort out if the chicken came before the egg, says nutritional psychiatrist Uma Naidoo. “In my practice, I often see people after a referral and then help them correct how they eat to improve their gut microbiome and, ultimately, improve mental health symptoms,” Naidoo says. “But we need to envision the gut-brain axis as a two-way interaction in which mental health can also impact the gut.”
Naidoo works to bridge the gap between what we eat and how we feel by taking a holistic approach that integrates her passion for food—she’s also a professional chef—with evidence-based techniques to improve patients’ well-being. We talked with her about her latest book, This Is Your Brain on Food; how to use a whole-foods approach to healing the gut and brain; and which foods she finds helpful for combating the effects of anxiety.
(For more with Naidoo, listen to her chat with Elise on The goop Podcast.)
A Q&A with Uma Naidoo, MD
Q How do you integrate psychiatric treatment with nutritional interventions? A
In psychiatry, we base diagnoses on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which gives clinical criteria for mental health disorders. Not everyone falls into a certain category, yet they still might not feel well and may not meet criteria for a specific disorder. This is one example of where nutritional psychiatry can be highly impactful.
I’ve seen that these patients benefit immensely from nutritional strategies when they stick with them over time. I get referrals from the whole gamut of specialists, from gastroenterologists to orthopedic surgeons, who want their patients to feel better through food—or at least get a consultation with me regarding the medications they are taking.
Some of my patients are referred to me while on psychiatric meditation, and I work with them to add nutritional strategies. Some of these patients may decide to taper down their medications under the careful monitoring of myself and their physician. But it’s not one or the other—food or medications—it’s about integrating both.
My approach is holistic, combining integrated and functional psychiatry philosophy. I look for the root cause. But I am also not against prescribing medications. There are certainly individuals who are sick in my practice and need medications to feel better. I move gradually with my patients because for someone who is very depressed, exercising every day may seem impossible. I start by seeing if they can just take a walk with their dog every day or get out of the house. I approach movement and exercise in a stepwise way and work with people around how much they want to do.
Q How are the gut and brain linked? A
Anatomically speaking, the vagus nerve directly connects the gut to the brain, forming a bidirectional highway between these two parts of the body. There are at least 39 trillion different types of bacteria in each person’s gut microbiome and each of our microbiomes is unique. Therefore, how we eat and how we feel from a diet are highly individual.
Dysbiosis or imbalance of the gut microbiome from eating processed foods, preservatives, dyes, and unhealthy fats can lead to inflammation and, potentially, leaky gut. What also happens in this process is that the hormones and chemicals traveling to the brain become disrupted, and there may be inflammation or neuroinflammation.
When we talk about mental health and the gut, it’s like the question of whether the chicken came before the egg. You might believe it all starts with the diet, which causes dysbiosis, and then symptoms of anxiety develop. In my practice, I often see people after a referral and then help them correct how they eat to improve their gut microbiome and, ultimately, improve mental health symptoms. But we need to envision the gut-brain axis as a two-way interaction in which mental health can also impact the gut.
Q What are your first steps when meeting with a patient? A
I spend a lot of time trying to understand their food habits. If someone comes in with a very distinct complaint, such as “I’ve gained weight because of a medication” or “I’ve lost weight because of anxiety,” I work to help them establish what could be going wrong.
For example, I was treating a business executive who came in with high levels of anxiety for the first time in her life. She thought it was purely due to the stress from her recent promotion at work and thought she might need an anti-anxiety medication. But I discovered that she was now traveling a lot more due to this promotion, eating on the go, and sleeping in hotels or on planes. Those processed, highly sugary foods and the disrupted sleep combined with her stress levels disrupted her microbiome and caused inflammation, which presented as anxiety. I worked with her on how to eat better, sleep better, and manage stress even with the travel. She started to improve and ultimately did not feel she needed the medication.
Q How do you help people create a healthier diet? A
I start by first establishing where people are at, and then I work with them to see what smaller changes they are able to make. We begin by trying to include healthy sources of fiber in their diet and incorporating more vegetables into every meal. If they make an omelet for breakfast, I’ll encourage them to add spinach, mushrooms, and other vegetables to start to add this biodiversity to their microbiome. Then we’ll start to add servings of fresh fruit to meals. I challenge people to try to add as many different vegetables and different colors into their meals as they can.
The phytonutrients in colored foods, such as flavonoids and carotenoids, have an antioxidant effect on the body and help remove reactive oxygen species from the body. At first, I don’t focus on specific foods that have vitamin D or vitamin C because you’re getting so many more phytochemicals, nutrients, and minerals from the wider variety of vegetables and fruits that you pick in a whole-foods diet.
Next I work to build in specific foods that are shown to be beneficial based on the person’s preferences about what they like and don’t like to eat. Spices are easy to add into most foods, and it’s great because they’re salt-free and sugar-free. You can buy organic spice in a little jar that will last you for many meals and give you the added benefits of that spice, depending on whether it’s oregano, rosemary, or turmeric.
Q What type of diet is beneficial for anxiety? A
More than 90 percent of the receptors for serotonin—the neurotransmitter involved in mood, cognition, rewards, and learning—are located in the gut, which is why food is so important. When I work with clients to create a healthy diet, we talk about foods to add in and also foods to consider cutting back on. I suggest avoiding gluten, added sugars, and preservatives, as well as unhealthy fats and oils, which often come from eating out at restaurants and not knowing what types of fats or oils are used.
I want people to embrace getting good sources of fiber—fruits, vegetables, and beans. I also encourage people to add in prebiotic and probiotic foods that are the building blocks for a healthy gut.
Q What foods specifically have merit for people with anxiety? A
I emphasize omega-3-rich foods, which include fatty fish such as salmon, mackerel, tuna, herring, and sardines. There are several studies that have shown omega-3 fatty acids are beneficial for anxiety as well as depression.
Turmeric is a spice with a lot of health benefits. The active ingredient is curcumin, and a pinch of black pepper can help enhance the absorption of the curcumin and make it more useful for anxiety. You can add a quarter teaspoon of turmeric with black pepper to soup or even a smoothie.
The other foods I emphasize are those that contain vitamin D, such as fatty fish, cheese, mushrooms, and eggs.
Uma Naidoo, MD, is a nutritional psychiatrist who serves as the director of nutritional and lifestyle psychiatry at Massachusetts General Hospital. She is also on the faculty at Harvard Medical School and is a professional chef. She is the author of This Is Your Brain on Food.
This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.
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