While not entirely new, the concept of food-as-medicine has increasingly gained widespread attention and scrutiny over the past couple of decades. Titles such as 2005’s The China Study by Dr T Colin Campbell, which championed a vegan diet and whole foods as best for optimum health, or Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, which was also published the same year, became best-sellers; the trend has continued since, largely in response to a world faced with the consequences of a low-nutrition fast-food diet.

More recently, there has been a growing field of study into the effects of food not only on our physical health, but also our mental health. And with that, an increase of easily accessible information online, some of it unverified, and at times contradictory.

“That is the reason (why) I wrote the book. I like to joke that a lot of people use Dr Google, because, you know, we tend to go online and look something up. But we don’t always know the person writing that blog, or where the information is sourced from. I understand we all rely on Google, so there is nothing wrong with that. But you have to be a little careful about the source of the information,” says Durban-born and US-based Dr Uma Naidoo, author of the recently published The Food Mood Connection (published as This is Your Brain on Food in the US), which explores the connection between nutritional choices and mental health.

Her field of study, nutritional psychiatry, is still considered to be in its nascent stages, and Naidoo, is seen as a pioneer in the field. Her biography is far more intimidating than the soft-spoken and patient interviewee she is.

A Harvard-trained psychiatrist, Naidoo currently serves on the faculty at Harvard Medical School. She founded and directs the first clinical service in nutritional psychiatry in the US, at the Massachusetts General hospital. She also studied nutrition, as well as graduating from the Cambridge School of Culinary Arts as a professional chef, where she was awarded the MFK Fisher Award for innovation. During her studies at Harvard, she also raked up a few accolades, including a Junior Investigator Award from the American Psychiatric Association and a Leadership Development for Physicians and Scientists Award from Harvard.

“Being born and raised in Durban, I grew up in a very large Indian family. And there were lots of mothers and aunts and cousins in the kitchen, so I really didn’t spend much time cooking, but I was always the kid hanging around. And when I had the opportunity to study abroad, I was able to take the family spices and recipes with me.

“And that was when my cooking journey began, because my mom and aunts and grandmothers were no longer there to cook the meals. I would email and call home and get the recipes and understand how to cook. Cooking really became for me… a very creative and mindful space,” she explains.

That love for cooking and the role of nutrition in the body was soon incorporated into her medical studies: “As I was learning about the medications to treat mental illness, that while some of them may be effective, they also have devastating side effects like weight gain, and several other things, metabolic symptoms and things like that. So I felt that if I was going to use the power of this prescription pad and write a prescription for a patient, I also needed to provide more options for that individual.

“That holistic part of me really comes from my Indian background. Because it’s really about mind, body and soul; in my family there’s the Ayurvedic practitioner, but also regular medical doctors. So I had that view of looking at a person as a whole being and not just one organ system. I didn’t just say, ‘oh, here is a prescription you can take’, I would say: ‘Well, are you exercising?  What meals are you eating?’”

Come 29 October 2020, Dr Naidoo will be giving a virtual masterclass titled, Diet for the Pandemic Era: Brain-Based Nutrition to Build Resilience and Antifragility, hosted by South African platform, Brainfarm. She will delve deeper into her field as well as concepts explored in her work, starting from the premise of her book, the connection between the gut and the brain.

“Many people don’t realise that the brain and the gut are connected. They are far apart in the body, so it’s not unusual for people to think, ‘well, how can they be connected?’ But throughout our lives, they are connected by a 10th cranial nerve, called the vagus nerve. I like to think of this nerve as a very powerful superhighway that transmits chemical messages between these two areas in both directions. And what that ultimately starts to mean is that how our food gets digested in the gut, can impact our emotions through chemical messages that get formed based on the bacteria and other microbes in our gut,” explains Dr Naidoo.

She further elaborates, explaining that “39 trillion or more microbes of different kinds live in our gut to take care of us”. In return, we ought to be taking care of those microbes should we want them ‘to take care of us’ – and help with our mental and physical health. What does this mean? Healthy and nutritional foods help protect the microbes living in our gut.”

“There’s also a substance called serotonin, which people often refer to as the happiness hormone. It is also what is used in medications; selective serotonin reuptake inhibitors like Prozac and Zoloft. Those are very frequently prescribed by psychiatrists and doctors for depression and anxiety and several other conditions. Well, more than 90% of the serotonin receptors are actually in the gut.

“So that’s another reason to realise that if they are related to the happiness hormone, and what we eat, eating is digested in our gut, then it’s also going to impact the hormone levels and other chemicals in our body. If we are eating junk food full of a lot of trans fats… when we are eating a lot of junk foods, which are highly processed, all of that actually affects those gut microbes… and then the bad microbes start to eat all that junk food and take over. When the bad bugs overcome the good bugs in your gut, that is when you start to get inflammation in your gut, which can lead to neuro or brain inflammation can occur. And that’s when you can get worsening of mental health symptoms or the beginning of the onset of some anxiety symptoms. Although I do want to be clear that that’s not the only reason people do not feel mentally fit. But if we’re talking about food, it is one of the ways that foods can be very impactful in terms of your mental health,” explains Dr Naidoo.

She emphasizes that even while her book is already on shelves, there is constant stream of new research in the field of nutritional psychiatry, which along with her team, she regularly updates via social media. However, her primary focus remains on a diet based on whole foods. Says Naidoo: “‘Eat whole and be whole’, is the expression I like to use. A happy gut is a happy mood. By taking care of those gut microbes, you are taking care of your physical and mental health. Eat lots of colourful vegetables and fruits. A diet made up of that rainbow of colours is rich in antioxidants, which your brain needs to function better, and to fight off something called radical oxygen species, which get formed in our body naturally. But the more antioxidants you eat in your food, the more you can you can fight those off.”

In addition, she also recommends incorporating fermented foods and beverages such as kombucha, kefir, miso, and kimchi as way to bring back healthy microbes into the gut. By Naidoo’s own admission, many of these are dietary recommendations we know, but often don’t follow.

“Nutritional psychiatry as a term has really come up in the last decade. But the truth is that even researchers in the hospital where I work have been studying things like folic metal, folate, magnesium, omega three fatty acids, and other individual nutrients and food substances for decades. They’ve done hardcore research on these in relation to mental health. What nutritional psychiatry has done is help us think about them in the context of a plate of food. We don’t just eat one ingredient, right? We usually eat several things on a plate of food. And each of those foods contain multiple ingredients and nutrients. Nutritional psychiatry informs us on how to eat them together for better mental health, versus just taking one supplement or a probiotic or an omega three tablet,” she explains.

As director of nutritional psychiatry at Massachusetts General hospital, she is able to make sure that her patients get individual care, suited to their specific needs. While there is a standard science as to how different foods affect different bodies and minds, there is no one-size-fits all, and she is careful to point out that the book is not about serving up a prescribed diet as panacea: “It’s not about you can’t eat this and you can’t eat that; I give you lots of foods to avoid for specific mental health conditions. So if you have anxiety, and you’re eating a ton of candy, chocolates, and a ton of artificial sweeteners, maybe you think, ‘Oh, I’m trying to give up sugar, I’m going to have a diet soda’, you’re going to actually be consuming a lot of artificial sweeteners, which worsen anxiety. So it’s about knowing the foods to stay away from, foods that can worsen those symptoms.”

For the upcoming masterclass, which is broken into five segments of 30 minutes each, including a questions and answer section, Dr Naidoo will be exploring foods that reduce anxiety, foods that impact PTSD, affect our moods, as well as foods that affect focus, libido, memory and energy.

Whether one is able to actually visit the Nutritional Psychiatry clinic she directs, or can only access her work through the book, social media and website, one thing Dr Naidoo is clear on is that her food recommendations are not meant as a replacement for proven mental health medicine.

“First and foremost, I’m a trained psychiatrist, and I still prescribe medications. I’m not at all against medications. Medication can be lifesaving for people who are actively suicidal, who have symptoms of mania in bipolar disorder, or are losing touch with reality. I want to be clear that these strategies are really something that can always be used alongside other treatments. Unless you have a food allergy, or an intolerance to some kind of food, there’s no harm in upping your game on how you’re eating and improving your diet. The plan is really not meant to say to doctors that they shouldn’t be prescribing certain medications.

“It’s really about empowering the patient, empowering us as human beings. We are facing a pandemic, there’s no end in sight for many of us right now. We have ongoing uncertainty, you know; what are the things that we can do? What are the things we can control? We can control how we eat. And that’s where nutrition and mental health meet, and then nutritional psychiatry become a very powerful tool that a person can use for themselves to eat better for their mental health.” ML/DM