Welcome to "Tell Me More."

I'm Kelly Corrigan.

I'm a writer, a podcaster, and a mom.

This season, number 7, is unlike anything you've seen from us before because everyone who works on this show is reading the same headlines.

There is so much unsettling news about how people are actually feeling, so we have recruited the best scientists and researchers to separate fact from fiction and surface a set of practices we can all live by.

Join us for a 10-part conversation on wellness.

How do you get it, and how do you keep it?

♪ Those who have mental health disorders are much more likely to have metabolic dysfunction, and vice versa.

Corrigan, voice-over: This is Dr. Brett Scher.

He's a cardiologist and a leading expert in therapeutic uses of metabolic therapies.

He's spent most of his 20-year career using nutrition and lifestyle interventions to improve health.

Your health is not just your medical conditions.

It's the environment in which you live.

Corrigan, voice-over: This is Dr. Michael Lenoir.

He is a full-time practicing pediatrician.

He's the CEO of the African American Wellness Project.

He is also a former Citizen of the Year for Oakland, California.

We don't talk about our innate knowledge of our bodies.

Our bodies, to me, are the barometer.

Corrigan, voice-over: This is Cava Menzies.

She is a musician who has worked with people like Chris Martin, Dave Grohl, and Daveed Diggs.

She's also a long-time educator at the Oakland School for the Arts.

♪ OK, so off the top, I just want to say this is not a conversation about how to lose weight.

We are only here to consider whatever relationship there might be between food and mood.

Will you lay out the ways that you have seen food affect mood and therefore what kind of recommendations you typically make?

Scher: I mean, food and mood are so interrelated in a number of different ways.

I mean, one, we don't think about it enough, the emotional connection of food.

It's how we were brought up, our holidays, our family.

The joy we spend with people frequently is around food, and that obviously affects mood, but there's also more of a biologic sense of how food affects your blood sugar, your insulin levels, how fuel gets to your brain, how your brain creates energy, and all those things can impact your mood.

It's kind of interesting to bring, I guess you could say, the two worlds together, the emotional side of food and the physiological side of food, and how they can affect how you feel from a day-to-day basis, and that can be as extreme as signs of mental illness or giving you complete joy and everywhere in between, so the hard part is to try to boil it down to one recommendation and say, "This is how you eat to improve your mood," because it's so complicated and so individualized.

Does everybody want that from you everywhere you go?

Oh, yeah, oh yeah.

Everybody wants the one answer.

We like simple things, right?

Scher: We like simple things.

We like to take complex situations and concepts and boil them down to one thing because that's what gets headlines, right, and that's what makes people feel better, that, "Oh, I know the answer."

There is a lot of comfort in knowing the answer... -Yeah, -but we don't know the answer.

We don't know the answer for everybody, so we have to kind of individualize things about our approach to food, and that's what makes it sort of exciting and fun and interesting but complicated and harder to boil down.

So give me a quick round the horn on how-- a food that affects your mood in a certain way.

Fruit for me, anything that's touched sunlight, I literally feel like I'm ingesting the sunlight, and it just elevates my mood.

Corrigan: Mmm, mmm.

For me, I think I got to say it's a nice cooked steak because I love the protein, and it's got the emotion for me and the history for me, like, my dad grilling a steak on the barbecue.

I feel like I need to defend red meat because it gets too much of a bad rap that it doesn't deserve.

Corrigan: Yeah.

My experience with food, the joy or depression has to do more with the cultural semblance of people around food rather than specific foods themselves.

Yeah, yeah.

Although there are times when I slip, like this morning when I had that apple fritter, there was a certain guilt.

It was kind of a love-hate relationship with that big apple fritter.

Well, that, the love-hate thing is so real.

Scher: Yeah.

Like there's so much pressure and guilt around food.

It's almost like a tender topic to touch at all, but the fact is that we are hamstringing ourselves in terms of mood if we are totally unaware or defiant in the face of the facts.

Yeah, and if you set the world up as good foods and bad foods, you're setting yourself up for guilt.

Apple fritter.

-Apple fritter.

-Right here.

He's recovered well, he looks like he's doing OK, though.

Haven't quite recovered yet, but I got to tell you, there are a couple of foods that are interesting because one week coffee's terrible for you, and wine is awful, and the next week wine is great for you.

It's confusing to people.

Corrigan: And I think that's sort of this fundamental thing that's underneath this whole series, which is it's really hard to know who to trust and what information is going to age poorly and be overwritten, like the food pyramid.

So what's the latest with the food pyramid?

Scher: The food pyramid gets complicated.

Do we follow the food pyramid like this or like this, and you can make an argument for either one, right side up or upside down.

We know when a drug is studied it is a randomized controlled trial that goes for maybe a year.

That's the quality of evidence we're sort of used to, but then when it comes to nutrition, it's completely different.

It's a much lower quality of evidence, yet we take the findings sort of with the same gusto, and that's where this disconnect comes in.

So the science that the food pyramid is built on is unfortunately sort of like a house of cards.

I mean, it really can easily be dismantled, so we have to be more flexible.

It's interesting hearing about the science because I think the one missing link is that we don't talk about our innate knowledge of our bodies.

Our bodies, to me, are the barometer.

We know what it feels like to eat healthy.

We know what it feels like when we're ingesting something that's giving us fuel and giving us energy, and sometimes, it doesn't match up with the food pyramid, and sometimes, it doesn't match up with the science of it.

Yeah.

I mean, this whole concept of personalized medicine and personalized nutrition, and tools exist to measure this, but they're not immediately available to everybody, whether it's, you know, the CGMs, the continuous glucose monitors that everybody in Silicon Valley is wearing, you know, but it's not gonna make its way to the everyday person, but we can learn how different foods affect our biology through that, and that's--it's that type of knowledge that I think would be so important for everybody to have.

Just how do we disseminate that?

Are there elements of our genetics that have this huge impact on, say, our metabolism, which has then this huge impact on our proclivity for mental wellness or unwellness?

Yeah, I think the answer to that has to be yes, but the key is that the genetics don't set it to be true.

Just because you have a genetics that make you a little more susceptible to bipolar disorder or to type two diabetes or whatever the case may be doesn't mean you're going to end up that way, but it can make it that you can't handle refined carbohydrates as well as somebody else can, right?

Like, how can two people eat the exact same meal the exact same time and have completely different reactions to it?

Well, our bodies are different.

So yes, absolutely.

I think genetics sort of set the stage, but then we personally, by the choices we make, decide how those genetics are expressed and if they express in health or disease or somewhere in between.

Right.

And the way that we make those choices is somewhat informed by nurture... Scher: Yeah.

Corrigan: as you're saying, and also informed by the culture in which we make these choices.

Scher: Mm-hmm.

Menzies: Mm-hmm.

That's been running through my head this whole time is we live in a dopamine culture, and it's not just young people.

We all are looking for these dopamine hits, and so I think people eat to feel good.

People eat to feel validated.

It's no longer just about community or just, you know, getting back to natural foods.

It's really for the rush, and we live in a dopamine culture.

That's so interesting because the whole series began with this look at nature, like whatever genetics that you have that predispose you to mental wellness or unwellness, nurture, which are these early years, who are the relationships, what's the environment, and then all this behavior, all these options, choices, all of which happens in a context, which is our culture and then your smaller culture of your town or your region.

Well, what we've learned through the pandemic, even before, that, your health is not just your medical conditions.

It's the environment in which you live, so social determinants like housing, poverty, violence.

Those are social determinants that, at the end of the day, have a great deal to do with how healthy you are.

There's a lot of knowledge certainly in the African American community on diet, but then you have these food deserts, and there's no place to buy these foods, and they are very expensive even if you can identify those that most people need to have.

Do you know that if there are neighborhoods where there's terrible food deserts or people don't have a chance to exercise or no green spaces, if their mental health is worse?

The assumption would be yes.

If you look at the health of Black men, they're the only demographic group that does not benefit from socioeconomic status.

The death rates, the disease, morbidity and mortality among Black men across the economic spectrum is very similar.

It's not always--not the absence of knowledge or the absence of the ability to pay.

It's patterns.

I grew up in a household where my mom-- my mom, you know, was a vegetarian.

She was a huge food advocate, healthy eating, but she also was able to stay home with 3 kids, and so she spent her whole afternoons cooking, and we had these incredible meals, which was a blessing and wonderful to have, but it was a privilege.

What about, you know, a middle-class single parent who drops her kid off at school at 7:00, goes to work from 8 to 5, picks their kid up, is exhausted from the day?

We're talking about nutrition, we're talking about health.

There's an implication that you're able to cook.

There's been times in my life where I've just thought, "Fuel."

I'm not really using food for the enjoyment of it.

It's just what's gonna carry me over.

I've definitely eaten, like, a spoonful of peanut butter... -Yeah, absolutely.

-and thought, like, "This will get me there."

Or knowing that home-cooked meals are better but that I don't have the time to.

I have, you know, to complete whatever it is.

I ate oodles of noodles last week.

There.

Right.

I'm a grown woman, and I'm an empty nester.

Like, there's just no reason on earth -that I can't make myself.

-Yeah.

It goes back to you.

I mean, being a chef and talking about, you know, your patterns as an 8- and 9-year-old.

If you grew up in a house where there are home-cooked meals, you're more likely to learn how to cook and have that.

For me, it came as a single father of 4 girls, who were complaining about diet every single day and that they were eating the most terribly cooked meals, so, I mean, I was forced by group pressure to go do something.

But I think it's important for us to understand that finding the right diet for each individual doesn't follow one pattern, one recommendation.

We don't know what we should recommend for everybody.

You know, if we recommend the Mediterranean diet for everybody, not everybody likes fresh fish.

Not everybody's gonna want to eat that.

We have to factor in how does it make you feel?

Are you hungry?

Does it quell your cravings, right?

Are you satiated, and does it fill you up emotionally, and does it impact your metabolic health in a beneficial way?

Like, that is how we find the right diet, but that's a lot harder than saying... That's person by person.

Why aren't those questions asked?

Like, if I go for a checkup, why is that series of questions not asked?

Because it takes time.

It takes time, it takes knowledge, it takes interest.

I mean, that's gonna be a 30-minute office visit with your doctor, which you don't have now.

Which is why I don't think you can have this conversation without linking it to the medical industry because there's norms within that industry, and I think a lot of people feel like they get that specialized care if you go outside of the typical medical field, and then it's like who has time and resources to pay for that?

Normally, you're paying out of pocket.

Insurance doesn't cover that, and so those questions aren't being asked.

One of the things that's come up before that made me particularly interested in talking to you was that maybe mental health is more of a metabolic condition than we're aware of.

Yeah, I think that's spot on.

There is a strong level of evidence now showing that those who have mental health disorders are much more likely to have metabolic dysfunction, and vice versa.

Those who have metabolic dysfunction, whether it's metabolic syndrome, prediabetes, type two diabetes, are much more likely to develop mental health disorders.

Now, it doesn't prove causation, but at the early stages, it's certainly suggestive.

Now we're learning that metabolic interventions can actually improve people's moods.

There's one study that looked at people with treatment-resistant bipolar depression and gave them this medication metformin, which is a medication for blood sugar and insulin sensitivity and type two diabetes.

It's not thought to have brain effects, but it improved the depression symptoms in everybody who reversed their metabolic disorder.

Something like that just has to make us wake up and say, wait, there is this connection.

The brain is connected to the body.

When the body can become what's called insulin resistant, so can the brain, so if we can help people improve their metabolic health, then we can improve the way the brain is creating energy and transforming energy, and that can help with symptoms.

The brain is not isolated as, like, mood or seizures or cognition and thinking.

The brain needs to create energy for all of those executive components, I guess you could say, and we know that all of those are influenced by the brain's ability to create energy and process and metabolize, so there is a definite connection.

Now, the point you bring up is very important, that it's not necessarily all about genetics.

It's not necessarily all about neurotransmitters.

It's not necessarily all about our past history.

All of those things can influence our mood, but so can the metabolism.

Focus on metabolism.

That's where we can really make the biggest impact for most people in their mood.

How else can you affect metabolism?

Well, I mean, nutrition gets the majority of the attention because, like I said, we have to eat.

It's a decision we make every day and probably is the most impactful.

Eating in a way that helps you maintain stable blood sugar and lower your insulin levels and maintain a healthy weight, which can then also impact blood sugar and insulin, that is the key.

Now that's the simple answer.

The more complicated answer is exactly how to do that, but I think those are the factors we should be looking at and how the diet affects our ability to manage glucose and insulin, but by no means is nutrition the only way.

Exercise is key.

I would love everybody to be in the gym doing resistance training 3 days a week and getting their cardio 3 days a week and doing mobility training and interval training.

OK. That's a bit of a pipe dream.

There are people in this conversation who don't do those things.

Right.

So that's a bit of a pipe dream for the general population.

There are at least two.

Ha!

No.

We got 3.

We got 3.

Oh, my God.

We're such a bunch of slouches here.

No, but that's exactly my point.

That makes my point completely.

Like, if that's the standard we're holding and you say you have to do this to be healthy, it's not gonna happen, right?

So that's where just doing more than we're doing now is a very appropriate goal, and we have to sort of instill that in people, just being active, and that's where just stepping on a scale and looking at the number doesn't tell us what we need to know about your metabolic health, which then can feed into your mental well-being, as well, and your mental health.

So it's more about looking under the hood at the metabolic health than it is just looking at the number on the scale.

And there's resistance to looking under the hood, especially in certain communities, not wanting to go to doctors, not wanting to know what's wrong with you, and so I think if that is the starting place for you to understand your own biology, it's tricky because a lot of people avoid doctors -to begin with.

-Mm-hmm.

Corrigan: Yeah.

Do you think that the introduction of GLP-1s will reduce mental health disorders in the United States?

Ooh, that's a great question.

So GLP-1s are a specific medication that can-- it's an injectable medication for most people that started off for treating type two diabetes but now are being used for weight loss.

They go by the names Wegovy or Ozempic.

They're being used from everything for treating people with severe obesity to Hollywood celebrities wanting to lose a few pounds, and they mostly act sort of in the gut on what's called a GLP-1 receptor, but we also have GLP-1 receptors in our brain.

There definitely is this crosstalk, and there are researchers now studying using these medications to directly impact mood, but there's also clinical experience suggesting that they can worsen mood, so it's one of those things where, I guess, it shows the complexity because maybe you're losing weight and you're feeling better and you're exercising more.

Maybe that's why it improved your mood.

Maybe it is a direct effect from the medication that's affecting your mood, or maybe it's a direct effect that it's making you nauseous, which is a common side effect, which affects your mood.

So in this video series that I did, it was interesting to get different clinicians and researchers and their opinions because it's an emerging topic, and it's something that's being studied, but it's something that can go either way in individuals.

Variation is the norm, variation is the norm, variation is the norm.

This comes up every time, right?

But the point is, there's a biologic reason for why it could be beneficial, and there's biologic reasons for why it could be detrimental.

And there's a clinical reason.

237 diseases associated with obesity.

237 diseases are associated-- Associated with obesity.

Corrigan: Uh-huh.

Menzies: Wow.

And we're seeing-- if you just came into my office and just sat in the waiting room and looked at the children who came through there, you would understand the urgency of the situation we're dealing with.

We have children over 250, 300 pounds.

I'll see at least 2 or 3 a day.

Are they typically experiencing mental health disorders, as well?

Well, there's so many other things in Oakland that they can be experiencing mental health disorders about.

Right.

It's hard to separate out one or the other.

So I think there's no question if you help that person lose 100 pounds and improve their metabolic health there will be an improvement in mental health but not the whole thing.

If they're worried about the rejection on TikTok or, you know, all the things that adolescents have to go through, improving metabolic health isn't going to fix that, but it's one important piece of the puzzle that we can address.

And it may just increase your overall resilience such that those rejections that are inevitable have less of a shot to just bring you all the way down.

Scher: Yeah.

Menzies: Right.

So what do you see in your school?

In my school, I think I see an onset of depression and anxiety, especially in the times that we're living in.

I think young people having access to social media, having access to the news in ways that we never really did growing up, they're navigating inner biology that's really complex.

Their nervous system is impacted.

There's a lot of issues that they're dealing with that I think are issues that we don't, and so then you couple that with how they're eating, you know, what kind of resources they have, depending on where they're coming from in the school system.

I work in downtown Oakland.

Our kids are coming from all over Oakland, and they have different access to different kinds of resources.

I see a lot of students stress eating.

That's a big thing, and I also see a lot of students just completely withholding from food, and I'll ask them, "Have you eaten today?"

And it's like, "No, I haven't eaten at all today," or, "I never eat breakfast."

"I never eat breakfast" is actually probably the most common one that I've seen a huge increase in students that don't want to eat until 2 or 3 p.m.

Even with my own child-- I have a 19-year-old son, and I just recognized pretty early on that he didn't want to eat until late in the day.

Sleeping patterns then get really impacted by what they're eating.

They're staying up all night, having to perform early in the morning, which is really challenging for them.

I go back.

I'm just convinced you got to get them at 3, 4, 5, and 6.

Country: Right, but that stresses me out because what if you didn't?

I mean, everybody who's watching this is thinking, "Uh-oh.

Did I miss my window?"

Scher: "I missed it."

Like, how often do people really change their eating habits, and how motivating is a mental health crisis to double back and consider nutrition as, like, a medical intervention that maybe could even rival medication or talk therapy?

Like, sometimes during this series, I've wondered if we're gonna start saying to people who have depression, "Oh, well, we're gonna get you a nutritionist, "and we're gonna get you a physical therapist, "and we're gonna get you a personal trainer.

"This is the team that you need actually "in addition to potentially a psychiatrist with a prescription pad."

I love what you just said.

The term you just said was nutrition as a medical intervention, and that is so key rather than just, like, "Eat healthier," but here is a way you can eat that is a medical intervention.

So that's one thing that I like to promote and discuss about ketogenic diets, not that, you know, everybody needs to be on a ketogenic diet, and then you said this is not about weight loss, so that's not what I'm talking about, but I'm talking about a way of eating that changes your metabolism and changes the fuel of your brain, and ketosis, ketogenic therapy is the only diet that does that.

There are a number of different diets that can work in different ways, but to actually change your brain's chemistry and your brain's fuel source, that's a medical intervention that has been shown to help with seizures and epilepsy and is now being shown to help with mental health disorders.

So that is a dietary prescription, nutrition as a medical intervention.

So that's one thing I'm most excited about in terms of how we approach nutritional ketosis as a medical intervention.

Again, not that it's for everybody, but it should be used as a medical prescription to help people with their mental health who may benefit from it.

My last question-- and this is for everybody, if you could change 1 or 2 things in society to help decrease mental health disorders through nutrition, what would you change?

Hmm.

One thing I would change is I would hold media accountable for the way they convey nutrition research.

Two, I would change the way we subsidize and price crops and, you know, wheat and corn and soy and vegetables and meat so that we focus on making the whole natural foods the cheapest and the ultra processed food the most expensive.

That may be a bit of a pipe dream, but I would love to see that type of a change.

I think I think about the food deserts and just more accessible grocery stores that actually carry natural foods that are available to everybody, especially in impoverished areas.

That's a big one, and then the medical thing-- I'm gonna harp on that in this whole interview-- is just that the conversations that are happening when you go see a doctor are more thorough, that they actually take individualized time and attention to really understand you and your body and craft a plan that makes sense for you.

Yeah.

I would intensify the pressure on the system to give parents whose children are leaving breastfeeding or formula feeding a more intense focus on what a good diet looks like, where there's some consensus on at least fruits and vegetables and not so many high processed foods and calories because there are some things that we all agree on that do ultimately affect mental health, but I think what we do is what-- we really focus on breastfeeding, we really focus on that formula feeding, and then it's the Wild West after that.

They just start doing things that they were taught to do, and I think if we spent more time on the child between the ages of 2 and 5 we'd have better educated children and better educated adults.

My contribution is that I think we should get the most influential celebrities and ask them to never do ads for highly processed foods and only do ads for healthy foods because the fact is that it's a performing enhancement tactic, and I'm sure, like, all the great athletes in the world, all the great musicians who are on tour, which is almost like an athletic performance, are using nutrition to keep their spirits up and to keep their energy up, and so I wish they would talk about it more and highlight it and show their craft services, that there's all sorts of great food there that's good for energy and mood.

You see that clip of that soccer player who sat down for his interview, and there were a couple bottles of Coke in front of him, and he moved them aside and said, "Drink water"?

-It was exactly what we need.

-So great!

So great.

-Yeah.

-Thank you.

My pleasure.

So great to be with you.

-Thank you.

-Thank you, Kelly.

Thank you for inviting me Thank you.

Really fun to be with you guys.

Corrigan: Here are my takeaways from my conversation with Bret, Cava, and Dr. Mike.

Number one, for better or worse, when it comes to mood, food is powerful.

Number two, like movement, take a minute to notice how food makes you feel.

Number 3, we can't ignore metabolism when we look at mental health.

Number 4, here's a rule of thumb.

Eat a little better than you're eating right now.

Number 5, there are 237 conditions associated with obesity.

Number 6, nutrition can be a legitimate medical intervention.

Number 7, we have to make good food cheaper and more available, and number 8, nutrition is a performance enhancing drug.

If you'd like us to send you this list, we're happy to do it.

Just send an email to PBS@kellycorrigan.com.

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