The 6 Pillars Of Nutritional Psychiatry
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Dr. Naidoo’s To-Dos
This is Dr. Uma Naidoo. She’s a Harvard-trained psychiatrist, professional chef graduating with her culinary school’s most coveted award, and a trained nutritionist. Between those three qualifications, she knows her stuff when it comes to the niche that is nutritional psychiatry.
She’s also the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital (MGH) & Director of Nutritional Psychiatry at MGH Academy while serving on the faculty at Harvard Medical School.
What is nutritional psychiatry?
Nutritional psychiatry is the study of how food influences our mood (in the short term) and our more generalized mental health (in the longer term).
We recently reviewed a book of hers on this topic:
This Is Your Brain On Food – by Dr. Uma Naidoo
The “Six Pillars” of nutritional psychiatry
Per Dr. Naidoo, these are…
Be Whole; Eat Whole
Here Dr. Naidoo recommends an “80/20 rule”, and a focus on fiber, to keep the gut (“the second brain”) healthy.
See also: The Brain-Gut Highway: A Two-Way Street
Eat The Rainbow
This one’s simple enough and speaks for itself. Very many brain-nutrients happen to be pigments, and “eating the rainbow” (plants, not Skittles!) is a way to ensure getting a lot of different kinds of brain-healthy flavonoids and other phytonutrients.
The Greener, The Better
As Dr. Naidoo writes:
❝Greens contain folate, an important vitamin that maintains the function of our neurotransmitters. Its consumption has been associated with a decrease in depressive symptoms and improved cognition.❞
Tap into Your Body Intelligence
This is about mindful eating, interoception, and keeping track of how we feel 30–60 minutes after eating different foods.
Basically, the same advice here as from: The Kitchen Doctor
(do check that out, as there’s more there than we have room to repeat here today!)
Consistency & Balance Are Key
Honestly, this one’s less a separate item and is more a reiteration of the 80/20 rule discussed in the first pillar, and an emphasis on creating sustainable change rather than loading up on brain-healthy superfoods for half a weekend and then going back to one’s previous dietary habits.
Avoid Anxiety-Triggering Foods
This is about avoiding sugar/HFCS, ultra-processed foods, and industrial seed oils such as canola and similar.
As for what to go for instead, she has a broad-palette menu of ingredients she recommends using as a base for one’s meals (remember she’s a celebrated chef as well as a psychiatrist and nutritionist), which you can check out here:
Dr. Naidoo’s “Food for Mood” project
Enjoy!
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Aspirin, CVD Risk, & Potential Counter-Risks
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Aspirin Pros & Cons
In Tuesday’s newsletter, we asked your health-related opinion of aspirin, and got the above-depicted, below-described set of responses:
- About 42% said “Most people can benefit from low-dose daily use to lower CVD risk”
- About 31% said “It’s safe for occasional use as a mild analgesic, but that’s all”
- About 28% said “We should avoid aspirin; it can cause liver and/or kidney damage”
So, what does the science say?
Most people can benefit from low-dose daily aspirin use to lower the risk of cardiovascular disease: True or False?
True or False depending on what we mean by “benefit from”. You see, it works by inhibiting platelet function, which means it simultaneously:
- decreases the risk of atherothrombosis
- increases the risk of bleeding, especially in the gastrointestinal tract
When it comes to balancing these things and deciding whether the benefit merits the risk, you might be asking yourself: “which am I most likely to die from?” and the answer is: neither
While aspirin is associated with a significant improvement in cardiovascular disease outcomes in total, it is not significantly associated with reductions in cardiovascular disease mortality or all-cause mortality.
In other words: speaking in statistical generalizations of course, it may improve your recovery from minor cardiac events but is unlikely to help against fatal ones
The current prevailing professional (amongst cardiologists) consensus is that it may be recommended for secondary prevention of ASCVD (i.e. if you have a history of CVD), but not for primary prevention (i.e. if you have no history of CVD). Note: this means personal history, not family history.
In the words of the Journal of the American College of Cardiology:
❝Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk (S4.6-1–S4.6-8).
Low-dose aspirin (75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age (S4.6-9).
Low-dose aspirin (75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding (S4.6-10).❞
~ Dr. Donna Arnett et al. (those section references are where you can find this information in the document)
Read in full: Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology
Or if you’d prefer a more pop-science presentation:
Many older adults still use aspirin for CVD prevention, contrary to clinical guidance
Aspirin can cause liver and/or kidney damage: True or False?
True, but that doesn’t mean we must necessarily abstain, so much as exercise caution.
Aspirin is (at recommended doses) not usually hepatotoxic (toxic to the liver), but there is a strong association between aspirin use in children and the development of Reye’s syndrome, a disease involving encephalopathy and a fatty liver. For this reason, most places have an official recommendation that aspirin not be used by children (cut-off age varies from place to place, for example 12 in the US and 16 in the UK, but the key idea is: it’s potentially dangerous for those who are not fully grown).
Aspirin is well-established as nephrotoxic (toxic to the kidneys), however, the toxicity is sufficiently low that this is not expected to be a problem to otherwise healthy adults taking it at no more than the recommended dose.
For numbers, symptoms, and treatment, see this very clear and helpful resource:
An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose
Take care!
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Wheat Belly, Revised & Expanded Edition – by Dr. William Davis
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This review pertains to the 2019 edition of the book, not the 2011 original, which will not have had all of the same research.
We are told, by scientific consensus, to enjoy plenty of whole grains as part of our diet. So, what does cardiologist Dr. William Davis have against wheat?
Firstly, not all grains are interchangeable, and wheat—in particular, modern strains of wheat—cannot be described as the same as the wheat of times past.
While this book does touch on the gluten aspect (and Celiac disease), and notes that modern wheat has a much higher gluten content than older strains, most of this book is about other harms that wheat can do to us.
Dr. Davis explores and explains the metabolic implications of wheat’s unique properties on organs such as our pancreas, liver, heart, and brain.
The book does also have recipes and meal plans, though in this reviewer’s opinion they were a little superfluous. Wheat is not hard to cut out unless you are living in a food desert or are experiencing food poverty, in which case, those recipes and meal plans would also not help.
Bottom line: this book, filled with plenty of actual science, makes a strong case against wheat, and again, mostly for reasons other than its gluten content. You might want to cut yours down!
Click here to check out Wheat Belly, and see if skipping the wheat could be good for you!
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Chair Stretch Workout Guide
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝The 3 most important exercises don’t work if you can’t get on the floor. I’m 78, and have knee replacements. What about 3 best chair yoga stretches? Love your articles!❞
Here are six!
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Healthy Cook’s Anti-Inflammatory Diet & Cookbook – by Dr. Albert Orbinati
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Chronic inflammation is a root cause of very many illnesses, and exacerbates almost all the ones it doesn’t cause. So, reducing inflammation is a very good way to stay well in general, reducing one’s risk factors for very many other diseases.
Dr. Orbinati starts by giving advice for adjusting to an anti-inflammatory diet, including advice on trying an elimination diet, if you suspect an undiagnosed allergy/intolerance.
Thereafter, he gives guidance on pantry-stocking—not just what anti-inflammatory foods to include and what inflammatory foods to skip, but also, what food and nutrient pairings are particularly beneficial, like how black pepper and turmeric are both anti-inflammatory by themselves, but the former greatly increases the bioavailability of the latter if consumed together.
The rest of the book—aside from assorted appendices, such as 8 pages of scientific references—is given over to the recipes.
The recipes themselves are, obviously, anti-inflammatory in focus. As one might expect, therefore, most are vegetarian and many are vegan, but we do find many recipes with chicken and fish as well; there’s also some use of eggs and fermented dairy in some of the recipes too.
The book certainly does deliver on its promise of flavorful healthy food; that’s what happens when one includes a lot of herbs and spices in one’s cooking, as well as the fact that many other polyphenol-rich foods are, by nature, tasty in and of themselves.
Bottom line: if you’d like to expand your anti-inflammatory culinary repertoire, this book is a top-tier choice for that.
Click here to check out Healthy Cook’s Anti-Inflammatory Diet & Cookbook, and spice up your kitchen!
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How To Leverage Attachment Theory In Your Relationship
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How To Leverage Attachment Theory In Your Relationship
Attachment theory has come to be seen in “kids nowadays”’ TikTok circles as almost a sort of astrology, but that’s not what it was intended for, and there’s really nothing esoteric about it.
What it can be, is a (fairly simple, but) powerful tool to understand about our relationships with each other.
To demystify it, let’s start with a little history…
Attachment theory was conceived by developmental psychologist Mary Ainsworth, and popularized as a theory bypsychiatrist John Bowlby. The two would later become research partners.
- Dr. Ainsworth’s initial work focused on children having different attachment styles when it came to their caregivers: secure, avoidant, or anxious.
- Later, she would add a fourth attachment style: disorganized, and then subdivisions, such as anxious-avoidant and dismissive-avoidant.
- Much later, the theory would be extended to attachments in (and between) adults.
What does it all mean?
To understand this, we must first talk about “The Strange Situation”.
“The Strange Situation” was an experiment conducted by Dr. Ainsworth, in which a child would be observed playing, while caregivers and strangers would periodically arrive and leave, recreating a natural environment of most children’s lives. Each child’s different reactions were recorded, especially noting:
- The child’s reaction (if any) to their caregiver’s departure
- The child’s reaction (if any) to the stranger’s presence
- The child’s reaction (if any) to their caregiver’s return
- The child’s behavior on play, specifically, how much or little the child explored and played with new toys
She observed different attachment styles, including:
- Secure: a securely attached child would play freely, using the caregiver as a secure base from which to explore. Will engage with the stranger when the caregiver is also present. May become upset when the caregiver leaves, and happy when they return.
- Avoidant: an avoidantly attached child will not explore much regardless of who is there; will not care much when the caregiver departs or returns.
- Anxious: an anxiously attached child may be clingy before separation, helplessly passive when the caregiver is absent, and difficult to comfort upon the caregiver’s return.
- Disorganized: a disorganizedly attached child may flit between the above types
These attachment styles were generally reflective of the parenting styles of the respective caregivers:
- If a caregiver was reliably present (physically and emotionally), the child would learn to expect that and feel secure about it.
- If a caregiver was absent a lot (physically and/or emotionally), the child would learn to give up on expecting a caregiver to give care.
- If a caregiver was unpredictable a lot in presence (physical and/or emotional), the child would become anxious and/or confused about whether the caregiver would give care.
What does this mean for us as adults?
As we learn when we are children, tends to go for us in life. We can change, but we usually don’t. And while we (usually) no longer rely on caregivers per se as adults, we do rely (or not!) on our partners, friends, and so forth. Let’s look at it in terms of partners:
- A securely attached adult will trust that their partner loves them and will be there for them if necessary. They may miss their partner when absent, but won’t be anxious about it and will look forward to their return.
- An avoidantly attached adult will not assume their partner’s love, and will feel their partner might let them down at any time. To protect themself, they may try to manage their own expectations, and strive always to keep their independence, to make sure that if the worst happens, they’ll still be ok by themself.
- An anxiously attached adult will tend towards clinginess, and try to keep their partner’s attention and commitment by any means necessary.
Which means…
- When both partners have secure attachment styles, most things go swimmingly, and indeed, securely attached partners most often end up with each other.
- A very common pairing, however, is one anxious partner dating one avoidant partner. This happens because the avoidant partner looks like a tower of strength, which the anxious partner needs. The anxious partner’s clinginess can also help the avoidant partner feel better about themself (bearing in mind, the avoidant partner almost certainly grew up feeling deeply unwanted).
- Anxious-anxious pairings happen less because anxiously attached people don’t tend to be attracted to people who are in the same boat.
- Avoidant-avoidant pairings happen least of all, because avoidantly attached people having nothing to bind them together. Iff they even get together in the first place, then later when trouble hits, one will propose breaking up, and the other will say “ok, bye”.
This is fascinating, but is there a practical use for this knowledge?
Yes! Understanding our own attachment styles, and those around us, helps us understand why we/they act a certain way, and realize what relational need is or isn’t being met, and react accordingly.
That sometimes, an anxiously attached person just needs some reassurance:
- “I love you”
- “I miss you”
- “I look forward to seeing you later”
That sometimes, an avoidantly attached person needs exactly the right amount of space:
- Give them too little space, and they will feel their independence slipping, and yearn to break free
- Give them too much space, and oops, they’re gone now
Maybe you’re reading that and thinking “won’t that make their anxious partner anxious?” and yes, yes it will. That’s why the avoidant partner needs to skip back up and remember to do the reassurance.
It helps also when either partner is going to be away (physically or emotionally! This counts the same for if a partner will just be preoccupied for a while), that they parameter that, for example:
- Not: “Don’t worry, I just need some space for now, that’s all” (à la “I am just going outside and may be some time“)
- But: “I need to be undisturbed for a bit, but let’s schedule some me-and-you-time for [specific scheduled time]”.
Want to learn more about addressing attachment issues?
Psychology Today: Ten Ways to Heal Your Attachment Issues
You also might enjoy such articles such as:
- Nurturing secure attachment: building healthy relationships
- Why anxious and avoidant often attracted each other
- How to help an insecurely attached partner feel loved
- How to cope with a dismissive-avoidant partner
Lastly, to end on a light note…
Don’t Forget…
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The Best Form Of Sugar During Exercise
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝What is the best form of sugar for an energy kick during exercise? Both type of sugar eg glicoae fructose dextrose etc and medium, ie drink, gel, solids etc❞
Great question! Let’s be clear first that we’re going to answer this specifically for the context of during exercise.
Because, if you’re not actively exercising strenuously right at the time when you’re taking the various things we’re going to be talking about, the results will not be the same.
For scenarios that are anything less than “I am exercising right now and my muscles (not joints, or anything else) are feeling the burn”, then instead please see this:
Snacks & Hacks: Eating For Energy (In Ways That Actually Work)
Because, to answer your question, we’re going to be going 100% against the first piece of advice in that article, which was “Skip the quasi-injectables”, i.e., anything marketed as very quick release. Those things are useful for diabetics to have handy just in case of needing to urgently correct a hypo, but for most people most of the time, they’re not. See also:
Which Sugars Are Healthier, And Which Are Just The Same?
However…
When strenuously exercising in a way that is taxing our muscles, we do not have to worry about the usual problem of messing up our glucose metabolism by overloading our body with sugars faster than it can use it (thus: it has to hurriedly convert glucose and shove it anywhere it’ll fit to put it away, which is very bad for us), because right now, in the exercise scenario we’re describing, the body is already running its fastest metabolism and is grabbing glucose anywhere it can find it.
Which brings us to our first key: the best type of sugar for this purpose is glucose. Because:
- glucose: the body can use immediately and easily convert whatever’s spare to glycogen (a polysaccharide of glucose) for storage
- fructose: the body cannot use immediately and any conversion of fructose to glycogen has to happen in the liver, so if you take too much fructose (without anything to slow it down, such as the fiber in whole fruit), you’re not only not going to get usable energy (the sugar is just going to be there in your bloodstream, circulating, not getting used, because it doesn’t trigger insulin release and insulin is the gatekeeper that allows sugar to be used), but also, it’s going to tax the liver, which if done to excess, is how we get non-alcoholic fatty liver disease.
- sucrose: is just a disaccharide of glucose and fructose, so it first gets broken down into those, and then its constituent parts get processed as above. Other disaccharides you’ll see mentioned sometimes are maltose and lactose, but again, they’re just an extra step removed from useful metabolism, so to save space, we’ll leave it at that for those today.
- dextrose: is just glucose, but when the labeller is feeling fancy. It’s technically informational because it specifies what isomer of glucose it is, but basically all glucose found in food is d-glucose, i.e. dextrose. Other isomers of glucose can be synthesized (very expensively) in laboratories or potentially found in obscure places (the universe is vast and weird), but in short: unless someone’s going to extreme lengths to get something else, all glucose we encounter is dextrose, and all (absolutely all) dextrose is glucose.
We’d like to show scientific papers contesting these head-to-head for empirical proof, but since the above is basic chemistry and physiology, all we could find is papers taking this for granted and stating in their initial premise that sports drinks, gels, bars usually contain glucose as their main sugar, potentially with some fructose and sucrose. Like this one:
A Comprehensive Study on Sports and Energy Drinks
As for how to take it, again this is the complete opposite of our usual health advice of “don’t drink your calories”, because in this case, for once…
(and again, we must emphasize: only while actively doing strenuous exercise that is making specifically your muscles burn, not your joints or anything else; if your joints are burning you need to rest and definitely don’t spike your blood sugars because that will worsen inflammation)
…just this once, we do want those sugars to be zipping straight into the blood. Which means: liquid is best for this purpose.
And when we say liquid: gel is the same as a drink, so far as the body is concerned, provided the body in question is adequately hydrated (i.e., you are also drinking water).
Here are a pair of studies (by the same team, with the same general methodology), testing things head-to-head, with endurance cyclists on 6-hour stationary cycle rides:
CHO Oxidation from a CHO Gel Compared with a Drink during Exercise
Meanwhile, liquid beat solid, but only significantly so from the 90-minute mark onwards, and even that significant difference was modest (i.e. it’s clinically significant, it’s a statistically reliable result and improbable as random happenstance, but the actual size of the difference was not huge):
Oxidation of Solid versus Liquid CHO Sources during Exercise
We would hypothesize that the reason that liquids only barely outperformed solids for this task is precisely because the solids in question were also designed for the task. When a company makes a fast-release energy bar, they don’t load it with fiber to slow it down. Which differentiates this greatly from, say, getting one’s sugars from whole fruit.
If the study had compared apples to apple juice, we hypothesize the results would have been very different. But alas, if that study has been done, we couldn’t find it.
Today has been all about what’s best during exercise, so let’s quickly finish with a note on what’s best before and after:
Before: What To Eat, Take, And Do Before A Workout
After: Overdone It? How To Speed Up Recovery After Exercise
Take care!
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