Nutritional Psychiatry with Dr. Drew Ramsey (Part 1)

Dr. Drew Ramsey: [00:00:00] One of the parts of the male mental health crisis that doesn't get talked enough about men are wasting a lot of their time and their relational potential on things that don't give back to them in meaningful ways, and then fail them later in life. 

Margaret: How to be 

[music]: patient.

Margaret: Well, welcome back to How to Be Patient today. We have a guest that I poached from the a PA, so thank you listeners for wanting us to come speak there so we could get Dr. Drew Ramsey to come speak on the podcast. 

Dr. Drew Ramsey: That was easy. I was a big fan of your podcast. Before the A PAI was getting, I got DMed by Samantha on my team.

She's like, you should check these two out. I was like, I, I know about them. I'm going, I'm hoping to meet them. 

Margaret: That was actually nuts us. Our reputation 

Preston: precedes us. Okay. Really? 

Margaret: That was nuts for us though. I like told Preston after I went to your panel and rudely asked you a question probably about nutritional psychiatry.

I was like, this person knows about our podcast. And knew, knew what it [00:01:00] was, which was like, we were, we were shocked that anyone knew what it was. 

Preston: Oh, she was like, live tweeting me during this presentation. She's just texting me like, oh, yo, this guy's really good. Okay. I think I'm gonna try to get on our pod.

Okay. I'm gonna ask a question. Yeah, I'm, I'm definitely asking a question. And then, and then she just sent a bunch of like dunking emojis and gifs that players, players doing like Alley. And I was like, I feel like he's coming on the podcast. 

Dr. Drew Ramsey: You're okay. Unrelated, but don't take the dunk emoji away from me.

Margaret, that's, well, I'm glad that you came to the talk. I thought, I'm trying to remember your exact question, but I remember thinking it was a good question, uh, was that, oh, lemme ask about eating disorder. I think you've got eating disorders and sort of orthorexia and nutritional psychiatry recommendations.

Is that right? Mm-hmm. 

Margaret: It was, yeah. Good memory. 

Dr. Drew Ramsey: So, uh, but it's a treat to be with you all. I mean, I think all I'm speaking for all of psychiatry now. When I say this, that those of us who are early in social media, we get a big kick out of the folks who are coming in and, and getting strong influence and putting out a great [00:02:00] message about mental health.

So it's a, it's a treat to be with both of you. I like what we like what you're doing. I like what you're doing, so thank you. 

Margaret: The a PA officially likes what we're doing. That's all I need, honestly. How did I become an 

Dr. Drew Ramsey: official APA representative? We'll 

Margaret: talk about, we'll, we'll discuss all my projections later in the office.

[music]: Okay. Alright. 

Margaret: Sorry. I'm gonna introduce you though, for those of our audience who don't know who you are. You are Dr. Drew Ramsey. You are board certified psychiatrist, author, and leading voice and nutritional psychiatry and integrative mental health, which is why you are here. And you have a new book out that I believe came out in the spring and that you gifted us a copy of.

And by us, I mean I took it from Preston immediately once you gifted it to us at the a PA. But now we both have copies, um, which is. Healing the modern brain, nine tenets to build mental fitness and revitalize your mind. And we, as I said, are so glad to have you on. Um, before we talk about anything real, we always do an icebreaker.

Dr. Drew Ramsey: Are you [00:03:00] icebreaker down to icebreakers are real. 

Preston: Whoa. Let's unpack that one. 

Margaret: But yeah, let, okay, before, well 

Preston: since, since we're on the pro like psychoanalyst, why I, on, I'm on Olympics here, like 

Margaret: the burner this time Mike. I was like, I'm excited for this episode. And it's like, Margaret, what are, what is all this?

Um, I guess, can we do the icebreaker? I, I feel so off. Let's break some ice. I of you together. I'm so the two of you together. I'm like, um, we're playing a a would you rather game for our icebreaker, uh, this time, which is a new one that we haven't done before. So I made up a bunch of, would you rathers based on reading your books and my overconsumption of TikTok and it is mostly psychiatry related.

This podcast related, would you, rathers Preston, would you like to answer them as well? 

Preston: Yeah, I wanna answer too. Okay. It's been with my icebreaker, which was just telling Drew everything I ate in the last 24 hours. 

[music]: We'll get to that. 

Dr. Drew Ramsey: I to [00:04:00] let's that one, that one, because I think everybody went, you know, some people listen to no nutritional psychiatry, which this idea of what we eat affects our brain health and how we feel.

And it's also like a nice place for us to put time and energy, uh, especially according to the recent research, especially if you have depression. So I would definitely wanna hear Preston's whole meal. Yeah. Yeah. Hear that guys. After, after. Would you rather, this is, this is, you're gimme a scenario and I've gotta pitch.

You're the stinger. Okay. You give would one sentence 

Margaret: for your rationale, but that's it. So you, I won't make you totally just pick and then be like too bad. But you, you, you have a short sentence that you can say, it sound like one of 

Dr. Drew Ramsey: my supervisors where eventually they just got frustrated like. You, you just have one sentence to tell the patient.

That's it. And I want you to come with that sentence. This is the game, right? Okay. Alright. Just gimme residency flashbacks. 

Margaret: Okay. Are you, are you guys both ready? Yeah. Okay. So we'll switch off Who answers first? So the, my first would you rather is, and they get, [00:05:00] I think, increasingly hard or unhinged. So would you rather all patients, psychiatry patients in particular were eating enough fiber or eating enough protein?

Dr. Drew Ramsey: That's, that's, I mean, you're asking me which of two essential nutrients I'd prefer. I don't know. That's, I mean, meeting the 

Margaret: USDA guidelines. 

Dr. Drew Ramsey: If you're gonna be a little deficient in one of those things, I would say fiber probably is, is better to be deficient in than protein. 'cause protein deficiency is gonna lead to neurotransmitter problems more quickly than the fiber which will lead inadequacy, which you could get close.

Hey, this is a complex sentence. I haven't hit a comment yet. And mainly be influencing inflammation, which you could address in some other ways. 

Margaret: Period. Period. That was a good sentence. Okay. Preston, your answer. 

Dr. Drew Ramsey: Um, 

Preston: I agree.

The two sent two word sentence there. 

Margaret: I think I would go with fiber. So that's, we'll come back to these [00:06:00] questions, but, okay. Second one, Preston, you can answer this one first. So you can't cop out. Mm-hmm. Would you Rather, myths about SSRIs disappear from the internet or myths about the danger of fruits and vegetables versus the carnivore only diet disappear.

Preston: Oh, so this is about which misinformation would I like to dispel? 

Dr. Drew Ramsey: Yes. 

Preston: Okay. Um, honestly, I would much rather dispel misinformation about SSRIs because if people feel fine with SSRIs, I'm fine with them taking their antidepressants in addition to the carnivore diet or whatever weird stuff they wanna do.

But if, but the thing is, if we dispel the information about the carnivore diet and other weird fad dieting, it's like a hydra and more stuff is gonna sprout up. But people are still gonna have their, 

Dr. Drew Ramsey: you know, suspicion or skepticism towards SSRIs.

Margaret: Dr. Ramsey. 

Dr. Drew Ramsey: So when we're talking about the carnivore diet, [00:07:00] we're talking, one of our colleagues actually, uh, Paul Dino, I think is a psychiatrist. And, and so if you're going to actually base this answer on the evidence mm-hmm. Looking, and I'm a big fan of SSRIs. I want everybody listening to, I prescribe SSRIs.

I was just on a conversation about medication, like I'm a psychiatrist. I like psychopharmacology a lot. I think there's a lot of hope. Promise. I'm a fan of SSRIs. The number needed to treat, which is how many patients do Margaret Preston, I have to recommend an SSRI to and have them take it to get one into full remission is seven to nine for an SSRI.

The number needed to treat for a Mediterranean diet, according to the Smiles trial is four. And, and so if by dispelling misinformation about, uh, carnivore diet and fruits of vegetables draws people into nutritional psychiatry, which one thing Paul has a huge following. He never wears a shirt. He's a very attractive man, actually.[00:08:00] 

Uh, he, I had, what was that teenager? I was like, I'll say I was not 

Margaret: specifically targeting him with this question. I'm more talking about my TikTok feed. So, well, who 

Dr. Drew Ramsey: I, I guess, but like, who else is there? Like Paul is the carnivore and no one else is popularized it as much as he has. I, I don't think 2.1 million followers, smart psychiatrist, great at media.

So, um, and yeah, he went in residency with Zach Rosen, which is really weird. When I was a teenager, my aunt lived down the store, uh, down the street from Zach Rosen. I had a crush on his older sister. And so it was really, and I reconnected with Zach recently and then I learned he was in resident, he was co-resident with Paul.

Isn't that Oh, interesting. Isn't that wild? 

Margaret: The world is so small. 

Dr. Drew Ramsey: Yeah. That's my one word answer. 

Margaret: So, so you would like to dispel the misinformation around food if you had to choose between the two? 

Preston: Yeah, I think so. Stir excitement about nutritional psychiatry, which has a much more favorable number needed to treat and probably [00:09:00] lower 

Margaret: side effects.

That's 

Dr. Drew Ramsey: my rationale right now. Yeah. Mm-hmm. Fair and, and a little better way into psychiatry because you're gonna be more intrigued about creating an alliance with me around food than medicines, even if medicines were a little bit more effective. Mm-hmm. 

Margaret: Okay. My next question, this is a similarly kind of comparing, so.

Would you ra We've done a couple exercise and I know in your book healing the modern brain, one of the tenants you talk about is like exercise and movement, um, as well as nutrition and other elements that we'll get to. But would you rather, if you had a patient with depression and so like you could wave a magic wand and suddenly they had a robust evidence-based exercise intervention that they were doing and enjoyed versus the Smiles trial to treat their, um, depression.

So basically you could wave a magic wand and we don't have to worry about behaviors or access or whatever. It's like suddenly this intervention definitely without a hitch will happen for them. We could prescribe them like pills. Yeah. 

Dr. Drew Ramsey: [00:10:00] Yeah. I, I give you exercise first. 'cause the number needed to treat us too for exercise.

And so exercise is probably the most powerful brain health intervention that we have. I'd call it movement. Like I do the tenet of movement with the idea that mm-hmm. The best recommendation for mental health from a quote unquote exercise perspective is to tell our patients to go dancing. Mm-hmm. And I go over some of this data in the book because most of my career I've been like, you should exercise 150 minutes a week.

You should lift, you should build muscles. And, you know, that's like good advice, but it's, it's not as exciting as specific advice. Like, Hey, do you like to dance? Have you gone to Daybreaker? Mm-hmm. Which is this awesome sober dance party. Have you ever taken like a dance class or a ballroom class? Oh wow.

That helps you socialize and connect a little bit too. Mm-hmm. So, uh, um, I would, I would go for movement or exercise over nutrition. If I could wave a magic wand for patients 

Margaret: and Preston, 

Preston: yeah, I think I would too. But I don't think I'd recommend dancing. I would recommend, um, [00:11:00] soccer and I would say, Hey, actually if you join this co-ed league on Monday nights, we are like really hurting for players right now.

And certain positions, especially like if you wanna come to, it's five E five all indoor. It's a turf field, but there is a goalkeeper if you wanna play that outside of it. It's really just kind of a hodgepodge on the field, but it's fun for the whole family and there's a very small chance you'll get a ball directly to the face, but it does it and they have ice packs if it happens Otherwise.

Dr. Drew Ramsey: If like someone's visiting San Antonio and wanted to like play on your team as a goalie, is that like possibility or do you need to be like there for the whole season? Yeah, dude, we, 

Margaret: Hey. He has like a house. You could stay with him. You guys can a bro. Well, this weekend let you know what our schedule 

Preston: is. I, I've got goalkeeper gloves for you.

You just have to get you like a penny or something. 'cause I don't have the jersey yet. Okay. But you know, you, so what if you guys 

Margaret: did a men's wellness retreat together? 

Dr. Drew Ramsey: Yeah. I'm gonna be in San Antonio in November. So, you know, we, uh, we've got the makings of the American Consult [00:12:00] liaison, psychiatry annual conferences in San Antonio this year.

We can, 

Preston: we can make that happen. I think Margaret, I think you're honest I, of the men's wellness retreat, because the ones I've seen just try to mimic seal trading and they just like shave their heads and shame them. And you're like, in there, done that over again. It's like Marco's like, I'll do that for free.

Yeah. Like 

Dr. Drew Ramsey: I do like the, like arms linked singing together is like the sun comes up. I, I like that part of the seal train. I think that's like. Like very beautiful. The ones that I've, my limited seal training videos. 

Preston: Mm-hmm. Yeah. It's just a bunch of guys being dudes. You know? 

Margaret: What's better 

Preston: than that? Other than that, 

Dr. Drew Ramsey: Preston, what would be on a, a, a male mental health retreat in your mind?

I'm just curious. Mark and Margaret. I'm just, is, is a younger, newer generation of psychiatrists. Yeah. 

Preston: Margaret, our resident, male expert, wellness expert for sure. She's 

Dr. Drew Ramsey: dating young men. I mean, it's like, 

Preston: whoa. Not to make assumptions, but just like, whoa, like. I think it would be, [00:13:00] so if I think about what promotes general wellness, um, for like all humans, it's gonna be like socializing, exercise, good nutrition like we talked about.

But then it, I would specify, make that specific for guys. So things that makes dudes like to collaborate. So a lot of sports, but also a lot of things that they have to build together. So it'd be like, like construction and Legos and puzzles. We're gonna 

Margaret: play work from home bike. Interesting. You just like a 

Dr. Drew Ramsey: Caterpillar As a sponsor of our male metal windows tour, this is like, dude, 

Margaret: honestly, 

Dr. Drew Ramsey: like I know it's like been at 11 o'clock, I'm on the backhoe and my other buddy's on the big dozer and that would be great.

Preston: Oh. Oh. Imagine as you go up into the mountains and they're like, okay, first task for male mental health is we gotta move all this dirt from this pile to that pile and here's the backhoe. 

Dr. Drew Ramsey: Or maybe it builds a shelter. I probably a lot better, maybe it builds a shelter. I like, I like moving dirt a lot and digging holes.

I think that's generally actually. Really? Yeah. I'm like, 

Margaret: I'm, I'm like laughing because literally as a joke, me and my [00:14:00] friend Helen, who was on the podcast as a child psychiatrist, talked about eating disorders. We had this running joke whenever our male friends would say something sexist to us that we would just add things to the list of things we think guys like, and one of them was just dirt.

So you're like, what? We got a big pile of dirt. 

Preston: Just moved it around. Yeah. That's male wellness right there. 

Margaret: What? What a guy. What's better than that? Okay, my last question for, would you rather was, would you rather have past Preston or eyes a patient? Just kidding. That was actually the last question I wrote down.

That's a one like I need to be done. 

Dr. Drew Ramsey: No, that's a tough one. That's a good one. That's, I don't think that's fair at the beginning of the podcast 'cause we haven't really had time together yet. So maybe you all give me a session and if you remember at the end I, I guess sounds a li it's more judgmental than I like to end sessions.

Mm-hmm. And it's more conclusive than I like to end sessions, but if this podcast were a session, I'll, I'll, I'll let you know matter if my current caseload, which is a little impersonal. It's just also, [00:15:00] 

Margaret: that was a very professional answer. I liked it. Um, okay. Well we are gonna take a quick break and when we get back we're gonna talk a little bit more about your work in nutritional psychiatry and then kind of hone in on your newest book and how you view nutrition as one of these nine elements you talk about of kind of in reading it, thinking about the lifestyle elements that aren't medications and aren't a specific psychotherapy for helping our patients or for people who are listening who aren't therapists, aren't psychiatrists helping themselves, they're loved ones.

We will be right.

It is September and September is Sepsis Awareness Month, and it's more important than ever to talk about a podcast that we think every clinician should know about, which is the sepsis spectrum hosted by critical care educator. Nicole Kic. 

Preston: One thing I really like about the podcast is that the goal isn't to be droning on through CME, but it really takes stories from ICU teams, prevention specialists and [00:16:00] sepsis survivors, and makes things conversation and easy to access.

Margaret: You can listen to the sepsis spectrum wherever you get your podcast, or you can watch it on Sepsis Alliance's YouTube channel to learn how you can also earn free nursing CE credits just by listening. Visit sepsis podcast.org.

Okay, we are back. We're gonna start by talking about nutritional psychiatry. I know you already gave us a little bit before I attacked you with weird, would you rathers, but. For people who don't know, because I don't think a lot of people have access to this nutritional, psychiatry understanding. How would you describe the field at this point?

Dr. Drew Ramsey: I think the field is now in a robust place. Lots of data, lots of interest. Still probably the best, kind of the most palatable intervention we have. Um, let's just talk with the definition. Start with the definition, like palatable. [00:17:00] You know, thi and it got in me interested, uh, early. So everybody, I'm a farm boy.

I grew up in Indiana. I tell some of the story in the book. Um, and then I moved to New York City and did residency at Colombians and stayed in New York and had a, a period of my life where I was like living in these two distinct worlds, urban New York City life as a psychiatrist, which I adore and I love.

And, um, and then this really rural existence in southern Indiana. And, and so nutritional psychiatry kind of for me is born from being in these two places and, and also seeing what's happening to our patients in terms of what they're eating. A lot of the misinformation that're getting, um, and the opportunity that was coming out in the data.

I define nutritional psychiatry really in a straightforward way. For me, it's food. And for some of my colleagues, you know, they're interested in supplements, eh? Okay. Lots of people are telling you to take supplements. I don't find enough people in mental health that are talking to you about your food.

And when we approach food from a, a mental health standpoint, almost always we think are thought of as experts in eating disorders. And, [00:18:00] and you know, just like for sure there's a lot of pathology in eating. There's also I think, a lot of opportunity in health and what I call eater evolution that needs to happen.

So simply nutritional psychiatry is the use of food to optimize brain health. Like what should you eat to have the healthiest brain? That's the question I started with ki kind of when I was, uh, where you all are. Right? Right. Sort of in residency as a vegetarian, some data was just coming out. Omega threes really like a big new thing.

Uh, so the use of food to optimize brain health and to treat and prevent mental health concerns, and I say concerns, meaning that if you don't have symptoms, but your grandfather died by suicide after a catatonic horrible psychotic depression. Yeah, that's on your mind, that's in your genes. You're thinking about that.

And we want people in a much more active stance and kind of obviously being more responsible with what we understand about ourselves and our families and how that can direct us towards eating differently than, than really most people are eating or than a [00:19:00] lot of people are eating these days. Mm-hmm.

And so that, that's nutritional, psychiatry and a little bit of, you know, where, where it came from and what it is. The idea isn't to replace medication. The idea isn't to, um, you know, say that all mental health problems are because we're eating, you know, horrible chemicals in our foods. But it is to recognize there's a lot of research now.

The changing how you eat changes your brain health changes how you feel, changes outcomes with depression, anxiety, A DHD, a number of our kind of most disabling mental health disorders. 

Margaret: No, I think what I really liked in both of your books that I've read so far is that there was less of a. Pathologizing or further kind of fear inducing reading.

Reading. It didn't induce shame, I think, and I don't think anyone writes books to induce shame, but I think the tone you took is like, how do we build strengths around this And like use people's creativity in their family [00:20:00] backgrounds, their cultural backgrounds to help them slowly build up a different way of evolving, as you're saying, into different types of eaters without focusing on pathology first or something that is scary and bad first, which I think is for a lot of lifestyle changes.

The place a lot of people get information online is like, did you like it's tension grabbing to have someone be like, did you know that this is really wrong and bad? And like people don't wanna tell you this. And you did not use that in your books. At least my reading of them. 

Preston: Yeah. If I was feeling shame, I knew that you were gonna write, be kind to yourself at the end of the paragraph and have a little section about grace and forgiveness there.

Dr. Drew Ramsey: Yeah, that's been a bit, that's a been a big theme for me. Uh, something I learned from patients early on. I remember actually very distinctly, I was thinking about this patient earlier today and I didn't know why been treated for years. Her name was Meg and, and she was a just wonderful woman, really long, horrible course with depression.

But I just remember there was a, she came in once and she's basically like, you know, you're, you're kind [00:21:00] of new at this, but you're sort of a downer 'cause you just only want to talk about like my illness and how sick I am. And I live in this fucking depression my whole life. And I, I need some more positivity outta you.

And, and it wasn't like an avoidant thing, which I think oftentimes our field is like, oh, if you wanna talk about positivity or strength, or your pesto recipe, or there's the door, your weekend plan, like you're, you know, you're being avoided. You're avoiding this. You're not, yeah, you're not, you're not talking about real stuff.

But, you know, I think, um, all of us need encouragement and support. I think we all respond to that in, in a way that's really helpful. I think we want that from our clinicians and our therapists when they see our strengths, especially when we don't see them. Mm-hmm. You know, in some ways, part of our role is giving voice to the strengths we see.

I, I call it, for my patients. I, uh, I call it their relational potential a lot of times because I feel it, you know, as I sit with them and I am having like a wonderful relational experience when you're sitting with somebody who maybe is really anxious, really shy about sharing themselves or being [00:22:00] vulnerable or being in a relationship.

You know, it's important I think for us to see that and, and see our patients' strengths, you know? Yeah. I'm glad that came out in this book. That was like, uh, I don't know, this is a little bit of a different book for me. The others are all just about food, and this one is, was much more personal, uh, about this kind of idea of mental fitness, I think came from what I do with patients, which is a, I love talking about food, but you know, it's a piece of it.

There are these other, you know, along with meds and psychotherapy, these other things that I always find myself getting back to. I find, you know, the, these tes people are like, how'd you pick them? I like, they're the stuff that we all agree works. We, we might argue about SSRIs, but like, nobody's gonna argue about sleep.

[music]: Right. A lot of times we, 

Dr. Drew Ramsey: we don't kind of link just like it was really, it's really amazing. People don't link their food to their mental health. Like when you tell people, Hey, your depression risk is dictated by your nutritional intake. Mm-hmm. It's like, wow. It's like, or like, hey, if you eat a Mediterranean diet added onto your SSRI, like 30% of [00:23:00] that population will go into full remission from their depression.

Margaret: Right. And 

Dr. Drew Ramsey: so we, we also don't like these other tenants, you know, exercise we do to our mood somewhat, but like sleep or, uh, you know, connection and, and to really get explicit like, Hey, this is, this is where you need to spend your time to have great mental health. 

Margaret: I, I wonder if we could ask a little, or I could we, I could ask a little bit like, what made you, it sounds like from your clinical experience, you were seeing these things emerge and I remember talking to you a little bit about a PA about writing this book and kind of moving from more of the focus you've had in nutritional psychiatry to.

Broader than just nutrition. What, what inspired you to be like, okay, I need to, you know, do the very difficult thing of writing a book about this and move away from what you've, into a broader field, I guess, than what you've been doing or writing about. Like what were you seeing that was like, this needs to be out there?

Dr. Drew Ramsey: You know, I, I think is what drives all of us. It sounds maybe a little cheesy, but it was the desire to be authentic. I, I wanted what [00:24:00] cheesy, um, I was being seen as, and which is really, you know, largely been food has been my platform. And, and that's been somewhat intentional. It's fun, it's tasty, it's visual, it's easy to Instagram and it's really compelling and exciting to people in a way of, of talking about our mental health.

It also fits with my narrative. I grew up on a farm. I like to grow food. I like to cook food, but when I said with patients, you know, these other elements just kept standing out. And also you see them work, you know, is, is, uh, and it's hard to ignore that because in our field. Especially where you are. Um, the part of our field that I'm in, I'm in private practice and, and so, you know, it's not like being part of a research program where there's a lot of data and metrics and rating scales or even part of a academic, um, kind of program where there's, you know, a certain way things are done.

It, it's, um, it's a very, you know, personal, uh, way of practicing medicine. It's just you. And, and so, and I say this [00:25:00] because when you see people get better, it's just really clear. Um, and, and that's true in all of those settings too, I guess. But, um, as a, as a someone in private practice, you really pay attention because that, like if you, how I put this like.

If you don't help people take steps towards getting better, you, you're not going to be, um, working in the field very long. And so it, it's, um, and so that, that's where these tenants stick out. You see people get into relationships and form connections and they're just beaming and you're like, oh my gosh, you were so ill.

Like we were thinking about hospitalizing you last week and now like, you're great, or at least you're happy, or at least you have this smile that I haven't seen forever. Like, what was that? And it's like, I don't know. I just, like, I met, I met this guy and we started talking and it's like, wow. You see that, you see someone just go like, you, you all have seen this clinically, uh, right, just beside themselves with insomnia or this happens sometimes I'll see patients and they didn't get their morning meds and they're on a stimulant, and you're like, oh, no, like, what's like, just [00:26:00] like totally like volume down, like what's going on?

And it's like, oh, I missed my med this morning. It's like, oh, okay. Like, because you know, there's uh, um. There, there's that sense of really paying very close attention to what lights people up. And these are the things that I felt over and over again. I would see light people up and whether they need meds or whether they need a deep psychotherapy about some maybe trauma or a strange development or, you know, things in their character.

Like, these things always help make that work go better. And I don't use 

Preston: always lightly. That's a heavy always. Um, one thing that like strikes me about these tenants is how they all are like united through food. 

Dr. Drew Ramsey: Huh? What do you see in Preston? 

Preston: Almost like it's the point of the book, but I, I think my, my point is that like, fundamentally, like if humans [00:27:00] want to connect with other humans, it's by like sharing food.

You know, it, it's like, it's like the earliest way in which you can like build trust with another person is to like, take a bite of something breast breastfeeding. Yeah. Or the, you know, we can go there too. 

Dr. Drew Ramsey: Let's not get into, let's not get into breastfeeding right now. There's a lot of lactation in my house and I have a really deep relationship with, uh, that process and breast milk.

And I find it really strange that like a lot of people are repulsed by breast milk or when you ask people if they've like tried their breast milk or you know, their husband's tried their breast milk, it's like, I dunno, it's sort of strange. People act like it's gross. It's 

Preston: really weird. 

Margaret: Preston, how does this conversation make you feel?

Preston: Y you know, I, I actually, my mind went blank and I was just picturing a bunch of breast milk, um, like in my fridge. And then it made me think of that, uh, there's like a, my strange addiction where all these like bodybuilders were drinking breast milk and they were getting like imported from other states.

Oh yeah. So that's actually the biggest consumer in a thought. Yeah. Yeah. There's 

Dr. Drew Ramsey: the underground breast Strange [00:28:00] market. Yeah. I guess. I guess so. Uh, that's next book. You know, if you're lucky Preston, like if you're lucky, right? If you end up with a freezer full of breast milk. I dunno. I think that, I think a lot about like what are actual markers of masculine, modern, masculine success.

Mm-hmm. And, and and, and I think freezer of breast milk you haven't purchased is kind of because Yeah. I'm saving that for the wellness retreat partnered with you and, I dunno, maybe you Yeah. It's maybe not the best for, we should move on to other tenants. I would say They're 

[music]: gonna get derail us. 

Preston: Yeah. I think ultimately my point is that like, um, and maybe this is like the entire thesis of your book that I'm regurgitating to you, but every time you engage with one of those tenants, it returns you to food in some way.

Like if I'm exercising a lot, usually if you're like on a team or running together with people, you then go eat afterwards. So then you're fostering connection and, and not even necessarily like the type of food that it is, but [00:29:00] it's all, it's always comes back to food is medicine of, of any nature. But then you can change the quality of food to improve it.

On top of that, 

Dr. Drew Ramsey: no, Preston, I, I think I like to initially, 'cause I could sense you're gonna be a good psychiatrist somehow because I, I've actually not ever thought of that, to be really honest with you. It's like a really beautiful interpretation. Um, it, it's, uh, I really appreciate that. I, I, I really quite honest, I'd not, I thought about this as a book where I'm trying to like, show people I'm more than just food and nutritional, psychiatry and, and, um.

I, you know, I'm, uh, I, I really like to, you see food in all of it, but it's 

Preston: all food, you know? It's like, well, and that's okay. Like, that's like what's life is, you know? Just, just one thing, bro. No, but really, like, whenever, whenever I'm reading a book, a novel and I see two characters break bread, I'm like, communion, camaraderie, eating together, you know, it's, it's like, it's like fundamental to the human experience and that that's like what a lot of those tenants felt like to me, rather than like [00:30:00] nine pillars lined up, there's nine of them Right.

Going crazy. Yeah. Nine pillars lined up, you know, it's really just kind of like nine vertices that are all connected, or eight vertices that connected in the center through food. That's how I see it. It's like a star. I 

Dr. Drew Ramsey: appreciate that. 

Preston: You know, like yarn. Yeah. So, so anyways, that's, that's my interpretation.

Dr. Drew Ramsey: I like the interpretation. 

Margaret: One of the things that you talked about. Both books, but like the neurophysiology or the studies we have on different elements of nutrition and how they impact people's mental illnesses or mental health and prevention. I think something that I'm curious your thoughts on as someone who spent a lot of your career in nutritional psychiatry is that there's been a lot of conversations, especially knowing you are in New York and I think at Columbia from the therapeutic lens of like what food means to people and you know, why people eat certain things, why certain people binge or don't binge, and there could be a [00:31:00] million reasons for that.

But I wonder from your positive viewpoint, if there are ways therapeutically you bring up with people their strengths around f around food or their patterns of eating, their creativity with eating their history of relating to their food community that you talked about in the how to eat to beat anxiety and depression.

Dr. Drew Ramsey: So Margaret, I think there are a few things in here. First of all, everybody listening, we're gonna tell you the good stuff to eat for your mental health. And it revolves I've, I have like my little fun rhyme, seafood, greens, nuts and beans, and a little dark chocolate rainbow celebrations. Don't forget the fermentations, but that was added by Catherine Roberts, one of our colleagues.

Uh, but, but I'll say there are certain food categories that have more what's called nutrient density. And, and nutrient density is really a principle idea of nutritional psychiatry, which is that when we just think about calories, when we just think about eating disorders, we're not helping patients fill their plate.

We're not directing people towards, you know, what I would call are just foods that, again, have more [00:32:00] nutrients for mental health, right? Serotonins made from tryptophan. What foods have the most tryptophan. None of us seem to know. Everyone says like Turkey, which is, that's just not true. Or, or magnesium. We know magnesium's amazing for our sleep.

It's great. Everybody loves magnesium. We all have like six different types of magnesiums and our supplement cabinet. But when you ask people like, what's your favorite? Like, I don't know, three or four magnesium foods because like this mineral's so important, right? We'd all have some, it's like people don't dunno.

Patients don't dunno. Psychiatrists, doctors don't know things like folate. I remember actually like a Harvard educated colleague, like, you know, favorite food sources of folate and it's like, none. And, and so that really intrigued me as an opportunity, but also just like a strange lesson about brain health.

Like we all, you know, it's sort of sort of like, it's like mental health awareness. We like to talk a lot about it, but when it comes time to doing things about it and doing some of the obvious things and evidence-based things about it, we kind of struggle. And [00:33:00] we get, and we, and we don't know, just some of the most basic, and like, if this was a test, hey, you've got a brain to keep it, just gotta pass this test every year.

It's a simple test, just like basic stuff. Like, eh, like, you know, simple questions. What are, what are some great sources of protein for your brain? You know, where, where do you find vitamin E, one of the fat soluble nutrients that's really important for optimal brain health. It would be great. Everybody would know more about it.

When, when you were saying like, it's a te a test, simple test. I think the basic point is in asking some simple questions about nutrition, you get a great sense of how people nourish and care for themselves. And, and you know, there's just a, a profound lack of knowledge that we don't. If every year you had to take a test to keep your brain and it was about the basic nutrients your brain would need, and everyone had this information, we'd be a lot mentally healthier.

Like the data is super clear about that. And you know, if you look at, for example, the nurses' health [00:34:00] study, uh, which looked at ultra processed foods. So the nurses who are eating the most ultra processed foods in their diet had a 50% increased risk of depression. It's just like very much in the data. You look at a study of 10,000 Mediterranean, uh, 10,000 students in Spain, those students during college, the ones who ate a mo more Mediterranean style diet, the, actually it's just the top half of the class.

They had a 35 to 50% decreased risk of depression over the four and a half years that the study was done. And so there's just this really kind of clear way we, we want people to, uh, you know, when you're asking about like strengths, I wanna hear about the food categories and celebrate what you're doing well, right.

When I ask about leafy greens, if you. Tell me, I don't know any saute greens. You like salads, you haven't tried them recently, but you love pesto. I, I wanna try and celebrate those things. You're, you're a good seafood eater, right? You are paying attention to processed food in your [00:35:00] diet. You know, about fermented foods and anything that I see there are a lot of, especially younger people, like treated like younger men, right?

Where they actually, you know, really pay attention to their nutrition, have some cook cooking skills. Um, so, uh, and I do this simply with a, a nutritional psychiatry history, which for me is around understanding what it's like for you. What's a day and your life is an eater. Like, you wake up, how are you feeling?

What do you eat for breakfast? Like, what else? Most people have three or four go-to breakfasts, right? What's lunch like, especially, you know. You all are in residency, there's a handful of places you're eating lunch. There's a handful of orders that you have pretty quickly in these kind of hearing, the hearing about snacks.

Then hey, what in the afternoon? Snacks, coffee, what evening? Coffee dinner. Right. If you push people to just give a little more detail, a few more examples. You now have a kind of broad brush stroke of their dietary pattern and, and you're asking about like how nutritional psychiatry works along with nutrient density.

Another big kind of [00:36:00] lesson for me in the data was we spend way too much time obsessed with single nutrients, more B12 or macronutrients, more protein, and we don't spend enough time thinking about dietary pattern. Mm-hmm. And, and, and that along with the leafy greens, you're probably eating pizza. You're probably having a few beers on Friday.

That, that your, your kind of overall broad brushstroke dietary pattern. Looking at these food categories, which is how nutritional psychiatry works, what are your rainbow vegetables? What do they look like? Where do I hear them in your dietary history. Oh wow. I didn't hear any, or I just had a patient start taking a food journal.

You look for like, you know, there's, there's seafood is there's not, right? There's a lot of fast food or there's not. And so that, that's kind of how I try and get a sense, again, to celebrate the wins, to have people say it themselves. Psychiatry's, kind of in some ways easy where, you know, people come in and say, Hey, how you doing?

And, and they, they'll share same thing you ask people, like, tell me some of the challenges for you right now and what you're eating. Again, those, those two [00:37:00] great things to add on to interpretations and mental health right now. And, um, the one that's harder for therapists in here with me, but, you know, uh, what are you challenged with?

So you say it out loud, you know, and, and then there's some accountability right away that's starting out. 

Margaret: I have have a, a million thoughts, but I also know like for Preston and i's even short so far, careers and training, the people I work with has been pair mostly like. Women in transition age points and eating disorders, um, and perinatal, not eating disorders necessarily.

And so my population bias is, is pretty heavily in that population where I see a lot of anxiety, perfectionism, self-criticism, and specifically body image stuff, not just in eating disorders. And so my, I think leaning is to help liberate them from food rules for like, that they need to eat enough. And then we'll start getting into some of these other parts of optimizing.

Um, but I'm [00:38:00] wondering for Preston, like who has a different lived experience than I do of being in like sports, being in like a military background, what kind of. Thoughts and question comes up with the populations you work with and just your, because I feel like our population, we've talked about this on air a lot, that the populations we treat are pretty different.

And so my, I have my certain things I push back at vocally, but I'm wondering for you how this lands and treating more, more men. 'cause frankly, I don't treat men now. I treat children. So, 

Preston: so, um, it's interesting you should say that 'cause I, I really kind of am divided into two populations. So I treat like active duty military, um, on like our local bases.

And then also I treat kind of, um, basically general, the general psychiatric population of South San Antonio, which is a lot of, um, like impoverished people with pretty poor access to food. And you know, San Antonio's not a desert in itself, but it has plenty of food deserts [00:39:00] in the surrounding areas. So, um, rather than it being like almost like an eating disorder problem with a lot of those patients, it's really just about like making sure that they can consistently have.

Any access to food or, or like being, being able to like, connect them with case management so they can get food stamps so they can find something to eat. So the, so usually like, I, like, I'm not like talking with them as much about like the quality of their food. If I'm just like, as long as you can like, find something to eat, that's awesome.

And, and then on the other side, we have these military members who are actually very resistant to medication for a lot of other like, political reasons. So, to, to give you some kind of more context. If you are an active duty pilot and you're like considered like a flyer is what, what's called the military, if you're put on an SSRI, you have to be flightless or you're grounded, not allowed to fly an airplane for up to 90 days because of they wanna monitor your free mental stability.

So a lot of people are reluctant to seek out diagnosis and also [00:40:00] give diagnoses for things like depression, anxiety, bipolar disorder, 'cause they can be career ending, um, diagnoses to give. That means that the, this is a population that's highly motivated, very capable and willing to try things outside of medication that require more effort.

So these are people that are really interested in using exercise and nutrition, those kind of changes to modify their lifestyle. So I, like, I don't, and I've like, actually felt like I don't have enough tools to counsel people on all of their, like, nutritional aspects to like optimize their mental health.

So it's one, one reason why I'm excited about these, this podcast and these books because I do have this population lined up that like would very much benefit from nutritional psychiatry among, like everything else. 

Dr. Drew Ramsey: I think one of the professional accomplishments I was proud of, of is after my second book, 50 Shades of Kale came out, which like a silly book about kale.

Um, I, I, uh. Uh, it's a great Kale cookbook, but we launched National Kale Day and for one year we [00:41:00] partnered with the Department of Defense and every military based commissary in the United States had lots of kale, had National Kale Day posters that we printed, had kale recipes that they were giving out.

Um, I think kale in the cafeteria. And so I, uh, yeah, so it's wonderful to, uh, it's great that you're, um, working with our military and our servicemen and women and, uh, I certainly appreciate those comments. I, I think, uh, um. Just to share with everybody in terms of the population I treat, uh, I guess in residency it was a lot of, um, students at Columbia.

Um, I worked, um, uh, during the end of residency and right afterwards in a community service, in a community mental health clinic where we ran a day program, so a large kind of caseload of patients with bipolar disorder or schizoaffective disorder, chronic paranoid schizophrenia. Um, and that's actually when I first started understanding and learning about the importance of talking about food.

It was a long time ago, um, and it was, sorry, I've got a bele here. Do you wanna say hi to the podcast? I wanted ask, you know, [00:42:00] you're talking about, uh, the different populations you both treat. You're talking about? Uh, uh, I think a very important idea. Our colleague, uh, Puja Lain, who's book Real Self-Care, talks about this kind, you know, liberating women from all of the kind of unnecessary and, um, often expensive and time expensive work and wellness work that actually often doesn't benefit them.

And, and a lot of the food rules that, you know, come from a very kind of patriarchal notion of how women should eat. And, and I'm wondering if, what's the difference, kind of rules and values. Because like, I, I wouldn't say my house, I have like rules necessarily like, eat what you want to eat. But I think there's some like values that for the most part we try to adhere to.

I don't know if it's like an 80 20 rule, but like, you know, tr trying to be more plant forward, more vegetables, trying to have our meats and seafoods be of, you know, a certain quality. Um, trying to limit moments of food insecurity, which is a great point. You brought up Preston. Like your nutritional psychiatry role [00:43:00] is assessment, encouragement.

Um, food insecurity increases the risk of depression in the elderly by 10 times. Food insecurity and adolescence increases the risk of a PS suicide attempt, I think by four times. So in terms of like a powerful intervention for a lower socioeconomic status population that's struggling with foods insecurity, it's one of those things that, you know, nutritional psychiatrists, like more magnesium, more omega threes, more seafood, greens, nuts and beans.

Mm-hmm. And like that's all important stuff. But, but underneath it is, is, you know, kind. For me, calories started in, in his calories, started with community psychiatry, which is access, which is serving our patients more vegetables at lunch to help model that and help make sure they had access. Um, uh, connecting people.

There was a, a great workshop I went, went to, which was, um, an Indianapolis, uh, a woman who is uh, working with different homeless shelters and running cooking classes where they'd basically take different ingredients from different things that they had and [00:44:00] they'd kind of create a new meal out of it. And so if you had a little onions and a, you know, a little taco kit and, you know, um, I dunno, something else that maybe doesn't feel like it would go together.

And it was like a workshop around creativity in a lot of ways and using what you have, but also, again, as you said, just about getting enough calories. 

Margaret: I do feel like one of the core. Parts that is missed. And sometimes like, because it's, you can't profit necessarily off of teaching people cooking skills in the way you can from selling them a product that's like a one time buy or multiple times buy.

But that people think, and you talk about this in your book, like, and I think I've experienced this earlier and then in learning how to cook and taking cooking classes in adulthood, that it's not that they don't like certain foods, it's just that they've only had one iteration of a food. And that it's not, you have to force yourself to like things you don't like for the rest of your life.

It's like, oh, you actually have some skill deficits and this could be a really good, this could be [00:45:00] something you can actually learn easily and enjoy. 

Preston: Like I hated cauliflower until I discovered boiling water. You know? That makes sense. That makes a lot of sense. Like now it's so good. 

Margaret: You're like, and then I lit up the fire in my cave.

Dr. Drew Ramsey: Are you like a mashed cauliflower guy? Is like a riced cauliflower, Preston. 

Preston: Uh, I've, I've not, I haven't rice in restaurants, but I'll, I'll mash it up and then I, I add a little bit of like, Tabasco sauce, maybe some buffalo sauce as you get, like those vegan wings. Mm-hmm. Great. 

Dr. Drew Ramsey: They're pretty good. Yeah. A vegan wing.

So like a a a cauliflower wing. Yeah. Okay. Exactly. I've 

Preston: not, 

Dr. Drew Ramsey: I've not had that. Okay. 

Margaret: Can I ask you guys a question that is overlay overlaps with your, like the male mental health stuff and then like nutritional psychiatry? I feel like I often see male influencers when they come up on my social media. It's like, optimize this, that, and the third about food, and then they'll be [00:46:00] eating like an entire plate of like.

They'll have like rice, cauliflower, chicken, and then like hot sauce on it. And they're like, not even in a cut. They're just like, can you talk about that male culture of influence on fitness online? I don't know. I don't, I don't know how to format this in a question, but it's so foreign to me, but I feel like I see it come up.

Dr. Drew Ramsey: Is it a stylistic thing and and what you're seeing the men present food as Yeah. Or is it like the combo like big meat carb, Tabasco? 

Margaret: Well, it's, it's like male orthorexia in some ways. I think like, it's like a more male-centric orthorexia that's like, you see like female fitness define orthorexia 

Dr. Drew Ramsey: for our audience.

Mark. 

Margaret: Yes. Yeah. So orthorexia not technically in the dsm, but it's kind of like a rigid fixation to the point of, in some ways dysfunction, if you wanted to call it a disorder, but kind of fixation on certain rules and clean eating. Um, that can have many definitions depending on the diet. You define it by that, I guess eventually, if you were gonna call it orthorexia, usually it's getting in their way and it's not [00:47:00] totally.

It can be egosyntonic, but it's making it so that some other functioning is hard for them. Um, if we're, if I'm seeing them and I'm treating them. Mm-hmm. Uh, and so I feel like the things I see online are like, like I feel like you see female fitness or health and wellness influencers, and they have like these big plates of like, they might be eating small portions, but they'll have like colorful foods, lots of vegetables.

They're like eating dainty things and not eating a lot of meat. And then I see like male influencers and it'll be like rice and boiled chicken and like, like drop taking creatine and like, which I'm not against creatine. Like it's so different of the presentation of like healthy Yeah. The 

Dr. Drew Ramsey: board for wellness.

Yeah. The board. The board with like my cutup meat. Yeah. 

Margaret: And 

Dr. Drew Ramsey: like yeah, like a stick of broccoli maybe. 

Preston: Well, so I, I have some thoughts, but, but I'll let, uh, Dr. Ramsey answer her on this one. 

Dr. Drew Ramsey: Oh, I don't know. Preston, you go first. I don't know. I don't know. I want to hear from you. You're, you're, and I 

Preston: do love speaking on [00:48:00] behalf of all men.

So here we go again. Speak on the young ones. I'll take the middle age ones. You take the young ones. Go ahead. Okay. Okay. So, um, what I've noticed is a common theme with a lot of these male mental health or fitness influencers is a lot of what they're trying to sell is discipline to their base. So they're, so, essentially their sales pitch is, you don't have everything that you want in life.

Like, you don't have the job you want, you don't have the money you want, you don't have the girly desire because you're undisciplined. So I'm gonna show you a model of what true discipline looks like, and that's not something you can display. Easily because discipline is like, it's a continuous choice daily, right?

So instead they, they show ways that you can deprive yourself of pleasure and, and lock in and grind and things like that. So, so in this whole narrative that they build of self-deprecation, that they encourage, like weird things, like they're like, you know, stop looking at porn. Stop jerking off. Don't worry about chasing women and stop drinking alcohol.[00:49:00] 

Fucking, fucking, like, don't breathe at night. Like, tape your nose or tape your mouth with this shit so you like, breathe through your nose. And then, um, on top of that, like, you know, no fancy processed meals, like you're gonna deprive yourself that kind of pleasure too, and that's what's gonna give, bring you to salvation.

So I don't see it as much as like very centered around the food itself, but fitting into this larger narrative of, if you want the things that you hope to get out of life, you have to suffer now. You have to deprive yourself in some way and like, would you rather suffer the pain of hard work or suffer the pain of regret is like mm-hmm The pitch they always give.

So I think you're just kind of looking through the window and seeing one part of this whole factory process that men are being sold right now. 

Dr. Drew Ramsey: I think men are missing the ability to listen well. But maybe I should turn that into a disciplined thing like you give 60 minutes of hardcore active listening right now.

Young man, what did she say?[00:50:00] 

Well, still, still talking about yourself for 10 seconds. Two of two of them, one of them. Um, you froze. Yeah. That's a great take of the discipline. Uh, uh, because I, I think there is a notion it really backfires for men. You know, when I, when I think about what I do as a psychiatrist, I am an agent of hedonism, right?

Because the biggest pleasure people get in life is through emotional connections with other human beings, right? Friends, uh, you know, partners, lovers, uh, mentors, right? Not in the same person, but Right. We love these connections. We, we thrive on them. Uh, and, you know, so the idea that this discipline and deprivation, right, where you're focused on draining yourself of pleasure, you know, it doesn't, it doesn't work.

It's kind of where stoicism has been taken to an extreme, some stoic ideas. Really important for men today. [00:51:00] Men do lack some discipline. Men, uh, do lack drive and purpose. Uh, men are struggling to live in the, uh, I would say, you know, newer, better, more interesting parts of their brain. You know, there's a, there's a way that male culture can really get boiled down to, like meat sports, porn misogyny, uh, in a way that, that, you know, uh, is very, is one of the parts of the male mental health crisis that doesn't get talked enough about men are wasting a lot of their time and their relational potential on things that don't give back to them in meaningful ways and then fail them later in life.

And, and, and, uh, so, you know, discipline. Yeah, it's important. Uh, you know, I, I, I, I'm definitely a product of discipline, but discipline around pleasure, deprivation. That, that's not an effective strategy because there's no dopamine in it, first of all, right? [00:52:00] There's, uh, it's like raw dogging. It's like, okay, or, or, or you could read a book or you could like talk to the girl next to you.

It'd be nice, like, or you could like write an email to someone in your family. You need your, like, there's a lot of things you could do at that time besides stare at the map. So 

Margaret: like, as someone, I make jokes, but I don't, as someone from not, I don't have the lived experience of being a man, a, a young man, and as someone who you already 

Preston: hear first guys, Margaret does not have the lived experience of being a man, 

Margaret: womanism and feminism centered spaces.

I, I don't know. I think also very frankly, like you experience enough as like a fe, a young female doctor from some male patients, and even if it's a small amount of male patients who sexualize you, it makes you not want to work. I think like that, to me, that's part of the mental health stuff. And why I, I don't treat as many men is that like, I have had [00:53:00] male patients be very inappropriate towards me.

And it's like, this is, I don't know, it's like I, I, one I've always wanted to treat eating disorders, and that just happens to be the population, but it's also like, who can I be heard as like a woman speaking in these kind of male spaces. But 

Dr. Drew Ramsey: yeah, not sexually objectified. I mean, I think there's also a way that in the more kind of traditional, uh, old school model of psycho, uh, analysis and psychotherapy with a, you know, generally male therapist and female patient, right?

That, that erotic transference is always encouraged to talk about, expected a little titillating, right? But, but when you swap it and suddenly you're with a male patient who's sexually objectifying you, you're in a, you know, essentially a very private, quiet room. Uh, it doesn't feel that way at all. So, um. I do suspect that as you get more time in the clinical space, and you know, really you're talking about a clinical challenge, which [00:54:00] is sitting with men, and one of the major barriers they're having to mental health is their tendency to, um, sexually objectify women and treat you as, as primarily like acute well woman who maybe if they're lucky, like they could go out with you sometime and, uh, maybe kiss you.

And it, it, it's just, it, it like you're a physician, you're there to take care of their mental health and you know, very quickly you're experiencing right away the repulsiveness of that. Mm-hmm. And so, you know, um, I, I wonder if over, you know, over, over time, that's what I get interested in sitting with a, you know, men who struggle with a variety of things like this, um, where especially as you sit with the young man and you really like, uh, like them, you see like the great potential in them.

You see, you know, they're there in therapy and then sometimes you hear some things coming outta their mouth. Uh, you know, it surprises you. Um, and, and I guess for me, I think that's also like, you know, that's where countertransference, how we feel about our patients is so important, right. Of just that mm-hmm.

That moment. Right. Then when you kind of, you know, the [00:55:00] record scratches and you see the more grading side of their masculinity, 

Margaret: I think you're, you're correct. I think I, in doing child now, I work with family systems and it's easier for me to work with when there's less of the one-on-one and like, like figuring out how to make a family system work and working with younger men and like childhood I think poses less of that.

I, I think there's also the kind of issue as a female trainee of how much, at what point do you say like. Not just like, is this something to work through? But like, how do I spend my time when there's an access problem across psychiatry and like, does this make a sustainable career to, you know, I mean, I had a resident when I was a med student who I rotated with, who was like, you know, taught, gave a presentation on the risk of female trainees being like stalked and things like that.

And I don't know, I don't think there's a clear answer. And I think also there's a lot to be said about what [00:56:00] therapy across gender lines can do for people in, in many different directions. In terms of positives, 

Preston: food for thought really you're 

Dr. Drew Ramsey: talking about like people, people that you, uh, it's all coming back to food for Preston.

When you think about like your population, I'd say one of the populations that I've, uh, been fortunate to treat are, um, matriarchs. And these are, uh, women who, uh, often are, uh, you know, are running families, um, complex family systems. Taking care of parents, um, taking care of their partner in a certain, you know, way.

Um, and, uh, but you see that there's a way that the family system and the mental health of the family system really depends on them. They're the ones paying most attention to it. There's the ones who are orienting of the people in that system. Um, I think those are all really important questions also that have really shifted since I trained Margaret in terms of, um, you know, more and more residents like yourselves who [00:57:00] are, you know, ha on social media, having platforms, putting content out there.

Um, you know, certainly the gender differences and the kind of fears and concerns about that. Um. Do think it's also one of the things about, um, female patients speaking with men. One of the things that, that, uh, about these issues that's been interesting in my career is, is that boundary that we have as psychiatrists and how that actually allows us to have relationships with women that are really different.

Like by proxy. I've spent, I don't know, 20 to 30,000 hours, not by proxy, but just by like my career. Mm-hmm. Like listening to women and like need to listen, like really carefully honor what they say, be like thoughtful of how I talk back. Mm-hmm. And I don't think that's an experience, uh, I mean men certainly have in the workplace, but, you know, it's, it's kind of, um, I think about my patients really as my boss, right.

Because I do just work for them. And, um, and so it's, it's been um, you know, speaking with different women across the lifespan has certainly been one of [00:58:00] the, I dunno, one of the places I think I've learned the most in my career. Yeah, as a therapist, you know, one of the, one of the ways that you can, you can end up helping men is you hear a very unfiltered, uh, version if you're doing the job right over time from women about, you know, kind of real challenges that men have.

Um, and so then as you're working with young men, you know, like what I tell a patient now is like, cancel a session is, and he is asking like, am I gonna get double charged? I'm like, you know, I'm from the Midwest. I think you're canceling this session to try and be a better boyfriend. And that, that seems like a treatment goal we've had.

So, uh, I don't, I don't think I, I don't think I could double charge you. You know, it's, uh, so, you know, it's, uh, yeah, it, it, it's, it's a really wonderful place in some ways to, um, learn about more about gender dynamics and how they play out and how people experience them 

Margaret: in, in working with women. It has been interesting over time, over, I mean, again, only over the last [00:59:00] four years, but to.

Hear about the things and hear about the complaints at times or dynamics that are happening, but then also to hear how the disempowerment that they've internalized themselves as part of this is like where our work ends up being often, right? Like it's our work with that their patient is often never, it's very rarely all about changing someone, some, some bad actor or bad guy in their life.

And more about, I feel like my pattern has been, ends up being about, and why do you think you like, deserve this? Like, why are we staying here or why are we not doing anything or speaking up about it? Um, which I think is also part of the like dynamics of how, how these things continue to happen. Um. 

Dr. Drew Ramsey: Yeah, it's easier not to confront people.

I mean, that's one of the things you all are learning in training, right? That you have, you have a certain moment in a session, you know, somewhere between minute 22 and minute 42 usually. And that's your opportunity to say something and, and to, uh, [01:00:00] confront someone in a way that works also, which is different than just confronting people.

And, and so that, you know, confront folks in a way that helps them heal. Um, or, you know, this kind of idea, how do you, you know, uh, empower someone to speak up in a relationship, to give voice to something that, you know, might lead to a fight or a disagreement or even a breakup. Um, but, you know, uh, so yeah, it's, uh.

It's a very fun thing about the work you all are, are starting out on, as I'm sure you're experiencing. I still, uh, I still work with, uh, a couple of patients I treated in residency. Mm-hmm. And it's really, uh, just incredible treat that you get to know someone really, uh, during a, a very large chunk of their life cycle.

So you both see the kind of how illnesses can progress, but also what happens when people get better. And so it's, uh, yeah. Or this type of thing is, you know, Margaret, as you're talking, I I'm thinking like, wow, I, I wonder as you sit [01:01:00] and find a place of safety with these, like the men that you're talking about, right.

And find that place of, you know, a little bit of medical authority, uh, a little bit of, um, what, whatever it is you find right, that, let's just say in one of these situations that you're able to like help one of these men. Mm-hmm. There's also some way that that's so informative both experientially, but, but also in your treatments with women of, of late.

You know, having a space to kind of sit with that and, and having a, uh, an empowerment already by some of our role. So. 

Margaret: Mm-hmm. Yeah. No, I mean, I, I dunno if I've talked, I've talked about some of this and then we'll, we'll go to break in a second. And we have one short segment where we wanted you to help me, Preston, make our lives more, uh, by your pillars.

Help us because we did good. Some challenges in your book. 

Dr. Drew Ramsey: We gotta get back. We know we gotta get back to mental fitness, otherwise people are like, it's like better the tenants like burn the, do 

Margaret: our listeners like this, our listeners like this. Okay. 

Dr. Drew Ramsey: Alright. Everybody is, we talked 

Margaret: about if free will exists on a recent episode that I think is out at this point when they hear [01:02:00] this one.

That was like we talked about free will with, um, Allison Stoner, who was a Disney Channel Child Star and now advocates for mental health in Hollywood with child stars. So like our listeners are down for, for our, alright. Okay. Um, but I always say my, uh, my dad is a primary care. He's retired now. He is a primary care doctor and I think.

To your point of how do you see yourself in these, my dad, like super funny, goofy dude who just like, also was raised as a farmer, uh, and then went into primary care. So I think, I think a lot of my, like feminist thought on, on these things with patients and with boys and men actually comes from having someone who is like, yeah, this is, you know, this is how you should be.

He, this is how girls and women are. Like, he was the one that was like, you can be a doctor if you wanna be. So, I don't know. It's very interesting. Well, you, you have 

Dr. Drew Ramsey: a, you have a standard for men because you had a good one in your life. 

Margaret: Yeah. Yeah. A deeply unserious. Good one. [01:03:00] Um, okay, well, speaking of men fixing our lives, we are gonna take a break and take the break and then we pressed into a food diary and I tried some of your recipes, but we're gonna see if you can help us optimize our mental health via, uh, your pillars in our last segment.

Dr. Drew Ramsey: That's what I'm here for, and by proxy. I hope everybody listening is gonna learn something about optimizing their mental fitness too. Optimization.

Preston: Hey listeners, we went long. Both of us did had a 

Margaret: YAP session. 

Preston: I, I think we talk for another hour after we say we're gonna go to the break. So what we're gonna do is just break this up into two episodes. We're gonna take a week long break and the nice thing is we've had plenty of time to meander and talk about male mental health and the global picture around nutritional psychiatry.

But when we do come back for the second episode, we'll start to get to more of our personal relationship [01:04:00] with food. So I have a food diary that we're gonna break down and Margaret, you had some recipes that you did. I tried some of his 

Margaret: recipes from his book. Um, but we do focus on Preston's Food Life a little bit more than mine.

Preston: Sorry. Yeah, I'm an open book. What, what can I say? Open cookbook really. So that's where we'll stop for now, but if you do like these two parters, please let us know. If you want us to get more authors on or find more niche topics within psychiatry, we like doing this, so we want to hear how you feel about it.

You can always come chat with us at our Human Content Podcast family. We're on Instagram, TikTok at Human Content Pods. You can contact us directly at how do be patient pod.com, or you can find more of me and Margaret on our respective social media platforms. I'm at it's prerow, Margaret's at Badar every day.

I've been making some badar myself every day painting by numbers. About 40% done with my most recent one. Shout out to everyone leaving all the nice comments. We really appreciate it and we read them even if we don't answer. So please keep us in your ears and. [01:05:00] Keep sending your thoughts. 

Margaret: I went in on answering best on your YouTube comments for all of season one the other day.

Preston: I've, I've been finding the comments on Spot on Spotify. Same, and I'm trying to answer them too. Yeah. I was like, oh, people comment on there. Yeah, so you can comment on Spotify and we look for them now, so it's like social on Spotify these days. Thanks again for listening. We're your host, Preston Roche and Margaret Duncan.

Our executive producers are me, Preston, Roche, Margaret Duncan, will Flannery, Kristin Flannery, Aaron Corny, Rob Goldman, and Shahnti Brooke. Our editor and engineer is Jason Portizo. Our music is Bio Mayor Benz V. To learn more about our program, disclaimer and ethics policy submission, verification in licensing terms and our HIPAA release terms.

Go to howdy patient pod.com or reach out to us at Howdy. patient@humancontent.com with any questions or concerns. How to be patient is a human content production.[01:06:00] 

Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, they probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the [01:07:00] background.