Book Review: Change Your Diet, Change Your Mood by Georgia Ede, MD
| By Dr. Ronald Hoffman
The notion of a food-mood connection is not new; it’s come to be accepted as a pop culture verity. Pioneers like psychiatrist E.M. Abrahamson who wrote Body, Mind and Sugar in 1955, and William Dufty who wrote Sugar Blues in 1975, highlighted the role that hypoglycemia plays in mental disorders.
Lately, there’s been Grain Brain, by David Perlmutter MD, that focuses on the deleterious effects of gluten and refined carbohydrates on brain function; more recently, Christopher Palmer MD ( a guest on Intelligent Medicine) advanced a unified theory of the origins of psychiatric disorders as manifestations of diet-driven metabolic impairment in his book Brain Energy.
What these authors have in common is dissatisfaction with current mental health treatment paradigms. From cradle to grave, rates of behavioral and cognitive disorders seem to be skyrocketing; Soaring childhood and adolescent rates of autism, attention deficit disorder, depression, anxiety and bipolar disorder baffle pediatricians; adults are increasingly reliant on antidepressants and anti-anxiety meds, achieving middling relief; and aging Baby Boomers are poised to swamp an already strained medical system with Alzheimer’s and other dementias.
“Psychologists say they can’t meet the growing demand for mental health care” heralds a recent headline from NPR.
Into this fray comes Harvard-trained psychiatrist Georgia Ede MD who doesn’t merely echo the theme that diet has an impact on mental health; she offers some novel new insights in her new book, Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health.
Dr. Ede has two decades of clinical experience including many years at Smith College and Harvard University Health Services, where she was the first to offer nutrition-based approaches as an alternative to psychiatric medications. Dr. Ede speaks internationally about dietary approaches to psychiatric disorders, nutrition science, and nutrition policy reform. She teaches a CME course in ketogenic diets for mental health, and writes about food and the brain for Psychology Today, DietDoctor.com, and her own website DiagnosisDiet.com.
In her interview with me for the Intelligent Medicine podcast she describes how her interest in nutritional solutions for psychiatric disorders became an outgrowth of her own professional dissatisfaction with the conventional mainstays of psychiatry—drugs and talk therapy—as well as a quest to overcome personal health obstacles.
In Change Your Diet, Change Your Mind, she decries the abysmal state of nutrition research, which is based on sketchy epidemiological studies. Studies that call for universal adoption of plant-based diets, she asserts, are colored by ideological bias, subordinating objective nutrition science to a trendy and questionable notion of what’s needed to save the planet from climate oblivion:
“I was genuinely shocked to learn that there is absolutely no science (or logic) behind recommendations to eat plant‐based diets, balanced diets, high‐fiber diets, low‐cholesterol diets, or diets containing whole grains, low‐fat dairy products, or rainbows of fruits and vegetables. At best, these ideas represent well‐intentioned guesses based on deeply flawed, unscientific food questionnaires; at worst, they are intentional distortions of the facts designed to protect professional reputations or serve political and commercial agendas, not to protect and serve public health.”
When it comes to optimizing brain function, the reigning champ is said to be the so-called MIND diet, a hybrid of the low-fat DASH diet and the Mediterranean diet—despite equivocal results in clinical trials.
The food industry, only too happy to oblige, has capitalized on health-conscious Americans’ new-found obsession with plant-based diets, whole grains, and fiber, invoking shaky science to buttress their claims of dietary and environmental rectitude.
Instead, Ede maintains that much-vaunted vegetarian diets may skimp on nutrients essential for optimal brain function; animal protein delivers omega-3 fatty acids, B12, iron, zinc, iodine, vitamins D and K, carnitine, critical amino acids and other nutrients that support neurological health.
Central to her vision of brain health is that excess dietary carbohydrates stoke production of insulin, which leads to insulin resistance in the brain—dubbed “Type 3 diabetes”. In this state, the brain loses efficiency in utilizing glucose as its main fuel. Lowering—or even virtually eliminating—carbohydrates, as with a ketogenic diet, flips the switch of brain energetics to reliance on a more steady-state fuel: ketones.
Thus are eliminated the highs-and-lows that exacerbate mood disorders. Insulin receptors in the brain are re-sensitized and brain metabolism improves. We can get off our sugar roller-coasters and achieve calm focus.
These are by now acknowledged themes, embraced by the low-carb diet community. But what is novel is Dr. Ede’s nuanced take on how best to garner the benefits of diet modification for both mental and physical health. Spoiler Alert: It’s not just about blood sugar.
Drawing on her extensive research efforts, Ede gently but persuasively points out that many heretofore vaunted “superfoods” may not be what they’re cracked up to be.
For example, fiber and polyphenols, while conferring benefits in moderation, may have unanticipated consequences for sensitive individuals; cruciferous vegetables may interfere with thyroid function; phytates and trypsin inhibitors in grains and beans may inhibit nutrient absorption; tannins, abundant in “healthy” tea and certain herbs, may irritate the gut; salicylates, present in berries and other fruit, and nightshades in tomatoes, peppers, eggplant and potatoes, may act as neurotoxins, adversely affecting behavior in susceptible persons; oxalates, in green leafy vegetables, may harm brain and gut, in addition to just their traditionally ascribed role of promoting kidney stones; histamine-triggers among plant foods include dried fruits, avocados, eggplant and spinach; lectins, pervasive in plant foods, may worsen leaky gut and promote autoimmunity.
Hence, Ede’s recommendation to push back against the plant-based diet dogma and consider withholding many commonly extolled nutraceuticals. She proposes a 3-tiered approach:
First, to consider an ancestral or Paleo-style whole foods diet that modestly limits carbohydrates and selectively includes “kinder, gentler” fruits and vegetables.
Then, if mood optimization isn’t achieved after six weeks, consider progressing to a more stringent keto diet that drastically restricts carbs.
And finally, if the requisite endpoints haven’t been achieved with keto, undertake—perish the thought!—a carnivore diet.
The latter sounds extreme, but Ede invokes science to demonstrate that, with the proper implementation, it can be safe and sustainable. Although not for everyone, for some with challenging mental conditions—even for those suffering from refractory body-wide pain, autoimmune conditions, or inflammatory bowel disease—the carnivore diet can be a boon.
Ede provides detailed meal plans and helpful advice on how to ease compliance with these seemingly challenging diet regimens.
Studies are in their infancy, but anecdotes abound attesting to the benefits of one or another of these strategies for relieving symptoms and reducing or even eliminating medication requirements for sufferers of depression, bipolar disorder, obsessive compulsive disorder, even schizophrenia.
While I have some reservations about Ede’s downplaying of the benefits of soluble fiber, plant-derived polyphenols, and the long-term safety of an exclusive meat diet, her iconoclasm offers a refreshing perspective for those patients who don’t get better with stock “eat the rainbow” strategies.
With such promising results, and the “meh” outcomes in many cases from conventional therapies alone, Ede’s approach should certainly be entertained as part of an all-of-the-above program for psychiatric conditions.
Listen to this week’s Intelligent Medicine podcast episode with Dr. Ede here.
