Dr Rupy: Drew, I'm really interested in this concept of mental fitness. Why don't you walk us through this term mental fitness and what it means?
Dr Drew Ramsey: Mental fitness is a new idea. It's an idea that we can do more for our mental health, and I think we all are looking for that right now. I wanted to give people a framework based both on the research, my clinical experience working with patients for almost 25 years now, like what do we do? A lot of times mental health we think about as something we want to maybe avoid or not talk about or we don't get into it until it's a crisis. And that's a horrible way to protect really your most important asset, your brain, your mental health. So mental fitness is about knowledge and new knowledge for a lot of people, which we'll be talking about because we need, we know a lot more about how your mental health works than ever before, but people often aren't using that and how they think about their choices. We need some new skills. We've got to learn some stuff. I had to learn to split board to achieve optimal mental fitness. I didn't know about that. I had to learn about lentils and about pesto. Everybody has some lessons about mental fitness that can increase really your capacity for what I think we're best at, creativity, loving, connecting, healing. That's when humans I think are feeling our best, doing our best. And then we need some new habits. Sorry, mental fitness. So knowledge, skills, habits, and all of this leads to a more enjoyable, more mentally sound life. Not that you're not going to have challenges with your mental health or tough things that happen to you, but you're going to go into those much better equipped, much more in some ways insulated. That's mental fitness.
Dr Rupy: Yeah. You know, when I heard the term or read the term mental fitness for the first time in your book, Healing the Modern Brain, it kind of reminded me of my current exercise regime. So I was just sharing with you offline that I turned 40 this year and it's top of mind for me to be in peak optimal condition right now because of the unfortunate but expected gradual deterioration in muscle quality and bulk and all the rest of it. And I want to be around for as long as possible for my boy who's 10 months old now. And when I think about what I do in the gym, when I'm doing those reps, when I'm progressively overloading, what I'm doing is improving my resilience to what what life will throw at me. And when I think about mental fitness, I'm like, okay, yeah, it's it's getting those reps in. It's creating a really strong foundation so that when we do have those inevitable ups and downs as a result of living, whether it's in a modern environment or a rural environment, we are more able to withstand those those stresses.
Dr Drew Ramsey: That's exactly right. And we need more than muscle mass as you know. And then there's that, there's that way even for muscle mass, I think everyone listening, I bet you knew, you had some ideas right away. If you wanted to start building more muscle mass right after this podcast, everybody knows a few things. You could do some pushups, you could lift. When it comes to building our mental fitness, I found that a lot of us just have questions or we run into feelings or ideas or or ways that our minds work that we didn't expect or or doesn't work sometimes. And so mental fitness is really to help both as we age, but also as we endure the different stages of life, not just endure, also try to thrive. The whole the point of mental fitness is human life is amazing. It could be filled with creativity and love and generativity, like the good stuff. But especially today, you have to work particularly hard and in a particular way. You have to incorporate more new science. You you have to do some stuff. And if you don't, the research is quite clear what's going to happen to your mental health. And so that's, you know, as you say, you're thinking about muscle mass, you're thinking about, you know, how to be there physically for your son. But it probably for you as a dad and what the research shows, the most important thing for you and your son is around your emotional health. If you're ripped at 52, 51 and a half my age, but you're depressed, you're still drinking a lot, you're spending your weekends out on psychedelic journeys, you know, or clubbing, whatever, right? Whatever version of middle-aged male life you could do. I don't think, I don't think you're protecting his health. I don't think your longevity matters.
Dr Rupy: Yeah.
Dr Drew Ramsey: But I'm a psychiatrist, so you know, I'm I'm about the feelings and the connection and the way that especially for for men with their sons, the way that that that is, I mean, there there's really nothing like that for your mental health in terms of challenging it in some ways. It's really, you know, your fitness gets really optimal when you challenge it, when you sign up for that race, when you sign up for a new class, when you get into a new regime. And I think it's the same is true for your mental fitness.
Dr Rupy: Yeah. Um, we've talked a lot before about food as medicine, nutritional psychiatry, of which, you know, you're one of the leading voices, um, globally, I would say. Um, before we dive into that, because, you know, people have heard us talk about this on the podcast in the past, and I think it it always deserves a refresher. I want to talk about some of the, the perhaps the the more surprising elements of, um, mental fitness that you talk about in your book that I'm personally really interested in at the moment. You know, I I mentioned I'm I'm really trying to connect and um, think about the spiritual side of my journey, which sounds a little bit woo woo, it sounds a little bit out there, but actually I I strongly believe in and I think it's, you know, how we're wired as as human beings. And you talk about this in your book. Um, I wonder if we could start by talking about this concept of grounding. Um, and people might have heard grounding, uh, from the machine that's been marketed to them on Instagram with these like
Dr Drew Ramsey: There's a grounding machine now? Like you don't need the book, we've got it on Instagram.
Dr Rupy: It's like a like a mat that like you plug into an electric mains and apparently it grounds you. Like that that's that's what's being sold right now on on Instagram. But obviously your your version of grounding is is very different and I think it's a lot more natural. Um, so why don't you why don't you introduce this concept of of grounding and and and how you see it?
Dr Drew Ramsey: Yeah, for sure, and and thanks for all the things you said prior. And everyone, if you're listening, if you're sensing Rupy and I know each other, I have a particular affection for Rupy. It's true. Uh, I remember you turning 30. Um, I've known you that long. I remember you before the podcast. And you're one of the men in my life where I I've just taken such pleasure in watching you grow and create and uh, it's just been really, it's been a treat. It's taught me a lot about about men and about friendships at a distance and about cheering for each other. So if if everybody gets personal or I get misty eyed, that's why.
Dr Rupy: Thank you so much, man.
Dr Drew Ramsey: Man, it's just great to be with you and I just I love seeing your successes. I think everybody listening does and I love, I I don't think it's woo woo. I think all of us, everyone listening, you know, there's something especially as you're aging in your 30s and 40s and 50s where you begin to think about that if it's not a part of your life, you wonder what is going to be a part of your life in terms of as you think about bigger things and as you age. Um, so the spiritual side of this is very important. It's throughout the book. You know, I think about this kind of psycho-spiritual journey that we're on of our own development. And I think the book is a request in a lot of ways for people to make space for that. And it's very hard. It's one of the challenges. Um, grounding and the idea of grounding in the book comes from my experience with nature. I I wrote this book during a time, um, just as COVID came on board, I was finishing Eat to Beat Depression and Anxiety. And it was a really challenging time for all of us. It was a challenging time. I didn't plan to write that book during the pandemic. And and, um, and then after that, as we're kind of going through the pandemic, my family moves from our family farm where, you know, kind of always have been in some ways a spiritual base to me to, uh, the mountains of Wyoming. And and it's this huge shift in nature. You know, I've always been like a nature kid, even though I spent most of my career, early career in New York City. I trained at Columbia and stayed on as the as a faculty member there for about 20 years. And um, and and even in that urban environment, it was just so clear to me when I would go to Central Park or when I would go upstate for a weekend or in the uh, sometimes we'd have a a winter house in Vermont and you just kind of go out in the nature and something would change in your biology. I think we all feel that. And I think a lot of us um feel that in a spiritual way. Something bigger, something deeper. It's like the nervous system picks up on a a different language. Um, part of healing the modern brain is trying to share some of what I I think in very spiritual terms is the science of this. That actually there is something going on. Your brain is picking up the the trees in forest exude these molecules called phytoncides. We breathe them in and they change they change how our brain is is firing and functioning. They they shift how our immune system is regulated just a little bit. And so that let down we feel that kind of in some ways activation of that parasympathetic rest, digest, relax. I find the forest quite interesting because there's all that and then there's like when you hear the crack of a stick in the distance and especially here where there are a lot of bears. I was on a paddle board out in big nature just the other day. Um, and I and we came across a moose, which is one of the more dangerous animals here and her baby. And you know, both like beautiful National Geographic moment, but that tension between safety and fight or flight is also part of what the grounding experience, what you don't get with the mat. It's part of that experience of can you return your nervous system back to safety in nature? You know, can you sit, can you listen and can you tune into all of your senses? So grounding everyone is one of these nine tenants. And and I call them tenants of mental fitness because I wanted something that all of us could agree upon in this in this era that we're in where there's so much contention, there's so much marketing, there's so much that like, ah, I don't know, you don't know. It it you know, we all agree things like sleep, nature, connecting, uh, these are really fundamental. And so grounding is one of these tenants. It's it's later in the book, it's tenant seven, uh, to to try and honour one nature is all around us. You can see you're here in my my uh office where that's my fancy psychiatry couch where I do the modern psychiatry work. Um, still have couches. And there's lots of plants in here. It's always been true for me of my office. I'm always trying to grow things, either in a greenhouse or on our farm when we had it just for me, it's a very fulfilling, very um, magical place. The idea that little seeds become plants, become food. That's just always captivated me as an idea. And so grounding, and I'm curious your uh sort of experiences and what's been happening to you, what's been pulling you in. It sounds like fatherhood, but I think everybody's also very curious, you know, how does grounding inform your mental fitness?
Dr Rupy: Yeah, I mean, I think me and my wife have had a a practice where we put our phones away and we go for a walk. So this is even preceding us having a kid. And it's in those moments where I get a chance to relax. And I'm not blessed to to live really close to rural environments like uh the picturesque National Geographic uh um uh moments that you just described there. But like there's always a park, right? Even in most urbanized environments and cities, there's there's a park nearby. And ours was particularly lovely with trees and stuff. And I've always noticed that in those moments, I feel a lot calmer. You know, some people who are skeptically minded might just say, well, it's the absence of inputs. It's the absence of you being in front of a computer screen, which can be quite stress-inducing. It's the absence of you bombarding your senses with a podcast or a newspaper article or whatever it might be. It's the absence of you, you know, being glued to your phone if you're not taking your phone with you. And I think that's very true, but
Dr Drew Ramsey: I think those are all sensory inputs. And it's not an absence of sensory input. I mean, it's a shift in sensory input, but you know, on the phone, you're looking at things and hearing things and getting signals from your environment and you're responding to them. It's digital. It's um, it's not in a lot of ways based in reality in the sense that it's not specific to this time and place.
Dr Rupy: Yeah.
Dr Drew Ramsey: And and not to push back, but you know, the people who say like, oh, it's just the absence of those things. It's like, no, you're still getting sensory input. It's a shift in sensory input. I guess as a psychiatrist, how I think about it.
Dr Rupy: Yeah, totally. And you know, a part of the book that I was really interested in reading about was um the and you're right, it's it's a it's a differential input. It's a different sensory um experience. And uh there was there was a part where you talked about how we're more acclimatized to green or our eyes are actually designed via evolution to be more perceptive in green environments. We were going to pick out certain elements. I wonder if you can expand on that.
Dr Drew Ramsey: There's there's lots of research about this, but I'll tell you, I learned it from a hospital CEO, Lisa Harris, who uh she was building this new, the new hospital in Indianapolis, Indiana, the Eskenazi Hospital. And there were two features that we were doing an early tour and we're walking to the ER and she stops and we're in this kind of glass entrance way and and on either side there are garden beds. And she says, these are going to be filled with trees and gardens. So even when you walk into the ER, the last thing you see before dealing with this chaos is nature. You see green. And she started telling me about this research that just seeing green. And it sounds like one of those things administrators say, except Lisa Harris is a physician, uh, she's an incredible physician as well as being a hospital CEO. And so, uh, also this hospital put a garden on their roof, which a lot of different hospitals are doing. They're kind of getting more green space, more natural space into the healing experience. And so green and and seeing green and and everyone, I I challenge you to test this because you know, I read this research and I you know, I like to try things out. And I find for me, it's true that when I see more green and blue tones, when I see a natural setting, I find this also when I see non-linear things, like a more organic shape, like the mountains where, you know, if there is a straight line, it kind of sticks out. Um, something happens to my nervous system. And I think it's one of those parts of mental fitness that that I like a lot where it it encourages us to experiment and try things in our own lives. And so just like Lisa Harris, uh, Dr. Lisa Harris encouraged, hey, let's uh, you know, let's see how green affects things. Let's put more green in the hospital. See how it affects you. And and everyone there noted. So another thing that hospital did, they got rid of the fryers and they put this big kind of salad bar in and they put a farmer's market at the hospital. And in the early days of this, the vegetable consumption of the hospital staff and the healthy eating just skyrocketed. You know, this idea of just, you know, you have the farm fresh food, you have the stressed out healthcare workers and the families who are dealing with lots of medical stuff. Let's put these together and and try and create something that's a little more healing. So, um, so grounding, nature bringing in whether you're in a hospital or an urban setting, um, whether you get out for a big walk. I I really was inspired when I was living in New York by the people who you know, would just be pretty disciplined. They, you know, hop on an early train, they'd pop up state, they'd get dropped off at a trail head. There are a variety of ways you can do this or you can take the A train. I do this to surf sometimes. It's wild to be like in your apartment and then, you know, an hour and 15 minutes later in the ocean, like on a surfboard, like in in nature in a certain way. So it is all around you. You have to seek it out in some ways and and uh and as you pointed out, you know, it's a great time to get away from technology and the phone.
Dr Rupy: Yeah, yeah, absolutely. And there's there's also something else that I wanted to to ask you about looking at the research um more specifically about why these natural environments are so so healing. I I and just to riff off that, I'm not a surfer, even though I really tried to be a surfer when I was living in Australia. I would go to this small secluded beach before my night shifts every time I was doing night shifts whilst I was working in A&E um in Sydney. It was a little beach called Delwood Beach and I'd go in there uh just before going to my night shifts, dip in the ocean, I'd feel super refreshed and I'd get on the bus and I'd go and do my night shift. And it became sort of like a right of passage, like a a routine for me. And I remember speaking to my um uh housemate at the time who wasn't medical and it was like, the reason why you feel refreshed, dude, is because it's got like this energy and it's like, you know, it's recharging you. And I was like, dude, it's probably just because the water is nice and refreshing and it's cool and it's just a way to wake me up. But then I read in your book about the latest research showing natural environments including forests and beaches fill the air with powerful molecules called negative ions. Negative ions are molecules with an abundance of electrons, hence the name, but they play a real positive role in brain health. Let's talk about negative ions because when I've heard people talk to me about this, it's usually not scientists, it's usually not people such as yourselves. So I'm I'm fascinated about ions and and how this can play a role in in my fitness and how it did play a role in in keeping me going during during those grueling night shifts.
Dr Drew Ramsey: Yeah, I love that story about getting out to the ocean. and everyone, I wouldn't call myself a surfer. I paddle out as best as I can and try not to get thrashed by the waves. I find it very invigorating. But I think that's a great example of you're in a stressful urban environment, right? Being a a young doc, a young call, that is like really mentally fitness demanding. And we see that because so many physicians burn out, right? We lose so many physicians to suicide and depression and addiction. So there there's a way that you've got to institute stuff like this. And and all of you, whether you're a physician or not, you know, you have moments like this or periods like this in your life when it's really hard to. You know, it's much easier to kind of like, I don't know, scroll on Instagram and eat some chips and maybe have a soda because you know, you're going to be up late and you need some caffeine. Um, it takes, you know, it takes a choice. It pays off right away. And so part of what's going on is Rupy's hopping in, right? As he's shifting his physiology. The other thing that I like about this, it's a with with food, I call it the food-cebo effect. It's like you make the avocado salad for yourself and you eat it at work and you feel amazing. Even before the nutrients hit you. Because you you know, you know, you've done something for yourself. You've been in service of your health and you know it. And I think we do respond to that. Negative ions. So everybody, if you've experienced this, you walk to the beach and you kind of get there at that like misty layer and you get a little bit of a like, whoa, like cool feeling as you look out and contemplate our existence. You know, part of that is you're on the edge of something and you can't see the horizon. Part of that are these negative ions. They're when the water smashes up against uh, you know, the the wave and the surf, that misty stuff breaks up the water molecules. Also in the forest, you get a lot of negative ions, right? And so as you walk in the forest and you feel that shift, part of that is what we mentioned earlier, these phytoncides, part of that is also negative ions. There's actually a rumour uh in the Columbia psychiatry department. I don't know if this is true. I won't say his name, but there was a senior faculty member and they were doing research on negative ions and there's a lot of things that affect our mood, but this was one. And one of the senior faculty members said, oh, you know, I'll try it out just to see how it is. And he got kind of like hypomanic, like a little high almost on the negative ions. He was like super like giddy and funny and you know, settled down afterwards. So, you know, they're one of many things that have a you know, a little effect on our mood for some people, like this guy, you know, maybe a big effect. Uh, some of you are more compelled and and and feel like that that edge of the beach more than others. Uh, but I think the the idea behind mental fitness is encouraging you to explore these things. Some people don't like the beach, but they love the forest. Some people don't like the forest or the beach, right? But they love their backyard. And and so there's all kinds of ways where you can get more grounding, more nature in your life. And I and I encourage that. The the another tenant is engagement. There's a difference between standing in your backyard grass with your shoes on and your shoes off. There just is. Try it. Little little little self-experiment. You know, there's a difference making pesto with basil you bought and and a little basil uh that you grew. Basil's super easy to grow. It's easy to have homegrown pesto. Anyone can do it. And so again, maybe those aren't moves that that you like, maybe some of them you do, but mental fitness encourages us to kind of build more of a framework in our lives that protects these core tenants. And in your time in nature is one of them. I think we can all agree. It's one of them that this delicious, I'm going to call it delicious modern life, uh, tends to push out. It's easy to be very stimulated by the screen, to work from home, to not go outside much, to not have adventures in nature. And so, uh, you know, I I hope uh people take this as a signal. I I it's funny we're having this podcast now. Less than a week ago, like five days ago, I slept in a tent with our son who's 11. So I'm about a decade older than Rupy and our sons are about a decade apart. And you know, it's such a treat as you're understanding parenthood to to start to travel with your kids, to get out into nature with your kids. And anybody who has, you know, kids, you get them out into nature and you know, they whoop and they holler and they jump on rocks and you see that you kind of see that like they fit there. You know, they splash in the water and it's just like, oh, this is like one of the early lessons in grounding for me. We'd been living in New York and we couldn't figure out what to do exactly. And so we we solved this in a strange way. We thought, why don't we move back to the farm and I'll commute to New York from the farm in Indiana. Which which worked out for a little while. And uh, so I got to experience these two settings and I got to experience my kids and my dog in these two settings. You know, it's an urban setting and then this rural setting where they have 100 acres to race around. And that's what they do. I mean, it was just wild, a little experiment. So, I'm glad I'm glad the grounding tenant uh um appealed to you and I hope everybody listening sees where mental fitness kind of comes in. It's one of these nine things that the need for this book is that the modern world has taken some things away from us. It's taken healthy food away from us. It's taken good sleep. It's taken time in nature. It's really degraded the quality of our human relationships. And the more you push back on that, the more you reclaim these things that again are tenants. We all agree, if you don't have them, you're not going to have good mental health. The more you reclaim those, I think the more you insulate and build your mental health.
Dr Rupy: Yeah, I think it's a lovely framework as well because people can look at these nine tenants that you describe in the book and decide, okay, which area do I need to focus more on? And you know, the waiting is going to be different for each person in terms of the effect and what they choose to focus on, where they feel that they're lacking. Um, and I think definitely grounding was one for me. And since having our child, I've noticed things as well, like, I mean, he's only 10 months, so he's like, you know, crawling around and trying to stand and all the rest of it. So it's like chaos in our flat at the moment. But we have a little bit of green space and I've noticed during the summer months, whenever he's in the green space and he's looking up at the trees, he's so much calmer. He's so much more in tuned. And I've I've been walking around on the grass like barefoot as well just to sort of ground myself. And there's a lot of research looking at gardening and its impact on not just mental health, but you know, physical health, um cardiovascular health. And I've always ascribed it to the fact that we're getting people out and bending over and using their hands and exercising and the community element of it. But I'd like to think that as part of this multi-factorial reason, there is a grounding element to it as well where you're playing with the dirt and you're, you know, getting your hands involved and you're connecting with the soil. Um, so, yeah, no, it's it's it's wonderful to to hear about that whole element of it.
Dr Drew Ramsey: And that that goes right into there there are these three ideas I want everybody to to look at these tenants. I call them lenses in the book. And you're mentioning one of them where Rupy's entirely right, you know, there's negative ions, his nervous system settling down, there's more kind of stimulation, there's the green colour. Uh, but but the of the the three kind of new ways we have to think about our mental health, particularly illnesses like anxiety and depression, is thinking about the microbiome, thinking about inflammation, and then the third is thinking about neuroplasticity, which is the fact that our brains grow and and change and repair themselves. And that those processes are are really dependent on choices that we make every day. And so going out in nature is one of these tenants and and and the tenants I try and connect through these three ideas, saying, hey, if you're going to think about depression, anxiety, and your mood, and your cognitive health, right, really the, you know, what's most important about our mental health, you you have to know about neuroplasticity. You have to be thinking about growing new brain cells. You have to be thinking about what is all this new science about inflammation telling us about the brain? And so Rupy, you're entirely right, a lot of that data about gardening, I've never thought it was the bending over because I'm just sore. I've probably, I'm a psychiatrist, I'm in, I'm going to be like top 10 in terms of amount of gardening I've done. Maybe that's not, but I'm I'm guessing I've done a lot of gardening and farming and and uh tractor driving. So, um, what I always thought it was was being a feral creature in the dirt. And then I thought the spiritual part was putting seeds in the ground and getting food, as I mentioned earlier. I think the new science tells us there's a lot going on in terms of the microbiome. There's a lot of data. Um, Daphne uh uh Miller is a great uh family practice doctor in California. She wrote a book called The Pharmacy, which with an F, which and part of that she talks about some of the research here in the United States and the Amish, but uh she looked at some research I think out of Germany of of kids who were still on farms and had exposure to barns and you know, farm chores and just, you know, their inflammatory systems work differently. You know, the way that they get triggered by things, they just have so much exposure uh that they have less asthma, they have lower autoimmune rates of autoimmune disorders. And so, you know, part of it is the physical labour. I think part of it that I write about in the book is the natural sleep cycle. On a farm, you just you don't sleep in. Some of the best working hours are those early morning hours because it's still cool. You can get so much done um right away in the morning. If you have livestock, they need tended to. Um, if you have crops, you know, again, it's a nice time to be out there working. So, um, and and by the end of the day, you're exhausted. Um, you know, on a and and boy, by the time the sun goes down, you're just you hit the pillow and fall asleep right away.
Dr Rupy: Yeah, yeah, there's no need for any uh sleep optimization routines, I guess when you're uh working that farm life.
Dr Drew Ramsey: It it's really, you know, I haven't gotten to experience a lot of it. I don't want to mislead people that I'm a huge farmer, but I I got to experience enough of it and certainly more than most people growing up really rurally. You just kind of you grew up in nature with the cycles, um kind of out in the elements more. Um and then certainly as I spent more time in the farm later in life, it's funny, it was really after we had kids, we we I started, I'd really had this like decade of urban existence and then my wife and I started going back for the summers and I remember there'd be this scramble in May. It was it's a little early to plant the garden in Indiana, you're still a little frost risk, but like I plant this huge garden in May and then go back to the city and we'd work for a month and then come back and try and uh, you know, get as much of the summer, especially with telemedicine, you could kind of spend more time uh gardening and farming. But really great for the mental health. I think uh also one of those places that um, one of the tenants everyone is the tenant of unburdening, which is uh around the thinking about trauma in modern terms and thinking probably sharing some of my experiences as a psychiatrist of just, you know, hearing how embarrassed people are sometimes by things that stick with them. Maybe it was like a mean teacher and nothing, you know, they just were mean to you, but it really shattered your self-esteem in some way that you know, again, people are sometimes embarrassed. Um, unburdening is really asking people to, you know, when possible because trauma is hard to to um, process and move through it in a way that liberates them more in their present life. Um and I find gardening and and working in plants, I've had a lot of patients who just they find a lot of solace there. It kind of keeps their hand busy and and allows them to settle in and and kind of process things. So I think gardening, time in nature, again, I'm really I'm really appreciate you picking up on these parts of the book just because they illustrate I think for a lot of us, you know, the need for it, the way that if you're not intentional, you can have a very inside sedentary life. And then some of the science behind it, how, you know, it's really wild to look at like there are six or seven now clinical trials of forest bathing to treat clinical depression. And you asked about the green earlier, I just remember this research. Five of those are outdoor. They're like formal, you like, I mean, this would help my depression, right? You go out into the woods and like play games and then like settle down, let's like do a quiet walk and do sensing stuff. That would be great. But they also had two of them that were virtual reality. And I think about this sometimes, right? You know, that that maybe some people don't have, you know, certainly some people don't have easy access to nature. Can you get some of the um advantages in VR? And you know, apparently according to the science you can. So, uh, one of those great ways
Dr Rupy: That's incredible. Finally a use case for the uh the the Vision Pro uh Apple goggles.
Dr Drew Ramsey: I get vertigo when you're my age. It's like you're just I did like the someone brought in there's like a kayaking game. And I remember I felt the couch. like my nervous system was so I was like so old. and then for like the next three days I was I was horrible. So
Dr Rupy: I want to talk a bit more about inflammation um actually as as you just mentioned it earlier because you know, I'm fascinated by inflammation. I wrote about inflammation in pretty much all of my books, I would say. The last one, healthy high protein, had a chapter on inflammation, protein and fibre or gut health. Um, and I feel like I'm just scratching the surface, but I realize that it is absolutely connecting the diseases of modern living, you know, whether it's cardiovascular disease, neurodegenerative issues, uh psychiatric health, uh mental mental health. You know, it's just so um foundational to to so many issues and the balance of inflammation is so important. So I'm curious to to to hear how you talk about inflammation with patients, how you link it to your own work and and and what are your thoughts on on on inflammation and mental wellbeing?
Dr Drew Ramsey: I think the first point is that everybody in mental health should hear is that I look for it. And that that's new. We didn't used to think about this or look at it in the same way. I look for it when patients are reporting their medical history to me, if they're having, you know, things like rashes or inflammation or uh, you know, in terms of like itching and skin things or bloating, um, or whether they have inflammatory diseases. Um, I I look for it in terms of, you know, psychiatrically in terms of what we call kind of um activation or or agitation, you know, where people are presenting in a state where, you know, they're they're really getting very disturbed by things. You know, they're getting uh um and so inflammation is our body's alarm system, everybody. I think we know that. And it's this big buzzword in medicine. And essentially the idea is that our modern life, you know, the reason I call it healing the modern brain is that your modern brain, you know, your brain has changed some, right? There's now microplastic, a teaspoon of microplastic in your brain. Right? There is now a whole host of foods with lots, you know, what is there 40,000 new chemicals in the grocery store that, you know, considered safe, but you know, it's just like new stuff in your brain. Um, and your brain is in this new modern context. And so inflammation again is our body's alarms. And the idea is that as our alarms are going off more and more, right, there's damage, right? If there was like 22 firefighters in this podcasting room with me, we'd be a little disturbed, right? They'd get hungry, they'd need, they'd drink all my seltzers, right? They'd be on the couch, they'd be noisy. It would be hard to make a good, we'd still, Rupy and I would still make a podcast. We'd figure it out, but it would be more challenging. And so, uh, that's that's kind of the idea that you want, certainly want the firefighters here anytime they want to come by, but also when there's a fire. And so the idea is are we triggering the body's alarm system? Now, since I'm in mental health, I really just mostly think about the brain and the gut. Uh, no offense to the other organ systems, but the the brain has its own immune system. You know, people kind of don't think about this. You know, your brain can't respond to the alarms in the same way as the rest of your body. It can't swell. It can't create a bunch of pus. And so its immune system has to be different. Its immune system is paying attention, right? It's kind of got its antenna up and it's listening to the periphery, to the rest of the body. So if the rest of the body is a lot of inflammation, one of the things, you know, some of the things that cause inflammation, um, you know, we can see in our everyday lives, poor sleep, and most people I meet, if we get into sleep quality, they're struggling in some way. I noticed that when I started monitoring my sleep, I'm one of those people like, yeah, I'm a great sleeper, about like seven, eight hours. Not when you track it. It's like five hours and 18 minutes a night, doctor. I go, whoa. You know, I was like, wow, that was a little bit of a wake up call of needing to do something. Uh, but uh so poor sleep, a lot of people still smoke, a lot of people drink a lot of alcohol. Alcohol and and lots of alcohol consumption is very normalized in our modern world. Um, uh there's a lot of stress and chronic stress that people, you know, just kind of in a vigilant, anxious state. You know, people don't realize this, there's a lot of untreated mental health concerns. You know, people don't kind of uh sometimes appreciate some of the antidepressants like Prozac are also anti-inflammatory. Um, and and so, you know, so inflammation is again, one of these, it is a big deal. What you say you feel like you're scratching the surface, like me me too. And but I think as a farm boy and a psychiatrist, there's some ways I try to make this as a clinician really quite actionable. If inflammation is a problem, how do you know that you have problems with it? You can measure a C-reactive protein, you can get an ESR, not the most specific rate. You can also, it kind of, you got a lot of sniffles, there are other physical signs and symptoms that you've got some inflammation. Do you have really, really bad allergies? That's a good example. If you have bad allergies, what happens when your allergies treat? Do you feel great, optimistic, hopeful, energetic? No, you start to feel sad. You feel a little down. Um, a lot of my patients when they have allergies and you know, they have that first attack, it really affects, they have a lot more anxiety, they have more mental health symptoms. And that's because these these systems are really linked. And so inflammation is one of the ways that mental fitness works. If we engage in mental fitness and you know, and it is effective, which the science says it should be and I believe it is, our levels of inflammation go down. We honour the sleep that we need and prioritize it. Not just saying, oh yeah, I'll get eight hours, like creating your bedroom as a shrine to the most important eight hours for your brain, which is when it cleans out all the garbage during sleep. And you don't want your garbage to back up in your home, you certainly don't want it to back up in your brain. And and so these ways going out in nature, you know, uh eating the foods that you know, if you listen to Rupy's podcast, you know all the foods I'm going to tell you to eat too, like uh and I'm going to tell you to eat Rupy's recipes because they're delicious and I loved healthy high protein by the way. I love your books and I love you as a man who cooks and inspires us all. So, uh you know, we can talk nutrition, but you know, the foods that we recommend, you know, I have my little rhyme, seafood, greens, nuts and beans, and a little dark chocolate. It's just places to start. I've added in, don't forget the rainbow celebration and the fermentation. It's not the best line, honestly, but I'm working on it. But just those are food categories, right? We want to be eating more fermented foods and more lentils and more wild salmon and anchovies, right? These are the and why? Well, part of that is it keeps us a healthy weight. Keeping a healthy weight is part of fighting inflammation. Part of that is those foods are the foods we've always eaten and our our bodies recognize them and and most of those are, you know, if we think about a quote unquote anti-inflammatory diet, those are the foods that everybody recommends, more olive oil, you know, more white beans. Um, as we talk both talk about in our books, you know, these foods have more nutrient density, this key principle of nutritional psychiatry. And in Eat to Beat Depression and Anxiety, I have this big like illustration of inflammation of like, hey, here are all the things contributing. So we can look all of us, like me too, right? We look at it on the page and say like, how am I doing? And and really have that check in that we need is a way to assess this aspect of our mental fitness. Are you living a lifestyle that, you know, does what you can uh to regulate inflammation? I think if you know any of my work, I'm really here to change your lifestyle, to change how you think about mental health in terms of, you know, a lot of people want to battle inflammation as a first step, maybe lots of supplements or really, you know, um kind of uh specific uh rigorous uh regimens. That you know, that's not, I'm I'm really interested in the day-to-day, week-to-week, month-to-month, you know, I know I'm going to recommend pesto this year, next year and in 10 years because it's a combination of nuts, greens, olive oil and garlic. And I think that's good for you. And all the science seems to say that's good for you. So, you know, again, tenants, things that you, and I guess for everybody listening and and Rupy, I guess you too as a 40-year-old doctor, here's a little mental health check in. The most important thing is the way that this affects your lunch, the way that this conversation affects you, you know, over the weekend and on Monday and how you really start to make different choices or for those of you who have this dialed in, I think there's another important thing, man, to really like honour it. A lot of you listening, you know, you know the nutritional stuff, you've got it diet dialed in, right? You've kind of sifted through the information and know about inflammation. You're moving your body more than ever. You're drinking less than ever before. So, you know, there there has been, there are a lot of folks listening who, you know, the main main part of this conversation is affirming. You know, that like you're doing it and it and it pays huge dividends.
Dr Rupy: Absolutely. I mean, I think from I'm I'm really curious actually to to know a bit more about um the wider aspects of inflammation lowering interventions that you might have come across. So not necessarily ones that you recommend, but ones that you're keeping your eye on. So I think, you know, throughout your book and previous books, people can get a handle on how improving sleep can reduce inflammation, improving movement and regularity of movement, variety of movement, food, big lever to pull when it comes to uh reducing inflammation, greens, nuts, good uh sources of omega-3. Um and now, you know, we're just talking about grounding and being outside. Um, I'm really fascinated by some other lesser known techniques of inflammation lowering that perhaps people wouldn't have come across. Um,
Dr Drew Ramsey: I've got a few for you. I've got a few.
Dr Rupy: Yeah, you go for it. I'll see if I can and add some some if uh if if we don't uh align.
Dr Drew Ramsey: Number one, and I get into this in the book is the deep science of the dance party. This has been really lost in modern cultures. There's um there's a lot of dancing, a lot of drunken, there's not there's not a lot of good dance parties anymore. If you look in the data around movement, exercise and mood and depression, one of the most effective interventions is dancing. And you know, often when in medicine particularly we recommend exercise, people think we mean like lifting weights and running and you know, that that stuff's good for you, but a lot of people don't want to do that. I share a story in the book of a patient who I've been telling to exercise or asking to exercise for a long time and came in one day just totally glowing and she'd been at a tango class. And I had no idea years ago she'd done a lot of tango dancing and she'd gotten back into it. And and it was, you know, both it was great exercise. She was moving for hours, but also it was really good for her social connections. It was really good for just being with other people. So in terms of inflammation, your question like, what am I keeping my eye on? I'm keeping my eye on a few things. One is how connection and how deepening real human connections, you know, a lot of people always say IRL, like it has to be in real life. It's like, I don't know, I feel deeply connected to Rupy. I don't know him super well, but I follow his Instagram and I get to talk with him a few times a year and we email and DM a little bit. You know, it's a real human connection for for both of us. And so fostering and kind of uh nurturing those relationships greatly affects your inflammation. You know, if you look at people who are socially isolated, they have higher inflammatory factors, you know, the risk of depression is just like it goes up and it's horrible as you get more and more socially isolated. We also see this is one of these feedback loops that happens. The reason I talk about depression everybody is it's it's the most dangerous illness in terms of you. If you look at what is most likely to take you out of your top form, right? What's most likely to cause disability and what causes the most disability for our planet is clinical depression. It it causes the most disability and that word's really important. Right? We think about disability in in some ways as physical handicaps and and physical disabilities. And and that's certainly true, but but disability is really when we're not performing at our best for any reason. And and so depression, substance abuse, those hit us earlier in life and they take more years away than something like heart disease. And so one of the kind of uh focuses of my work has been thinking about how do we really, you know, how do you have 60, 70, 80 amazing years, not how do you have 150? I think it's one of the ways that my interest in inflammation and and neuroplasticity and regimens like this, how do I put it? It's um longevity isn't of a lot of interest to me because I'm really interested in the quality of the time you have here. And and what I see happening now is a lot of people are getting kind of um seduced by the siren song of their mortality fears and packaged up in a lot of different interesting programs as opposed to addressing what's most important. I'll share with you something from my therapy, Rupy, is a great interpretation my analyst gave me two months ago. And he and he and he chuckled and he said, I think you need to bring death into everything. And I was sitting there putting my son to bed that that night and I was like chewing on that interpretation. I'm like, how do I bring death? Like I was like, that's an awful interpretation. I hate this idea. Like what is that? I don't want to think about that now. And it really like brought me into the moment in a way that that um uh focusing our time and energy and money and efforts on getting longer and spending more time here and using more of the earth's resources for our own pleasure and our own will and our own ego. I think the real value for for everybody listening is in optimizing today. And treating today like it's incredibly valuable. It's a day to take care of your brain, to take care of most importantly your human relationships. Um, and and so, you know, that that again, this idea of the disability adjusted life year, this DALY, this notion of how do we reduce your disability? It's it's requesting in some ways you focus and pay attention to depression. Right? The incidence of depression is pretty high. If you look at some of the statistics in America, like one in four women over the age of 60 are taking an antidepressant medication. You know, a lot of people see that and they say like, oh, that's like over prescribing. I don't know, most women I know who are over the age of 60 are are quite wise. They don't just do things. You know, they do things that they know work. And and so, you know, there's been uh um, you know, there there's been a lot of talk and a lot of debate uh about depression and and mental health over the last let's say five or 10 years, especially online. There's been a lot of misinformation about psychiatric medications. There's currently a lot of attacks on all of that. And in some ways with this book, Healing the Modern Brain, I wanted people to to hear from a psychiatrist. I prescribe all those medications. I'm very grateful for them. I think that there's not a better time ever, ever in history to have a human brain, to have mental health problems. We know more about it. We have more resources, we have more treatments, we have more evidence than ever before. Um, but I wanted also to put out something that we all agree on that that more and more people need to do to take care of their mental health that's lacking, to have a framework, to kind of um, look look at what you could do in an everyday life.
Dr Rupy: Yeah, absolutely. I love that focus on um on death, actually. I think that's uh it it it's very stoic and it and at first instance, when you hear that for the first time, it doesn't seem to make sense. But the more I focus on that personally, and I think, you know, everyone has to personalize it to um their own circumstances, it makes me a lot more grateful. And gratitude is something that I keep with me all the time. And I think in the knowledge that this all will cease to exist at some point in the future, hopefully not soon, but at some point, it does make you a lot more grounded in the present and you become a lot more appreciative of everything if for example's sake, you would know that everything would end tomorrow. You you know, the the raindrops on your face as you walk to the train station don't become annoying anymore, they become refreshing. They become a spectacle. Um, the, you know, the chatter that you hear uh when you're commuting that might be annoying because you can't listen to your podcast, actually becomes immersive. Um, it's, you know, just a a complete reframing of your day-to-day and it's something that I I try and practice um myself and I kind of catch myself. I had this conversation with um another psychiatrist actually, uh who you might know, um Alok Kanojia. He's um uh healthy gamer online and he talked about every time you meditate and you catch yourself like wandering and you try you bring it back to yourself and you're like, oh, it's a bad meditation. I got to bring it back. That's actually the equivalent of doing a press up. That's the equivalent of doing a pull up. That's you like reminding yourself of bringing yourself back to the present. So that that's something actually that's a good thing. You caught yourself and you're bringing yourself into the moment or whatever you're concentrating on. Um and it and I feel like, you know, this sort of this practice of reminding yourself to be grateful is an equivalent, but one that you don't need to do with your eyes closed, cross-legged. It's actually something you do day-to-day.
Dr Drew Ramsey: Yeah, I talk about this in Healing the Modern Brain around trying to kind of take these concepts that I find a lot of people in session initially are a little like they've tried it or they're a little, you know, uh or haven't thought about it, things like breath work. For me, like I I can go from, you know, talking and assessing someone who's really struggling and having suicidal thoughts and it's critical to, you know, two minutes later being in a session where someone's excited because their daughter's getting married. And I can't miss a beat. And so how do you do that? So one of the ways that you learn to do that is through your breath. You know, another way that you learn to do that is really just just as Alok was talking about, right? It's a it's a process by which you're doing a rep. You know, you get good at it by doing it a lot, by being intentional about it. But yeah, this idea of bringing back your attention is the same thing we notice when we read, right? All of us, especially those of you like me, maybe have a little dyslexia or just aren't as good at reading. Boy, you'll be at the end of that paragraph and be like, uh, what was that about? And you'll go back up, right? And that's the same thing where you're pulling your mind to really stay focused, stay on track. And it is like a muscle that you can build. It is like anything. Just like if Rupy and I decided after this podcast, we're going to move to Japan and open a little restaurant together and live out our days there with our families, right? In five or six years, we'd be doing a podcast in Japanese. You know, we'd learn to we'd learn to cook food. You know, it it would take a while, but our brains can do that. Just like that, your brain can learn to focus a bit more. The one I like is to you mentioned earlier where we turn kind of irritability into gratitude. You know, not that we want to be polyanna-ish that everything is great and we should always feel good, but that um there there's a notion that gratitude is always about giving thanks for the positive things. And in the book, I write a little bit about, you know, gratitude is also giving thanks for our challenges. That's a big part of parenthood, right? It's not always good. It's almost always hard and and and filled with some anxiety. It's filled with lots of wonderful moments and wonder too, but it's filled with a lot of learning. And so, you know, having gratitude for that challenge um and and for some of the challenges in our lives is a part of uh I think one of those reps as well. Again, that switching from irritated and frustrated into some gratitude that you know, you're up for the challenge. It's one of the great great most likely.
Dr Rupy: Which in itself is anti-inflammatory, which is where we started this little segue. Um, you really threw me off with the dance parties. I love that. I recently went to an electronic dance uh music festival. So I'm glad I was helping with my mental fitness whilst I was dancing.
Dr Drew Ramsey: I mean, what did you think? How did you feel that night? How did you feel the next day? I mean,
Dr Rupy: Well, I felt pretty groggy, not because I was drinking or anything because I I was completely sober. Um, but we got stuck leaving this festival in the north of England uh by the car park for three and a half hours. And so I felt pretty horrible the day after. And so I I have to almost like go back and have the same experience, but without the uh um commuting issues.
Dr Drew Ramsey: Well, you got to leave a little early. I think this is a good, these are some of the powerful, powerful lessons of middle age I have for you. You know, there's the footwear that needs to get more comfortable. There's leaving a little early to beat the line so you're not up too late. Um, and I do think also with some of these, you know, call them self-experiments, it is important to sort of um uh like find the gems, but understand that not everything's a gem. That we try things, we try foods we don't like, we try exercise classes, we try friendships, you know, and they don't all work out or go the way we want. And it's important, it's important to have that be a part of it, right? It's it's not that you're going to drop everything, but but that you're allowed to experience things and and choose. I have this conversation a lot with people as they're starting relationships where they don't know, you know, and I was like, well, so you know, sounds like you're figuring it out. Like that that's okay. That's part of an early like you have permission to not know for a while um about things or at least you should have some to figure it out because when there's too much pressure to know, you're going to make the wrong conclusions. But yeah, inflammation, I do have strange, you know, recommendations. Dance parties for sure. That that's one of them. I like the gardening and getting your hands in the dirt. We've talked about big nature and that's a really important one for inflammation. You know, things I'm paying attention to or at least wanting to learn more about is how different dietary patterns are affecting inflammation. There's been a lot of uh interest recently in ketogenic diets in mental health. You know, there's we're going to have actually a lot of data about that. There are a number of trials that are going to be reporting over the next five years. So we'll be able to make better evidence-based recommendations. There's been one pilot trial now that's really interesting for people with bipolar disorder and and schizophrenia. Uh, but but that there's going to be interesting research in the microbiome, how we can shift the microbiome and how that affects inflammation. There was a great diet study out of Stanford looking at really eating more fermented foods being the the major mover in terms of affecting the microbiome in a way that actually decreases some inflammatory markers and inflammation. Um, so I'm that's exciting me. I'm um uh there have been more trials on mental fitness. There was a calm trial, which is a a trial that was in some ways very much what's happening for a lot of patients. People got encouragement around the kind of big lifestyle factors that we know, nutritional psychiatry, um, sleep hygiene and exercise. And through uh this trial, it was a um delivered remotely, you know, people showed equivalency to cognitive behavioural therapy, which is one of the gold standard psychotherapy treatments. And so, you know, again, what I think is really important is that we we remember we're living in an era where there are a lot of treatments. Uh a few of them certainly rise above the others in terms of the amount of evidence and the quality of evidence. Um, and that increasingly lifestyle and lifestyle factors, especially for illnesses like depression. Like everybody, we have number doctors use or this uh metric number needed to treat. Like like how if if I've got this medicine, how many people do I need to give it to to get one of them completely better? And so the number needed to treat for an SSRI antidepressant is like seven to nine. Um, you know, I have to talk to seven people or meet seven people with depression to get one into full remission with something like Zoloft or Prozac. Maybe in the hands of an experienced clinician or psychiatrist specialized in that, you know, maybe that's a little higher. Um, for transcranial magnetic stimulation, it's six. That's like a where we use magnets on the brain for diet, the smiles trial, which Felice Jacka ran, had a number needed to treat of four. And then for exercise, the number needed to treat is two.
Dr Rupy: Gosh.
Dr Drew Ramsey: And so, you know, when you think about how how we want to engage with patients around these illnesses, it's not that it's all exercise and food. I have lots of patients who really, you know, bipolar illness is a great example. You know, gold standard treatment is definitely to be treated with medications to prevent mania and depression. Um, same thing things like anorexia, like gold standard treatment involves treatment with antidepressants and atypical antipsychotics. It just like that's how patients get the best in terms of recovery. Um, but you know, there are these other uh pieces that we definitely want to emphasize. And actually over the last and the time we've known each other, the the guidelines have changed. The APA show guidelines have changed, APA guidelines have changed, exercise and nutrition are now included as primary steps in how we think about these illnesses.
Dr Rupy: Yeah, yeah. I I'm I'm definitely watching the keto area with a lot of interest myself because I think for certain people, and I want to underline that for certain people, a ketogenic diet might be worth a try. Um, I would always put that further down the line after something that me and you would align on in terms of a Mediterranean diet with lots of fibre and legumes and uh good quality fats. But the keto diet is very, very interesting. Um, and another area which I I'm not too sure if you you you've got uh much interest in is um vagal nerve stimulation. Um, so, you know, just for listeners, you know, the the vagus nerve is this long winding nerve, um, starts around like the sort of horizontal plane of of the bottom of your ear lobes across your your brain stem and then sort of innervates multiple parts of your body below your neck, you know, your heart, your lungs, your digestive tract and just sort of like winds out everywhere. And they've found that vagal nerve stimulation with some FDA approved devices can significantly reduce inflammation. Now, I think the current use case at the moment is for things like rheumatoid arthritis, but as as we've been talking, inflammation is so uh important to a number of different issues including mental wellbeing, uh mental health. Um, it stands to reason that it might have an impact. And there's ways in which you can stimulate your vagus nerve right now, you know, through breathing exercises, being more grounded, etc, meditation.
Dr Drew Ramsey: Humming, I like humming. Yeah, yeah, humming, yeah. Singing is probably my favourite. Everybody, I think when singing more in your life is good for your mental health and good for your vagus nerve.
Dr Rupy: There you go. Yeah, singing. I mean, I I it's a I I I don't want anyone to be around me when I when I'm singing uh for their own mental health.
Dr Drew Ramsey: That's a horrible thing to say. You should absolutely want people around you when you're singing. Who are you going to harmonize with? Who are you going to bust it out with? Oh my gosh. We're definitely singing next time. Um, the vagus nerve is really interesting. Vagus nerve stimulation is also kind of in the when we think about uh uh depression that doesn't respond to multiple uh treatments, you know, like antidepressants, psychotherapy, vagus nerve stimulation is kind of in uh in the treatment plan sometimes. It's not used a lot. I think the vagus nerve and and using the idea of the vagus nerve, um, is really important in terms of how we think about our nervous system and our mental health, right? Building these skills and some of them are vagus nerve skills. Uh, I just led a workshop with a woman who created a vagus nerve deck and and and there are all these interesting exercises she has about kind of engaging with your vagus nerve. Melissa Romano, she she reminded me that I'd forgotten the vagus nerve is the largest of our 12 cranial nerves. And as you're mentioning, it sort of senses everything down below. It's also the major way the microbiome can communicate with the brain. Right? People you all of a sudden hear this fact and it's kind of presented in a misinformation way that most of the serotonin in your body is in your gut. And that's factually true. It doesn't have much to do with the serotonin in your brain. They're separate pools. There are about 500,000 um uh serotonin neurons in the brain. There's not a lot of them. But the way that serotonin and and these other neurotransmitters do in the gut, do communicate with the brain is via the vagus nerve. So the vagus nerve is kind of hanging down and sensing the gut. And one of the ways that the gut communicates is via the the the organisms in the gut that digest fibre and create things. They create things like short chain fatty acids that feed uh the the inner lining of our colon. Those short chain fatty acids are also signalling molecules that increase the tight junctions um between the the lining of our colon, which is a good thing. Um, and and so the vagus nerve is, you know, you know right away, right? When we say we feel it in our gut or when you get nervous, right? The place you feel it is in your gut. That's vagus nerve phenomena. Right? That that's how your brain is is sensing the gut, sensing what's happening. Um also, you know, as I often point out, we all we all have the experience of how good our brain is at sensing the gut when you eat something that's off. You know, you get just a little bit of food poisoning, you know, you you often know for about 30 minutes, maybe 45 minutes beforehand that you're going to be sick, right? You kind of sense it a little bit. It feels a little strange. And so this is all around this very primal function we've had of being able to sense what we eat and use that information. Uh it's obviously always been key for our survival. Um I think manipulating the vagus nerve whether um so I've had some arrhythmias in my life and the first thing I'll do is go up and and uh start humming, rubbing my vagus nerve which is right here, and then bearing down, like you're like you're needing to go to the bathroom. Um, and and that increasing the intrathoracic pressure, the the vibration, and then the massage are the three ways that I think we can get a little uh more stimulation of the vagus nerve. Vagus nerve people have also heard about it in terms of it kind of triggers what the parasympathetic part of our nervous system, which is the rest and digest. And I also I like to put in there, it's not just rest and digest, right? It's rest, digest and connect. Because really until you're settled down, take that breath, right? Focus, work that muscle of being really present, you can't really connect with people. And and so I I like thinking about a parasympathetic nervous system is not just for this, oh, it's fight or flight or it's rest and digest, but it's no, it's also it's in the state where we can be connecting, we can be creative, right? We can um be uh more meditative and thoughtful and and so it's in some ways the state we want to get into as much as possible. And I hope mental fitness, don't talk too much explicitly about the vagus nerve, but you know, in some ways that's really what I'm after is for people to be in this more kind of um regulated, uh um uh mentally empowered state.
Dr Rupy: Yeah, yeah, you know, it's interesting because the more I have stresses in my life, you know, uh a baby, obviously I'm trying to reframe that, you know, it's a very, very positive thing to to experience and, you know, every day I'm grateful for it, but it's stressful. Um, and running a business and doing all this other stuff that with the podcast and um, the Doctor's Kitchen app and all the rest of it, the more I'm leaning on um these sort of the the extra sort of characters there are, uh these extra tenants if you like, um of mental fitness. You know, I think I've got my diet dialed in, sleep as best as I can, movement, um but things like grounding, um extra anti-inflammatory activities, whether it be dancing or extra unintentional movement. Um and even things like supplements. I mean, I'm not a massive fan of supplements, but I do take omega-3 fish oil. I think there's enough evidence for me from a cardiovascular point of view to to to recommend that and take that myself. Um, and I'm exploring other things like broccoli sprouts and um, moringa, some powerful anti-inflammatory ingredients that I incorporate as a supplement to a diet that's already pretty good as a baseline. And I always recommend people think about it that way. Um, are there any others that you that you think of or in terms of those those extra additions uh to to uh harmonize inflammation from a supplemental form or um or any medications or pharmaceuticals that you think we should be keeping an eye on as well?
Dr Drew Ramsey: You know, I mean, I think everybody's interested in the way that the GLP-1 medications are affecting inflammation. I think that, you know, there's been a lot of uh controversy about things like turmeric in terms of um, you know, I think the American Society of Medicinal Chemistry issued a statement saying there have been a thousand human trials and none of them are positive. You know, there have also been a lot of people who have had benefits. I I think in terms of um what you just mentioned and and not from a supplement or medication standpoint, although, you know, there's lots of cool stuff coming out about that, but you know, for you as a man in your 40s, I think that the the final tenant, tenant nine, which is the tenant of purpose. Is everybody, you know, as you heard Rupy go through all these things that are super important. You know, and at the same time, you it's a lot to keep in the air at the same time, you know, as uh being a clinician, being a father, being a husband, engaging in self-care, running an app, running a podcast, having other, right? It it gets to be a lot of things. Um, and so your your sense of purpose, which, you know, as we all hear in this podcast for you, the thing that comes up the most is your son in a powerful way. And so your sense of purpose is really shifting. You know, you've been leading and inspiring lots of people and that that will continue. But there's something else that's opened up for you, which is around fatherhood, which is around being a man in your 40s and how your purpose shifts. Uh, I'm probably particularly keen on this having just turned 50. I don't know, something happens, something very powerful happens. Um, and so for you, that sense of purpose and sitting with that, it's a very short chapter, everyone, and and I think all of you can look in your lives wherever you are and think about the way that our purpose and our sense of purpose has shifted from those angsty days in our 20s where we probably shouldn't be being asked too much about our passion and our purpose, but we should be living and exploring and building skills to the 30s and 40s, you know, where you're engaging in it and and seeking it and to your 50s, 60s and 70s where hopefully you're relishing in some sense of how you've understood that for yourself. Purpose is a very personal thing. In the book, I really encourage people not to think in such grandiose terms. Not that you can't change the whole world. I mean, Rupy is, right? But some of us, some of us maybe um are are going to have a a different type of influence. Um, there's all kinds of ways that we find purpose and I think it's one of those parts of the modern world that's been pulled away from us that used to be in some ways much, you know, there were there were more clear tracks in front of us on how we found purpose, whether that was um, you know, through our institutions or churches or um, uh, you know, through patriotism, you know, lots of those still exist, but I think in the modern world things have really shifted for people. Um, and so thinking about your purpose and how you pursue that and how that um, you know, as I as I note in the book, we've all had those days like when you wake up with a sense of purpose, right? You've got to be somewhere, you've got something really important to do, you know it's and I mean, you don't need an alarm. You set out your clothes the night before, right? You run over the interview in your head. I was doing that a little bit before. I was a little, I don't know, a little I've been giving an interview and and just a little bit. You know, I was kind of going through my routine. I found my sound bites, right? I was really purposeful this morning. I made sure I didn't have too much coffee. I tried to make sure, you know, I don't want to be too personal, but some personal, I want to make sure, you know, all the stuff. And and so having a sense of purpose, right? Why? Because if you're still with us, I wanted you to get a sense of inspiration and hope, but I also you want you hear that kind of almost drill sergeant part of me. It's like, I I want I want to hear about your mental fitness progress. I want a serious revamp. I want to hear about amazing sleep. I want to hear about incredible nutrient density. Tell let's share, please. How did you just really deepen your connections with the most important people in your life last week? And how are you going to do it next week? And not in a burdensome way, you know, but but much more in a way that I hope is uh encouraging because of the benefits of that to you. That it feels great. It feels great when we sleep well, when we eat well, when we move our bodies and dance, when we connect with our friends and families and and loved ones. So, um, you know, that's what I hope people are taking from healing the modern brain.
Dr Rupy: Yeah, absolutely. Drew, honestly, you're you're fab. I love your books. I love this book in particular. You know, it's a it's a great read and I think there's so many actionable tips and certainly things that I've taken away from it as well that I I wasn't fully expecting. Um, but I'm glad. I'm I'm I'm really glad that you've written this for as many people and and it's really interesting to see how you've surfed the last 10 plus years that you've been in the public eye. Um, and how much psychiatry has changed and you know, being at the forefront of nutritional psychiatry and then incorporating all these other sort of elements of of lifestyle medicine into your practice. It's it's it's brilliant. So I appreciate it, man.
Dr Drew Ramsey: Well, thank you. As I as I say in the beginning of the book's dedicated to my patients because I really feel without them and I don't know how many tens of thousands of clinical hours, I've just gotten to sit, listening to people on the couch a lot. And when you do that, it holds you accountable. It holds you accountable to be reasonable and not hyperbolic and not over promise and under deliver. Um, but also to really pay attention. You know, people walk in and they're really, really in a bad spot when they met you and now they're they're feeling great. And they're, you know, engaging in a relationship and they're and you know, you really want to pay close attention, like what happened? What did they do? What did we say? What did we discover? Was it a medicine? Was it an interpretation? And and so again, that's where these tenants come from. I think are really lessons that I learned from my patients that no matter where you are in your mental health journey, human connection always feels good. You know, no matter where you are, having a sense, having being able to hold on to like your sense of purpose or we didn't talk much about the first tenant, self-awareness. Which you know, is is painful. Like self-awareness is hard, right? We sit because we got to sit and do the thing that's often hard for people, which is really accepting and honouring what we're good at and and and the ways we're in the world that we like and and then looking at our challenges and just being honest about that. You know, some of the things that we struggle with, we're going to struggle with, you know, there are things about ourselves that we can change and other things sometimes we don't. And so self-awareness is is so key to this whole process. So I just wanted to slide it in there at the end. It's something that as a therapist, I'm always working on in myself and in my patients. Um, how how can we how can we come into this really knowing as much as possible about ourselves?
