Exploring the link between diet and depression

On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham discuss the growing evidence around the impact of diet on mental health, particularly depression. The conversation is inspired by the CMAJ practice article, “Diet and depression,” co-authored by Dr. Nicholas Fabiano.

Dr. Fabiano explains how the mechanistic connection between diet and depression is not well understood, but it is theorized that diets known to promote inflammation may play a part in exacerbating symptoms. He highlights findings from the SMILES trial, which demonstrated how dietary interventions like the Mediterranean diet—rich in leafy greens, fish, fruits, and whole grains—reduced depression symptoms in trial participants.

Dr. Rachelle Opie, an accredited practicing dietitian and credentialed eating disorder clinician, offers practical advice on how physicians can coach patients toward dietary changes in a way that is inclusive, sustainable, and sensitive to individual needs. Drawing from her work on the SMILES trial, Dr. Opie highlights the importance of a whole-of-diet approach that prioritizes small, achievable changes, such as incorporating legumes, beans, or frozen and canned foods. She emphasizes trauma-informed, weight-neutral approaches to avoid triggering or alienating patients and encourages focusing on what patients can add to their diet rather than restricting foods.

Together, the hosts and guests explore how subtle, realistic changes in dietary habits can provide meaningful improvements in mental health without placing undue pressure on patients.

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Transcript

Dr. Blair Bigham:

I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. This is the CMAJ podcast. So today, Blair, we are talking about one of our favorite topics, it feels like, depression. And we are talking about diet and depression. 

Dr. Blair Bigham:

Jola, this makes sense to me when I'm on the Tim Hortons diet on a 24-hour call shift, I feel pretty miserable. If I go a week without eating a salad, I feel pretty miserable. And every May when I'm like, "Oh, it's time for my summer body," and I do nothing but eat salad, I actually feel great.

Dr. Mojola Omole:

Let's change that narrative. Every body is ready for the summer.

Dr. Blair Bigham:

I love that.

Dr. Mojola Omole:

Whichever shape your body is, it is ready for the summer.

Dr. Blair Bigham:

I love it.

Dr. Mojola Omole:

Summer body year round. It's always, every body is a good body.

Dr. Blair Bigham:

365. Does that mean I get to eat salads 365? Well, maybe I should. We're going to be talking to a friend of ours, Nick Fabiano from the University of Ottawa, a resident psychiatrist, who looks at how lifestyle changes like exercise, like diet can influence your mood. I'm also wondering how we actually make this stick. I mean, it makes sense, but I have a terrible diet. I'm a physician. I know the risks of coronary artery disease and eating the way that I do, but I do it anyways.

Dr. Mojola Omole:

I have great diet.

Dr. Blair Bigham:

We're really excited to talk to our second guest who's a dietitian, who's going to help us kind of put this theory into practice. That's up next on the CMAJ podcast.

Dr. Nick Fabiano is the lead author of the practice article in CMAJ titled “Diet and depression” He's a third year psychiatry resident at the University of Ottawa and a friend of the podcast. We last had him on to discuss an earlier practice article, “Exercise as a treatment for depression”. Nick, welcome back.

Dr. Nicholas Fabiano:

Thank you for having me.

Dr. Blair Bigham:

We're still talking about depression and ways we can mitigate it. How big of an impact can diet have on reducing symptoms of depression?

Dr. Nicholas Fabiano:

Yeah, that's a great question. So the whole field of lifestyle psychiatry, so looking at diet, exercise and other lifestyle habits is a really growing field and a lot of them can have substantial impacts on depression. There's still ongoing research in the area to really delineate how much of an impact, but since we know that the food that goes into our body really gives us the energy to do different things and really go about our day, we know it can have a significant impact on our mental health and by extension stuff like depression.

So, from the studies that we have right now, we know diet can have a significant impact. To give an exact number, it would be really hard to quantify, but it can really reduce those symptoms and even some research has shown that it can prevent the onset of some depression. It's a super important factor.

Dr. Blair Bigham:

So, help me out with the biology or the pathophysiology here. How exactly is diet or let's say a crappy diet making someone feel depressed?

Dr. Nicholas Fabiano:

Yeah, so that's a great question and another area where there's a lot of research that's going on mechanistically to kind of see what's causing this. I would say to simplify it and highlight some key mechanisms, one of the big things that a lot of places in medicine go to is inflammation. So a poor diet, so eating a lot of ultra processed foods, and when I say that, I say things that are like pre-packaged like ramen noodles or foods that have a million ingredients. Those can lead to some more inflammation which, kind of, can spread to your whole body, your brain, stuff like that, of that sort. And that's involved in the pathophysiology of a lot of different mental disorders, including depression.

Another lens that we sometimes look at as well is also the gut microbiome. So what you're eating affects what's in your gut as well too. So if you're eating a lot of low nutritional value foods that cause a lot of inflammation and don't really feed your gut microbiota in a proper way, we know that our mind and gut, there's quite a significant connection between the two. And that link can also lead to derangements, which again, by extension can lead to adverse mental health consequences, depression, anxiety and stuff of that sort. And again, looking at it from a multifactorial lens, oftentimes it's not just that your diet is causing depression, but more of a factor that's contributing. So, it's really important that we address that and talk about that as well too.

Dr. Mojola Omole:

Is there a duration of how long you've consumed these foods that could be an issue? Also the other question is, is this reversible? If you stop eating processed foods, will your symptoms improve?

Dr. Nicholas Fabiano:

It's hard to say in terms of how long you eat X food to result in depression or anxiety, but we do know that continuing these lifestyle habits for time can add onto those different risk factors for developing depression. And from the preliminary research in the field of dietary interventions for mood, we do know that it does have some pretty quick effects. If you're able to make some diet substitutions, so eating more leafy greens, eating healthier foods, and removing those ultra processed or processed foods, some studies have shown that even within 21 days there are significant changes in your mood and even remission in depression.

Oftentimes this is also with first line treatments such as medications and psychotherapy. But this intervention through helping with diet also leads to significant changes as well too. And pretty quick turnaround times, which oftentimes are even faster than some of our medication or therapy options.

Dr. Blair Bigham:

We're going to talk about which diets are most effective. But first just give me a sense of the numbers here. If someone comes in, they have depressed mood, what can changing their diet do for them compared to say an antidepressant or exercise like we spoke about the last time you were on the show?

Dr. Nicholas Fabiano:

So, it's hard to have comparative analysis right now to say, is diet better than medication or psychotherapy? In exercise, the field's a little bit more developed where we have network meta analyses where you're comparing all these interventions and their effect sizes. The dietary field in terms of interventions is very much still in its early phases. It's hard to say that can you compare a specific diet or dietary changes to one of these first-line treatments and what their effect would be? So, I'm not sure that I can give a definitive answer from that end, but at least saying that some of these preliminary trials have shown that when you have these dietary interventions that there is a significant change.

To quote one of the major trials, one of the first trials is the SMILES trials. It was a twelve-week trial of dietary intervention where people had poor diet starting in, they had a dietary intervention. And after that, by the end of the study, 32.3% of the dietary intervention group were in remission from depression, and that's compared to 8% of the control group. So that's quite a significant difference. Again, these are small trials though, so it's hard to generalize it to the bigger picture of everything from that end, but it is very promising results and pretty quick turnaround times as well too.

Dr. Blair Bigham:

So what diets are we talking about? What foods are we avoiding or what foods are we promoting?

Dr. Nicholas Fabiano:

Right now in the field, the most common diet that's been studied is the Mediterranean diet. And to give a view of what that looks like, it's placing an emphasis on leafy greens, it's eliminating processed foods. You want to focus on kind of proteins from fish more often, and also making sure that you have a good mix of vegetables, fruits, and grains as well, too. And that's where most of the research has been. Again, because the first trial with the SMILES trial, that's where it was focused and stuff branched off from there. However, there's not enough research to really say one diet is better than another. And sometimes you get lost in wanting to perfect this diet and you look up a diet and want it to be exactly this specific diet and buy this specific thing.

You can really get lost in the details and the nuances of a specific diet and it can become very overwhelming for patients or someone trying to follow. So, I think the best approach is more so to emphasize on dietary groups. So looking at a leafy green group, what kind of things do I like within this dietary group? Or proteins, what kind of things would I like inside of here? And picking and choosing from healthy options and eliminating some of the more unhealthy options rather than trying to specifically fit into one diet. It can be very hard for people and maybe not realistic from a time or even money perspective too.

Dr. Blair Bigham:

What is the grand potential here of just lifestyle changes when it comes to curing or improving mood disorders? If we add exercise, if we add an improved diet, is there a stacking effect here? Do we get to a place where nobody's depressed simply through lifestyle?

Dr. Nicholas Fabiano:

Yeah, so it's hard and it's a great question that you bring up because right now to bring it back even further, when we look at mental illness as a whole and if we want to section it down more to depression, we still don't even know the mechanisms completely in terms of what causes someone to be depressed. We have hypotheses with regards to biological causes, psychological causes, social causes and stuff of that sort, but we don't really know the mechanism completely. But as I mentioned before, with diet and exercise and stuff of that sort, it tackles one of the areas, that inflammation and also helps with brain-derived neurotrophic factor, which helps is essentially Miracle Grow for your brain where you're able to feel a lot better and have improvements in your mood.

So, all of these kind of go together and work under that lens. Not necessarily that it will cure depression completely, but sometimes it's more of not a bandage approach where you're kind of looking at from the core issue where there's arguments where sometimes people say that mental illness is metabolically driven and there's been books and different things written about that where there's the metabolic origins of mental illness. So, really getting down to that.

The other side of that is with some of our treatments in psychiatry, whether it's antidepressants, whether it's antipsychotics, a lot of them have metabolic side effects. And by that I mean things like weight gain, issues with the glycemic control. Being able to engage in healthy diet and exercise techniques is really important for counteracting some of those effects as well too. So it's kind of those two lens. So mechanistically, exercise and diet can both help alleviate some of the factors that may be contributing to the depression, maybe not overtly causing it one-to-one. And then in the same breath, it's good for the overall health of the patient who may be at a higher risk for some of these metabolic risk factors.

Dr. Mojola Omole:

Oftentimes people feel as if physicians blame them or their health like, "Oh, you don't exercise, you're not moving, you eat like crap, that's why you're depressed." How do we as physicians convey this message that it's not like, without blaming  the patient, but trying to help them to understand how exercise and changing the foods that you consume can help with your depression?

Dr. Nicholas Fabiano:

And I think that's a really great question that you bring up that is oftentimes something very relevant to the patient in front of you. Because I think sometimes, particularly in psychiatry and when we're looking at mental disorders, we have a different lens compared to more physical health disorders. When someone has asthma or something, you're not necessarily blaming them for having asthma. And then there's that inherent kind of when the patient's coming to you, they're asking for help. But sometimes for mental illness, people almost feel that they caused it, they caused this depression because of, like you said, the lack of exercise or poor diet, which isn't the case.

So, I think it's very important as the provider to really frame it that way to the patient and frame it such that this depression or this anxiety that they're going through is not their fault. It's not something that they wanted, that they're already taking the right steps by being in your office and talking to you. And then I think also mechanistically, not getting into the super big details of stuff, but having that conversation with their patient that they understand that some of these factors may be contributing to their depression. And it's not because they didn't do them that they're now depressed and stuff, but framing it more that, "Now that we're here, I'm happy that you're here for help, but now that we're here, if these are something that you're interested in talking about, let's have that discussion. If not, that's okay too, right?"

Because even though these things are beneficial, like you said, adherence wise, you really need that motivation from the patient, whether it's diet or exercise. And if you're just throwing it in their face all at once saying, "I need you to run this much, I need you to fix your diet," that's so overwhelming and it can be condescending even to the patient in front of you. So, I think kind of putting it on the table saying, "Hey, these could be contributing factors. I'm happy to help and have that discussion when you're ready," goes a long way versus throwing it to them all at once. "Hey, you have depression, you need this medication now, you need to do this." And it just is not conducive to change, but more so opening up the discussion, allowing them to take the lead.

And then same for both exercise and diet, asking them what they think would be realistic and what they want to do. Maybe they don't want to change their breakfast, lunch and dinner and stuff, and maybe it is a little bit unhealthy, and that's okay if that works for them right now. But making those small steps and allowing them to take ownership of their health too and making those changes with your guidance. Because at the end of the day as a physician, we want to be able to provide them that information, not necessarily take the paternalistic route and say, "You need to do this." More so like, "I'm happy to help you and here are the tools that I can give you and instructions, but I'm here to support you, not force you to do anything."

Dr. Blair Bigham:

Nick, this is awesome. We're going to keep unpacking this with our next guest and thank you so much for joining us again.

Dr. Nicholas Fabiano:

Thank you for having me.

Dr. Mojola Omole:

Thank you, Nick.

Dr. Blair Bigham:

Dr. Nick Fabiano is the lead author of the practice article in CMAJ titled, “Diet and depression.”

Dr. Mojola Omole:

So, Nicholas Fabiano mentioned the SMILES trial that examined the connection between what we eat and depression. We're going to be speaking to Dr. Rachelle Opie, an accredited practicing dietitian and credentialed eating disorder clinician. She's actually the one that developed the eating protocol for the SMILES study. She's from Melbourne, Australia. Rochelle, thanks so much for joining us.

Dr. Rachelle Opie:

Thanks, Jola, for having me.

Dr. Mojola Omole:

So I just want to start off with can you just give us what the quick overview of the SMILES trial was?

Dr. Rachelle Opie:

Yeah, absolutely. We looked at dietary improvement as a treatment option for major depression disorder. And my role, I was PhD candidate working on the SMILES trial where I designed and delivered the modified Mediterranean diet. So that was the dietary intervention component and the control group we used as a social support condition. So basically wanted to control for the human interaction aspect of it, and we saw really impressive results. So we saw a third of the diet group achieve remission of depression compared to 8% in the control group.

Dr. Mojola Omole:

That's incredible. I want to get more into the findings, but so the protocol adapted the Mediterranean diet for the Australian context. So, what would that look like?

Dr. Rachelle Opie:

Yeah, absolutely. I used the Mediterranean diet because it's the most extensively researched diet. It's shown to have wide-ranging health benefits for say certain cancers, diabetes, heart disease. So we wanted to then say, well, what would that look like in a depressive population? And so we wanted to make sure it had the key nutrients that we believe are likely to improve depressive symptoms, so ensuring it had adequate, say, oily fish and olive oil. You've got these polyunsaturated fats and monounsaturated fats. Making sure you've got sufficient red meat, say for iron and B-12, and the list goes on there. But what we wanted to make sure was that we then adapted it for this population with major depressive disorders taking into account the side effects of that disorder.

So for example, if individuals say had altered appetite or increased cravings, say reduced appetite or more cravings for higher sugar, high salty foods, we needed to adapt that. The same as making sure that we took into account altered motivation, reduced desire to cook and prepare food or altered sort of concentration. So, if they were finding it difficult to retain information around recipe ideas, et cetera. But then we wanted to adapt it also for an Australian population. So Australia is a very multicultural population, so people do not naturally consume a Mediterranean diet. So we wanted to make sure we kept the key elements of the Mediterranean diet, but then incorporated their cultural ways of eating and being very sensitive to their individual food preferences as well.

Dr. Mojola Omole:

So like Vegemite?

Dr. Rachelle Opie:

Absolutely.

Dr. Mojola Omole:

Where does the Vegemite fit into the Mediterranean diet, for example?

Dr. Rachelle Opie:

It's great. I mean, yeah. So the thing is, Jola, is like if for breakfast the person didn't want to have oats, then you thought, "Well, what can I still ensure that they're getting these key nutrients?" So it's things like whole grain bread with Vegemite, which still ensure that you're getting fiber, you're getting your whole grains, you're getting B vitamins. And that was really about considering what would have those key nutrients that are likely to be beneficial, but really sensitive to the individual's food preferences.

Dr. Mojola Omole:

Perfect. So you mentioned a little bit before about some of the key findings. What other findings did you find with the SMILE study?

Dr. Rachelle Opie:

I think what's interesting from the dietary perspective is that, so as part of my PhD, I created this ModiMed score. So the score was based on 12 components of the Med diet, and that score was out of 120. So if you get 10 points for each element. And now what we found on average, the participants at the end of the trial on average were getting a score of 55 of 120. So, we weren't seeing not even 50% compliance, yet we saw such impressive results. And I think that's an amazing finding to say that people do not need to eat this perfect diet in order to see really wonderful mental health benefits.

I think also because the diet is so varied, what we saw was that our individual elements, so we saw improvements in whole grains, fruit, dairy, olive oil, pulses, and fish. But on average, people are only increasing their foods by half a serve or a full serve, but it's because of the totality of the diet that when you add it all together, that was quite substantial. I think the other interesting component was that we saw reduction of discretionary items. So, we're talking things like chips or chocolate or soft drinks, reduced by 21 serves a week. So we're talking three serves a day reduction in discretionary choices.

Dr. Mojola Omole:

Oh, wow.

Dr. Rachelle Opie:

But the thing I want to emphasize here was that was without shaming or blaming, this was the diet was ad libitum. Clients were encouraged to eat according to appetite. There were no foods that were off limit. I think the way this happened was that we were just encouraging ways to include wholesome, nourishing foods, and subsequently those foods just fell by the wayside.

Dr. Mojola Omole:

Did you guys also look like at any confounding maybe medication changes or anything like that, or-

Dr. Rachelle Opie:

Yeah, we adjusted to multiple factors. So this was whilst taking into account BMI, we took into account physical activity, so many factors, and that was still shown to be very significant.

Dr. Mojola Omole:

Oh, wow. So what exactly is it in the Mediterranean diet that causes this effect?

Dr. Rachelle Opie:

Yeah, I think probably the approach I tend to take is it's a whole of diet approach. That it's about the synergistic effect of nutrients and foods in combination because people don't naturally eat a single food or nutrient. And I think really that's probably what we want to consider. It's also because if you eat the food, the totality of the diet, that accounts for those social components. So, things like supporting communication, connection and community, which is so important and vital to our mental health.

I think also when you look at the Mediterranean diet, when you think these oily fish, these whole grains, it's very much plant-based diet, so legumes, fruits, veg, moderate amounts of say poultry and lean meats and olive oil is the main added fat. That diet is high in phytochemicals and polyphenols, it's high mono and polyunsaturated fat, lots of vitamins and minerals, pre and probiotic fibers, and it's a lot about that dietary diversity. So, it's just, there's so many wonderful aspects to it. It's hard to pinpoint what is the one key thing, and I don't think there is.

Dr. Mojola Omole:

Do we know if other diets have similar effects?

Dr. Rachelle Opie:

It's not that the Mediterranean diet I think is superior to anything else, it's that's been just most widely tested. Really, when we look at other diets, any traditional way of eating is likely to be beneficial. So for example, a Norwegian diet or a Japanese type diet, because they've got similar components, they've got a lot of oily fish, green leafy vegetables, whole grain cereals or high fiber foods. So, that's really key. But I think also because many of those ways of eating is about community and social connection and culinary activities, which is likely to be so important when you consider the benefits of these lifestyle aspects.

Dr. Mojola Omole:

So how do physicians, how do we effectively coach our patients to improve their diet lifestyle around when it comes to depression and the improvement around diet? I still said diet, I'm trying not to say diet.

Dr. Rachelle Opie:

Yeah, no, that's fine. I mean, I think it is coming from a space where it's non-judgemental, it's non-shaming, it's very person-centered. I would suggest being trauma-informed, taking into account the high rates of trauma amongst clients with mental health conditions. And my recommendation would be making sure it's weight neutral, so ensuring that it's eating disorder safe. Again, taking into account the high co-occurrence of eating disorders and major depressive disorders.

But the way I would suggest doing it is use counseling skills like motivational interviewing, which was developed by Milner and Rollnick and what that, I think about the OARS skills. I'm not sure if you've heard of those where it's about open questions, affirmation, reflective listening, and summarizing from there. I think that's probably the approach to take.

Dr. Mojola Omole:

And so what would you say, you said the positive things to do. What are some maybe pitfalls that we should avoid when we're talking to patients about how to approach a different lifestyle when it comes to their eating habits?

Dr. Rachelle Opie:

Yeah, I mean, I think just drawing back onto the trauma and eating disorder focus is really considering because of that high co-occurrence is making sure that we deliver our advice in a way that is eating disorder safe. So, making sure that we are not feeding into diet culture. We are conscious of weight stigma. We're using neutral language around food. We're reducing moralization around food. Again, very person-centered, very weight-neutral, trauma-informed approach.

I'd suggest recognizing dieting is amongst the most common risk factor for an eating disorder. So like you were saying, Jola, is being careful of using the word diet. I tend to try to focus on the word Mediterranean lifestyle instead, and I would strongly recommend not focusing on limiting discretionary foods. I think instead, change the focus to what can you include. So what in your day have you felt you wanted to add in or where in your week have you felt you wanted to make a change?

Dr. Mojola Omole:

I think that works for, we're talking about depression, but I counsel a lot of people about different health things that include changing their lifestyle and trying to add more water, adding more fiber and all those things into their eating habits.

Dr. Rachelle Opie:

Yeah, perfect. And I think it's so much easier to add in rather than remove, because at the end of the day, if you want this to be sustainable, it's got to feel pleasurable, it's got to feel realistic. And in doing that, that just feels very achievable.

Dr. Mojola Omole:

So, we as physicians have very brief interactions with patients compared to dietitians who are more knowledgeable and can spend more time. How can we communicate the message succinctly? You have someone who comes in, they're struggling with their mental health and maybe you've asked them a few probing questions. How can you create that environment to talk about this in that short minute of time that we have with them, if possible.

Dr. Rachelle Opie:

Yeah, Jola, I suppose I feel very fortunate I've got the luxury that I can spend so much time with clients to work through it. I think at the end of the day, if a clinician comes in with curiosity, with non-judgment and really explores simply what a client feels they would be ready to change and encouraging one small change that you recognize as being beneficial for improving their mood, that's likely to be a really important start because that will spur on further motivation to change.

I think if someone has a traditional way of eating, for example, if they naturally eat an Italian style diet, then encourage them to go back to their grassroots there and really build up on that. If there's one message to impart is recognizing that mental health improvements can be achieved without a focus on weight, diet or restriction. Observational studies and intervention studies have demonstrated that time and time again that we can see improvements in mental health, independent of weight changes. And I think that's a really important thing to sort of drum in, is that we can do it in a way that is palatable and enjoyable without having to worry about restriction.

Dr. Mojola Omole:

Fair enough. That's great. Thank you so much.

Dr. Rachelle Opie:

Thanks, Jola. Thanks so much for having me.

Dr. Mojola Omole:

Dr. Rachelle Opie is an accredited practicing dietician and credentialed eating disorder clinician from Melbourne Australia. So Blair, after that conversation with Rachelle and Nicholas, what's cooking for you? What's marinating up there?

Dr. Blair Bigham:

I think the most, for me, it was surprising. I guess it makes a lot of sense, but this idea that you don't have to make this drastic change. You don't have to have a perfect diet. You can just go make subtle changes, do what you can along the way, and you can actually have quite a substantial impact detected.

I thought that was really interesting because normally when we talk about research in a trial, you're talking about all or nothing. The protocol has to be perfect. The whole regimen has to go perfectly just to see if you can detect a difference. But here, I think what was the number? 55 out of 120 points, people didn't totally transform their diet. They just made those little subtle changes, ate a couple less snacks. They were just mindful, and that seems to be all it takes to improve your mood. I thought that was really reassuring and surprising.

Dr. Mojola Omole:

The part that I agree with you, the part that I'm struggling with is just when I talk to patients about, because I'm talking to them about their diet for gallbladder and that type of thing, and just the cost of food and that the Mediterranean diet actually is costly. If we don't find ways to talk to people about, okay, for example, a can of beans is actually cheap. You can make quite a lot of things with a can of beans with some lentils. And I think that's-

Dr. Blair Bigham:

That's how I got through university.

Dr. Mojola Omole:

Yeah. And I think it's shifting people. I guess what I'm trying to say is that us as physicians have to just be a little bit more creative and meeting our patients where they're at that, yes, it's great to say eat fatty oily fishes, stay away from red meat, but honestly, a thing of ground beef is cheaper than trying to buy a whole bunch of fresh fruits and vegetables. However, a can of beans is cheaper than two pounds of ground beef. So, I think it's trying, relearning that, maybe switching to a diet that has more plant-based that you can get your foods from, canned or frozen is also helpful.

Dr. Blair Bigham:

And I think that's the key takeaway is that it is just about a subtle shift in that we don't need to get people to totally buy a bicycle or buy a whole new perfect diet for the week. It's just about those incremental changes that can have a pretty big impact on your health.

Dr. Mojola Omole:

And I find that it's a struggle using the word diet. We keep on saying diet, diet.

Dr. Blair Bigham:

Right.

Dr. Mojola Omole:

And sometimes I see when I say to patients, "Oh, you have to clean up your diet." They're like, "No, my diet is really great." And I'm like, "No, no, no, no, no. It's habits." And I think we also have to be very mindful that the word diet can trigger different things in different people. And I'm working on trying to find a more neutral way to say habits and because I think diet comes with so much judgment with it where I'm just literally meaning, what are you eating?

Dr. Blair Bigham:

And habits run deep, right? I think we heard this with Ashley White on our podcast a couple months ago, that your diet is a product of your upbringing, a product of a lot of trauma and stress for some people, and that we definitely don't want to make this sound pejorative that somebody has failed to adequately address their body's nutrition.

Dr. Mojola Omole:

This has been a great conversation.

Dr. Blair Bigham:

Absolutely. Really interesting. That's it for this episode of the CMAJ Podcast. Our podcast is produced by PodCraft Productions. If you can, please like or share our podcast or drop a comment, wherever it is you download your audio. It helps us get the message out. I'm Blair Bigham.

Dr. Mojola Omole:

And I'm Mojola Omole. Until next time, be well.