17. Change Your Diet, Change Your MIND with Dr. Georgia Ede

We had a fascinating conversation with our friend and colleague Dr.Georgia Ede about the background, details, and the vast scope of her work treating mental illness--of all sorts--with variations on the ketogenic diet.  Fully conventionally trained, Dr. Ede used her insight into her patients' conditions, paired it with developing understanding about nutrition, and has found varied and individualized approaches to what we eat and how it affects our brains. 

We explore with Dr. Ede the applications of her dietary recommendations for conditions both psychiatric and neurological, the safety of her protocols, and the nutritional science as it applies to mental and physical health.

We hope you enjoy this conversation, we certainly did!

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Transcript

[00:00:00.000] – Dr. Georgia Ede

The cornerstone of my practice has become the ketogenic diet. It's not the only nutrition strategy I use in my work, but it's become the cornerstone of my work because it's the most powerful mental health intervention that I have at my disposal. So when I'm counseling people about ketogenic diets- You mean more powerful than medications? Yes. Okay.

[00:00:19.930] – Dr. Dr. Lemanne

You have found your way to the Lemanne Gorton podcast where Docs Talk Shop.

[00:00:28.170] - Dr. Gordon

Happy eavesdropping.

[00:00:35.440] – Dr. Dr. Lemanne

I'm Dr. Dawn Dr. Lemanne. I treat cancer patients.

[00:00:38.740] – Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:00:42.550] – Dr. Dr. Lemanne

We've been in practice a long time.

[00:00:43.700] – Dr. Gordon

A very long time.

[00:00:46.540] – Dr. Dr. Lemanne

We learn so much talking to each other.

[00:00:48.390] – Dr. Gordon

We do. What if we let people listen in?

[00:00:56.780] – Dr. Gordon

Schizophrenia, bipolar disorder, anxiety, obsessive compulsive disorder, post-traumatic stress disorder, major depression.

When we hear about these terrible conditions, our first thought as physicians is usually not change the diet, we are more likely to think of powerful medications as being the backbone of treatment. Of course, if you want to know the truth, we physicians think of these treatments as, well, not terribly effective and know that psychiatric drugs come with baggage, uncomfortable, sometimes even dangerous side effects. Does diet really play a role in helping patients? Today's guest says the answer is yes. Diet can help treat these disorders, and at least in some cases, diet may provide more relief than drugs. Today, we have the pleasure of talking with our friend Dr. Georgia Ead, Harvard-trained and board-certified psychiatrist. With those credentials, she is, of course, more than qualified to engage in talk therapy, to prescribe medications. But what makes her unusual is her expertise in nutritional and metabolic psychiatry, that is, how our food affects our mental health. In her new book, Change your Diet, Change your Mind, Dr. Ede examines how very particular, but not that difficult, dietary interventions can alter our metabolism, and therein serve as powerful tools in the treatment of psychiatric conditions. If you have ever wanted those particulars, she is your go-to.

[00:02:42.610] – Dr. Gordon

The complete title of her recent book is Change your Diet, Change your Mind, a Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health. Her book offers concrete solutions solutions for psychiatric and neurological health, based on the latest scientific and clinical evidence. 

So seriously, if you have any interest, say if you know, love, or are someone with any concerns about mood or brain health, I highly encourage you to buy the book. It's a wealth of information about so many imagined and unimaginable topics well-researched. A delight to read. I have it in and on audible. Nice reading, by the way, Dr. Ede. And plan to print up some of the diet plans for reference for my own patients. I also suggest you dive into Dr. Ede's work at her website, Diagnosis, Diet, dr. Com. But don't just take my word. Let's listen.

[00:03:52.740] – Dr. Gordon

Thank you, George, just so much for joining us here today. Dr. Dr. Lemanne and I and Dr. Ede, know each other, going back almost a decade. But this is the first time we've had to meet and chat since the publication of Dr. Ede's wonderful book. I've got quite a stunning introduction of you, Dr. Ede, Georgia. I think we can go by first names here. We all know each other. But I think I'm going to... I could read it now, but I think I'll just read it separately with Tom later, so we don't have you blushing to great extremes as I describe the things that I expect people to learn from and about you. If they read your... If they listen to us, get a hold of that nice book over your corner, over your shoulder there on your bookcase, Change your Diet, Change your Mind, Change Our World, should be the subtitle to it. And also visit your website, which I've been referring patients to for years, diagnosisdiet.com. And if somebody wanted to glean really a great bulk of the information that feeds the book, it's on your website.

[00:05:11.910] - Dr. Ede

That is true. And there are other useful things on the website, too. Free resources, things like a free clinician directory. If people are looking for a metabolic practitioner to support their mental health with ketogenic diets, for example. Information about the book, of course and information about my clinician training program for clinicians who want to learn how to safely incorporate ketogenic diets into their care of people with mental health conditions. All of that is there, too. So, yeah, please do come on. Come on over.

[00:05:45.180] - Dr. Gordon

Lots of resources. And I think we'll back up a little bit because there are just maybe a few people who don't really know who you are. And I can introduce the simple sentence that you are a fully Harvard-trained psychiatrist psychiatrist, fully board-certified and able to function doing mental health therapy and mental health prescribing. How did you get into this niche that you so brilliantly expanded?

[00:06:13.540] – Dr. Ede

Well, the long story short, I practiced conventionally for 10 years, offering psychotherapy and prescribing medications. I had conventional medical training and psychiatric training and practiced the way other psychiatrists do for A solid 10 years. And then, and honestly, never thought about how nutrition affected mental health. It never crossed my mind once that the brain would care about what we were doing. Really thought about food choices, primarily as a way to control my weight, since I grew up with a weight problem from childhood. So I think that's how still a lot of women think about food. So anyway, it was really through my own selfish pursuits of trying to solve some of my own health problems that cropped up from me in my early 40s, that I started exploring nutrition, really learning about nutrition science. And it would be years even after that before I started incorporating it into my work, because I really wanted to make sure that the dietary interventions that I had been learning about, I really wanted to make sure they were safe first before I recommended them to my patients.

[00:07:30.720] - Dr. Gordon

Then how did you introduce them to your patients, considering there wasn't at that time a book or a wealth of literature to refer them to?

[00:07:42.900] - Dr. Ede

Yeah, at the time that I started incorporating these principles into my work, I had a mixed practice at that time. So I had a small private practice, a nutrition-based practice that I opened in Cambridge, Massachusetts, back then. And I also was working several days a week at Harvard University Health Services in student mental health. So working with university students and faculty and staff, I had been hired there largely, primarily to prescribe medications, which is what most psychiatrists are hired for. We had lots of wonderful therapists there. We had about 40 wonderful therapists there, maybe 10 or 11 psychiatrists. So the psychiatrists were hired to prescribe, for the most part, to do medication management, and the therapist did the therapy. But at the time, the psychiatrists on staff were allowed to offer complementary therapies that were interesting to them. For example, one psychiatrist on the staff offered acupuncture, for example, and I became interested in offering nutrition consultation. I was given that flexibility to offer nutrition consultation to students, faculty, and staff who were interested. So it wasn't my primary role, but they gave me that flexibility, which was lovely. I I practiced a mixture of conventional psychiatry and nutritional psychiatry while I was at Harvard until the leadership changed.

[00:09:23.230] - Dr. Ede

And when the leadership changed, the new director who's no longer there said, This is beyond your scope practice, and we need you to stop.

[00:09:33.310] - Dr. Lemanne

Can I ask you? I want to fill in for our listeners. You were practicing it, it sounds like, with very high functioning patients. So these are Harvard students and professors and staff, is that correct?

[00:09:44.840] - Dr. Ede

Exactly.

[00:09:45.750] - Dr. Lemanne

What were the diagnosis or the problems, if you want to put it that way, that you were seeing? And what types of things did you see that you thought, wow, maybe this is going to improve with nutritional interventions. So could you talk a little bit about that? Who you saw, why you saw them, and what made you think, nutrition might be playing a role in their issues, and maybe we can fix that.

[00:10:08.290] - Dr. Ede

Yeah, Dawn. I'm enjoying thinking about that question because I haven't thought about that before. In college mental health, anybody out there who's worked in college mental health knows, while you might... A lot of people may imagine that it is a low acuity population where you're working with college students, so they're young, they should be healthy. They probably have things like depression and anxiety and adjustment issues just being away from home or maybe exam stress, academic stress, things like that. It actually is a very It is a population which is extraordinarily vulnerable to serious mental health disorders. In fact, many of our most serious mental health disorders arise during that window of time, late adolescence and young adulthood.

[00:11:01.680] – Dr. Dr. Lemanne

You're talking about things like schizophrenia and bipolar disorders and breakdowns and the really serious more general vision, like I would call it, psychotic issues?

[00:11:17.850] - Dr. Ede

Absolutely. So very serious mental illnesses. Often people have their first psychotic break, their first manic episode, their first major depression with suicidal ideation. Often those initial episodes where the mental health disorder is becoming obvious happen when people go away to college. So that is a really vulnerable time. And so the psychiatrists who work in college mental health work very hard and And many times it often feels like you're working in an emergency room. We have students coming in, multiple instances of people coming in throughout the day in crisis, needing hospitalization, needing to take a leave of absence, needing to take, and sometimes even to leave college altogether. So it's a very, very vulnerable time and a very It's a population where you see these mental illnesses emerging. So I actually loved working in college mental health. It was my specialty, and I worked in college mental health for 13 years. So then the other Third question you asked was which conditions, so schizophrenia, bipolar disorder, anorexia, PTSD, attention deficit disorder, OCD, major depression, really just about every mental health condition we would see in college mental health, with the exception, of course, of Alzheimer's disease.

[00:12:53.870] - Dr. Ede

And so there was a lot of... It was a really great diversity of the conditions. The other question you asked was, which conditions did I think nutrition interventions might help with and why? I had already, after studying for a number of years, nutrition and mental health before I started incorporating into my clinical work. I did a really deep dive into nutrition, a deep dive into brain health, brain chemistry, food chemistry, all kinds of other aspects of nutrition and mental health study. I did for a number of years before I started using it in my clinical work. So I was already really strongly convinced that it didn't matter what the diagnosis was, that all of these conditions are brain disorders, and all brains need to be fed properly in order to function optimally. So I went in with that hypothesis, that nutrition, that giving people the right information about nutrition and helping them make the most important diet changes to their diet, the most impactful changes to their diet, could theoretically improve just about any mental health condition. So that was the belief that I went into that work with.

[00:14:15.120] – Dr. Dr. Lemanne

Well, thank you. That's really helpful, I think, for our listeners to have that context. I am curious, what were some of the changes that you would see in the people that you were helping? It sounds like a university setting. People are in dormitories or eating out a lot. It's not a cooking culture, usually, at that age and stage in life. So it'd be interesting to hear what the changes you asked them to do were, what benefits you saw, and how did they actually accomplish those? For instance, if people were living in a dormitory or another typical college situation where cooking isn't prominent.

[00:14:52.630] - Dr. Ede

It's another great question because you're exactly right about food culture on college campuses is pretty atrocious. So the social culture of eating on college campuses, the kinds of foods that are available in dining halls, there are very unhealthy foods available at every meal and in every dining hall, even the special dining halls. I was quite privileged to work at two very prestigious institutions where students had every advantage in terms of what they were offered for foods. And both of the places I worked, Harvard University for seven years and then Smith College for five years, both of these institutions had lots of options for students in terms of dining halls. They had kosher dining halls and vegetarian dining halls, even a dining hall for athletes where it was mostly complex carbohydrates. But there was no such thing as a Whole Foods Dining! There was no such thing as a dining hall where you could go and know that you would not be offered a lot of processed and sugary foods. This was a challenge for me in terms of working with college students is that not only were all of their friends eating a lot of processed food all day long, and often well into the night, pizza and all kinds of ice cream and all kinds of other things, sweetened coffee drinks and everything.

[00:16:28.660] - Dr. Ede

But even if they were trying to eat healthier, there was nowhere they could go to get a little food sobriety. So it was an uphill climb for them. And they're young and attachment and belonging among young people that's like oxygen, right? You want to get to know people, make friends. You don't want to stand out as different, and you want to socialize and do the same things everybody else is doing. So it was a really tough environment to be practicing nutritional psychiatry psychiatry, which is exactly why after 13 years of that, although it broke my heart, I did leave. I did leave College Mental Health so that I could practice full, really, real nutritional psychiatry. But I did have many cases at Harvard, more at Harvard than at Smith. But at Harvard, I wasn't just working with undergraduates. I was also, at least for the first few years, working with with faculty staff and graduate students. So these were people who cooked largely for themselves. They were more mature. They were more motivated often to change their diets. They were past that early window where we feel invincible, and they were starting to really start families, for example, the graduate students, and taking more control and more responsibility for their food choices and for health.

[00:18:01.380] - Dr. Ede

I had quite a few people, graduate students and faculty and staff, who came to me specifically for a nutrition consultation for a variety of different conditions. We would talk about Nutrition Interventions. And back then, because this was 2008 or '09, I wasn't talking to most people about ketogenic and low-carbohydrate diets. I eventually did start to do that even at Harvard. But at first, all I was doing was talking about nutritional quality, talking about, for example, paleo-diet, and helping people understand the potential benefits of ancestral diets for better brain health. You were moving all the processed foods and the refined carbohydrates and the vegetable oils and going back to a diet that's more nutritious and safer that really could support optimal brain health. So I did a lot of that. But then I also, in many cases, would talk about elimination diets or low carbohydrate diets with those who are interested. So in the book, I give a couple of examples. For example, a young woman who was a graduate student who had tremendous anxiety, panic attacks, what she described as emotional eating, lots of irritability, and a variety of other mainly anxiety-type symptoms. She did not want to take medication.

[00:19:39.690] - Dr. Ede

She knew I did nutrition consultation, and she came to me and said, Is there anything I can do other than take medication. And after taking her history and the pattern of her anxiety episodes, it became clear to me that her anxiety was being largely driven by the way she was eating. And so when I said, It sounds like you have that you're really sensitive to carbohydrate and that you might want to consider a low carbohydrate diet. And she was very open to this and very motivated. She changed her diet right away, and really just to a diet that was essentially wholefoods, low carbohydrate, things like meat and cheese and nuts and vegetables, low carbohydrate vegetables. Her symptoms were 90% gone within a few weeks. That's one example that I included in the book with her permission. Then another is, again, a graduate student who was really struggling for years with self-injury, with bipolar disorder type 2, lots of depression. And he was not interested in making major changes to his diet, like going as far as paleo, for example, which really he requires that you restructure your diet from the ground up. He said, But I'm ready to make one change.

[00:21:06.050] - Dr. Ede

So one of the questions I'd like to ask is, Is there a change that you feel ready to make between now and our next appointment? He said, Well, yeah, I could try gluten-free. And so that's what he did. And honestly, that's all it took for him to experience tremendous relief from his very serious long-standing bipolar depression. So There are many different dietary changes that can be useful to people outside of ketogenic diets. But in order to practice, in order to really recommend truly ketogenic diets, I really did need to leave the college mental health environment in order to practice that way.

[00:21:49.670] - Dr. Gordon

I'd say there's another aspect to the fact that these diets worked so well for these two people. You have a real skill in approaching the thorny issues of somebody maybe should change their diet. I could come up with numerous examples, but you just asked that young man, is there one change he's willing to make? Which is very generous and not prohibitive. I noticed that even when you talk about the paleo diet, you don't say, what I tend to say is, no grains, legumes, no dairy, no this, I know that. But you always say in the book, and I think we've got a chapter that Dawn has shared on the screen with us for us to look at, which, of course, our audience can't see right now, but if you've got a book, open to chapter 12. But you talk a lot about food as a risk or an opportunity. You know that there may be risks to you, including the fruit cassava in your fruit-alowed paleo diet because it might have some toxins. You might have problems with raw cruciferous vegetables, reminding me what I'd forgotten that arugula is a cruciferous vegetable because I like it so much.

[00:23:14.600] - Dr. Gordon

I don't think of it that way because, yes, raw cruciferous vegetables in endocrineology medicine are a risk for thyroid. So you have a very gentle approach that must be empowering for patients to take a baby step and feel like that's okay, that's something to work with?

[00:23:38.460] - Dr. Ede

Well, yeah. I mean, wherever you can start, start there, right? So there are all kinds of wonderful changes people can make to their diet that can get them closer to optimal brain health. So it doesn't matter how fast you go. It's definitely not an emergency in a lot of cases. But why not take your time? And there are some people who are all or nothing people, and they want to jump 100 % into a new dietary strategy. And there are other people who are one at a time people. And I really want everybody to have a seat at the table in terms of whether they want to go fast or slow. And lots of people are willing to make changes to their diet, and they know diet is important, and they're excited about eating healthier. But the information that they've had about which changes the ones that are most worth making has been incorrect. A lot of people think they've already tried. They have already tried a healthier diet. I've already this or that, and it doesn't work. They've tried sprinkling the superfoods on top, and they've tried nibbling around the edges. They've tried taking some of the bad things out.

[00:24:49.610] - Dr. Gordon

They've taken out meat on the advice of the Harvard School of Public Health, where some of their friends take classes while they're seeing you in the clinic. They've tried something. I'm really glad that you're listening.

[00:25:01.200] - Dr. Ede

Thank you very much. It's where people are given the wrong information about which changes that wants to focus on. If you're going to do all that work to change your diet, because changing diet is not easy, you want to make sure the changes you're making are worth making. And you want to make sure the foods you're spending your hard earned money on are worth buying. So there's just a lot of foods out there that aren't worth it. If you know what a food is supposed to do and you understand which nutrients it contains, then you know which foods to focus on. And we've been told for decades to base our diets on some of the least nutritious and riskiest foods on the planet.

[00:25:47.570] - Dr. Lemanne

I have to say here that you're not talking about... Well, you are, but you're talking about some of the risky foods being the sacred cows. Forgive the It's a vegetarian pun here. For instance, you dismantle the idea that there are superfoods, and you really go after things that people are told to turn up the volume on very, very hard. For instance, legumes and cruciferous vegetables, nuts and seeds. People are told in my field, which is oncology, those are your go-tos. That's what you want to emphasize if you have, for instance, an oncologic disorder. And you really go into why that is not scientific and what the actual problems are with a lot of those foods for a lot of people. I really thought that was pretty spectacular. Can you tell us a little bit about... First, let's just do cruciferous vegetables. One of the issues, for instance, in breast cancer is that people often have concurrent thyroid disorders. It's a chicken and egg, again, forgive the pun, but we don't understand the direction there. But people with thyroid issues tend to have a higher risk of breast cancer and vice versa. And it's not well understood.

[00:27:09.340] - Dr. Lemanne

But one of the things that we tell patients, the canon of nutritional canon, one of the things that we tell patients with breast cancer is eat a lot of crucifered vegetables and soy. And you talk about the research that links that to, I'll let you go ahead because it's just spectacular. You have a whole chapter or so about this in the and it's wonderful. Tell our listeners why you might have a problem with that particular recommendation.

[00:27:38.710] - Dr. Ede

Yes. Cruciferous vegetables can interfere with thyroid function, and I think a lot of people are not aware of that. And so the cruciferous vegetables, for those who aren't super clear about what those are, it's an enormous family of vegetables. Lots of different vegetables are Cruciferous vegetables. And so if you walk through the produce section of your supermarket, a lot of what you see is cruciferous vegetables. It seems like broccoli and Brussell Sprouts and kale and arugula, cauliflower. And we're told that these are some of the healthiest plant foods we can eat.

[00:28:15.920] - Dr. Gordon

Cabbage. Don't forget, cabbage. All the cabbages.

[00:28:19.520] - Dr. Lemanne

Radishes, turnips, rutabagras.

[00:28:23.080] - Dr. Ede

Yes, exactly. Watercress. Watercress. Go figure.

[00:28:27.020] - Dr. Lemanne

Watercress.

[00:28:30.990] - Dr. Ede

It's exactly right. There are so many cruciferous vegetables, and we just don't realize how many. And we're told that they're exceedingly healthy for us. We think of some of these as superfoods, and they are nutritious. They do have more nutritional value than quite a few other vegetables do. But they also, just like all vegetables, they have a downside. They protect themselves like all plants do, with very clever chemical weapons so that they won't be completely vulnerable when they're sitting out in a field, peaceful in a field, appearing to be innocent and defenseless. They're, of course, anything but. Even though they can't move and grow and chase, they can certainly defend themselves against predators. And it's important for us to know if we want to be optimally healthy, we want to understand which fruits and vegetables are the least likely to harm us because all plant foods are trying in their own way to harm us. It's not that they're all succeeding, but that that's what they're trying to. And so if we understand the differences. So the different types of things that are in crucifix vegetables There are natural pesticides. These are designed to ward off little pests that might come along, say, the stock of broccoli sitting in the field.

[00:29:56.570] - Dr. Ede

There are natural pesticides inside broccoli. These are called isothyocyanates. So these isothyocyanates, they're there to attack bacteria and fungi and insects, and worms. And they also are the same molecules behave as what are called goitrogens. And goitrogens interfere with your ability to make thyroid hormone.

[00:30:21.110] - Dr. Gordon

Can I ask a question about that? My understanding, and this is from my... I come to this through Adele Davis, Weston Price, paleo, all those things. But I thought that cruciferous vegetables, the problem with their goitrogenic function is primarily active when consumed raw, which, of course, is always how we consume arugula, sometimes how we consume kale, and rarely how we consume broccoli. So are they still there? Are those goitrogens still present in cooked cruciferous vegetables?

[00:31:00.530] - Dr. Ede

They are, but to a much lesser extent. So when you cook them, you really do significantly reduce their goitrigin content. So that's why the recipes in the book are always using smaller, like lower amounts of cooked crucifers. It allows for the diets that I put in the book do allow for a certain amount of cooked crucifers vegetables just to give people some flexibility in their diet, more variety in their diet. But I do caution people against, especially if you have thyroid condition already or you have iodine deficiency, then I really recommend that people be careful with raw crucifers vegetables, especially high amounts of raw cruciferous vegetables, things like kale smoothies, for example.

[00:31:48.770] - Dr. Gordon

First of all, that sounds terrible, but anyway. And I think you also make a point in a chapter that I'm reading past this one about that raw or cooked, they can definitely affect gastrointestinal motility. It's just something worth, as you would have said to that one patient who took out one thing, we're having gastrointestinal issues. Take out raw and cooked cruciferous vegetables for a while, see if it makes a difference. It may or may not for any given person.

[00:32:23.170] - Dr. Ede

I actually had a patient a few years ago who had tremendous anxiety, OCD, really health-focused anxiety, paralyzing in a lot of ways.

[00:32:36.190] - Dr. Lemanne

For our listeners, OCD, obsessive compulsive disorder, the compulsion, an obsession over, say, cleanliness, washing the hands, or a compulsive action, stepping over a crack a certain number of times, or something like that.

[00:32:51.500] - Dr. Ede

Precisely. So obsessive compulsive disorder of somebody who is disabled, to some certain extent, by either obsessions or compulsions or both. Exactly, Dawn. So he had a very health-focused obsessional anxiety, the fear of terrible diseases befalling him. So was very, very focused on every somatic symptom that he had. So he came to me because he wanted to try to use a ketogenic diet to reduce his anxiety and also to lose some weight. We ended up talking about his gastrointestinal function because he was about to... He had gone to a surgeon for a consult for a painful rectal fissure, which is a tear in the rectum. And the gastroenterologist had advised him to double down on his intake of fiber, to eat more nuts, lots of cruciferous vegetables, and chia seeds, and things like that in order to increase the fiber in his diet and therefore, try to heal the fissure. So he did. He very dutifully doubled down on his fiber intake, and lo and behold, a second fissure formed. So he went back to the gastroenterologist, and the gastroenterologist said, Okay, well, I guess there's nothing else we can do. I'll schedule you for surgical repair.

[00:34:22.220] - Dr. Ede

Now, this terrified this patient because this patient did not want... This was during the pandemic. He did not want to go to the hospital. He viewed the hospital as a hotbed of viral activity, and he was terrified. So we ended up talking about it. And I said, Well, what would you think? Would you be willing to try just as an experiment, doing the opposite, reducing the fiber in your diet as much as you can, taking out the foods that are hardest to digest. And this would be, I recommend taking out the cruciferous vegetables, the nuts and the seeds. He was already on a low carbohydrate diet, so we didn't need to remove the grains or legumes. And he did this, and within two months, the fishers, both of them were 80 % healed. So he canceled the surgery. And Well, that might not seem like something a psychiatrist would normally be talking to people. I mean, the gut and the brain are linked in lots of different ways. And this man was really... His anxiety was focused on this particular health issue. So it was It was very much appropriate to trying to help him feel better.

[00:35:35.170] - Dr. Ede

And this is just one example of the upside-down nutrition information that most physicians have in their minds. It's not based on biology. It's not based on an understanding of how food actually impacts our health. It's based on lots of untested theories that have become what we think of as common wisdom.

[00:36:02.370] - Dr. Gordon

Can I ask you? Go ahead.

[00:36:04.580] - Dr. Lemanne

You mentioned in the book that you're not really a fan of nutritional epidemiology. That really stuck out for me because legumes are having a moment, and soy has been having a decade or two or three. Soy has been the darling of a lot of nutritionists and people who give nutritional advice, especially to In my patient population with cancer. Soy can do no wrong. The more of it, almost the more of it, the better. I think people know that moderation is important, but what I call moderation is probably a little too much for most people. Talk a little bit about soy. It has some hormonal activity. It has, apparently, has some goitrogenic activity. What benefits have you seen from removing soy in patients with psychiatric disorders?

[00:37:03.500] - Dr. Ede

Yes, so removing soy comes along with the paleo diet pattern. When you switch from a standard typical diet to a paleo diet, you remove the grains and the legumes, and soy is a legume. So the legumes are bees and lentils, and soy beans are beans. And so by removing... I can't say that I've had any patient where all I have done remove the soy. So I couldn't answer the very specific question that you asked, but I can say that switching to a paleo diet can bring tremendous benefits for people for their gastrointestinal health and also for their mental health, for their gastrointestinal health, because all of the legumes are really quite challenging to digest. And so they're actually quite famous for this.

[00:37:54.930] - Dr. Lemanne

That's very diplomatic.

[00:37:59.710] - Dr. Ede

They come by their reputation, honestly. But in any case, in addition to being very difficult to digest because of the nature of the starches that are inside of legumes, which a lot of it is resistant and that we call to digest. It's also that soy also contains these isoflavones, and one of them is thyroid peroxidase, and that's the enzyme that your thyroid gland uses to insert iodine into thyroid hormone, which is what needs to happen to make the thyroid hormone functional. So that enzyme that builds thyroid hormone is interfered with by soy, and that's not something that you can destroy easily.

[00:38:41.190] - Dr. Lemanne

Can you make up for that by taking in an iodine supplement? I mean, if somebody is going to eat a lot of soy, would you then just have them take more iodine? And would measuring the blood iodine give you any information about how the soy is affecting their system?

[00:38:58.250] - Dr. Ede

That's actually a really good question, because if you eat soy regularly, your iodine requirement will be higher. So if you're going to include soy, if that's important to you, then you do want to include more iodine in your diet. But if you have hypothyroidism, I would advise that you avoid the soy altogether. But the other piece of that question is, how do you measure? Iodine is actually very difficult to measure.

[00:39:26.260] - Dr. Gordon

It's hard to measure it in the urine, a random urine for iodine.

[00:39:31.810] - Dr. Ede

Exactly. So with your much more extensive background, Deborah, than mine in functional medicine, how accurate is that urine test?

[00:39:42.370] - Dr. Gordon

It's a moment in time. So I ask people to... I like to include in the multivitamin that I recommend to people, a low dose of iodine, about 150 micrograms, is part of that multivitamin. And so if they are supplementing beyond that, because there are some protocols where people are taking a dozen milligrams, not just micrograms of iodine, and can really take too much, which can also backfire in the thyroid in some ways. I ask them not to do any excessive iodine for a couple of days, and then the lab collects a random urine. The range is quite wide of acceptable iodine levels. Somewhere, I think it's 50 to something approaching the multiple hundreds. But The ideal range, as I've been schooled by more nutritional thyroid people, is around 150, probably micrograms. I'm not sure of the units, but we'll put that in the notes. But a number about 150 to 250 of iodine in a random urine. I definitely have had patients whose number is really low and who supplement with iodine and their thyroid function is both subjectively and measured. There are people who don't want to take thyroid hormone for whatever reason, but taking too much of it can be problematic, too.

[00:41:13.030] - Dr. Gordon

I think it is good to work with somebody who's comfortable checking a random urine for iodine.

[00:41:20.680] - Dr. Lemanne

Would the random urine for iodine show that the iodine wasn't being used and maybe it was being excreted? How does How does that compare to the serum iodine? And does that have anything to do with the fact that you'd expect the iodine level to maybe go up if you're taking too much thyroid peroxidase toxins in your soy or Brussels Sprouts? How do you like to interpret that? And how do you compare that to the blood iodine level? Do you like to use a blood iodine level, either of you? I hope I'm making sense I'm trying to think this through. Okay, so I have a patient who's eating suddenly a lot of Cruciferous and soy. Is there iodine level, since they're not using it now, is it going to go up? Is it going to go down? Are they going to excrete more in their urine? What am I going to see there? And maybe that's what you were getting at, Deborah, with this being complicated.

[00:42:19.300] - Dr. Gordon

I've always been schooled against getting blood iodine levels, and perhaps, Georgia, you have more of an insight as to why that's true or more of a memory since I was an old the best in price direction that I got. From what you're saying, a cruciferous vegetables addressing the thyroid peroxidase antibody, a thyroid peroxidase function. I test almost everybody with their annual thyroid test for thyroid peroxidase antibodies. And Hashimotos thyroiditis is incredibly common. And I've never really thought about asking people to vary. I will after today, thank you very much, to vary their Cruciferous intake to see... Because I tell people they can only eat Cruciferous vegetables cooked and that that should mitigate it. But I'm going to now suggest they take it out altogether before we check their thyro-peroxidase antibodies. You should have a little bit of cushion of iodine in your blood, and that you should be excreting some of it. It's not like something that is... I was listening to a part of your book today. Your audible book is wonderful, by the way. You are a great reader, and it has a very kind feel to it. Very inviting. I appreciate that while being very scholarly.

[00:43:49.880] - Dr. Gordon

But one of the things you talk about, now I've totally lost my train of thought thinking of where is going with that. Oh, you talk about when somebody's in a ketogenic diet, how your kidneys can go into a tizzy if they're not properly comfortable with it and save, hold on to insulin, hold on to sodium, spill potassium, The importance of electrolytes. So iodine function, the kidney's attitude towards iodine, I believe, is more passive than active the way it can be towards the minerals, all the minerals. Yeah.

[00:44:36.890] - Dr. Ede

I mean, there's a world of difference between a carbohydrate-based diet and a fat-based diet and a ketogenic diet. So when people are in ketosis, it's just a different operating system. All your cells are just functioning in a different way. Different pathways are activated. And when you're in a higher insulin state, So high insulin states are really the public enemy number one, public health enemy number one.

[00:45:07.550] - Dr. Gordon

I think for all of our three specialties.

[00:45:10.240] - Dr. Ede

For any specialty, because it's just every cell, right? So it's exactly all three of our specialties. We would have a lot less to do, wouldn't we? If most people in the world understood the power and the importance of following a lower insulin lifestyle. So all that means is spending a lot more time in a lower insulin state. And that means making sure you're not eating too many of the wrong carbohydrates too often or too much carbohydrate for your personal metabolism. But it also means not over eating in general and not eating too frequently and making sure that you're getting exercise. And there are lots of these components to metabolic health, but it really boils down to, it's true, it's true, diet and exercise. It's just that we have been given the wrong information about what a healthy diet is supposed to look like. Back to your point about electrolytes is that everything is connected and all the systems work differently when you're in ketosis and when you're not in ketosis. And ketosis is just a low insulin state. It doesn't even necessarily need to be a low carbohydrate state, although that's going to be easier for you to manage.

[00:46:22.280] - Dr. Ede

But ketosis is just a low insulin state. When you're fasting, your insulin is low. When you're restricting calories, your insulin is low. And when you're eating a ketogenic diet, your insulin is low. Being in this low insulin state is super important for healing, for repair, for cleaning up after all the high energy activities of the cellular day. And so it's really important to be able to enter that healing mode on a regular basis, even if you're not in ketosis all the time. I'm convinced it's crucial for all human beings to spend periods of time in ketosis on a regular basis, even if they're not there all the time. But when you switch from a days, weeks, months, years of eating a high insulin diet, lots of carbohydrate, eating too frequently, eating a lot, and you switch to a ketogenic diet, your insulin levels can plummet, and your glucose levels, too, they'll come down rather quickly. And that's a shock to the brain and body because all of the pathways that were running the way your cells were operating in this high insulin state, they now have to shift gears and adjust to and adapt to this, suddenly this very low insulin state that they're very unfamiliar with because most of us are eating all the time and eating the wrong things.

[00:47:47.480] - Dr. Ede

So it's a big adjustment. And a lot of us have lost that metabolic flexibility, that ability to shift comfortably and quickly and easily between a mainly carbohydrate-driven metabolism to a mainly fat and ketone-driven metabolism. So all kinds of things can happen if you don't have good clinical support, especially if you're taking certain medicines or have certain health conditions. Because that shift, especially if you change your diet too quickly, can really cause a lot of severe fluid shifts, blood pressure drops, blood glucose drops, hypoglycemia, acid-based disturbances in the bloodstream, oxidative stress, lots of different things temporarily while you're adapting. Then after two, three weeks, things really quiet down and you found your new equilibrium. So when people are shifting on the ketogenic diet, they can lose a lot of excess fluid, they can feel dizzy, they can feel light headed. And if you don't supplement electrolytes, then you can end up feeling pretty bad for it completely unnecessarily.

[00:49:02.510] - Dr. Gordon

I think it's important to... Yeah, mixed electrolytes, I just wanted to say. Some people say, I'll just put more salt in my water. But you're right, mixed electrolytes. Okay.

[00:49:13.290] - Dr. Lemanne

So you mentioned two or three weeks. And that sounds a lot like withdrawal from an addiction to a substance, where things have to shift and you have to recover and you have to get into a new equilibrium and find a new balance. And you mentioned something that really struck me as At the beginning of our talk, of our conversation, you talked about food sobriety. I think that's what you said. Could you talk a little bit about that? I think that's a really interesting and powerful idea. The way that we eat can be climate forming in very, very detrimental ways. You've already talked about how underlying all three of the conditions that we each specialize in, Deborah, in brain diseases and Alzheimer's, dementia, you in psychiatric issues, and me with oncologic issues, a lot of those can be traced very, very specifically back to diet. And food sobriety, I think, is a really fantastic way of thinking about how we might gently conduct our eating lives. Can you talk a little bit about how you came to that turn of phrase and what it means to you? I think it's really interesting.

[00:50:28.160] - Dr. Ede

Yes, I came to through clinical experience because when I'm advising people about... The cornerstone of my practice has become, over the years, has become the ketogenic diet. It's not the only nutrition strategy I use in my work, but it's become the cornerstone of my work because it's the most powerful mental health intervention that I have at my disposal. So when I'm counseling people about ketogenic diets- You mean more powerful than medications? Yes, in many ways. Yes, Yeah. So when I'm counseling people about ketogenic diets and the potential benefits of that, it's often an easy sell for them to try the ketogenic diet. And when they experience the benefits, they often feel motivated to continue it. And so the beginning is, it's new, it's exciting, they're discovering things, they're feeling better. That's all great. But then comes the hard part, which is long term adherence. The obstacle that all of us who do this work come up against pretty quickly, if we're paying any attention at all, is the addiction, food addiction. Addiction, particularly to ultra Those foods that are unnaturally palatable and exciting, that give you that dopamine rush, and they're intensely flavorful. Flavor combinations that don't exist in nature, textures that don't exist in nature, and lots and lots of refined carbohydrate, which can be, for a good number of us, addictive.

[00:52:08.470] - Dr. Ede

And so when people have been eating that way for decades and they change their diet, even if they feel fantastic, it really is then all about adherence and long term adherence. And that's a challenge because we live in this incredibly tempting, toxic, environment of food convenience where almost everything around... We're usually never more than a few feet away from processed food. And this is really tough for people. It's really hard. And Imagine if you had struggled with alcohol addiction for a long time, and you finally achieve sobriety, and someone tells you, Okay, great. You're doing great. Now, here's your next challenge. Every time you're thirsty and you need water, I want you to go get it at the liquor store. So when people are dealing with trying to achieve food sobriety, and the definition of that in my mind is whatever eating plan quiets the food noise in their head and makes them feel like they've got a fighting chance and that they need a lot less willpower in order to get through their day, they feel protected and less vulnerable. Whatever helps them feel sober with respect to food, and that's going to be a different plan for each of them.

[00:53:38.570] - Dr. Ede

I'm basically asking them, Okay, you've achieved this wonderful food, so now go out into the world and Be confronted by multiple times per day all of these things that you are working so hard to avoid. It's really tough. And so the food addiction is very real. The science on this is quite strong, and there's some wonderful people in the field doing that work. And this is the number one challenge that those of us who work in metabolic psychiatry and those of us who use ketogenic and low carbohydrate diets to treat all kinds of other conditions, this is the hardest part of our work, is the relapse prevention, food addiction education, putting in all these supports, making sure that they have a plan, because this is going to be a lifelong vulnerability, unfortunately.

[00:54:33.730] - Dr. Gordon

The example you gave of the man who was very willing to sign on to the ketogenic diet, I think that's a hurdle as well. The hurdle of staying with it is brilliant. And yes, I think we're all familiar with that. I think the hurdle of trying something new is challenging for many people. And not just people who are eating in dining halls, but people who have every access to whatever they could really cook for themselves. And I so appreciated, essentially in the book, you have three model diet directions, paleo, keto, and carnivore. And there's a wonderful diagram near the end of the book where you can talk about how somebody could take baby steps. You call them quiet versions of each of these diets. That is not just quiet because it's taking out... You have an easy version. The quieter version is easier on the person, even though it may be taking out more foods. But you have there the quiet diet approach that is a really nice word. It's not easy, it's not simple, but it's quiet in terms of the effect on the person of what might be risky for you. Maybe taking that out would make this transition more meaningful to you because it'd be more effective.

[00:56:21.570] - Dr. Gordon

I think that's a brilliant concept.

[00:56:25.390] - Dr. Ede

Well, thank you. I've just come to those patterns through years of clinical practice. A lot of what I did in my early years of private practice, nutrition-based practice, was help people troubleshoot their diets. People would come to me and say, Well, I tried a ketogenic diet, it didn't work, or it made me feel worse, or I I had a carnivore diet, and it made me feel worse. A lot of, especially in my early consultations, were troubleshooting, and I learned a tremendous amount about food, about people, about behavior change, and the kinds of tips and tricks that work more often to help people who are not responding to these standard versions of these diets. So I learned very quickly that a standard ketogenic diet, there's lots of different ways to construct it, and some of them are a lot less healthy than others, just like a dietary pattern. Really the same is true for carnivore. Carnivore diets, you would think, well, that's the simplest pattern on the planet. You just to eat meat. Well, it's not that simple. People define it in lots of different ways. Some people include dairy, some people include spices, some people include alcohol, some people include caffeine, some people only eat beef.

[00:57:41.220] - Dr. Ede

I mean, there's just all kinds, there are many different variations. So I designed these quiet diets, grew out of that consultation work where I was helping people who already knew how to quiet their metabolism system, but they didn't yet understand which foods were working for them and against them. So there's the metabolic piece of the diet. That's one lever you can pull is the metabolic quality of the diet, meaning essentially how hard or easy that diet is on your insulin signaling system. Is it putting a lot of pressure on your insulin signaling system, or is it gentle on your insulin signaling system? So that's one lever you can pull, and that's a really powerful lever. But the other Another lever you can pull is the nutritional quality lever. And the lever where you understand which foods are easiest to digest, which foods are gentlest on your gut, which foods are gentlest on your nervous system, which foods are gentlest on your thyroid, which foods are gentlest on your immune system. If you marry those two principles of metabolic quality and nutritional quality, then you've got a really powerful intervention. The quiet diet, I I say in the book, if you would like to do a standard paleo or keto or carnivore diet, please do, because those are going to be easier and have a lot more variety in them than my quieter diets are.

[00:59:15.660] - Dr. Ede

But I put the quiet diets in to give people a deeper level of exploration in case those other plans haven't worked for them or in case they want the most efficient, the fastest way to get relief, if they're going to get safe with a lot less trial and error with a elimination strategy. So they're there for people to... And then I do encourage people, if one of these plans has worked for them, to then, if they wish, they can try expanding their diet and see where their personal safe hour limit is. And that has to do with keeping it on those glucose and insulin levels while they're doing it, but also paying attention to how they're their gut feels and how their sleep is and how their mind feels. Is their mind clear? How is their mood? How is their energy level? So that they can figure out a nice balance between how strict their diet needs to be to keep them well and how flexible their diet needs to be to keep them sane.

[01:00:18.420] - Dr. Gordon

As they venture out into the world. Right. Stuck in an airport overnight. You have to make some real choices.

[01:00:27.550] - Dr. Ede

Exactly.

[01:00:30.920] - Dr. Gordon

So let's see. I have a... I have a list of 20 questions that I want... I should probably make a consultation appointment with you on behalf of my patients. But one of the comments you make in the book is that there, and maybe we can wrap up with this, there's a real difference between food allergies I said, I know I'm not allergic to wheat. I've been eating it all my life, and I have no symptoms. Great. You don't have celiac. It hasn't devastated your internal organs. But you could have a sensitivity, number one. So to school people on the difference between allergy and sensitivity. But then number two, it's definitely true that food sensitivities are increasing by leaps and bounds in our current culture because we encounter so many toxins that we are ill-prepared to handle, not in the foods that we're eating, but in the air we breathe and the plastics that that food is contained in. I think there's been a big attention recently to microplastics and all these external synthetic elements can damage the integrity of our gastrointestinal system, feed some things into our bloodstream, and make us more sensitive to foods that indeed we are not allergic to, but they're getting under our skin of our gut, so to speak, and we get reactive.

[01:02:09.150] - Dr. Gordon

I think your diets are wonderfully suited to help people sort those things out and encourage people to be curious. I had a patient this week who saw her lab test before we could talk, and she said, I was so horrified, I just decided to do a whole 30 again, which we'll put a link to, but it's really essentially doing a little more strict paleo diet or your quiet paleo for 30 days. And she said, You know what? In three days, my years long tinnitus went away. And that isn't what she did it for. She did it for her cholesterol levels. And we don't know what it was she took out. But the idea that these sensitivities take all the... If you feel very courageous and adventurous, take out all the foods that could conceivably evoke sensitivities and see how you do. But do you think we have any hope for getting over our sensitivities, given that we live in a pea soup of environmental toxins?

[01:03:11.120] - Dr. Ede

Well, I love that. Really encouraging, just as you said, for people to adopt a curiosity mindset and do their own experiments. And really, anything is possible. And the story you told about someone's tenet is disappearing when that wasn't even what they were hoping to do. I hear stories like that all the time. People improve their diet in these various ways that make biological sense. And lo and behold, something improves that they weren't even thinking or trying to improve, including their mental health. I mean, lots of foods can impact mental health as well. These food sensitivities, there are really no good tests for them, and this is the problem. They're not true allergies. So true allergies have dramatic symptoms, very clear-cut symptoms, predictable symptoms, sometimes life-threatening symptoms. And there are tests for a very particular type of immune reaction. But these food sensitivities, there's no, even in 2024, no reliable way to test for them. I echo what you said about food sensitivities being largely about us having Our barriers, that we're losing the integrity of our barriers in our gut. We are becoming just much more sensitive to foods we should be able to tolerate.

[01:04:23.850] - Dr. Ede

And that's microplastics, it's antibiotics, it's medications, it's vegetable oils, it's inflammation from refining high in carbohydrates and high glucose levels. And they're heavy metals. There are lots of different reasons why we're breaking down in this way. And that's why I did feel the need to include these quiet diet plans for those people, for the growing number of us who are ultra sensitive, so to speak.

[01:04:49.270] - Dr. Gordon

Well, thank you so much for your time today, really. We could go on for the rest of the weekend. We are recording on a Friday, but we will cut everybody loose, and there will be lots of resources in the podcast notes about links to Dr. Ede's website, information about where you can get the book. And the book is full of all sorts of other resources about finding a practitioner, finding help, designing your own quiet ketogenic diet or whatever it is that's suitable to you. But I think I sent out a message to my administrative staff at my office as I was delving into this book. We need a permanent copy in the office, one or two copies to loan out. It's going to be a value for us because we put our patients on different diets all the time. So thank you so much for the work you've done.

[01:05:49.470] - Dr. Ede

Thank you both, my friends and colleagues, for inviting me. It's been really nice talking to you, and have a good work day today.

[01:05:56.260] - Dr. Lemanne

A real pleasure. Thank you so much.

[01:06:00.160] – Dr. Gordon

You have been listening to the Le Monde Gordon podcast, where Docs Talk Shop.

[01:06:07.040] - Doctors

For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop.com.  Happy eavesdropping.

[01:06:26.370] – Dr. Lemanne

Everything presented in this podcast is for educational and transformational purposes only and should not be construed as medical advice. No doctor-patient relationship is established or implied. If you have a health or a medical concern, see a qualified professional promptly.

[01:06:43.270] - Dr. Gordon

We make no warranty as to the accuracy, adequacy, validity, reliability, or completeness of the information presented in this podcast or found on the podcast website.

[01:06:55.370] - Dr. Lemanne 

We accept no liability for loss or damage of any kind. Result Consulting from your use of the podcast or the information presented therein. Your use of any information presented in this podcast is at your own risk.

[01:07:09.800] - Dr. Gordon 

Again, if you have any medical concerns, see your own provider or another qualified health professional promptly.

[01:07:16.650] – Dr. Lemanne

You must not take any action based on information in this podcast without first consulting your own qualified medical professional. Everything on this podcast, including music, dialog, and ideas, is copyrighted by Docs Talk Shop.

[01:07:34.340] - Dr. Gordon

Docs Talk Shop is recorded at Freeman Sound Studio in Ashland, Oregon.