So everyone welcome. If you can mute yourselves that would be great until after the presentation I'll leave plenty of time for us to have a conversation in the end I know there's quite a few experts in the room so I want to make sure we all get to talk about, about this really emerging field of lifestyle psychiatry excited to be here I'm a clinical professor of psychiatry at NYU Grossman School of Medicine. I'm also a clinical professor at the nursing school where I teach lifestyle medicine and going to be now branching out to lifestyle psychiatry. I'm the Associate Editor of the American Journal of Lifestyle Medicine so I'm glad to be here. So just to do a few quick disclosures and kind of for information more. I have been in this space for a short period of time I was in clinical medicine for about 30 years, and then transitioned to medical professionalism wrote this book about principles of medical professionalism have another one coming out in the fall of 2024 edited this book on lifestyle nursing and then have a general population general audience book called unblocked which is basically on the principles of lifestyle psychiatry lifestyle psychiatry as a field was really put on the map by this book, edited by our colleagues and Stanford's Doug Nord see, I don't know if he's on the call but he is a member of our caucus, and that came out in April 2019 from the American Psychiatric Association, and the second book that will be coming out in this space, I added co edited with a psychologist colleague of mine, called lifestyle psychiatry through the lens of behavioral medicine, it will be out in December, 2023, it's already on Amazon for pre And what I've done is taken what Doug did in his book and really took it from a behavioral medicine lens and try to expand upon those constructs with the psychological input. So what I'm going to be focusing today really is talking about definitions of what lifestyle psychiatry is going on in the gut make brain connection, talking about the interaction with the gut microbiome with the brain current evidence, and then I'm going to just put in some slides about climate change which I think is really important when we talk about food and how that interacts with our body, our planetary health and our physical health human health. I don't want to go into too much detail about lifestyle medicine today just so that we can kind of consolidate some of that information is available for free 5.5 CME hours on this from this link. So this is a video of WHC 2020 it's in collaboration with the American College of Lifestyle Medicine, which is an organization about 14,000 members, and the White House Commission, put this together so that you can have it it's very good for 5.5 CME hours. If anybody's interested, please just watch this and you will have this recording. So if you can't capture it right now you will be able to capture it later but I suggest you do that. I'm just going to touch upon it a little bit today I'm not going to go into too much. So what are the six pillars of lifestyle medicine, really, this is where the bread and butter of what we talked about lifestyle interventions are nutrition physical development, restorative sleep social connection and avoidance of risky substances. So, so really, in New York City, we've done a really good job within the 11 hospital systems within the New York City area that they actually, they actually have in develop lifestyle medicine programs, Michelle McMachen is the director of lifestyle medicine and nutrition in the New York City Health and Hospital System, and they have now really done a great job in Bellevue, they had a waiting list when they first opened their clinic of 650 patients, and they have amazing results not published yet but it's getting close to closing to be there. So, so I took the I've come to this lifestyle psychiatry space from life medicine I'm a fellow of the American College of Lifestyle Medicine, and I really thought during the literature I realized that we have a lot to offer a psychiatrist and help mental health professionals in the lifestyle medicine space and this is an article written for the primary care physician that really talks about the fact that we, we have a intersectional relationship between our physical and mental health, and we need to understand that if we don't address the mental health needs of our patients, we're going to not be able to really address their physical health as well. So I want everyone before I go forward to take a deep breath with me and just think for a second about how we've evolved as the medical field of psychiatry. So just think about all the, please mute yourself if you're not muted. So that others won't be disturbed. Thank you. So when we when we talk about this medical field of psychiatry you know at some point we thought everybody was demonically possessed. We were taking off parts of brains we were locking people up in basements, we were putting everybody on the couch you know the couch is helpful psychoanalysis is help for many, but not for everyone. Then we went to the other extreme where everybody was initially put in psychopharmacology, and yes it's helpful for many, but I think when we're thinking about where we're emerging and where we're going, we are going to continue to evolve as a field of psychiatry and we're going to continue to get the correlates of what's going on in the brain with our psychiatric disorders and I'm very excited about presenting one aspect of it. This is not at all everything about lifestyle psychiatry, but I think it's the beginning of the conversation in my world. I'm sure you're all familiar the biopsychosocial model of mental health and how we should be conceptualizing and using this as we're thinking through about how we're thinking about patients. And what I think that really lifestyle psychiatry is putting to add to that is adding the fourth aspect so that it was a biopsychosocial lifestyle model. Then, of course, when we're going to have psychotic and manic patients are severely mentally ill patients we're going to start with the biological, but then at some point we may be integrating psychological and looking at the social, but what we're also trying to do as a group of psychologists and lifestyle psychiatrists is that we should also be looking at lifestyle medicine. If you look at the red over there, those are really tracking with the pillars of lifestyle psychiatry, and these are guidelines from the Royal Australian and New Zealand College of Psychiatrists that have really been the forefront of this movement and really this came out in 2015. This came out in 2020 and what they did in those two countries for psychiatrists put out these clinical practice guidelines. This is their APA and they put out these practice guidelines for suggesting that for major depressive disorders, some mild anxiety and other mood disorders that we need to think of lifestyle changes in concert of when we're thinking about psychological interventions, if it's available. Of course, it's not always available, but as psychiatrists, if we educate ourselves on these lifestyle changes, then we're ahead of the curve on this. Of course, we're going to do fibromyalgia therapy and additional strategies as and when needed for severe cases. Just to define a few of the terms as I'm going to go through this presentation. I'm a New Yorker, so I've talked very fast. I'm really sorry about that, but it'll help us get through this material. Of course, you'll have this available to listen to later if you missed something. Wellbeing is a construct that is defined as a state of happiness, contentment, low level of distress, overall good and physical mental health, good quality of life. I think wellbeing composes and compromises a mental health, which we all understand what that means, brain health, which is basically brain development and cognitive health across the lifespan, and wellness, which is really a quality of life in a sense of wellbeing. The way that I like to conceptualize these is by this flattened Venn diagram, that wellness is something that we all will address when we talk about mental health, which includes wellness in addition to mental illness, and then brain health is cognitive health across the lifespan. Why this is so important is because as psychiatrists, our organ is the brain. Every field in medicine has an organ, and mental health is actually the term I think is done as a disservice because it makes it feel woo-woo and we don't really have a science behind it. If we actually think of all what we do as psychiatrists is brain health, I think that we really do ourselves a service and do our field a service. As I'm thinking about brain health, that really tracks with the pillars of lifestyle psychiatry and lifestyle medicine, which I've put in these icons with lifestyle psychiatry being what the glue that glues all these together. Case in point, the American Heart Association in 2022 revised their life's essential seven to have now eight. What they've done is they've added psychological health in there and said that without psychological health because of the bidirectionality and what's happening in the heart, they know that we would be unable to talk about heart health. You will see what they added in this pictorial is really talking about well-being, mindfulness, gratitude, optimism, self-purpose, and dealing with some of the disorders on the left-hand side. This first article that came out in 2020 is a meta review of the field of lifestyle psychiatry and really talking about the role of exercise, smoking, diet, and sleep, and the prevention and treatment of mental disorders. Beautifully written. It came out in World Psychiatry. One of the figures of this that I find very helpful to ground our conversation is this one from the article. If you can see in the middle, they're talking about five disorders. The literature has evolved since 2020, but I think this is a good starting point in the literature. Then looking about the strength of the evidence. The dashed lines, they have protective benefits, we can say, for these disorders because they have either prospective meta-analyses or Mendelian and randomized study, whereas the double-dashed lines have protective effects because they have both of those. Whereas the solid lines has evidence for efficacy and treatment because the evidence is higher. This is from the meta-analyses of randomized controlled trials. Then the double-solid is convergent evidence from these, and triple-solid lines are evidence from all of these. I think that what we're really talking about here as of 2020 of this article is we're talking about exercise, smoking, diet, and sleep. Having effects on these four disorders would tend to be very high in the list of the disorders. I think the most evidence is exercise and depression, exercise and ADHD. We're talking about sleep and depression, food. You can just see where the evidence is here. This article that came out in 2020, looking at the pathogenesis interventions and emerging methods. If you look at the middle two columns, that's what's going on in our body. Then the left column is really those lifestyle interventions, lifestyle bad habits that we may have. Then the right column is the disorders that we may see. We have two spaces where we can do lifestyle interventions. We can do it even after we do these unhealthy behaviors or to try to mitigate some of these before the changes happen in the body. Before the common pathway of inflammation starts, we can also do the lifestyle interventions there. In this 2020 article, they really talk about metabolic syndrome and mental health in the general population. About 20% of the population have metabolic syndrome. In our severely mental ill populations, incidence is 32.6%, very statistically significant. The key that came out of this study is about the bidirectionality. There's a 55% increase of incidence of developing depression if you have obesity. If you're depressed, you have a 58% increased risk of developing obesity. Some of the mechanisms and what happens are discussed, showed in this figure. Let's ground it in a little bit of the definitions. Excuse me, I've been a little sick, so I'm going to keep trying to hydrate my mouth. Talk about the definitions. In the literature, the microbiome and the microbiota are used interchangeably, but just really technically microbiota are the microorganisms that live in an established environment, and microbiome are the genetic material. Dysbiosis is a derangement of the microbiota. We can see that for many different things like antibiotic exposures, high-fat diet, alcohol. Our lifestyle we're going to talk about today, hygiene, immunodeficiency, hyperimmunity. This can cause dysbiosis. Then if we do dietary fiber, resistance charge probiotics and lifestyle, we can get back to homeostasis. I really, really want to focus on this brain-gut microbiota today. We have about a one-to-one ratio of the microbial cells and the human cells in our body. We don't know how many. We're estimating some say 38 trillion bacteria and other microbiomes. The human gene has about 23,000 genes, but the microbiome has 3.3 million genes, some articles say. Then in 2007, the Human Microbiome Project started, and they were able to sequence 60 million genes. There are a lot more genes and a lot more genetic material going on within this microbiota that's in our diet. What's really important here is that the gut microbiota is co-evolved from the same developmental neural crest that our brain has in embryogenesis. Why that's important is because there's so much communication and so much relationship that's going on between our brain and our gut and what's happened. When we're born, we're born with our gut microbiome having nothing. There's nothing there. We just have a gut. Over time, it develops. What develops is not only the gut, but different parts of our body all have microbiota. This is really important because this is emerging data. I think that even if we talk about environmental toxins and things that we put in our skin and other aspects of what we're doing in our body, there's microbiota everywhere. There's a study that came out recently from MD Anderson where they even looked at tumor cells, and they were able to isolate microbiota in tumor cells. Depending upon if it was a healthy microbiota or an unhealthy microbiota, they were able to say that there was a better prediction of a response to chemotherapeutics. It's the data there. It's emerging. It's really an exciting area. I can't tell you what all of this means yet, but I can tell you that you should watch out for the literature because it's very exciting. We know that depending on what we eat, and if you see in the left-hand side a plant-based diet and the right is Mediterranean, and the upper is the standard American diet, we call it. It's a Western diet. I'll talk a little bit more about what that is, but if you look in the triangle, it'll give you a little idea that there's a lot of processed food, fast foods in the Western diet. Then the plant-based foods is really whole food plants. Then the Mediterranean diet includes oils and fish. You can see that the difference of what's going on in the gut microbiota. What we know is the bacteroides tend to be more prominent in the plant base, and they're the healthier ones. The pharmacides are more in the Mediterranean and the Western. It's to be understood, but it's important. I will show you some of the data that's coming out by this. Sorry about that. This is really just focusing upon the fact that our gut generally changes over time. In the elderly, the composition evolves and it changes. This really helps me point out that sometimes when we're looking at this data and the studies, you have to be very careful because a lot of this is looking at what's going on in the fecal matter. The gut, some of these microbiota only live 20 minutes. By the time it's defecated, it may have nothing to do with what's going on in the gut. We have to be careful when reading these studies and looking at the future of what this is going to hold for us as we understand its effect on mental health. Here again, it's just showing that you notice that we have nothing, we have very little when we're born, and then these microbiota develop over time. You see that they decrease when we're aging at the same time that we're having neuronal loss. There is some similarity in what's going on between the two. I can't talk much about this, but there are many factors that influence the composition of the microbiome. I think that this always, every time I show this slide, people are like, stress? Yes, stress affects, it's not just diet. There's some really compelling data that's coming out that stress affects what's happening in the healthy versus the unhealthy gut microbiota. Exercise, the environment, the birth mode, vaginal delivery, you get a lot of your microbiota from the vagina, even cesarean, you'll get it from the skin and from the environment. Diet, we'll talk about later, medication, but pet ownership is very interesting because it helps in diversity of your gut. The name of the game, there's a few names in the game in gut microbiota in health, and one of them is diversity. We want beta diversity, and that you get when you have pets, so very fascinating. This is just a pictorial of some diseases associated with dysbiosis in the gut microbiota. Just to show you some literature from different studies, but we're going to be focusing on the upper right-hand corner in our psychiatric disorders, of course, but I just want you to understand this. I think the reason I really wanted to just stop for a minute and pause before we go forward is to say that that first slide about saying how we've evolved as a medical discipline in psychiatry, but I think some of the emerging literature that's coming out about our gut also may make us pause about the silos of how we're thinking about disorders and the fact that maybe there's some common pathways, inflammation and others in gut microbiota health, that may be implications of the ideology of a lot of these disorders and therefore have implications in treatment. As we're continuing to evolve in medicine and understanding these, I think we need to keep an open mind about that as well. This is an interesting study that came out of Nature Review's Neuroscience in 2020, and really talking about the literature. Again, I want to pause for a second because a lot of what I'm presenting is preclinical stuff. The upper left-hand side is talking about neurological and, of course, psychiatric disorders as well associated with gut dysbiosis. In the right and the left bottom, it's talking about mouse models that show the influence of gut microbiomes in those disorders, the upper hand right showing myosomal showing gut dysbiosis and those disorders and the fecal transplant in the in the bottom. So so what it's saying is this is this is the spectrum of everything we have. What you're missing here is human trials. So this was published in 2020 and I will show you the human trials that have come since then. But what I'm suggesting is that these are the preclinical trials that have come out. So there are many metabolic contributors to mental illness. We know this 25 percent of our patients with psychiatric conditions show inflammatory signs. We have a free radical formation with oxidative stress. There's myocondrial dysfunction. We're going to talk more about the gut microbiota. This is tryptophan, cryogenic metabolism, epigenetics and HPA axis. And this is a pictorial that kind of puts all of that together. So with a healthy diet with phytochemicals, vitamins and minerals, poly and monounsaturated fats and high fiber, we're talking about all those in the middle that I just mentioned and the mechanisms that were all this happens. I mean, we're not going to be able to get into too much, but we know that neurogenesis through HPA axis causes it through BDNF and it maintains hippocampal density and BDNF. We're talking about oxidative phosphorylation. We're talking about methylation age with epigenetic changes and the tryptamine kinuring metabolism. It's really important because of neurotoxic metabolites that can happen in depression. So when we talk about brain health and mental health and food and the gut microbiome, this article that came out in 2020 from Horn et al. really talks about three hubs of the but great but brain gut microbiome. And the hubs are all linked in a bidirectional loop. Okay. The blues is showing the going both directions, different components of food influence the brain, the gut and the gut microbiome by different communication channels. Dietary components can influence the gut directly and reach the brain. And after absorption for the small intestine, in addition, diet can influence gut microbial composition and diversity and can modulate the gut connectome and some microbial derived molecules are absorbed and reached the brain by the systemic circulation or the vagus nerve. Who knew? When I went to medical school, we had no idea of some of this stuff. And when you read some of these articles, they talk about those little molecules going through directly through the vagus nerve to the brain from the gut. So it's fascinating area and has many implications. So serotonin, you know, we know how important that is for our mental health and in our discipline, nine in preclinical studies, it's been established by certain researchers that 95% of our body serotonin is produced in the gut. Yes, it's stored in the rafi nucleus in the CNS, but it's actually produced in the gut. And the gut microbiome influences a serotonin production based on the food that we eat. And especially the tryptophan. And you remember two slides ago, I had the tryptophan in the middle of that. So we, what we're eating and the stress and the other parts that affect the gut microbiome, the tryptophan is really important. And that is of course, a recursor for our serotonin hires tryptophan leads to increase serotonin. Preclinical studies were found that impaired microbiome may lead to half of the circulating serotonin and circulation. So you can imagine if you future researchers, what that could be, what that could be looked at and what they could do for those studies. Serotonin is secreted into the vagal nerve and into the circulation and affects brain areas. And we know that it's stored in the rafi nucleus and it's crucial for the regulation of sleep, appetite, pain, sensitivity, and mood. I don't need to tell you that. So when we're going to be talking about processed, about food and how that's affecting the gut. So one thing I wanted to do, you guys to take home message was about the diversity, the beta diversity, but the other is about the class of the types of foods that we're eating. And this is really interesting because it's not perfect. This Nova classification, and there there's a lot of conversation in the literature that we need to revise it. Yes, I agree. But right now this is what we have. And the Nova classification of processed foods are looking like this. So if you think back 40, 50, 60 years ago, you know, what percent of our diet was this ultra processed packaged foods, very little, right? We were eating healthy foods, whole foods. We were eating meals within them with the McDonald's station and this fast food sort of market. And, um, a lot of the, the convenience foods that become ultra processed. So group run is unprocessed or minimally processed foods. And that's exactly what you would think whole foods. So sometimes you go to the market and you go to the supermarket and you'll see plant based on there, but it still may be processed because you can take the most beautiful whole food, like a tomato and make it processed in ketchup. Okay. Ketchup removes all those fiber bonds and everything that our gut microbiome needs to survive. So 95. So our gut microbiome needs fiber and it needs unprocessed foods. And that's where we're seeing the fiber in this chart. So when we're talking about feeding our healthy gut microbiome, the only foods in our body that in our, in our diet that provide fiber are whole food, plant-based foods. Once you process them, you remove all the fiber. So when we talk about this group, number four, these ultra processed foods, they don't have any fiber, even though they may look like they're vegetables, you know, but they don't have the fiber left in them. And in the middle, we have these different types of foods. So this is a study that was done by Jule and all that came out in 2020, beautiful study that looked at 40,000. Uh, they looked at trends actually, and 40,000, uh, people between 20, 2001 and 2018. And what they looked at is looking at the NOVA foods that were consumed by the males and the females. And what you will see is shockingly above 50% of the foods in this population that was studied are eating 50% of their foods. I'm sorry, not 50% of population, 50% of the foods that they're eating in this population study were ultra processed foods. Okay. And again, I'm telling you, these have no fiber and they're unhealthy and they're not good for our healthy gut microbiome. They, they contain sugar, salt oils, no fiber and dysbiosis occurs. What you will note is the trend, which is actually very concerning. And it continues to be concerning that the trend is going upwards and the trend for the minimally processed foods is going downwards. So they also looked upon and looked at this, uh, same data set, uh, around racial divide of Hispanic, non-Hispanic blacks and non-Hispanic whites. Our Hispanic colleagues are doing the best in this group with about 50% of their diet is ultra processed foods, but that's still very high. But again, and you look at the trends, the trends are exceedingly going upward and continue to go upward. So why am I so worried about ultra processed foods, ultra processed foods, things in packages, things that, that, that, that are not whole food, plant-based fruits and vegetables, they lack fiber. Our gut microbiome die without fiber. That's their food, healthy gut microbiome need them, especially the short chain amino acids to keep healthy healthy through the mechanism described here. It helps with neuro neuronal plasticity and decreases oxidative stress with neuro protection. So without them, um, we're going to be, uh, seeing a problem, uh, with catecholamine depletion and decreased neuroplasticity and increased oxidative stress. Uh, I think, uh, Steve Sugden, who I hope is back on the call for this slide that he shared with me. So let's talk about specific disorders and where the literature is on that, um, depressive disorder. So this is the first study that was published 2016, which shows you how recent this, this, uh, literature is, and this is preclinical data. What they did was they did a study that they took. Um, let me look at my notes really quickly. I believe, uh, yeah, there was 34, uh, depressed patients, 33 healthy volunteers, and they, they, uh, took the fecal, fecal, uh, FMT, the fecal microbial transportation, and they, they put them in microbiota depleted rats. So they just had them have no rats in their microbiota because everybody has a microbiota. So they depleted them. And then they, they took from depressed patients and they took from healthy controls and they looked at what they found and they found the people, the rats that had the depressed patients microbiota ended up having anadonic behavior, increased anxiety, increased intestinal time, and trends towards increased, uh, plasma C reactive protein. Whereas the ones that had the healthy controls and non-depressed patients, uh, they were, they actually did not show any changes. They used, um, uh, Beck anxiety inventory, Beck depressant inventory, and HamD 17 as what they use as the markers, exciting stuff. Since then we have some clinical trials, but let me just go through the literature because there's not a lot. So you get, they get a sense of what the, where the literature is. The SMILE study here is a randomized controlled trial. It's a first one to look at the dietary improvement as a treatment approach for depression. What they did is they encouraged eating, um, uh, whole foods. Now, if you look at this pyramid here, this isn't a, this isn't saying you have to only eat whole food, plant-based foods. It's talking about increasing the healthy foods and decreasing some of the unhealthy foods. So it was increasing some of the, what they call what, what they, what they wanted them to eat. What they found is they encouraged avoiding sweets, refined and processed foods, and, uh, avoiding fast foods and are all possible. And what they found that the number needed to treat for the depression based on this study was 4.1. Whereas I believe for SSRIs and other medications, the number needed to treat is a little bit higher than that. So this was a very positive, positive study. Uh, the pretty med studies are randomized controlled trial. This is the largest study to date. It came out in 2017, over 7,000 participants, adults, uh, they followed them for eight years. They had two interventional groups, uh, one with a Mediterranean diet that was supplemented with nuts. And one was a Mediterranean diet supplemented with olive oil. And there was a control group that was put on a low fat diet and the end point they were looking for was cardiovascular disease. So this, this study came out of the BMC medicine. So they weren't, this was actually, they weren't even looking for depression, but they did the store. They did the study and, and they did the scales and what they found, which was really exciting is the patients that, uh, with a type two diabetes, their risk for depression was 40% lower with the interventional groups when they had nuts. So if you have patients coming to you and they are told by their cardiologist to eat nuts, this is a study that's causing that problem or help, but it's a very exciting study that came out about the nuts. Okay. So this is a 2018 meta analysis and review of the observational studies. And what they found is for every 100 grams, increasing consumption of food or vegetables, there was an associated 5% reduction of risk of depression. And this is about the whole food and vegetables, not the processed or ultra processed foods and vegetables, the health of med study. This is what they basically did is they looked at the DAS depression scores at a week, uh, at three month baselines and three months. And they were able to look at, uh, it was a random randomized controlled trial, uh, supplementing with fish oil and improve the diets, uh, with, uh, and I'm sorry, I was just got a text. And what they found is that they, uh, showed a significant improvement in the, uh, the depression and anxiety scales at base, uh, at three months and six months with these patients. A men's trial is, uh, a 12 week parallel group, openly, uh, open label trial, uh, that showed that the Mediterranean diet in moderate to severe depression in young males, uh, was, uh, statistically significant, um, over the control that they called the befriending therapy where they had a non-clinical person, um, you know, provide social supports for the patient. And the P was, uh, significant here, P value. This is a recent study that came out in 2022. And, uh, it's a preclinical study, but again, it's, it's, it's putting, uh, really want to talk about more than just diet swimming exercises that they showed with these, these poor unsuspecting mice that they, they had a chronic, unpredictable, mild stress. They induced it. I'm sorry. Sorry, mice. Uh, they induced it and they found that the depression that was induced and the stress that was induced was improved, uh, through the exercise of swimming. Um, this is a case report studies. Uh, there were, there were, uh, very interesting only two, but again, this is where we're coming into human studies. And this is why I'm putting it up here. What they did is they took that, uh, fecal transplantation. And, uh, for the first patient, the HamD was 21 at baseline at week four, it went to nine. And then a week eight, it went back up to 19. We, uh, for the second patient, the HamD was 31, um, at week four, it was 10. And at week eight, it was 12. And all they did was this fecal microbial transplantation, uh, for these two patients. So very interesting study. Of course it needs to be replicated. So in anxiety disorders, I just want to go through a few of them really quickly. This came out in JAMA Pediatrics, looking at pediatric obesity, including a dietary component. Um, and they found the change in the depression and anxiety that was statistically significant, um, in this systematic review and meta-analysis. Uh, and they include, uh, 3000 articles and they, uh, this came out in 2019. Um, this study, uh, is in social anxiety disorders disorder. And what they basically found is that, um, they found that in the social anxiety disorder patients, gut microbiome of these patients versus healthy controls was different. So that in itself is important. They could tell you the genre of what that was different, but again, this is a 2023 article in translational psychiatry pointing to the fact that down the road, we're possibly going to be able to refine this further. Exciting, exciting study for me. This is a study that again, came out in 2023, looking at maternal anxiety, depression, and stress effects on offspring. And the findings are that there are the inflammatory biomarkers and they're showing some differences in this population came out, uh, in, uh, this year as well, 2023. So in bipolar disorder, this came out in world psychiatry, um, beautiful, beautiful article, uh, by Kryon, who's one of the leaders in this space talking about maybe gut microbiota is a missing link in psychiatry. I think, um, of course I'm a, I'm a, I'm a fan of this, of this concept, um, and really talking about how, yes, it's an emerging, uh, discipline, but if we can possibly make interventions to the gut microbiome and then affect the brain, because of course we know developmentally they're coming from the same space. Maybe this is the missing link that we haven't noticed all this time. This study is looking at, um, the really down the scope of this conversation, but it's a 2021 study really talking about PTSD and DD and bipolar disorder and the changes in the periphery, as well as the CNS. So it's multiple mechanisms and the pro-inflammatory profile in the periphery was as important as what's going on in the brain. And I believe that could be explained in the previous conversations we had about the gut microbiome and how there's multiple mechanisms of the interactions of what's going on in the gut and what's going on in the CNS, as well as now the peripheral. And this came out in 2021. This study is a bipolar, uh, Netherlands cohort study. Um, and what they did was, uh, they took 36, uh, recently diagnosed bipolar patients and they looked at, uh, what's going on in their diversity of the microbiome. And, um, they were able to, um, took the fecal samples and were able to find that there were, uh, consequences for mood and cardiovascular risk, because they found the correlation of the positive correlation with the Mediterranean sort of diet, uh, and, uh, patients with bipolar disorder improvement. This, this study is a systematic review and meta-analysis that came out, uh, this year. It's a meta-analysis of 18 studies. And what they found is a combination of diet and physical activity, improved depressive symptoms and functioning. And they also added the sleep-improving depressive symptoms in the studies that they reviewed. It came out in Neuroscience Biobehavioral Review, a good journal. So this is an expert review that was done in 2022 in molecular psychiatry, really looking at Jacka's team, who's a senior author here, uh, again, a leader and forefront in this space. Uh, they're all in, um, Australia, New Zealand area, uh, 5,000 patients, half the cases had psychiatric disorders, half were controls. There was no difference in the alpha diversity, but there was difference in beta diversity. Alpha diversity is saying that if you're eating 500 types of potatoes, you're going to have a lot of different gut microbiome, but if you're eating 500 types of fruits and vegetables, different types, not just the same, uh, type, you're going to have differences in your beta diversity because you're going to have different types of fruits and vegetables. So there's some authors that even say that you should aim for 25 different types of whole foods and vegetables per week. And then that helps really with the beta diversity. So just count things that you're eating. This is bell pepper. This is, you know, onions. These are, so just count them and try to have 25 in your diet every week. And this is one of the studies that really looks at that. And they found that, that, um, that is so ADHD, uh, case control studies, 360 children, primary school children on Mediterranean diets with lower odds of ADHD by half, um, uh, interesting study. Again, this is another case controlled, um, uh, less number, less number of patients, but what they also found, uh, that, uh, plant-based intervention was associated with lower risk of ADHD in these children. This is a mat, the Maddie study, a randomized controlled trial of ADHD children. Um, this was 134 children from age six to 12. Um, and then they found higher total amounts of fruits and vegetables were associated with lower levels of inattention in these teas, uh, children with ADHD came out in 2023. Again, we're just coming to this data right now. So, uh, stay tuned. So just, just to kind of summarize the summary of micronutrients and brain health, because this is clinical implications for everybody in the room. Nutritional research has really moved away from focusing on single nutrients in the brain health, because we really never consume them in isolation, but fiber has been associated with improved health in small scale observational intervention studies, about 95% of the population of this country does not eat enough fiber in their diet. Okay. So there's one of the take-home messages is adjust, increase your fiber, you know, don't, you don't have to stop all the unhealthy processed foods, but crowd out your diet was as much fiber, healthy whole food, plant-based that you can. Um, And there's these nutrients, micronutrients, omega-3 and zinc, they can affect brain health independent of the gut microbiome, but the others that I listed here are found to be beneficial only if we have a healthy gut microbiome, which is really important because patients may be taking these and saying, it's not doing anything for me, or you may be prescribing them. I'm suggesting that maybe their unhealthy gut microbiome may be implicated in why these interventions are not working. So just here, just really wanted to just touch on the fact that we really, it's challenging, research is moving, we need to conduct a high quality randomized controlled trials, we need to do FQTs, which is sometimes gross factors for some people, but yes, we are getting there. Just wanna point out that this study came out in 2015, which is a Lancet psychiatry talking about this evidence that nutritional medicine should be mainstream in psychiatry, again, written by some of the Saris and all his group, really talking about emerging and compelling evidence in psychiatry and how we need to make this mainstream. So this is a really fresh, 2023 came out recently, I believe it was August this year, clinical guidelines, if anything you read, this is the one article I suggest you read out all the ones that I have. And it came out of the World Federation of Societies for Biological Psychiatry and the Australian Lazy and Society of Lifestyle Medicine task force. And basically talking about the fact that they recommend lifestyle based in mental interventions for major depressive disorder, because the data is now there. And what they've done is looked at the data is strong level of evidence is A, limited is B, so could. So when you talk to your patients, if you have a level A evidence, you should, level B is could, level C is may, with this low level of evidence, okay? And so if you look at the domains on the left column, those are my lifestyle psychiatry domains. And if you look in the right columns, that's the level of evidence. So we don't have anything with level A evidence, we have things with level B and we have quite a few things with level C. So we're getting there, we're getting there. And if you notice, I didn't have the bandwidth to talk about the green space interventions, but those are very impressive as well for major depressive disorder with C1 level interventions. And so this is in the figure they describe in this article about lifestyle approaches should be the foundation of what we're talking about, because we have the information and the fact that it actually is very helpful in this empowering patients to be in charge of their mental health treatment, or at least having shared decision-making. And this is my favorite figure from their article, is a Swiss cheese model. So the green are the level of dark green is a grade B interventions, light green is C and yellow is the expert opinions. So while we know that we don't have the grade A, we have enough of the grade B and the C that could be helpful. And if we use enough of them, they can make a substantial difference. So again, I'm going back to this figure from the guidelines from our colleagues across in Australia and New Zealand, and how they have developed lifestyle interventions. My hope is the American Psychiatric Association will follow and also put lifestyle changes and educational resources for us as well, so that we can continue to move this field forward. Wait, wait. Somebody, if you might want to mute yourself, if you're talking, okay. And so just to touch on the climate change issue, because I think as we're talking about food, we're talking about these interventions, and I know everyone's talking about climate change and I'm thinking about it. And this came out in Lancet 2015. And if you look on the bottom, they talk about the impact on mental health there. And if you dig further into the information, the global greenhouse gas emissions from food production, there's a lot that's going on in the supply chain. And we talk about that a lot, but what we don't talk about a lot is what's going on in what the food that we're eating and how that's affecting the greenhouse gas emissions. And a lot of the food that we're eating that are non-plant-based foods are produced, are needed to produce and using and causing a lot of the greenhouse gas emissions. This is my favorite slide on this topic. And if you look at the packaging, the packaging, if you look in the key up there, the packaging is the gray. It actually is a small part of what's going on in some of these foods, but what's happening is the land use and the farming and the processing and the packaging is much less. But if you look at the top, the users and the producers of this emission, beef, lamb, coffee, shrimp, cheese, fish, pig meat. So those are up there. And you see what you see in the bottom is more of the plant-based stuff. And then when you talk about why is that important, Gia, why are you bringing this up? That if in the perfect world, everybody just ate plant-based foods and we had a healthy gut microbiota and we're feeding our unprocessed food to our gut and we're mentally doing better because of that, then the amount of land that we use for agriculture would be decreased by 75%. And we're spending a lot of land use for agriculture across these other diets. So I think that if you see that, currently we're spending a lot and it's very expensive for us as a world and as a planet, but if we try to approximate and go closer to plant-based, that's where we would be going. The World Health Organization in 2021 came out with a comprehensive mental health action plan. And if you look at the last bullet point that I highlighted, they talk about healthy lifestyle behaviors to improve health and wellbeing. As a psychiatry organization, we need to be also on that. So with that, I wanna thank you and open it up for conversation. Hey, Gia, there was a comment in the notes about if you could comment on like the bioengineered food and how that was impacting lifestyle. So, I think that's a good question. Steve, do you have any thoughts on that? I mean- I don't know as much data on it. So I was asking if you knew any data that I didn't know about. I don't have any other data other than, I mean, it's, I mean, I can speculate, but I think my speculations would be the same as yours. Yeah, yeah. So basically, the way that I, I don't know the data on that, but I think that's a good question. But I think the, what the data, what the research has really been focusing on is the ultra-process aspects. Any other questions? Thoughts? I just want to, first of all, congratulate both Gia and Steve for caucus, starting the AP caucus on lifestyle psychiatry. And some of you may know it already. My, and I'll become president of the APA from May, 2024. And my annual meeting will be in Los Angeles in May, 2025. And the theme of that meeting, I have chosen it as Lifestyle for Positive Mental and Physical Health. Yay! And I look forward to, you know, getting help, considerable help from Gia and Steve and many others, because this is a very important aspect of our own life and also the lives of our patients. And there's people with serious mental illness, you know, they actually, they have considerable disability, both physical morbidity, their life expectancy is much less, and also their mood is affected because unfortunately people do not, we do not pay sufficient attention to our lifestyle. And I also just want to comment, one question was asked about the poor people do not have access. And that's definitely, this also affects the social determinants of health. And part of it is education and part of it is simply access. I have gone to the same chain in a supermarket in an affluent neighborhood and poor neighborhood in the same city. And in the poor neighborhood, I do not find many minimally processed whole foods stocked at all, you know, so the poor people don't even get exposed to it. Whereas in the more affluent neighborhoods, you know, they are sold. And also, unfortunately, sometimes, you know, And also, unfortunately, sometimes, you know, in some of the stores, you know, these items are priced higher, not because the cost is actually lower, but because they, you know, they think people will buy it because it's wholesome. So they increase the price. So obviously we need to pay attention to the price aspect also. So thank you again. Thank you, Dr. Viz. We really appreciate you, everyone. That's our president-elect of APA, very, very, very big supporter and so excited about your 2025 theme, presidential theme. It's very exciting for the APA. So, you know, that brings up a really important question. And I think, you know, just talking about interventionally what we're doing in New York, in this space, we've now defaulted all of the foods in the 11 hospital chains to be plant-based now, when people go inpatient. And then doing it in a culturally diverse sort of way. So, you know, we're doing Thai food, we're doing Mexican food. And most people, you know, the data has not been published yet, but I saw a presentation Dr. McMacken did on this and talked about how that their people are really enjoying the foods because they're more spicy and they're a little bit, you know, they're different than the average food. And what they've done is the first foods, first item when they're defaulting, they're saving food, 59 cents a plate, but they're also people are enjoying it and they're eating plant-based food. So they're not getting a stent and then going and eating pork and beef, right? And hotdogs. But then the other thing is the second item. If they say, no, I don't like that, then the second item is also plant-based. So then they have to really ask for, you know, the other foods. And if you do the right amount of spices and really make it interesting, people tend to like it. And it's really people finding it really, you know, I think north of 80% found it really good. So that's really important. And I think every hospital can do that. It saves money. So, you know, if you want to talk more about that, we can have Dr. McMacken come and talk to us about how she's done that in our caucus and other talks as well. So any other thoughts, comments? Bettina, I know you asked that question. Bettina, are you still here? Do you want to maybe comment on it? Do you have any thoughts about your question? Yeah, I don't see her. Okay, good. Juliana, you had a question. Yeah, I was just wondering about the role of supplementary probiotics. I know that it's not, you know, as good as like, you know, not eating ultra-processed and changing your diet, but I was just curious if there was a role for that in the psych hospitals or for our patients or for ourselves. That's a great question. And I think some of the studies, and I think the literature is mixed on that, but I know that if you've ablated your gut microbiome because of these medications and other things, then yes, to quickly get builded up, but we don't know if it's actually, the literature is not clear if it's helpful after that as well. So the question is also, is something in the whole food plant-based diet actually necessary? Because remember, we're focusing on fiber, right? So we're talking about, so there's something called probiotics and there's something called prebiotics. So probiotics are these microorganisms, right? Prebiotics are fiber. So the microorganisms need the fiber. So if you're just giving the probiotics without the prebiotics, they may not do as much help and good. So you have to kind of balance that out. And I don't know if the literature is quite clear on that quite yet. Thank you. Yeah, sure. Yes, Arani. Did I do that right? Almost, almost, Arani. Arani, Arani, okay. Yeah, I loved that presentation. I've been, yeah, I feel like all throughout medical school and kind of in early psychiatry training, I've been looking for stuff connecting the gut microbiome to psychiatry and the evidence that you presented in such detail is just so great. This was so fascinating. My question was about what the research is kind of showing about the relationship between the gut microbiome and the endocannabinoid system, because I know that's also an area of really growing research. Yes. I'm just wondering about your thoughts on that. Yeah, you know what? I'm going to defer to our addiction psychiatrist in the room. Steve, do you have any thoughts on that? About the endocannabinoid system. And, you know, I think we're still learning a lot. And I think that this is becoming a very hot topic just because opioid receptors, I mean, a lot of our opioids are also hitting the endocannabinoid systems. And when we're having such this high wave opioid use, I think that there's a lot of challenges that we're having. You know, of course, with the CDB oils and the stuff like this, there's a lot of talk that it's benign and it's helpful. And I think that there's still a lot to be, that we still have to learn. And where there's some talk about even changing cannabis to a schedule three type of, you know, to be able to have, you know, that's going to allow for more research and more investigation. And I don't think the final story is told yet. And I think we're still, the literature is just still too mixed right now. Dr. Viz may have a thought on this as well. Dr. Viz? No, actually. Oh, different topic. Okay, okay. Yeah, but I have a question though, yeah. Go ahead, go ahead. Yeah, I actually, you know, I generally do not believe in supplements because many of the studies in many fields show supplements, you know, don't have the intended effect, right? Like vitamin E and all, because the food, they have a relationship with other ingredients. And so that's the way to go. But the question I have was one kind of supplement, like basically these are capsules, you know, which have microscopic, you know, small amount of ingredients of various spices and herbs and all. So obviously they do not have fiber in them, you know, but at the same time, in terms of the polyphenols and other things, we are practically, we are not able to eat a variety of foods because of time and other constraints. So is there value apart from eating a whole food or plant-based food having these kind of supplements? Great question. And I think that I've heard this presented both ways, right, we talked about the fiber, but also I think that it's, if you do this, I talked to the CEO of MD Anderson, who's a physician, about 10 years ago, and I asked him this question, if there's one thing that you would take as a supplement, what would it be that you would take so that you make sure that you get an energy diet every day? And he was, you know, world-renowned, number one cancer center in the world, and he says turmeric. And it was a really interesting point because I think that, you know, there are certain things in these spices, including turmeric, that are very healthy for us. And I think we need to do some research. Of course, I can only recommend, right, the could, should, may, you know, the could and the should, and then the may, I don't know. And the literature is not, I don't think it's there in the way that I would want the evidence to be there. But I think that it, I would be careful by not getting, the problem is they're not regulated, these supplements. So we don't know how much people are getting. They may get too much. There's some data around too much turmeric supplementation in kidney stones and other problems. So I think that we could end up having problems that we don't know about if we overdo it and start recommending it without being in the diet. What I have in mind is the things like balance of nature, which is advertised and heavily priced, but there are also cheaper versions, but there you don't risk overdosing, but it's more a question of variety. And obviously I don't think we'll have any evidence on their effectiveness, but I just wanted to hear your thoughts on it. Yeah, that sounds great. Thank you. But people cannot rely on them alone, you know, obviously. That's a problem, yeah. Thank you. Mali, did you have something? Oh, no, Christina. Yeah. Hi, sorry. I'm on a bus if it sounds a little bit choppy, but super appreciate, you know, this topic and conversation and it just makes me think about my training at UVM where we really practice like the Vermont family-based approach. I'm a child and adolescent psychiatrist, but we offered a resource and had bought a lot of this like cookbook called Good and Cheap that helps families figure out how to cook if they have like food stamps or have like a lower income, like cook healthy meals for their patients and we would like prescribe and give them that cookbook as a resource to help them. So I just wanted to offer that out as a resource for folks as well. It's called Good and Cheap and it was really helpful, but just interested to hear from you maybe, Gia, how you counsel patients. I think it's great what you're doing on the inpatient unit, but how you help them bring that home as well. Yeah, that's great. That's a great point. So Christina, you know, I'm on the board of this organization called Plant Powered Metro New York. Everyone can Google it. It's a nonprofit and we have a lot of free resources on our website and we really, you know, and I'm a big believer in all the resources in the American College of Lifestyle Medicine. If you're a member of that, it's not very expensive to be a member. They have a lot of free resources available to members. So I tend to create those sort of handouts and those things, but I think education is key for our patients and really I talk about the pillars and then I just then go and I say, what is the path of resistance for this patient? And they're willing to make those things. I usually go with sleep first, honestly, in the lifestyle psychiatry spectrum. I think that that has the most biggest bang for the intervention oftentimes because it's easy. If you get their sleep where it needs to be, you can see a lot of benefits. So I usually work on that. Okay, Ali, thank you. Thank you. I know people are leaving. But I think giving them resources and handouts and it depends, it depends on the patient. I think the Plant Power Metro New York website has a lot of resources and we have a lot of cooking classes and seminars. The Physician Committee for Responsible Medicine has a 21 day kickstart, which is for free. There's a lot of resources out there. Once you start looking at these websites, then you start helping your patients navigate them so that they can get more information because what you can only do is open their eyes to the education. And I think it's a hit or miss. And I think over a long term, I try to spend five minutes of each clinical consultation just on lifestyle. And I know that's a lot of time sometimes for our patients, but over time, they tend to be able to make, make those changes. I hope that's helpful. Yeah. Super helpful. Thank you. Really great resources. And I think it'd be great for the caucus to maybe even have like a list of these or a place where we can go back to and reference them as well. Oh yeah. That's great. That's a great idea. And everybody can drop their, their own resources into that list as well so that we can have a running document with a live document. Let's do that. That's a great idea, Christina. Let's do that. And you know, go ahead. Yeah. Somebody raise their hand. I don't know. Kirthi, Kirthiana? Hi, I'm Kirthiana. I have a question that's like slightly tangential. But I'm a, I'm a med student and this is like so valuable for me to learn entering into medicine. So I really appreciate this lecture. My question is, I'm, I'm actually a vegetarian myself. And I've noticed a lot of my own issues with like, in terms of struggling to go vegan. And I'm sure like most of the patients I'll have in the future will have the same issues is my protein consumption is like very low and it's difficult to find like sustainable sources of protein. And especially with a lot of the, especially with a few of the topics we discussed. I'm wondering my own, like my own, I guess, fears surrounding consuming the alternative proteins. I forgot what it's called. Like impossible meat. They're processed foods. Exactly. So I'm kind of wondering, especially if we're now, if we're like educating our patients to navigate to more plant-based resources for food, how do we like help them consume protein that is not processed? And like, what is the future of that going to look like if we're trying to move away from processed food? Okay. So this is a whole lecture and I, and I would love to give it to you right now. I do this over 30 hours. So let's, let's, let's, let's just do the short version. Okay. The short version is do those, were you there when we talked about the 5.5 hours free of the lifestyle medicine intervention of the 5.5 CME, that's free. You should do that. Okay. You missed that. Maybe you came late, a little bit late. I talked about that. So there are 5.5 CME hours that are free that really talk about lifestyle medicine. And that's, I believe addressed in that conversation. Okay. The other, the other short version is we have to take a step back on what we really need is protein in our body. Okay. There's a few movies that are very helpful on this. And I can put those resources as well. I think what the health, which ones do you like, Steve, that are maybe the, I mean, there's a lot of literature on this, but, but part of the marketing issue in wow, this whole, how much protein do we need is, is a little complicated. Okay. We do need protein, but do we need it to the level that the dietary guidelines suggest? That's a question. Thank you, Rachel. She actually put it in there. So the 5.5 credit hours. Thank you, Rachel. I so appreciate you. So, so, so but, but, but, but the other thing is if you look, if you look at beans as a source of protein, legumes, nuts, you know, we have a lot, quinoa, we, there's a chart that I have that I can put on, I put on our website of the protein sources and where you can get it from and how you can get enough in your day to day. If you do that. Yeah. Steve, that's that I was losing that game changers. So if you watch game changers on Netflix, it'll give you a lot of this information as well. So I think there's a learning curve in the conversation around protein. I think we have to kind of upend some of the marketing sort of processed food. Some of the, how much protein do we need? How much protein deficiency do we see in the American populace in, in health? How many, how much protein deficiency do we see? Do we see a lot of protein deficiency? How much obesity are we seeing? How, you know, how much other illnesses are we seeing? So protein deficiency is, is not really a common problem. I think that the, the stress on that may be a little bit we get enough protein from plants and animals. I'm sorry, when plants and fruits and vegetables in our diet, if we actually reevaluate how much we're eating and do it in a healthful way I can put some other, some more websites on this. Does anybody know nutritionfacts.org, that website? Michael Greger, nutritionfacts.org, he has two minute videos. If you go on that website and Google that, search for that question, he has these, and he prevents, presents the evidence around it. It's a very good resource to actually get quick information on this topic as well. I highly recommend nutritionfacts.org because it's very evidence-based, you know, like there are lots and lots of very good studies and also, you know, in taking, you know, talking about proteins, you know, lentils, beans, nuts, they're all high in protein. But apart from that, there are studies showing, you know, for example, nuts consumption after controlling for everything else that itself promotes longevity. And the same is true for beans. And in fact, one of the terms is used is the Mexican paradox, you know, the longevity of people eating Mexican food, you know, is more and it's attributed to the, they eat plenty of beans. Beans. Beans. Thank you. And, you know, there's somebody in the chat that just says a lot of protein deficiency in older post-menopausal. Yes. So it's not zero. There is protein deficiency, but in the general populace, you know, when we're talking about it. So thank you for bringing that up. Yes. It's important to say it's not zero. There is protein deficiency, but generally in the general populace, it's less of a problem that obesity and these other animal protein diets cause cardiovascular disease. And you know, vegetarian is a really interesting problem. So one of the countries with the highest incidence of cardiovascular disease is India. And a lot of that can be attributed to, even though India's largely vegetarian can be due to the unhealthy vegetarian foods that they're eating. And that's another conversation around that and what that may be important. We can have all of these webinars. I mean, I think one of the things that I would love before we end, and I would love if anybody that's available and still here, if you could just throw in the chat something that you would want to hear about in the next few months of these webinars, because we're going to be doing their room every month. So we can make sure to include them and get experts from those different areas or send me an email. I'm going to put my email in here as well. People should be actually aware of this new book by a doctor. She's actually a doctor specializing in nutrition. Her last name is Lion, L-Y-O-N, and her office is actually in Wall Street. And I bought her book because a patient of mine read it. And her thesis is for women, especially, that the key to maintaining health, being thinner, being stronger, combating osteoporosis is really to eat sufficient protein. And her point is she thinks that women do not. And her theory of why there is so much obesity is that particularly women, but people, will need to have X amount of protein and will keep consuming calories of fat and carbohydrates and whatever until they get X amount of protein. So her way for people to be at better health is to really focus on their protein. And her point is that please don't shy away from meat. I mean, we're all aware about brain fat and like avoiding, you don't want brain fat. But she actually is very powerful because she does seem an expert. She really was a family practice doctor and she went and did a special PhD type of thing at Washington University, St. Louis, with a guy who was looking at nutrition. So she, I mean, she's probably worth reading. I have the book in my house. It's got a white cover, Something Forever is in the title, but her last name is Lion. But I think you're going to have questions from patients about it because it's really a bestseller that took off. And she's gorgeous. If you look at her, she looks like she should be on a fitness magazine. Her husband is a Navy SEAL, like they're all dedicated, you know what I mean, to the ultimate health. Yeah. Yeah. Send it to us, Stephanie, so we can take a look at it. That sounds really interesting. I'd love to hear about it. Peter Attia also stresses protein. And obviously, you know, like the question is where the protein source comes from. know, like as was pointed out, legumes, beans, they carry a high amount of protein, and obviously they can be supplemented with a small amount of honeymoon protein. And I think, but exercise is also important. That's not the point of this lecture, because you cannot, but also strength training and aerobics, both are important. And yeah, I think protein intake with strength training is important. Yeah, I hope next month, I'm going to, Doug Nordsee, who did the other lifestyle medicine book, can come join us and give us, he's more about exercise and chronically mentally ill. And we can continue to have, invite other people. If anybody in here, I put my email on the, in the chat, if anybody has any other ideas for other people, please just suggest it. We can start these conversations. I'm really excited about the level of expertise in the room as well. So we can continue to do this. Any other thoughts? I don't want to go too much over. Oh, just, could you put the last summary slide up? I just didn't catch it. Dr. Menlo, could you just put the summary slide up? Oh, you're going to, you're going to get this available to you. I was just, I mean, yeah, yeah, yeah. I'll give them to you. But I basically, it's what I said. I didn't, I didn't put anything new in there. I can put it up again for you if you want it. Yeah, sure, sure. I wanted to give enough time for discussion because I was talking too much. I put this in the chat also, but I think it would be, I think something that might be fun would be if we had like a monthly kind of lifestyle psychiatry challenge, something that all of us can kind of do like an evidence-based intervention or like a food or something for us to try. And like next webinar, we can kind of have a couple of minutes to talk about how that challenge went for us, you know, like things we enjoyed, things we struggled with. And that could be kind of like a nice inner, like interactive thing, you know? I know I, as like an intern, I struggle with making healthy meals for myself. So I rely so much on like the Trader Joe's prepackaged meals. And every time I hear about ultra processed foods and it's negative effects on brain health, like I, part of my soul dies a little. And salt too. So I, and I feel like, you know, we, I, we all have so much to learn from each other about, you know, how we can best take care of our patients and also what we can do to take care of ourselves. So I think that'd be, that'd be fun. Oh, I love that. Yeah. That sounds a great idea. Let's, let's, let's, let's brainstorm around how to do that. That would be so much fun. We could do, we could do a 10 minute cooking aspect or I don't know, we have to think about what people want. Yeah. Yeah. I think, and I'm sorry, I lectured too much today, but I really just wanted to get this information out there so we can, you know, like we have to start somewhere and Steve did a great job and starting it last month, but I really want to get the ground rolling so that we can have, share what we know. And I want to hear, you know, anybody else has prepared lectures that they want to do. Let's do it. So do you want to, does anybody want to take it on to maybe, oh yeah, Molly's saying, I'm looking at the chat. So do we, do we want to take it on maybe and try to, try to do, try to organize it for next month? Yeah. Take it on. That would be great. You can, yeah. The two of you are going to do it. Yeah. Share it. Why don't you guys do it together? Share information in the chat. That would be amazing. And so what we can do, then tell me, tell us, tell us how much time you need. You need 10 minutes, 15 minutes, and just kind of like start doing it. And if you need my help, I can give you websites to get recipes and stuff. Okay. I have one more thing, especially after Dr. Rysnopin suggested the exercise portion. I also tried this at the INCAP meeting and everyone seemed to love it, but I'm happy to like walk through chair yoga. So I do that kind of when I'm sitting at my desk and like doing work and kind of incorporating it into your lifestyle. You're just like at your desk so often that you can very easily do modified yoga. That's brilliant. So, you know, we should talk about that too. And I have, I have this thing called, I called exercise snacks. So basically I do that with my students and even with my patients when they're interested in doing that. So what you do is you have 30 to two, 30 seconds to two minute snacks for exercise every, you know, 20 minutes, 30 minutes, 40 minutes. And that's what we do. We're going to have a snack now. We're going to have an exercise snack. So you decide what you're going to do, you know, and this chair yoga sounds great, but you know, you can do squats, you can go up and down the stairs, you can do, you know, whatever it is that you want to do. That would be a snack. And so we could actually even have a running thread about different sort of ideas that people have because I just talked a lot about diet, but you know, exercise is so important. So we can, how we can get, and it's not even exercise, it's physical movement, right? It's like integrating it into your day to day, like you're talking about chair yoga. So that would be great to actually also incorporate into what we're doing as well. That'd be beautiful. Yeah. Oh, great. Great. Other thoughts. So we want to, so we're going to get this started next month. Other things that we want to do to make sure. So yes, I loved, I'm sorry, who said that about, you know, having more breakout sessions. So I think we should do at least one or maybe two breakout sessions so people can get to know each other and talk to each other. But this was just so heavy with data and I'm sorry, I didn't do it this time, but thank you for suggesting that. Who was that? Julia, Juliana. Yeah. Yeah. And even, even, even one would be great just to have a tiny bit of interaction, you know. Absolutely. Absolutely. Thank you for suggesting that. I'm sorry. I didn't do it this time. Other thoughts. Great. So I think, I think this is great. I hope this has been helpful. I hope this is a beginning of a conversation that we can continue to have. If anybody, please, if anybody has somebody that they think would be good to talk to us or other things, let's just, let's just to continue the conversation. It's over from Bliss. For next year. Okay, guys. No, Bliss is away, but I thought she was. Hi, Anne. We can hear you. What if we also, I don't know if this is possible for future meetings, but I think like having a clinical functional medicine, nutritionist talk about how their experiences are with, you know, incorporating this into their patients. I think it might be helpful. Like as far as the boys know, I actually know a few of them. Yeah. Yeah. So that's a great point. And I think before we do that, I would love to have a talk that, that really focuses on the difference between lifestyle psychiatry, functional medicine, integrative medicine, holistic medicine, and to really draw the distinction and the overlap and the differences in all these. Because I think that the, the fact that we have a lifestyle psychiatry caucus, it's, it's really drawing a distinction between this and what we have a different caucus, which is the integrative and complimentary medicine caucus, right? So there are some overlaps, but there's some definite differences. And I think to actually have that conversation about what those differences and similarities are may be a good way to begin that conversation. How does that feel? Yeah. So maybe if we have some of the other, you know, people that are in the lifestyle psychiatry space, we can maybe have Jack, you know, we people from Doug Nordsey that is writing about lifestyle psychiatry. And then so that, that we can just really tease out what those differences are so that we can understand, because I think fun. So the way that I quickly talk about it is lifestyle psychiatry is using the same pathophysiology for diseases as conventional medicine uses, right? So functional medicine tends to use a different pathophysiology for disease states. And the reason that's really important is the whole lifestyle psychiatry and lifestyle medicine movement went forward trying to work on the individual level of population health for these chronic disease states and ways that we can do it based on the same rigor that we use in the same way of looking at pathophysiology is as conventional medicine. So that's slightly the difference. I use complimentary medicine and I use alternative medicine in my own life, and I recommend it to patients all the time, but it uses a different lens, right? So we're trying to draw that distinction. But I think, but I think it's really important. And when maybe we can even have a panel and we can have different people talking about the differences of that so that we can have an understanding of where this caucus really sits in that spectrum. How does that feel? Yeah. Yeah. Does that make sense? I want to underscore that point in a lifestyle medicine is basically follows the model of medicine. You know, it's part of medicine. It's not separate from medicine. It should be incorporated in every physician, you know, scientifically minded physicians I think. And this, for some, we don't have much evidence for some we have strong evidence, but it's a, we are still working towards developing evidence. Does that make sense? All right, guys, it's 825. I think this has been an amazing conversation. Thank you for all that stood to the end. And I'm so excited about this caucus. And you know, if you have other ideas, other thoughts, let's keep sharing them. And let's, you know, I'll put my email, gmurlowmd at gmail.com or just feel free to put it in the discussion in our caucus and welcome, welcome to the caucus and well, and I'm so excited to move this field forward. We are the ones that are going to develop this for the American Psychiatric Association. Okay. So look at the people in the room and we're the leaders and we're going to develop this and let's do it. Let's do it together. It's a fun, it's a fun way to go forward. Thank you. Thank you all. Thank you all. I'm glad so many people are interested and the interaction also was very good. And asking questions is quite important because you all have a lot to learn. So that's good. So thank you again. Thank you. Thank you, Dr. Vance for being here and for your leadership and the American Psychiatric Association without you, we would not be, but you know, our goal is for this caucus to keep developing the literature and keep developing what we're doing, moving it forward. So by 2025, we would have some, a lot of people with understanding so that we can continue to keep helping educate and have the conversation going forward. Oh, Rachel, thank you for involving your, your child as well. Look at that. We're very interested. We're very interested. Thank you all. Okay. Bye guys. Bye.

lifestyle psychiatry

mental health

gut-brain connection

gut microbiota

dietary interventions

depression

anxiety

Mediterranean diet

biopsychosocial approach

nutrition education

American Psychiatric Association

holistic interventions