Good evening, good evening to those who are joining us today. We hope you all who are joining us tonight are doing extremely well tonight. We sincerely thank you for taking the time to join us. My name is Dr. Elvis Jain, and I serve as the Director for Social Determinants of Mental Health for the American Psychiatric Association. On behalf of Dr. Marquita Wills, the APA CEO and Medical Director, as well as Dr. Regina James, APA Deputy Medical Director and DDHE Chief, we welcome you tonight as you join us for the webinar, Nourishing Minds, the Role of Culturally Attuned Nutrition, Food Security and Social Determinants in Mental Health. This webinar aligns with the Looking Beyond series theme for the year and helps to engage a critical area of mental health, particularly for underserved and under-resourced communities. We have with us wonderful panelists who are change agents and transformational leaders in their respective areas within mental health and nutrition, whom I will now introduce. First and foremost, we have Dr. Adwoa Smalls-Mancy, who is an emergency psychiatrist, a lifestyle medicine physician, and President-Elect of the New York County Psychiatric Society. Dr. Adwoa Smalls-Mancy is a physician scientist, a writer, a medical media consultant, and an organizational leader. She also speaks and writes on mental illness, wellness, and public health. We also have Dr. Gregory Scott Brown, a board-certified psychiatrist and adjunct faculty member at the University of Houston College of Medicine. He's an integrative psychiatrist, mental health writer, and the author of the self-healing mind, an essential five-step practice for overcoming anxiety and depression and revitalizing your life. We also have Dr. Abiodun Atuloy, who is an assistant professor of nutrition, dietetics, and food sciences, and she focuses on inequities in food access and community food systems. She seeks to understand barriers that low-resource families, refugees, and immigrants face in accessing healthy, affordable, and safe culturally accepted food. And lastly, we have Mr. Ababa, who is the Senior Vice President of Social Determinants of Health for Highmark Health, a $26 billion national blended health organization that includes one of America's largest Blue Cross and Blue Shield insurers and a growing regional hospital and physician network. We want to set the tone tonight for a thought-provoking discussion to lay the foundation for our questions. And throughout our discussion, feel free to utilize the Q&A functionality at the bottom of your Zoom, and we will do our best to get to that. And at the end of our time together, you should receive a short survey with a code for those who desire CME credits. As a variety of research that links highly processed foods to a lack of essential nutrients, which are then linked to mental health issues, the importance of nutrition has been a critical social determinant that impacts mental health, demonstrated across a variety of studies over the years. Culturally attuned nutrition and food security play a significant role in promoting mental health by ensuring that individuals have access to food that is not only nutritious, but also culturally relevant. In many communities, food is deeply intertwined with traditions, family, and social support. Therefore, addressing food security from a culturally sensitive perspective is essential for reducing mental health disparities and fostering overall well-being in diverse populations. And now at this time, I want to dive right into our questions. And this first question is for you, Dr. Adros Mawdsbenty. How do social determinants of mental health, such as income inequality and housing instability, impact access to nutritious and culturally appropriate foods? When we think about the social determinants of health, it can be where you're living. It can be how much income you're bringing in, like you mentioned. And so that does affect what type of food you can have. If you are living in an area that does not have a lot of grocery stores, if you're in a rural area, that's going to affect the type of food that you frequently can get. Even if you're in New York City, where I am, there is a grocery or there is a bodega on every single corner. But what is the type of food that you have? And if you go to a different neighborhood that has maybe more resources or different type of people at different income levels, you're looking at different types of grocery stores or food options that are presented. You also have to think about how you are transporting your food and getting to your food. So if you are in a place that you have to rely on a car, but you can't afford to have a car, you are even in New York City, where not a lot of people have a car, you may not be able to drive far to get to the grocery store that has all the types of food that you want. You may not be able to carry as much, such as fresh fruits and vegetables, which are actually heavier. And that's something that I even have to think about living in New York City, where I'm walking with my groceries, I don't have a car that I can put it in. So it limits how much I can carry. And that limits maybe what type of foods you get, you may not get as many fresh fruits and vegetables, you may not, you might opt for dry food options, things are a little bit lighter, but that might be ultra processed. So in that way, the different types of social determinants of health, transportation, income can affect things. And the last thing I will say is also housing. If you don't have a home, where are you going to store your food? And I think that's the major thing that we think of, I often deal with people that are homeless in my line of work as an emergency psychiatrist. So they are not routinely getting food, storing it somewhere, they're relying on getting their meal from the next person that is benevolent, or if they're at a shelter when it's provided to them. And that can limit the type of food that you have access to as well. I recently saw a patient that came in saying that they were suicidal, literally because they had limited food options at the shelter, they don't eat chicken that served very frequently. So in that case, it's like I have nothing to eat, I'm eating less. So those are a few of the social determinants of health that can affect your food options. Thank you so much for that wonderful response. Yes, there's just so many limitations when we think about that, when we think about determinants for these types of communities. So thank you for that. Dr. Scott Brown, I'm coming your way. Can you discuss how food insecurity contributes to mental health challenges within marginalized communities, particularly among those who lack access to culturally relevant food options? This is such an important topic, and thank you for that question. And it actually reminds me. So a couple of years ago, I was privileged to do two interviews with Men's Health Magazine. I interviewed Common twice, and we were talking about this topic. And something that he told me offline was that there was a period of time in his life when he was trying to, you know, start eating a bit cleaner and focus on his health. And then he went back home to his parents' house, they were throwing this big party, and how he had just given up pork, and they cooked a big pot of greens and put pork in the greens. And how is he going to tell them no, because they're his family, right? And so we have to understand, I think, as part of, you know, our culture, food is very important. And sometimes the food that we identify as comfort food or the food that we're receiving from people in our family or people or friends aren't necessarily the healthiest food options. So I think it really does start with us focusing on how to make, you know, the food that we like, you know, more nutrient dense, and focus on how that can improve our mental health. And I'll tell you, there's a huge school of nutritional psychiatry. You have centers at Columbia University, at Harvard, that are focusing on this idea of the fact that we can improve our mental health, reduce our risk for conditions like major depressive disorder and generalized anxiety disorder by focusing on what we eat. And typically, what they're focusing on is increasing our intake of omega-3 fatty acids found in like oily fish, salmon, tuna, making sure that we're getting more dark leafy greens. Kale gets a lot of attention these days. I don't like kale until I was in my mid 30s, but I love it now. You can learn to love kale. Also focusing on nutrients like L-theanine, which is found naturally in green tea, which can help with anxiety. And then vitamin D is a big one. So it's hard to, 40% of Americans are deficient in vitamin D. And a lot of people actually don't realize this, but you have darker skin, you know, it's harder to actually convert vitamin D to its active form from the sunlight. Now the thing about this, I just want to spend just a little bit of time talking about this is that if you live in an area that it's not necessarily safe to go outside for a walk, you know, you can see how it might be more difficult to spend more time outside and get more sunlight to convert vitamin D to its active form. And that can increase our risk of being deficient. Low vitamin D has been linked with physical illnesses like cancer, but it's also been linked and associated with mental health conditions like depression as well. So I think as long as we are being proactive as psychiatrists, asking our patients about what their daily lives are, asking them about the neighborhood they live in, asking about what they're eating. Well, thank you so much for that, for that response. You know, I echo those those same sentiments and like you, I just recently started enjoying kale as well. Dr. Atuloy, in what ways does culturally attuned nutrition play a role in promoting mental well-being and a sense of identity within diverse communities? Thank you very much for that question. So I would say that food is more than subsistence because it kind of acts as a bridge to heritage and connects people to well-being. And when we talk about culturally attuned food, it is one of, I mean, it is not only about nutritionally balanced food, but it also deeply connects us to our culture, social and spiritual practice of specific community. For example, I can give an example as a community member here. I live in a college town that is home to a vibrant community of international students. And within the last one to two years, one of the community organizations received authorization to resettle refugees. And this marked the beginning of a growing and diverse population in our community. And we have seen different initiatives coming up like community gardens, which has helped to support refugees and immigrants in reconnecting with their cultural identity by allowing them to grow food that they are familiar with and that they love. And this is not only to provide nutrition for them, but it provides a sense of home and belonging to the new environment they are in. And in addition to the gardening that I mentioned, we have also hosted several community events where individual comes with dishes from their culture. And this is just a reminder that food goes beyond subsistence and it bridges communities together and provide a sense of community in diverse settings. Thank you. Thank you so much for that response. I think one of the things you said was creating that sense of belonging and fostering that vibrant sense of belonging within communities is really important to the well-being. And I definitely echo those sentiments and we see the studies that support that. So thank you so much. Mr. Ababa, how can healthcare providers and community organizations better address the unique nutritional needs of different cultural groups to improve mental health outcomes? First of all, I want to say thank you for the opportunity to be part of this esteemed panel representing Highmark Health. And as you mentioned from the outset, we are a blended health organization. So at Highmark Health, we are both a payer and a provider, and we work very closely with many community benefit organizations to address broad societal, you know, SGOH-related issues, as well as individual health-related social needs like nutrition and food insecurity. And so I think we have a profound opportunity to sort of bridge the gap between healthcare and the human and social service apparatus, the public health infrastructure, through better coordination. And so just to kind of give you a specific example of what we're doing in Western PA with Highmark, you know, broadly, I think it's important for providers to screen, right? We first need to screen for social determinants of health or behavioral health issues. And as both a payer and provider, we have the opportunity to collect lots of different data points, right? The race, ethnicity, language, sexual orientation, gender identification, as I mentioned, SGOH behavioral health data, and we have access to clinical and claims data. So we believe it's extremely important to have a full picture of the needs of our members and patients that we serve, because then that presents an opportunity for us to really address all of their needs, not just their physical behavioral, but also their SGOH needs. And so once we really understand the needs of the individual patient, we're then able to intervene in the most appropriate manner, in the most culturally and linguistically appropriate manner. So it first starts with screening, and what we've been able to do is fully integrate our SUH screener into our EPIC system, which allows the provider to more easily screen and then refer. And then we oftentimes, we refer, if they're a patient to a local community-based organization, and there's tools and resources, resource referral platforms that we use to make those connections for those patients to have their unique needs addressed. If they are a Highmark member, there's also a number of nutrition interventions that we make available to that individual member, and based on the data we have on that member, we would be able to, again, offer them a solution that's culturally relevant to them. We also see food as a tremendous opportunity to drive activation and engagement, as well as to help support someone's health journey. And so we take a whole person approach, and I would say, really, it starts with screening, and it's important to screen for nutrition and food insecurity, so therefore you're able to intervene in the appropriate and timely manner. Thank you so much, and I agree with that. The screening allows for us to have the context of the particular individual that we are attempting to serve. So thank you for sharing that. I do want to pause here very quickly and just turn my attention to the Q&A box to see if there are any questions that we can integrate into our time together. There is one, and the question is, and for anyone on the panel, are you aware of any specific programs or training for nutritional psychiatry that psychiatrists are able to take advantage of? I did a fellowship in integrative medicine through the Academy of Integrative Health and Medicine, and a big portion of, and that's open to physicians from various specialties, but a big portion of that curriculum did focus on the relationship between nutrition and mental health, and I know through that fellowship, they also offer individual courses that folks can register for. Okay, let's jump back into our panel discussion, which is really rich and thought-provoking, so I thank you all for engaging so far. The next question I have is directed towards Dr. Smalls-Mendte. What challenges do communities face when trying to access culturally appropriate foods, and how do these challenges intersect with broader social determinants of mental health? With trying to access culturally appropriate foods, I think you have to think of, first, are you in your cultural region? So if you have moved to an area, if you're an immigrant to a country, you may not have access to all of the foods that you're familiar with, and that can severely limit the food options that you would have because you're trying to learn how to cook with new ingredients. And we have typically seen where people are displaced, whether forcibly or they're going to a new country, that that changes their diets, and sometimes for the worst. I think of, when you think of the migration of Native Americans, the forced migration of Native Americans from one part of the country to the next, we often know, think of fry bread as being a food associated with that, but that wasn't in their original diet. That came out of the rations that they were given. If you're coming from another country, let's say if you're coming from South America and you're moving to the United States, you're in a region that doesn't have a lot of people like you, those foods that you're familiar with may not be there, whereas if you move to an area, I say New York City all the time, that's where I am, we have more of those options available because we have those communities and you have that available to you. So again, the food from your culture is going to depend on, that's available to you from your culture, is going to depend on where you are at. And even for me, when I lived overseas in England, there were some foods that I'm used to having that I like to cook, but they were no longer available. Dr. Scott Brown mentioned collard greens. I like that, that's not available to me, so I'm switching to eat something else that's a little bit different. And then a few of the other things that I mentioned earlier are income can affect your access to good transportation, meaning to get out to the areas that might have the food that you want, the environment that you live in, that can determine whether you have stores that have the options of foods that you like and that are also quite healthy as well. And then education, when you have less education, it can go both ways. Some people might know a lot about recipes, some people may not know as much, but how you are raised, how you're in your own household, I'm talking about that health education that just comes from being in a stable environment that's modeled from a parent or a caretaker that will affect the type of foods that you go on to eat for your life. Can I quickly chip in something? Yeah, so I wanted to add language barrier to the question, I mean, the response to the question, particularly when you're working with people that are non-English speaking and based on my experience working in the food system, it might be difficult for them to navigate the food system, especially when they go to grocery store interpreting food labels or when they are in like, for example, food assistance program like a week where they would need to go into the store with check, you get difficult for them to identify which food to pick, even to communicate with the store personnel might be difficult for them. Thank you. Thank you. Thank you for that. Thank you. Thank you. Dr. Scott Brown, what strategies can be implemented to ensure that mental health interventions consider the importance of culturally relevant nutrition and food security? Well, I think it starts with culturally competent care, which is what most of us are talking about here. And I know when I went through residency, that was a big part of our curriculum and apparently it was something that people were just starting to talk about at that time. But, you know, it kind of reminds me of, so there's a book, Jonathan Metzl wrote a book called The Protest Psychosis that some of you may be familiar with. Basically in that book, he highlighted the fact that in the 50s and 60s, you know, black Americans were disproportionately diagnosed with psychotic illnesses like schizophrenia, bipolar one disorder, when what they're really struggling with was depression or anxiety, in part because they were describing their religious experience of communicating with God, which is part of, you know, many African Americans' relationship with their faith. And so I think the same thing sort of applies when you're, when we're talking about food, right? I think screening is important, but I also think that the story is important as well. For instance, if you would have asked me if I grew up in a food desert, I would have said no. I mean, there was always food on the table, right? But we did spend a lot of time like getting food at the corner store. There was a fast food joint right down the street. We spent a lot of time there because it was about 15, 20 minutes away from the grocery store. And now just looking back, you know, my life back then to how it is now, I mean, I can get to five or six grocery stores within five minutes of my house. It's a totally different experience. So I ask all of my patients at their first intake with me, I ask all of them, what is typical breakfast, lunch, and dinner look like for you, right? And if they say, no, I didn't know, I said, well, what'd you eat for lunch today, right? And so I think in many ways, the best psychiatrists are the nosiest psychiatrists. We really, you know, get to the heart and soul of what's going on with our patients. That's a good place to start. Thank you for that. Thank you. Dr. Atuloy, how can policy changes at the local, state, or federal levels address the barriers that prevent communities from accessing culturally attuned and nutritious food options? Thank you very much for that question. So policy is an important tool to address the barriers that communities face. And if the policy doesn't support culturally diverse food system, it can cause a disconnect and lead to negative mental health outcomes. And in terms of like programs that policies, I mean, policy within programs, I'm coming from the angle of programming that supports healthy food for the community. So in terms of broadening eligibility for such program and streamlining enrollment, for example, in one of the program that I mentioned, the WIC program, simply opening room for easy to understand resources for the community might be a way. And the reason why I mentioned this is because some of the programs that are ongoing do not really have room to open up to addressing cultural issues. So when there are policy within programs that can help broadening what is allowed within the programs, it will go a long way in helping to ensure that culturally relevant food accessible to the community members. Thank you. Thank you so much for that rich response. It is greatly appreciated. Mr. Ababa, in what ways can collaboration between mental health professionals, nutritionists, and community leaders help address the link between food security and mental health from a culturally sensitive perspective? That's a really good, really good question. So I think those three stakeholder groups can join forces. When you think about the broad sort of public education that's required around this topic, it really starts with community-based organizations can help drive that trust and really address the distrust that a lot of these people who are dealing with these social determinants of health have with the health care system. And so at iMark, what we've done with our providers is to proactively work with community benefit organizations to have that trust with the community so that they can tell us what's the best way to solve their problems. And with nutritionists, they're the experts in nutrition education who can also help educate the community at large on various ways that they can improve their overall health and well-being through diet and proper nutrition. But this is a broad societal issue. There's no silver bullet to solve the nutrition and food insecurity issues, which are driving a lot of these physical and behavioral health issues. And so what we do is try to take a multi-pronged approach by deploying a number of community-level interventions that address nutrition and food insecurity and connect that to our clinical interventions, whether it's a behavioral or physical intervention. So one specific example we've done is actually to kind of connect all the dots is in Western PA, we launched what we call a social care network, which is a curated network of community benefit organizations that are helping to address the social needs of the members and patients that we screen. And I appreciate Dr. Scott Brown's comments earlier around it's not enough to just screen. And he tries to have a personal relationship with his patients, which is great. But what we're looking for as both the parent providers is to encourage and to incentivize all the providers in our network to consistently screen and ask the same standardized questions that therefore we have the proper data to analyze and from our end, be able to intervene, but also to recognize and to reward those providers who are screening properly and referring properly. Again, that kind of fits into our whole person health, whole person care approach, you know, because there are providers out there that aren't like Dr. Brown, who aren't consistently screening and aren't asking the questions. So that's critically important, but this is a big issue. And, you know, I've had previous experience working with the National Institutes of Health and Centers for Disease Control and Prevention to proactively, you know, engage vulnerable communities and leveraging data and analytics to hyper target interventions to those who have the greatest need. And so it's really going to take a village to address this problem. We haven't even talked about the political determinants of health, but that's there's policies and regulations that are impeding the progress for us to, you know, really make inroads in this area. But I think, you know, the more we can collaborate, the more we can come together and leverage each other's resources and connections and assets that bodes well for less advancing community health, as well as individual health. Thank you so much for that response. You know, I'm hearing a theme amongst all of you in terms of relationship building and trust being a really huge factor for culturally attuned nutrition. So it's good to see kind of that thematic amongst all of your responses. So I want to take a pause here because there are a few questions within the Q&A chat box that I want to get to. And these questions are going to be kind of, you know, just thrown out there and feel free to kind of jump in and take a question as you see fit. Okay. The first question is, please discuss how trauma, PTSD symptoms, and PTSD are intimately intertwined with ultra-processed food ingestion and how ultra-processed food addiction, which is a marker for psychiatric and medical comorbidity, above socioeconomic factors. I think that's an intriguing question. I'm personally not familiar with that link between ultra-processed foods and development of PTSD. I don't know if anyone else on the panel is quick to address that. No, I don't have any insight. You're not specifically for PTSD, definitely linked to a lot of metabolic disease and also to other diseases like heart disease, high blood pressure, things that also become risk factors for developing Alzheimer's disease and other mental illnesses affecting depression as well. Those maybe sugar spikes that you get, ultra processed foods also tend not to have as much fiber, which is very necessary for your gut microbiota. And one thing that you should remember is that a lot of our drugs work on serotonin that is made in the gut. If our gut microbiome is not happening and functioning in the right way, then we're not able to produce as much serotonin. Most of it is actually produced in our gut about 90%. And so then how are SSRIs going to actually work for our patients that we're giving? So the direct link to PTSD, I'm not sure, but definitely it does have an effect on your mental health. And so when people do reduce ultra processed foods and their diet, the data has shown that they do see an improvement in mental health factors, especially reduction in the risk of Alzheimer's disease and depression and anxiety. Thank you. Thank you so much. The next question is, can mental illness be cured with nutrition and natural medicine? For example, bipolar and schizophrenia. I wanna take this one. Cause I get a lot of my patients when they, not a lot, but a handful of patients, when they learn that I'm an integrative psychiatrist, they will come to me for this purpose. And the answer is simple and the answer is no, right? So if you have schizophrenia or if you have a bipolar one disorder, simply changing your diet is not going to cure those conditions. And there are some conditions that, you know, all the best evidence suggests that you will need to take a medication. Those happen to be two of those conditions. Now, there was a study that was published not too long ago called the SMILES trial, which actually looked into actually improving diet and its relationship with improving symptoms of depression. And actually showed that in that case, again, depending on how poor the diet and how severe the depression, you know, there's a potential argument to be made that improving your diet, including more quote unquote antidepressant foods, anti-inflammatory foods could potentially help in that area. There's some studies showing that it can help with ADHD. There's some studies that show that it can help with anxiety. But again, I wouldn't necessarily say that food or improving your diet alone is going to cure mental illness. It's a multifaceted process that includes focusing on your diet. Just to add to that, if I may, you know, the data that we're seeing, again, as a blended health organization, peer provider data, we're seeing that those members who have multiple health related social needs, so, you know, nutrition or food insecurity, housing instability and transportation issues, et cetera, as well as having one or more behavioral health issues, by addressing their health related social needs, they're able to fully engage in their care and treatment plan. And so I think that's sort of the better way to look at the role of, you know, nutrition. So it's never going to be a one-to-one sort of relationship. And, you know, that's why the nomenclature these days is whole person health. You got to look at all the data points. You got to look at their physical, their behavioral, their social health needs. And then you got to think about prioritizing the care plan. Right? So when it's food insecure, nutrition insecure, they're most likely not going to be able to adhere to their medication because maybe they can't afford it. Or, you know, they're probably less likely or they're probably more likely not going to be able to attend their doctor appointments because, you know, they're juggling multiple jobs or, you know, they're dealing with something else that, you know, doesn't permit them to be able to attend or they have transportation problems. So as Dr. Brown mentioned, it's a multifaceted, multilevel, you know, issue. And it's not a one size fits all approach, but that's why it's important for us to have the data. Right? Because, you know, there's multiple people that are screening for behavioral health. You have, now you have primary care providers who are screening for behavioral health, as well as social determinants of health. And so it's important, you know, we haven't even talked about interoperability, but, you know, psychiatrists of the world should have access to all of their members, their patients, you know, their patients' data so that they can intervene appropriately and, you know, ensure that the care plan is properly tailored so that that patient is receiving the optimal care, the best care in a culturally appropriate manner that works best for them in that moment. So I think that's probably the better way to kind of look at this. I agree with that. I just want to add to that patients who have been diagnosed with schizophrenia or bipolar one disorder, for example, require second generation antipsychotics that we know can affect metabolic health are much more likely to have a positive experience on their meds, you know, if we're also talking about nutrition. I mean, if a patient's taken a medication that's going to make them hungry, right, and the food choices that they're gravitating towards are not nutrient dense foods and are unhealthy options, it's increasing the risk for diabetes and obesity and heart disease, right? And that's going to affect, you know, their decision to adhere to that medication as well, right? And so I think when it comes to that, you know, the two go hand in hand. Thank you for your responses. Okay, so a colleague shared that there's an outstanding fellowship in nutritional psychiatry via the Integrative Psychiatry Institute for those who are interested in that. The next question is, is there a role for harm reduction guiding patients in food choices? Is there a role for harm reduction guiding patients in food choices? For example, would it be appropriate to encourage the patient to eat the greens even though it was cooked in pork, assuming stopping pork was for health and not religious purposes, without necessarily taking it as a failure or a reason to just give up the general striving to avoid pork when they can? And that kind of goes back to sort of, you know, for me, you know, data collection. I'm a data nerd. So, you know, I've solely started data and you have to understand the cult, you know, the preferences of the individual. And so, you know, there's lots of ways to, you know, consume a well-balanced diet, you know, and if they can't eat pork, that's fine. There's, you know, in greens there's other ways for them to get the nutrients that they need. So I think it's important to, again, you know, take a patient-centered approach and try to understand, you know, truly understand the needs of the individual patient and what their preferences are and tailor the care plan accordingly. And then I also think that you have to look at how much of something that they're eating and when you're making a recommendation. So are they trying to eat something healthier? Can it be a healthier version? Then maybe move them towards that. Is this something that they're eating every day or is it something that they're eating on a special occasion? So if they're only eating the greens or the pork two or three times a year, have at it, enjoy yourself, everything in moderation. And guess what? Pork has protein, it has fats. We need all of that as well. It's just when you have them in excess. So for me, I like certain things. I like sweets. Do I eat it all the time every day? No, it's in moderation and your body does need glucose to run. So I think if you have a conversation with your patient where you're talking about having that balance and that's, you know, what everything is about having that balance, I think you can guide them, you can guide them to making healthy decisions. And a lot of people know in general what is good. They may not know the exact details and points, but they have the general gist. So if it's not for religious reasons, if it's just a couple of times for a holiday, have at it. And even if it is all the time, just use a little bit less. Awesome. Thank you. Thank you. Two more Q&A questions. I know we're coming up on time, so I want to be conscious of that. What are strategies for promoting more whole foods, plant-based diets in diverse communities for whom meat-based dishes hold cultural significance, either in the clinic or on a public health level? So I used to work for a global food company, Sodexo, prior to joining Highmark. And my role was to really effectively engage the 100 million consumers, our customers around the globe that we were serving food to, to improve their, in an effort to improve their overall health and wellbeing. And so the approach that, you know, we took at Sodexo takes as a food company, other food companies take is self-help, right? So, you know, a good example is the, you know, the burgers that, you know, what we're serving in the healthcare, in the hospitals that we were serving. We were, we would make blended burgers, right? So it would be burger meat mixed with mushrooms and it was a blended burger. And so no one really knew it was a blended burger. They thought it was a regular cheese, you know, regular hamburger or cheeseburger. And so I think there's creative ways like that where you can, you know, introduce new types of foods that are healthier to people that are, have less fat and sodium and sugar so that they can, you know, maintain a healthier lifestyle. And so I think there's, you know, taking those types of creative approaches can really move the needle. I think that's beautiful what you just said. And I think on a clinical level, I think we shouldn't be afraid as physicians to talk, you know, with our patients about food, right? And make recommendations there, right? So if we're asking them about what they're cooking at home, we might make that recommendation. Like, why don't you try blending it with mushroom and seeing how it goes, right? Did you know mushrooms are very high in vitamin D, right? So having those types of conversations, I think can help as well. Wonderful, thank you for that. Next question. It is known that European countries have better policies restrictions regarding the types of chemicals and the foods that are known to put you at risk for illnesses. Why is it that the US does not have similar policies? Are there research differences? The only comment I'll make here is I think there's a very good question and the only comment I'll make here is I think there's a movement, you know, it's, albeit it's slow, but you know, you saw California ban some of those, you know, food colorings, right? Because it was proven, you know, a lot of it was based on European data that, you know, our body can't process that and it leads to, you know, ADHD type of behavior, particularly in young children. And so, you know, California being a progressive state with progressive leadership, you know, is doing that. And I'm sure over time, as the food is medicine movement in this country matures and accelerates, you'll see more and more states, you know, acting in the same way California has. Thank you, thank you. How can faith-based organizations help in particular with food pantries? That's challenging because, you know, we're, the most important thing is we wanna make sure that people are getting food, right? So, but I mean, I spent a lot of time thinking about, I don't have an answer, I think that's a really good question. But I think that, you know, faith-based communities in general, you know, we're speaking to a lot of people can offer like courses and workshops. And I mean, I think there are other ways of, you know, to sort of educate their communities about the very topic that we're having tonight. I think, again, the kind of sad thing about this is I wish millions of people could hear what we're talking about right now because it's so important. And I think that's why we have to take everything that we're talking about right now and, you know, in our various, you know, communities, in our friendship circles, in our social media channels, we need to, you know, continue to have this conversation because that's how we're gonna make the most positive change. And then I'll also add to that question I'm not sure whether you're asking how they can contribute to food pantries or how they can become one. But I think that they can either be the distribution center or they can set up a platform in order to give resources. So at one of the churches that I've gone to, they actually had every week on a evening they would have food distribution. They have essentially functioned as a food pantry. I'm not sure where they got the food from, what that partnership was, but you knew Wednesday night you can show up to church and there will be food available. At another church that I've gone to, they don't necessarily distribute the raw ingredients, but they are partnered with another church where they have a soup kitchen every Tuesday. And then we think of the whole, And then we think of the holiday periods where we're often seeing canned food drives and canned foods can be healthy, get the low sodium version, wash it off the sodium that's in it before you cook the ingredients. But a church can say, hey, if you have some of these non-perishable, healthier items, can you bring them so that we can donate them to our local food pantry? And the last thing I'll mention is during the pandemic in my neighborhood, it was almost like somebody organized it themselves where they literally set up a refrigerator and you could drop fresh groceries in that refrigerator for people to come and take. So that might be another thing that a church organization or even neighborhood might want to set up. It's since left, since the pandemic, maybe they felt that there were other resources people could access, but those are three ways that an organization can contribute. Just to add to that, I think both panelists made the same points I was gonna make, given my experience working with both faith-based organizations and food pantries. I think faith-based organizations also oftentimes have deep trust with the community. And so when you think about issues related to people feeling shame and prideful and not wanting to utilize and fully take advantage of these resources, this community resource, food resources from the community, they can serve as sort of the bridge to help the broader community or individuals who actually need the food to take advantage of them. Thank you. Thank you. One of the greatest satisfactions of being an adult can be in feeding your loved ones. What are the key factors for our collective psyche that have prevented society from spreading the joy of nurture to all members of the population, especially those most vulnerable? Can we just take that question? Sure. One of the greatest satisfactions of being an adult can be in feeding your loved ones. What are the key factors of our collective psyche that have prevented society from spreading the joy of nurture to all members of the population, especially those most vulnerable? My initial reaction to the question is, I think there's a lot of people out there that give back to the community. If I'm reading the question correctly, it seems like it's sort of like a glass half empty type of statement, right? I'm kind of optimistic. I feel I see a lot of people who are volunteering around the country, around the world, and I think that's a good thing. I'm kind of optimistic. I feel I see a lot of people who are volunteering around the country, around the world, trying to help their neighbors and their community, particularly in their times of need. We saw it with COVID, where a lot of people stepped up and supported each other. So I don't really see that from where I sit. I see a lot of people who still have the mindset of wanting to help each other, particularly in times of crisis. Thank you. Two more questions, and then we'll wrap up for tonight. For depressed, anxious patients that are eating too many processed foods, while you were working to help them improve their diet, do you recommend or prescribe multivitamins? Or do you measure omega-3 levels for certain depressed patients? What was the second part? Could you repeat that? Or do you measure omega-3 levels for certain depressed patients? Multi, oh, go ahead, sorry. Oh, you can go. I was just gonna say, I mean, multivitamins are so controversial, I mean, depending on who you ask. I think most docs would agree the best place to get your nutrition is from food. And that's my personal opinion, although there was a time in my life when I did recommend multivitamins, I don't anymore. I would, and again, I think it just goes back to asking patients what they're eating. And I think you can get a pretty good sense of if someone's only eating mostly processed foods and they're not including fish in their diet, they're probably not getting enough omega-3 fatty acids from their diet, right? Now, I think the bigger question is, and something that a colleague of mine asked me some years ago, it's like, if someone is depressed, how do you expect them to go and get up and make themselves a kale salad with salmon, right? They can barely get out of bed. And so I think it's important that, we're not only talking to the patient, but we're talking to their family and people who are helping take care of them. If you can make preparing a meal a social activity, then the spouse of a depressed patient, I mean, that's something that can actually help with that healing process. I'll take that from how we can help patients enhance what they already know. Modeling is very important. So a lot of us have learned how to cook from our caregivers, our parents, our grandparents. But if people don't have that, where else can they learn how to eat well and cook well? I actually have a wellness coach, and one thing that she recommended to me was turning to social media. And I know we have a lot of pros and cons about that, but for fitness and exercise, she recommended a few fitness influencers for me to follow. And when I think of how did I learn how to cook, it was from the Food Network. So if there are YouTube channels, there are a billion that can show healthy recipes related to every single culture that people can use, I think that would be a good thing to direct patients towards. Let some people help you. And there are psychiatrists within the APA who have written books about this. Drew Ramsey, a good colleague of mine, has a book called Eat to Beat Depression and Anxiety. It's full of recipes. Uma Naidoo is a Harvard psychiatrist who's written books on this topic, full of recipes. She's a psychiatrist and a chef. The other thing we didn't mention on this panel I just want to briefly talk about, because I think it's really important, is the importance of teaching our patients how to read a food label. Because I didn't learn that in medical school, and it's really important. So having those conversations with our patients, I think, goes a long way. That's awesome. Well, thank you all for such a rich and robust and fruitful conversation. I know I appreciate it, and I'm sure the participants appreciate your expertise, your insight, your perspectives. We truly appreciate your time and just lending us your powerful and strong and transformational voices tonight. This is a conversation that we can continue to keep having, but it was really fruitful and meaningful. Thank you so much. For our participants, thank you so much for joining us. As a reminder, you'll be sent a survey at the end of the webinar. Please take some time to provide us with thoughtful feedback, as we're always looking for ideas and strategies to enhance what we offer. Additionally, for those attending this webinar for CME credits, please make sure to obtain the code. Thank you all for attending, and have a wonderful, wonderful evening. Good night, everyone.

culturally attuned nutrition

mental health

food security

social determinants

cultural identity

nutrition interventions

policy changes

community collaboration

healthcare providers