Drew Ramsey, M.D., will be a featured keynote speaker at the Farms, Food & Health Conference, to be held September 26–29, in Traverse City Michigan. He is a psychiatrist, author, and hobby farmer, and a leading advocate for the use of nutritional interventions in mental health. He founded the Brain Food Clinic in New York City, which offers treatment and consultation for depression, anxiety and emotional wellness concerns. Here we ask Dr. Ramseyto discuss the basic tenets of his work and to share thoughts on the value of splitting time between Manhattan and rural Indiana.

How did you come to see the importance of nutritional intervention in mental health? How did it become a core principle in your work?

Nutrition and diet are important to me personally. I’m a vegetarian, an athlete, and I’m interested in wellness and health. It struck me through my training that we focused on treating disease, but we weren’t talking much about the role of food. And at the time, I was seeing more research about omega 3 fats and their importance in brain health. But I didn’t know what foods they came from, or what foods many basic nutrients came from. So my interest in omega 3 fats opened up a broader interest in what patients were eating. About this time, too, there was a new class of medications coming out that helped treat schizophrenia, but it caused patients to gain a lot of weight.

So I was confronted with this side effect. I was helping people on the one hand, but also harming their health in some way. And I felt that my skills in discussing food were limited. I wasn’t giving good advice that was interesting or actionable. I started talking to patients more about food and had more aha moments. I’d hear about panic attacks that followed missing a meal and then having caffeine, for example. Or a patient would inadvertently take an essential nutrient out of their diet, and their anxiety would go up.

When did you start talking about this more broadly, beyond your close colleagues?

We held our first workshop at the American Psychiatric Institute gathering in 2014. [The same year as Groundwork’s first Farms, Food & Health Conference.] It was a packed room. People were sitting in the hallways. The next year we held another workshop and the audience doubled. Then in New York City we had a room that could hold 600 people. It was filled and they turned away a hundred more people. So often the medical world gets framed as not embracing this, but that’s not true.

The big question right now is where does food and nutrition fit into medicine? I feel patients like their doctors talking about food and sharing recipes, encouraging a Crockpot for those who are too busy to do food prep. I look for those moments in my practice.

Give us an overview of the gut-brain connection that is such an important part of your work.

You can’t really have a healthy brain without a healthy gut. Your gut houses the largest store of genetic material in the body and is essential for your immune system. We also know this on an intuitive level. If our stomach is not well, we don’t feel well, period.

In recent decades, Americans stopped eating plants and started eating processed foods. We added sugars and fats that now account for most of our calories. When you do that you change the bacteria in the gut and it becomes hard to be healthy. The gut is the largest piece of the immune system.

So we are focusing on eating more plants and eating more fermented foods. That supports the health of the gut. It’s super cool science, too, the way that also supports neurotransmitters—some of the microbes in the gut make those. There was a study looking at the effects of a pro-biotic diet in a hospital, and it reduced hospitalization rates for mania by 90% over six months. During our history, we have changed gut health and brain health, but we can change it back. It can be under our control.

Can you give us a case study example of when and how addressing what’s happening in a patient’s belly helped in counseling for depression?

So, the clinical application of this is nuanced. People misinterpret this to mean something like “eat a piece of kale and you will be at peace with the world.” But that’s not it. This is about supporting brain health, and I have been inspired by the changes patients are able to make. A young man in my practice was eating a typical young American man diet. Burger. Pizza. Pasta. Not a lot of plants. He was struggling with anxiety panic attacks, low mood and feeling low-energy and brain-foggy.

And to be clear, this is just one example. There are lots of treatment options I employ. Medications may be appropriate, and there’s talk therapy to help me understand what’s going on. So I get curious and ask about his diet. He doesn’t like plants—any plants. We talked about 10 plants, a rainbow of plants and we got him curious about eating plants.

We talk about how this plays into his clinical concerns. Maybe he gets anxious in the morning when he skips breakfast or only has a big glass of orange juice. But put in scrambled eggs or oatmeal with blueberries and see how that affects his anxiety. He doesn’t like to cook, so my clinical coordinator is also a chef, and she did a cooking session with him. He gained confidence in his cooking and shifted from a western dietary pattern to more whole, real foods, plants, leafy greens, vegetables, seafood and well-sourced meats. Eventually a mindful awareness arose in him: what we eat affects how we feel. When he then occasionally had a fast-food burger or pizza, it didn’t sit well with him. This is about moving beyond guilt and inaction and fostering this way of eating in their lives, changing the behavior.

ABOVE: Photos taken at Groundwork’s Culinary Medicine Workshop, March 2019. By Gary Howe.

Would you call yourself a farmer-doctor or doctor-farmer? Tell us about how your farm life influences your day-to-day in New York, and vice versa. Share the value of that interplay.

Farmer-doctor or doctor-farmer? Hmmm. I am doctor-farmer. I am a physician above all things. That is the lens through which I see the world. And out of respect to real farmers, I am not a farmer. Yes we have a 170-acre farm, but the value of my farm to me and my family isn’t so much from products it produces, it’s the experience it creates. We wake to songs of dozens of birds. We feel the blessing of watching an eagle pull a fish from our pond. Seeing pastures in bloom and going through the life cycle. The farm pulls me so deeply into the natural world. Right now I am in this strange but wonderful schedule, a few days a week in Manhattan. And then the rest of the week in rural Indiana. Two very different cultures. And I feel so blessed to do both. I love living these two extreme versions of America. I love New York City, that I can walk across the street and get anything I want. And I love being on the farm, with its bad cell service and a long way from Whole Foods.

Yes, the two lives inform each other. I grew up on the farm and I try my best to be a farmer sometimes. Farming taught me about human health and people struggling with mental health. On a farm you see a lack of control over the physical world. You see a clear cycle to life. A farm exposes you to all of this in a way that few things do.

As we talk here, I’m getting all these images. In Indiana, our pond freezes and re-freezes as the winter plays out. And as that freezing and re-freezing happens, it makes sounds like whale song, and it cracks and moans, and to experience that and to be so present in the natural world, I find it very meaningful.

The other part that strikes me about these two worlds—New York and Indiana—is I go between a place where there is a mental health professional on every block to Indiana, where there are very few. And I see neighbors struggling with mental health and it is unsettling. Our Indiana community just recently went from one AA meeting a month to one a day. The county recently funded a recovery home that can take six women. So I’m thankful to bear witness to how rural communities are stepping up to mental health challenges.

Learn more about Dr. Drew Ramsey’s approach and books at his website, drewramseymd.com.