Drew Ramsey. Eat to Beat Depression and Anxiety: Nourish your Way to Better Mental Health in Six Weeks. Harper Wave/Harper Collins. New York: 2021. ISBN: 978-0-06-303171-5. pp.270.
Richard Zimmer. (Sonoma State University)
Can what you eat help reduce depression and anxiety? Dr. Drew Ramsey, a psychiatrist, nutritionist, and chef, contends that it can. A leader in the emerging field of psychiatric nutrition, Ramsey offers scientific evidence that inclusion of certain vitamins, minerals, and other substances contained in food are necessary to emotional well-being and brain development and functioning. In a book designed for the layperson, he lays out a comprehensive series of food choices that enables a person to choose among what he considers necessary elements, scientifically based, to help with depression and anxiety. These foodstuffs are not a cure for these conditions, but a supplement to addressing the food-related component of them.
Both explicitly and implicitly, Ramsey and psychiatric nutritionists are raising important questions for researchers and practitioners. These researchers include anthropologists specializing in food, psychology, medicine, public health, public policy, physical anthropology, and perhaps even folklore. The practitioners include primary care physicians, psychiatrists, psychologists, counselors, and nutritionists. These questions will be raised below, after a short review of Ramsey’s ideas.
Initially, Ramsey focuses on the brain because the brain, despite its small size and weight, consumes disproportionately more of the food we consume. The brain needs its own specific nourishment, such as B6 to fight inflammation and B12 for mood regulation. It needs zinc to help protect the immune system. The brain also needs brain-derived neurotropic factor foods, which, among other roles, helps the brain make new synaptic connections. Ramsey presents two illustrative cases. He reports that his patients’ previous physicians and therapists never explored their eating habits. He changed their habits to include what he sees as necessary foods for helping with depression and anxiety. They improved substantially as a result . The foods by themselves did not eliminate these symptoms and talk therapy was still needed. In simple terms, food by itself did not “cure” or eliminate the symptoms, but it alleviated them.
Ramsey then addresses an area of increasing focus in nutrition and psychotherapy—the “gut.” The gut is often called the “second brain” because it both connects a myriad of nerves to the brain and the rest of the body and feeds essential biochemicals as well. A person must “feed” her/his gut appropriately, such as eating probiotic yogurt, to ensure a healthy biome. And, because the gut and the vagus nerve are located near each other and work together, adverse symptoms like anxiety can be reduced (see, for example, Martin 2016, for a brief outline of the emerging field of polyvagal therapy.)
The above is but a brief outline of the specific foods and the specific issues Ramsey says must be addressed in terms of reducing depression, anxiety, and enhancing brain and nerve functioning. Of course, sugars and processed foods must be avoided because they enhance inflammation, which is bad for various forms of arthritis as well Consequently, Ramsey presents a multiplicity of food choices that carry specific benefits so that a person who feels an aversion to certain tastes, looks, and textures can pick what s/he likes His classic example is kale, which many people hate (Ramsey had written an earlier kale cookbook.) An interesting note, as well: some fast-food restaurants such as Dave’s Hot Chicken have offered kale slaw on top of their fried foods in deference to changing tastes. Ramsey suggests RAINBOW produce—multi-colored choices—to entice the eater. If there is any one preference for a diet, it is the classic Mediterranean diet—with lots of virgin olive oil, vegetables, and not too much meat. As Ramsey notes, he is not a purist and was once a vegetarian. He ends his book with lengthy chapters and recipes for appropriate eating.
Ramsey raises important concerns from a psychological perspective that may affect several areas of anthropological research. In terms of disclosure, I am an anthropologist and practicing psychologist. In terms of the latter role, I treat several different kinds of clients. The first is a general clientele. The second is a clientele with medical issues. There are different populations within this group. The first is those with eating disorders, such as anorexia and bulimia. The second is ones with severe obesity. I also work closely with physicians serving these populations.
What I have found is that rarely do physicians ask about a person’s diet and eating practices, and, even more rarely, do they refer that person to a nutritionist. Furthermore, physicians often get minimal training in medical school in this area. Consequently, they may fail to address that component of depression and anxiety that may be caused by a person’s eating pattern. One physician who has had extensive international experience said to me:
“The closest I’ve come has involved the connection between vitamins and
minerals on the one hand and the immune system and intellectual
development (Vitamin A is crucial to the immune system–low levels in
children in some poor countries are highly associated with higher
mortality; low levels of iodine of course cause cretinism and lower
Two nurses said the same thing to me: ‘Doctors don’t ask.’
Doctors also rarely ask how a person identifies racially or ethnically. This should be an important consideration, especially when considering obesity or related issues, let alone other possibly genetic related issues. Two examples come to mind. For certain of my clients, I get the intake sheets from the physician’s office—with the client’s consent. None of them list race/ethnicity, saying it is declined. Nor do they list the client’s religious preference. As for the examples: one client of mine self-identified as “white.” He was severely obese. When pressed, he said he was also part Samoan. He never told the physician that, even though it was a likely factor in his obesity. Similarly, another client self-identified as Hispanic. Again, when pressed, she allowed that she was half Native American. Further on in the intake, she was asked about whether Type II diabetes ran in her family. She said: “Yes, it did. I’m Native American and that happens.” But she never told the physician this.
This is an important factor to consider in treating obesity and Type II Diabetes. One must pay attention to ethnic origins and socio-cultural influences (see McCullough and Hardin 2015:17) for a general statement on researching and treating obesity. For example, there is a genetic propensity for obesity among Pima Native Americans (Baier and Hanson 2004.) Other Native Americans share similar genetic patterns (Schulz et al 2006,) which is why my client should have told her physician and her physician should have asked. In a comparison of the Pima in the United States and Mexico, American Pima were more at risk for Type II Diabetes in part because of environmental factors, such as adverse changes in diet, both in sugar and carbohydrates, lack of access to other foods, and lack of exercise. Schulz et al. 2006 contend that Type II Diabetes in this population (and elsewhere) is addressable by changes in diet and exercise.
There are often exceptions to this, such as physicians dealing with an older population (Roy et al., 2017 and Zarit and Zarit 2011:44t), with bulimia and anorexia, with perinatal and post-natal concerns, and with preparation for gastric bypass and sleeve surgery.
Similarly, psychologists and other counselors are not trained in nutrition as well. Like doctors, they can take continuing medical or education units if they so choose.
Anthropologists such as Janet Chrzan and John Brett have done pioneering and continuing work in nutrition and its connections to culture and public policy (see, for example, their excellent Beghahn series edited by them, listed below.) I would suggest some interesting questions. If there are pre-existing nutritional deficiencies in the environment, do they appear in cultural expressions, such as “We’re a depressed people”? Or take the converse argument. Ramsey says that vitamin and mineral deficiency can add to depression. The, if a person follows their cultural practices of drinking excessively, does that lead to more depression within them because alcohol leaches out vitamins and minerals? ( See https://www.psychiatryinvestigation.org/m/journal/view.php?number=744 and https://www.healthline.com/health-news/how-nutritional-therapy-is-helping-people-overcome-alcohol-addiction.) See also Janet Chrzan’s excellent study on alcohol’s role in culture [2013.])
This book is useful for undergraduate and graduate students in anthropology, psychology, medicine, sociology, and public health. As noted earlier, it is also written for a popular lay audience. It is also useful for the individual who wants to learn more about what can affect moods and address any relevant nutritional issues. Ramsey offers a ‘prescription’ of hope when the reader/eater follows his suggestions: “You have all the tools you need to succeed as you eat to beat depression and anxiety, nurturing your mind, body, and spirit as you sit down to every meal (2021:235.)”
2013 Chrzan, Janet. Social Drinking in Cultural Context. Routledge. New York.
McCullough, Megan B. and Jessica A. Hardin. Introduction. Reconstructing Obesity: The Meaning of Measures and the Measure of Meanings, in Megan B. McCullough and Jessica A. Hardin. The Meaning of Measures and the Measure of Meanings. Berghahn. New York. (pp.1-23.)
O’Connor, Richard A. and Penny van Esterik. From Virtue to Vice: Negotiating Anorexia. Berghahn. New York.
Roy, Samer N., Shreya Sahay Saxena, and Krishnakant Shah. Physician Approaches to Increasing Patient Health Literacy. In Karen Kopera-Frye, ed. Health Literacy Among Older Adults. Springer, New York. pp.35-52.ew York.
Zarit, Steven H. and Judy M. Zarit. Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment. Guilford, N.Y.
Baier, Leslie J. and Robert L. Hanson. Genetic Studies of the Etiology of Type 2 Diabetes in Pima Indians: Hunting for Pieces to a Complicated Puzzle. Diabetes 2004 May; 53(5): 1181-1186.https://doi.org/10.2337/diabetes.53.5.1181
[Accessed July 1, 2021.]
These sites are for Janet Chrzan’s edited books:
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Schulz, Leslie O., Peter H. Bennett, Eric Ravussen, Judith R. Kidd, Kenneth K. Kidd, Julian Esparza, and Mauro E. Valencia. https://care.diabetesjournals.org/content/29/8/1866.
[Accessed July 1, 2021.]
[Accessed July 1, 2021.]
Wagner, Dee. Polyvagal Theory in Practice.
[Accessed July 1, 2021.]