111: Good Food Moods | How To Support Mental Health with Nutrition | Dr. Melissa Mondala

Dr. Melissa Mondala  00:00

Here are some protective factors which we all love in the heart attack column which is exercise a really healthy diet, high HDL specifically and better stress management. I think that's important for everyone. And the protective factors for suicide is really connectivity and really being able to have the mental health piece taken care of having accessibility to that for a health professional and then being able to cope well.

Narrator  00:29

Welcome to the Plant Based DFW Podcast weekly show with Dr. Riz and Maya, a show broadcasted from the Dallas Fort Worth area that focuses on lifestyle medicine. This is the use of evidence based lifestyle therapeutic approaches, such as a whole food plant based diet, regular physical exercise, adequate sleep, and stress management to treat, prevent, and oftentimes reverse lifestyle related chronic diseases that are all too prevalent. Every week They feature a guest who speaks on one of these lifestyle medicine pillars. This show is for you, the person who is seeking to improve your overall wellness and quality of life. So whether you are driving, walking, or relaxing at home, we hope this show will provide you one more tool for your wellness toolbox. Let's meet today's podcast guest.

Maya Acosta  01:20

Dr. Melissa mandola is a holistic plant based physician, nutrition and wellness expert health coach, mental health advocate and recipe inventor. She has been featured in popular media such as Forbes, local news outlets and social media. She helps clients improve their lifestyle to optimize their health and achieve their goals and develop sustainable habits to live a healthy and balanced life. Dr. Mondala is a triple specialist and family medicine, lifestyle medicine and primary care psychiatry. She is one of the first and youngest nationally recognized lifestyle medicine fellows and is a strong community health advocate. She is a co founder of Dr. Lifestyle Clinic. She is extremely passionate about the science of human nutrition and it's always up today with the latest research theories and practices. Most importantly, she uses that knowledge to make individualized recommendations for her clients. You may recall that her husband was recently on our show, Dr. Micah Yu who spoke with us about autoimmune disease. If you missed that talk, please visit Episode 108. For this episode, we asked Dr. Mondala to share her presentation titled good food moods which covers mental health. You may want to grab a notepad and pen to take notes because this conversation will be very detailed. You can also visit the website for this conversation at PlantBasedDFWpodcast.com/111 to view the YouTube video version if you'd like to see the slideshow, but it's a pretty good conversation to listen to. It'll be easy, I promise. After the presentation Dr. Riz and I asked a handful of questions so make sure that you listen to the end and I will also be offering some closing thoughts. Also, I always want to be sensitive about topics that may trigger some listeners. Dr. Mondala will talk about the double pandemic with depression affecting 350 million people worldwide. Depression is the leading cause of disability and the second most common cause of death for teens between the ages of 15 to 17 years old. We will talk about the prevalence of depression, the diagnosis, warning signs, treatment and recovery. Dr. Mondala says that the best cure is prevention. Our goal is to offer you an understanding of depression. However there is hope Dr. Mondala will talk about things that we can do to reduce our prevalence or risk for depression. Things like foods that are rich and folate and magnesium and zinc and also stress management and exercise. As always, I will include the links for our guests in the show notes. Dr. Mondala is also offering a discounted guide and a plant based cookbook for our listeners. So again, make sure that you check for those links. Finally, remember that the Lifestyle Medicine Conference is going to take place in Grand Prairie, Texas, November 7 through the 11th at The Gaylord hotel. The website is lmconference.com. And as always, thanks for listening. Let's welcome Dr. Melissa Mondala.

Dr. Melissa Mondala  04:32

Thank you so much. Thank you both Maya Dr. Riz it's been a pleasure to connect once again during this pandemic. But most important to talk about things that are very relevant during this 2021

Maya Acosta  04:45

People tell you all the time you're so young, and yet you're so equipped in many areas that we were not used to seeing in our physicians. So can we talk about why it's important for you to return to this field or to add to the field of mental health your undergraduate degree was actually in psychology before you moved on to your degree in medicine, and now you've returned. And you've done another fellowship in psychiatry.

Dr. Melissa Mondala  05:09

Yes, no, thank you so much. I think it's, it's an honor to just be in the midst of lifestyle medicine community and plant based community, I never like to get the full credit, I think it just always has to deal with people who shared their personal stories of how plant based eating changed her life, literally, it's made them healthier they've dropped the weight, they got rid of diabetes, cholesterol, it's helped with their mood and their energy, and also gave them more purpose and meaning. And I think that's what really made it so real to me. And yes, I, you know, I've trained at Loma Linda, and I've seen people who live in the Blue Zones who live till they're almost 100. And they're like, either disease free or not on many medications, or add any medications, to see them leads, workout classes, and be with their family and make memories just gives me joy. And I, I knew that, you know, psychology is amazing, because I love studying human behavior and how we connect with other people how to establish healthy relationships, and really be be present. And so I enjoy that. And then when I studied more and more, I felt medicine on, you know, science, medicine, it's all one, I would say Avenue and it flows all together. You know, it's not I don't think it's very isolated in terms of that's the field of psychology. And that's the field of science. I think, just like the microbiome, right? It's everything's connected, I mean, health, gut health, mental health, you can't tease one out of the other. And so it's just, you know, when people say you're young and everything, it's really because, you know, when you wouldn't just like, you know, when you when you find a key and you open that door, you just keep going you want to you want more and more to understand not only the science, but how it can change lives. And I think, going back to family, I see all ages, and that just helps me bring in lifestyle medicine to life in and starting early and not leaving out any age and then adding to psychology and essentially psychiatry to really study the not just human behaviors, but mood disorders. And knowing that there's, you know, these are, there's a tendency of normalicy, and maybe our mood, but there's also a tendency where we need to address these mood disorders, before it gets to severe.

Maya Acosta  07:32

And we're very moody nowadays as a society nowadays right"?

Dr. Melissa Mondala  07:36

So true, right? 

Maya Acosta  07:38

Throw out any topic and there's so, so much division, so I can't wait for you to tell us a little bit more about what we can do to kind of alleviate some of this.

Dr. Rizwan Bukhari  07:48

I mean, that the the social isolation, you know, has has certainly contributed to a certain mood in our society, too. And I think people are starting to realize, you know, the sense of separation, and how much we miss getting back together. And, you know, I guess that's what do they call it? COVID fever is that when, when people are just, you know, they just are tired of being cooped up, and they want to get out and get back together and stuff like that.

Maya Acosta  08:11

We'll learn a little bit about how you yourself had IBS. And you kind of learned about plant based nutrition along with lifestyle medicine, and you've made some real improvements in your health. And then of course, you taught your husband as well.

Dr. Melissa Mondala  08:26

Thank you. Yeah, I'll be happy to share. So I can start the presentation, just so that you can get to know a little bit about my story on. And I think every story is a place where we can maybe see yourself, and where we can relate. And that's why I share my story, you know, because it all it takes one person in someone's life to really see how real this is and how it can change your life. And so I'm going to share my screen real quick. So I'm going to talk about Good Food Moods. And really, it's important because we're all craving to have a happier mood during these times. And you know, this mood issue is it actually develops at a very young age. We're getting earlier signs of depression and anxiety from children that just go undetected and then it gets worse in their teens and their 20s and then it impacts their life and impacts their work and their family life and how they build relationships. So that's why I wanted to talk about good food moods and mental health. But just a little bit about me is that I'm as you all know that I'm family and lifestyle boarded here and trained in Loma Linda and I I've just seen a variety of patients who they they kind of know already how to eat healthier how to engage in a better lifestyle, but they get stuck. Sometimes it gets stuck because they are not addressing their root causes of their mood on the depression and anxiety. And they're quite overwhelmed. And sometimes it's because of misfortunate events or stressful events that really had them maybe not adapt to a new lifestyle. And sometimes people feel fearful or paralyzed in those moments. But, you know, I really wanted to connect, how we can really get the mental health as the big piece and an even essential part of why and how we get healthier. So just a bit about my story here is that, you know, during my medical training, and I would say even before then I just in when I was in my teens and 20s, I just noticed my gut health was just very messed up, I didn't know what to call it. I just knew with any stressful event, I got loose stools, I got stomach aches and cramping and it was just beyond butterflies, you know, some people get anxiety and they feel like their chest is palpitating, they feel like their hands are sweaty. But you know, the my digestive tract was really sensitive to what was going around me and I didn't know how to cope healthy at that age. And no one really teaches you really to cope healthy in when you deal with stress. You know, you go to school you have, you have great family and friends. But still, it's not those topics that you talk about at the dinner table. And maybe not until things go wrong, you talk about your mental health, or maybe your digestive issues. And so I had IBS, and I didn't know it, but I'm in my 20s I finally got to that point where it became clear with the doctors I was seeing, and so I've tried different medications, and you know, I would cope, I would self cope with food. I think we all have this relationship with food, good food or bad food, we just love it because it's pleasurable, it's tasteful. And it boosts our mood. And you know, there there is some function and reality to it. But then when you have a negative relationship with food, and when your body's eating unhealthy products, which I did all processed food, all the animal products, I lived in Chicago too. And so I ate all the barbecue hotdogs, and my health just kept declining. And I was very unhappy, I was not performing as good as I should have in medical school. And I just my performance, my I would say my focus was off. But then I discovered through the years, you know, as I started eliminating the processed foods, and started eliminating the animal products and dairy, you know, I became more pescetarian and Mediterranean. And so I got some improvement there, I started to exercise quite frequently doing five Ks and 10 Ks and that was a bit better. But I would say when I turned fully plant based during my residency is when I found the most long lasting change. And that was when you know, my gut, my acne my, my mood was just elevated it was I felt so much better in it. And I knew if I went back to the other way of living, I would not be the same me, Melissa and you know, when people see me as already optimistic, and that's the thing with depression, you know, there's a typical depression where you think that, you know, people look happy on the outside and they look functionable they're focused, they do a lot and they, they're productive. But, you know, atypical depression is also the fact that it may not look like someone's depressed but you know, something else is still missing, they they don't feel like their best and they're, they end up getting less motivated and hopeless or they can sleep too much. So I think some people see depression as one way and don't realize that there's multiple ways to view depression and anxiety. And so, you know, when I turn plant based, my mood symptoms just helped so much I didn't have these weird depressive symptoms or those that generally feel and so my IBS was definitely well controlled and managed and I didn't have to go on loads of medication so I'm thankful there. So that's kind of my story and what how it all develops and you know, just like you, Dr. Riz and Maya, Maya going to conferences, you just are emerged into a plant based lifestyle, and you live it. And so now I just do it at my clinic and Dr. Lifestyle Clinic with all my patients. And so that's my focus. And this is my biggest mantra is that a healthy lifestyle is the first step in preventing and treating mood disorders. And so we know that there's a doubling of this pandemic of depression, it's really bad. We know during COVID there's, there's escalating rates of not just the death rates, but you know, even obesity is worsening. Every two out of three people are just getting overweight and it's just the all time high but also depression is always been one of those sad things because it is the leading cause of disability and the second most common cause of death in 15 to 17 year olds, so they're getting higher rates of suicide. So you may all wonder, you know, is depression the norm, some people get depressed because of life change, because of a transition to a new location or a change of job or even after pregnancy, people get the, you know, postpartum blues or postpartum depression. And with depression, it's actually pretty common. Just like high blood pressure and diabetes, it's common, the prevalence is 20 to 25%. And about 75% of those who actually seek help. So they may think that they have depression, do first with their primary care doctors. So that's just how the medical system works where, you know, just like you have a rash, the first question you see is your primary care doctor. But unfortunately, it's missed about 50% of the time. And so that's a huge number to be missing and get you see your doctor over and over and then 10 years, two years down the line, maybe we'll catch it. And maybe because you're in this crisis, and you can't handle it, and maybe the patient just ask for medications, or might see a counselor, but it takes a lot of bravery and courage and actually discernment to actually say, yeah, I'm depressed, I need help. And so I think it's our job as health professionals and family members and caretakers to recognize depression as much as we can. And so more than interesting fact, more than 50%, more than half patients on anti depressant don't actually meet major depression disorder. So what does that mean? So when that it's actually catch, they do all this screening through the pH Q9. And you know, they, they catch it, but sometimes they put them on antidepressants very quickly, they put them on, and maybe it's not actually time for them to use it. And maybe it's not the, the actual medication that's needed for them, according to their symptoms. 

Dr. Melissa Mondala  17:01

So just so you all know, the diagnosis of major depression disorder from the DSM5 is definitely a symptoms of two weeks at least. So you need these symptoms for two weeks. It's not just one day, it's not just a couple days, but two full weeks. And it's not because of maybe a loss of a loved one, like normal bereavement and grieving states, you can actually feel grief, and that's normal. When it's when you have prolonged grief, it's actually lasting greater than six months. And so when we say two weeks of depressed mood or loss of pleasure, that's like a red flag to us, you want to ask more, and you want to really look at other patterns such as sleep, are you sleeping too much or too little. So I think of insomnia less, you know, less than four. And I think of hypersomnia greater than 10. So just kind of look for that or someone who is sleeping throughout the day and just feeling unmotivated. And there's definitely a change in appetite and weight. Sometimes people are overeating or under eating, their weight fluctuates. Sometimes they're too slow in their actions, just they you just notice that they're unable to complete tasks, or other times they're just too restless, and agitated, that they can not perform as much as they want at school or at work or finishing house chores. And definitely there's a loss of energy fatigue. The thoughts are actually really something we always look at as psychologists, psychiatrists, you know, primary care doctors, counselors in general is looking at the thoughts if their true thoughts of self blame worthlessness, guilt, those are depressive thoughts. And so we always want to ask those questions and then difficulty concentration and not able to make decisions and the thoughts of death or suicide. So as you can see, these are, you know, you have four of these symptoms on top of the other symptoms, that's really the diagnosis of major depressive disorder. And when you look at this, it's you know, sometimes you can have some of these symptoms because of another disease so it's not like one you know, you definitely need the help of a health professional to kind of bring it together but at least you can have some clues of when to seek help if you have these symptoms. So just you might like this Dr. Riz because this is like the warning signs of just not only suicide, but a heart attack and what leads to it and so like the risk factors for heart attack we see this often is tobacco use , obesity, high LDL, the lack of physical activity, but also if you look at the suicide spectrum, you know, we we know that heart attacks are life threatening, but the things that become life threatening with mood disorders are the suicide so if there's prior suicide attempt, mood disorders, so anything of depression, anxiety, PTSD, schizo, bipolar, substance abuse, access to lethal, I would say like guns, for example, just access to anything harmful can increase your risk of suicide. Here are some protective factors which we all love in the heart attack column, which is exercise a really healthy diet, high HDL specifically and better stress management, I think that's important for everyone. And the protective factors for suicide is really connectivity, and really being able to have the mental health piece taken care of having accessibility to that for a health professional and then being able to cope well. And then some warning signs. So these are warning signs that we all just need to pay attention to if you have a heart attack, or something vascular, wary or anything dangerous, compared to someone who was about to commit suicide. So of course, heart attacks, chest pain, shortness of breath, cold sweats, nausea, lightheadedness, but suicide too the things, if there's any thoughts or, you know, someone makes comments about, oh, I want to hurt myself, I better wish I wasn't alive. I think you don't need me i. So all of these things are clues to Okay, let's let's have you see a health professional and maybe even go to the ER. So seeking means to find those lethal means are dangerous if they're feeling extra hopelessness, excessive. I would say it's not just to crying and all that. But it's really detrimental to their mental health when they're in just a place where they can't even recope recoup. And then of course, when they're having more substance use the alcohol and drug use, that's a negative sign. And so when there's any time of you have those mood changes, it's so important, because those are risk for suicide.

Dr. Melissa Mondala  21:55

And so just to give a quick overview, you may have heard this from your health professional or on television, like what are the drugs and the treatment to help treat major depression disorder. And we know that both psychotherapy, so some type of counseling, and antidepressants are definitely great ways to treat depression. And so that's your SSRIs, you've may have heard of Zoloft and Prozac Cymbalta to mirtazapine, or beauceron, these are all tools. And you know, I definitely acknowledge them, there are times when we really need them, and they can really help us get out of crises. I do want to share that the recovery state is important because some people think, with medications, you take it once you take it for six months, and you're done. But really, the natural course and outcome of major depression disorder, you know, is that majority of patients won't recover until I past that one year mark. And so we need to make sure that we take our antidepressants for four full year and sometimes a full year after that, depending on how many times you're relaxing, and the lack of recovery. You know, it's really because they're having these somatic symptoms, and what does that mean? You know, that they're actually getting palpitations, they're getting IBS, like symptoms like diarrhea? are they feeling numbness and tingling and they're feeling other sensations on top of their mood. So those are actually very challenging. But you know, I always say that when you think of mood, and all the neurotransmitters and all that's involved, I always talk about prevention and management because all these hormones are and neurotransmitters are really the ones driving your health and they can be to the point where your diet can support these types of neurotransmitters. 

Dr. Melissa Mondala  23:54

So let's talk about neuro epinephrine, serotonin, dopamine, glutamate, histamine and epinephrine. So you see, well, that's right. That's like the shape of the brain. But you know, I'll talk about omega threes in the brain but these neurotransmitters are very key because they help with your sleep. They help with your mood regulation, your your executive functioning so that means to make critical decisions in life you need all these all these neurotransmitters they are serotonin is not just your happy hormone, but it's something that allows you to regulate your your mood and and also to the point of your energy levels and dopamine we know that that's kind of your reward center. And so there's studies that people who don't cope well who have low dopamine are actually those are the ones that are using substances unhealthy substance like tobacco and alcohol so we we have to be careful. And then histamine people think of histamines is always a an allergy. type of neurotransmitter. But really, it's it's not just that it's a signal that regulates also your mood. And then epinephrine Of course, that's, that's another complex neurotransmitter that we, we also need to help with our, our sensation and feelings of pleasure and reward. And this is another you know me, I'd love to talk a little bit about the science. So I want to emphasize the brain D. So it's the brain derived neurotrophic factor. And this is the fun one, because this is really found in our brain, but we find that blueberries, soy nuts and seeds, cocoa can really help increase that and you want that because if those who have low BDNF are those who suffer from depression, anxiety, bipolar, schizo Gabba, and mold, those are other key players.

Dr. Melissa Mondala  25:55

And so as you can see, there's definitely traditional types of antidepressants and their way to dose them. But I would say that, as I mentioned before, it's it's about not only how you're using these medications and the recovery time, but paying attention to the foods that you're eating, some people try to find supplements, you know, and try to find ways to support their health. And, you know, there are some safe supplements and there are other supplements that are harmful. So I'm just going to kind of cue you in into what the literature is saying, but also give you a sense of caution to when to use this because St. John's Wort you'll see it over and over and maybe in your, in your drugstores as helping for mild and moderate depression. But really, we got, you know, it is comparable, there are what I would say that it's helpful in some studies that but there's, we gotta be careful because these things are, are actually have detrimental side effects, we have to be careful because there's a lot of junk drug interactions, there's GI discomfort that interacts with warfarin, and so I actually don't necessarily recommend St. John's Wort because it's just there's so much that you have to really look at with your medication list. So I always caution people whenever you're taking supplements Ask your doctor make sure that you're you're not just taking it as what the bottle says but what the doctor and a health professional can guide you with. There's inconclusive data on on other I would say supplements on saffron lavender though, the more I studied yet, you people take it through either essential oils or capsules, there's different ways to use it. But the side effects profile is actually very, very benign. But once again, it's good to have a health professional guide you through this. Um, semi semi is a natural curling molecule in the liver and brain and so that helps, you know support dopamine and serotonin and that's also shown to support the, you know, your efficacy here and tolerability. So that's basically what I like about this, it's, it's more, it's kind of the precursor to help with dopamine and serotonin, just like tryptophan and tyrosine, which we'll talk about, so it's a relatively safer one. 

Dr. Melissa Mondala  28:23

Um, omega three is, I would say big in brain health, not just in dementia, and Alzheimer's disease, but really, there's many studies that are showing that if you have low omega three, and you're DHA and your EPA are low, that means you have a higher risk for all these other mood disorders. So I would be mindful where to find your omega three, definitely you want to find it in your flax seeds and your chia seeds. We're big fans of that and sesame seeds. And to say that we also have to know that the if you look at the omega three studies, I look I actually just read a study about the basically the conversion of ALA, so there's three types of omega three, there's your DHA, you're EPA and your ALA and you're ALA you want to just make sure you're getting that from plant based sources. ALA is actually very volatile, it's easily oxidized. So we want to make sure we have enough of it. But because of the standard American diet, our omega three is actually really low and your omega six found in pro inflammatory foods such as animal based foods and dairy. The omega six is so high and it's actually been the highest ever where it's 40 to about one before, when people were eating more plant based that ratio is down really low to about three to one or four to one and so I like to emphasize omega three in my patients through plant based eating.

Dr. Melissa Mondala  29:58

B12. So the beyond B vitamins are essential for brain health and mental health. Because not only we're thinking yes it supports our nerves and avoids any issues a pair paraesthesia is but you know, when you think a B12 and we know that we can find them in your non dairy milks, you can find them actually I like to have it in yeast to take teaspoon sometimes you actually really need a supplement and B12 is once again, these are all cofactors you know, B12, thiamine, magnesium, zinc, I'll be talking about that they're all cofactors in your metabolism when it comes to converting all these all these neurotransmitters and hormones in your brain. So the best way to find it is from Whole Foods plant based and that's why folate is found very much so in plant based eating, and so there's a predictor of anti depressant medications response and really, that's awesome because, you know, the more folate you have, the more likely your your body's able to respond to the anti depressant medication. And so there's been a study that low folate blood levels have been associated with a lack of response and a slower response to an SSRI meaning an anti depressant such as fluoxetine. So we know even if we're taking antidepressant medications, we need to make sure that we're eating enough of our healthy nutrients and vitamins from plant based sources. And so what are some folate rich plants? Definitely their greens, beans and oranges. You can make meals out of these almonds, asparagus, avocados, beets, cashews, fortified cereals, kelp, kiwi, legumes, mung beans, I'm listing all of it, but literally, when I think of folate rich, it's easy to say greens, beans, and seeds. So it's it's really simple to get your full eight because you're if you're eating more plant based foods, so but I would say if you look at the studies, many people are not getting enough folate because they're eating more of the standardized American foods. And here again, I talked about omega threes in the previous slide, but I want to remind you that this is in the ALA form , and the seeds that I spoke about was flax, chia, and hemp nuts definitely are your walnuts, soybeans, edamame, a kidney beans, brussel sprouts, and wild rice. And people don't know this a lot. But firm tofu has a lot of omega three. So don't forget that your brussel sprouts and omega threes can be found in your tofu as well. 

Dr. Melissa Mondala  32:43

So flavonoids, so flavonoids is another word for phytonutrients. But specifically, something that has to do with polyphenol. So it's found in fruits, special tea, people like this, coffee and cocoa, but I you know, I'm, I'm sensitive to caffeine. So I say, you know, Coco, for me, possible benefits of flavonoids, it's because of the cognition effects, it increases cerebral blood flow, it protects against these neuronal stress, because of the anti inflammatory factors that can happen. If you're eating animal products, you want it you want a strong, resilient brain. So you know, keep eating those plant based flavonoids. And then it also stimulates the BDNF. And so flavonoids is basically what helps take away all those free radicals and serves as a antioxidants. So when you go to the produce store, as you see here, tons of different colors, fruits and vegetables, when I think of mental health, I think flavonoids too, as well. So not just omega three, or your B vitamins, but also your flavonoids. 

Dr. Melissa Mondala  33:54

Magnesium has been getting a lot of attention now. Not just because it helps with constipation and muscle aches, but also because it does support your mood. If you look, there are studies that say, Here depression was very rare hundreds of years ago, because there was people are actually getting more magnesium from their plants. And they had lower rates of depression and anxiety. And really, studies have shown magnesium has helped to improve sleep, decreased frequency of headaches, lessen anxiety, and depression. And so a nice study here down in 2013 is that vegans plant based eaters had more magnesium than those who were not eating enough plants are non vegetarians. And so if you're eating plany based you're actually getting enough magnesium. 

Dr. Melissa Mondala  34:45

Zinc is another one that's again, a lot of attention during the immune health and COVID and I would say it's not just how you know, it can support your immune system but more So it's a micronutrient found in plants once again, and in there are studies that show that low serum zinc predisposes people to treatment resistant depression. So what does that mean? There's some patients who are literally taking 1234 tried 10 different antidepressants. And sometimes it's because the root cause has not been addressed, which is they're not eating healthy, and they're not eating enough plants. And so zinc, a lack of zinc, can be a clue. And so there's another study that the repletion, when you start to give zinc, and you can add your antidepressant, it does help. It's a good extra add on, I would say supplements, but more. So it's based on what you're eating. And I, I always like to give advice carefully, once again, about the supplements, it's there, it's a tool there, but never to the point where it's lifelong, especially when you're not checking levels. 

Dr. Melissa Mondala  36:02

And so, curcumin, this is a fun one, because it's a spice, right, spices are not just anti inflammatory, but they help support our mood. So a recent study that is randomized, double blind, placebo controlled study, that's a fancy term, but we tried to say these studies are the ones that we can learn a lot from and trust in saying that, you know, showed a highly absorbed form of curcumin, so 500 milligrams twice a day, was actually shown to be effective for treating major depression after eight weeks of use. And so I, you know, when I think about plant based eating and supplements, like these are people who I who have mild depression and mild anxiety, if they're going towards moderate and severe, then I'm thinking about maybe placing medications along with these other therapies. But there are times when I'm telling you, when people eat, plant based and are exercising regularly, they see tremendous change. And really, cucumber in here, as you can see can be as effective as Prozac. And it really, you have to be mindful of our absorption. Of course, if you have IBD, or celiac or some type of absorption, difficulties that dosing can change. But curcumin is powerful. And here is an interesting study, I wanted to just show you, you may think well what's going on with this slide and you know, population observable studies, depending how you look at the studies, you may see that, you know, there's higher occurrences and depressive disorder in vegetarian compared to non vegetarian, what does that mean like, and you may hear this from other professionals and experts in nutrition, but then they'll do another study and and do another cross sectional study with the same studies. And then they'll say, oh, about 80%, of woman found a beneficial association between vegan diet and mood disturbance. And I would say just, you know, when you look at the studies, just to be careful, and to get the course where your scientific community in return to really share with you the patterns, right and how things are, and one, I would say one micro nutrient doesn't necessarily solve one thing, it's really the collection, the patterns of people's behaviors. You know, one thing supplement is not going to necessarily take away depression, anxiety, it's really all the plant based foods that you're taking. Because if you're only taking zinc, you still need the other types of antioxidants. And you know, the fiber is still very, very good, and you still need to exercise and sleep. It's never one thing that fixes everything. 

Dr. Melissa Mondala  38:42

So there's definitely a brain biome connection. And we've seen this at the microbiome level, and showing that there are about 90% of serotonin in your gut, that's huge. So your happy hormones are in your guts. 50% of your dopamine are also essential for your mood and energy levels. motivation and sense of reward are produced in your guts, your guts, what you eat, every day, every meal is extremely important. And so we want to be sure that we're protecting this microbiome, which is also where your immune system sits.

Dr. Melissa Mondala  39:23

With plant based nutrition, I want to encourage you look at the studies from 2000 to 2018. They've just grown from any before they were less than 50. And now there's near 400 over 400 of plant based vegetarian vegan diets in how they're trying to study that and how it's really shown to promote health. So the research in the science is there and we know we all see it in our in our patients and our day to day. It that it works and then here's fiber. Once again, there is definitely an overlap between IBS depressed mood and anxiety just like my story, just like, I would say 80 to 90% of my patients have either anxiety or depression, it's just so prevalent. And then they add another component where they've got, they've been living with IBS for years, or they even have functional, what we call functional is they have these GERD like symptoms, bloating, diarrhea. And they're, it's not because necessarily, because of a true, I would say chemical, you know, just order where we can necessarily fix, but it's because of what they're eating and because they're not able to cope healthy. So when you think about this, there's definitely an damage to the gut microbiome. And then the serotonin balances altered. And then also the gut motility is impaired when you don't have enough fiber. So we need to fiber to stabilize our entire gut and our mood. And of course, we know fiber is awesome, because we get them short chain fatty acids, that really decreases our inflammatory cascades. And then this is beautiful, or mono unsaturated poly saturated plant fat. So that also supports our brain because that's where we get all our, our brain mass from hard gray and white matter there. 

Dr. Melissa Mondala  41:21

So how much walnuts Do we need to eat? I would say 43 grams of walnuts is great on that promotes the short chain fatty acids, and particularly its butyric acid and the probiotic component. So 43 grams, that's a good number. Some people love numbers. So I that's why I gave that and suffering. So that's, we love it and I cruciferous vegetables, broccoli, cauliflower, or rucola, kale, cabbage. So I'm sure you can imagine these meals. But really, it's nice that it's shown to improve mood. 

Dr. Melissa Mondala  41:57

And here we we know once again, that TMAO is it's nothing to ignore. I think it's there's more and more worked on since this is a study in 2013 now, and we're in 2021. And we can still say that these are TMA's found in animal products and dairy products and really disrupt our microbiome and increase our rates for diabetes, stroke, heart attack. But these are things that also cross the brain, blood brain barrier. And if they go to the brain, you know, it's they're actually going to start creating problems with our arteries in our brain and lead to dementia issues. So we have to be very careful. 

Dr. Melissa Mondala  42:41

Here's processed food. This is my previous slide, right? You don't see anything green here, you think see everything that's extremely processed, nothing that you can find in in the farm or in your garden. It's and so we already know that some processed foods really disrupts the microbiome increases our risk for depression. arachidonic acid is one of those. It's a pro inflammatory compound found in animal products that adverse that really adversely impacts mental health. So it's here you go seeing the same theme over and over. And it's sad because arachidonic acid is found in the western American diet through animal products, cheese, egg, and also cow's milk. And really, that's what makes us susceptible to depression and anxiety. And our top five sources of arachidonic acid are eggs, chicken, beef, pork, and fish. And, you know, sadly, omnivores tend to consume nine times more of uronic acid compared to plant based eaters, so that's high.

Dr. Melissa Mondala  43:52

And then once again, just one egg increases this uronic acid and it can raise your, all of these dangerous levels. And once again, it goes into your brain it crosses the blood brain barrier. And so in medical training, we've learned about the cheese effect and that's a tyromeine substance found in cured meats, fermented foods and and once again, cheese, but this can actually worsen our blood pressure. So cause a hypertensive crisis and potentially hemorrhage and we want to just know that the more cheese but also more so if you're taking with other antidepressants, we have to be careful. However, you want to know that the same anti depressant medication that we recommend is doctors is a mild inhibiting medication. You can actually find that naturally in foods such as apples, berries, grapes, onions, green tea, cloves, oregano, cinnamon and nutmeg and these are safe. So the You can actually find these properties in plant based foods. 

Dr. Melissa Mondala  45:05

And tryptophan. And that's what I spoke about earlier. It's our essential amino acid that crosses the blood brain barrier. But really, the it what it gets converted to is your serotonin. And so we just want to make sure that we are eating healthy amounts of tryptophan and tyrosine. But you don't want to eat the unhealthy version, which is listed here is Turkey, eggs and cheese. The Healthy version of tryptophan and tyrosine are sesame seeds, sunflower seeds, and pumpkin. And there's an interesting study of using butternut squash seeds that social anxiety disorder reported a significant improvement in anxiety within just one hour of consumption. So I thought that was interesting. 

Dr. Melissa Mondala  45:49

And once again, here is our you know, we all kind of live and breathe lifestyle medicine. And so we need all components, we need to make sure that we're moving routinely, we're managing our stress, we're quitting tobacco, and risky substance use, getting adequate sleep, because this and also maintain healthy relationships, because this is our foundation for our mood, our foundation for health. And so I want to remind you, too, that we all need sunlight. So bright light therapy, sunshine is really effective for seasonal affective disorder, but also major, just depression. And it really has implemented to the point where you can have better response to your antidepressant, when you're getting enough sunshine, it can quick in the response. And it's really nice because it can help your sleep to and regulate your sleep. So I always recommending getting sleep first thing in the morning for at least 30 minutes. And just like your exercise, if you can do it first thing in the morning, it's great. And to the note of exercise, those who just don't move enough, we know that the studies are consistently showing that you have higher rates of depression. And we want to be careful because the we know that exercise is important for our metabolic health for such thing as obesity, diabetes, high cholesterol, but it's very important for mood as well. And so it actually helps our gut microbiome and gut brain access. And going back to exercise, there are studies too that show that 30 minutes of exercise is equivalent to an antidepressant. So I just say you know, when you're exercising, you're also preventing the use of being dependent on a antidepressant if you if you are to that point. So I encourage you to use exercise as medicine as much as you can. And stress management is key. You know there's unhealthy stress and healthy stress, there's the healthy stress that allows you to to stay on task to meet deadlines to be motivated. But there's the unhealthy stress that causes you to to really be to the point where everything is a fight or flight component, you're super anxious, you feel like the world is ending, you feel like you can't go on and I say find that sweet spot. And I think we all can take a moment to find that sweet spot and understand what that is. It's hard I understand it, but really trying to be mindful of how we respond to our environment, how we're thinking, is it negative? Is it positive? Is it something that we can actually use as a tool to get by our day, so thoughts, feelings, those are all real. And we need to also address that, and better our stress management tools. 

Dr. Melissa Mondala  48:56

I always talk about substance use because it's just something that people are becoming more dependent on during the pandemic, because we unfortunately, are not knowing how to cope, we tend to find something that brings us that pleasure, or that motivation or calms us or, or helps us with energy and it becomes this addiction triangle. And that's because there's either physical dependence because we just aren't used to something in our hand, if it's a cigarette, or it's a habit because we always pair it with something either going outside or with our coffee, or it's an emotional habit because we need it to cope with our depression anxiety. So, in these cases, I always say, find the support of a loved one health professional to break those addiction cycles. It's not easy, but it can be overcome once we get to the root cause of the behaviors and really finding out the Why's on and of course, there's tools how to overcome that. 

Dr. Melissa Mondala  50:05

And the purpose, motivation and wholeness. Is it really important? I think that drives our why and why why do we want to live? Why do we want to stay motivated. And if you can visualize that, if you can think those people around you, if you can do something really kind, it can really help your resilience, it can help you overcome what you're doing. And so this is just my why obviously, the US in the kitchen, my family, I would show them, but it's mainly here outdoors and, and being connected. So these are just a quick list of side effects of antidepressants, not to scare you from antidepressants, but to just show you that there are things that we need to be mindful of. And to show that, yes, if you're having issues with headaches or insomnia, you just need to tell your health provider. So work with your health provider to talk to them to actually identify, is it a side effect? Or is it just my mood. And, and, you know, I've put here, watch for discontinuation syndrome, because if you stop it without guidance of a health professional, you're anxiety, and depression or bipolar can actually get worse, especially if you stop it too quickly. And so here is just what's the hearing. Now, we are definitely fine looking for ways to support people with mental health issues, we want to be able to identify it, but also to take away the stigma around it, because people go undiagnosed or untreated, not necessarily because it's the fault of the health professional or the healthcare system, which Yeah, we can all point fingers there. But I would say too, is it's just when we're scared to talk about it. It's not necessarily accepted in our culture. But I'm glad now more than ever, we're becoming more, I would say aware, but also wanting to know that. It there is not just a plan, but there are solutions to getting better. When it comes to mental health and antidepressants. I just want to remind you, it works well for about only 50%. So those are high numbers, because depression and anxiety finding how, what and what what causes it, it's actually not as clear cut like diabetes and high cholesterol where you can find labs, and you can track numbers. So it's very complex. And so sometimes antidepressants don't work. That's why it's so so important for you to live a healthy lifestyle, because we know that that can support it in that works just to encourage people how much to eat seven fruits a day. And eight vegetables a day can help your, your mental health. And bottom line. Our favorite is just plant based eating and getting the support of your, your fellow friends, your community to do this. You're not alone when you're trying to transition.

Narrator  53:14

Well, thank you very much. I enjoyed that. And I think you wrote you really broke it down very nicely. But there's a pretty simple message, which is a, you know, a healthy lifestyle can prevent mood disorders, but a healthy lifestyle can also help treat them.

Dr. Melissa Mondala  53:30

Absolutely, yes,

Maya Acosta  53:32

I find it fascinating like to know that relationship between the gut and the brain, a large portion of serotonin and dopamine being in our gut are affected by what we eat, or by what we don't need. Like if we're not incorporating the healthy foods and the fiber and all of that, then our chemicals kind of change and then bring on some mood swings and things like that

Dr. Rizwan Bukhari  53:52

I liked the way you broke it down and showed so many of these things that we talked about the vitamins, the minerals, the the phytonutrients, the things that are in these foods have a significant and meaningful impact on on our mood, and also and on how if you have to be on an antidepressant, which, you know, we're not saying don't ever take them right. But if you need to be on one, it makes them more effective. And I never realized that antidepressants can be less effective if you don't have the right minerals in your body. So I like that

Maya Acosta  54:26

Right. Me too. That was a new one for me. I like also how you talked about that one of the biggest components is lack of connectivity, which a lot of us now lack in terms of physical touch and physical presence with loved ones. That's a little bit tricky to handle right now. Do you have any kind of recommendations on bringing connectivity back? 

Dr. Melissa Mondala  54:48

Yeah, youknow it's so important because now are either dependent on technology and texting and sending pictures and emojis and you know that's, you know, that can help in that builds a sense where we can feel closer, but no seeing this like having these eye to eye, I would say gestures and we can have feedback here virtually, I think it's important to have an organic conversation here. And, and being you know, that's, I think it's a challenge. But definitely having a phone call with a helps hearing an actual voice on the other line frequently, just as we say, eating three days. Now some people do three times a day, but having constant conversations with our friends and family. We need those doses to we don't want to wait a whole week without talking to anybody.

Maya Acosta  55:43

Right? Definitely. And Dr. Melissa, I think I read in the lifestyle medicine handbook that spending a few minutes just looking directly into the eyes of a furry friend can actually raise dopamine levels.

Dr. Rizwan Bukhari  55:56

So yeah, I mean, in fact, I'd like to hear more about your thoughts on, you know, what we noticed, you know, we would go for our daily walks throughout this whole pandemic, is we just started to see a lot more people with puppies and dogs. Yes. And so I think there was a, in fact, I had heard that a lot of the adoption agencies were out of animals. So there was people adopting animals like crazy. You have any thoughts about animals and their role in in mental health?

Dr. Melissa Mondala  56:22

Absolutely. So support dogs or support free animals, our you know, our friends, there are studies like, for example, people love a physical hug for person, but you can just touching a pet to can do the same difference. And that's why they go into hospitals and clinics to visit people. And I right after their stroke, I actually put in a console for pet therapy, because it's one of those things that gave the elevator mood.

Dr. Rizwan Bukhari  56:51

Nice. Nice. I like that. So I wanted to ask we, you know, getting back to a little bit about the, the zinc, magnesium, all these other things before light, or even GABA, you know, things that are important to have for mental health, people might ask, Well, can I just take the supplement over the counter? And how would you address that versus, you know, what we push as the eating the whole foods?

Dr. Melissa Mondala  57:14

Yeah, exactly. Some people are just say, Well, let me just take my zinc, magnesium omega three, and, and really, it's, it's in that small, they try to hyper concentrated in one pill, but really, you want all those nutrients attached to everything else, which can be found in a plant based foods and a whole foods and actual fruit or vegetable and because you know, you have your fiber and everything else. When it's when it's complex and found in nature, it's whole and safe. With the other supplements, you know, I like to it's a complex, I would say conversation because each supplement, you have to really know how much you're taking. And some patients so they're, they're plant based or vegan, but all they eat are the process versions. And so you actually notice that they're not if you take them to a registered dietitian, and you calculate everything, they're not getting the adequate needs. And so that's where we still have to do a lot of education. It's good to say class, whole food plant based, but is the best, but also, are you getting enough of it. And so even a little bit of omega three plant base, or a little bit of magnesium can help there is a place for that if people aren't actually taking enough of it.

Dr. Rizwan Bukhari  58:31

Yeah. Well, and, you know, when I when people ask me, say, for example, not supplementing for DHA and EPA, I'll say well, don't take a pill. Just incorporate more ground flaxseed into your diet, incorporate more walnuts or incorporate more chia seeds and hemp. Because you are taking it in the natural manner, and your body will know how to manage that, as opposed to just taking a pill where, you know, you're just focusing and concentrating on EPA and DHA. So I we're supplementing, but we're supplementing with Whole Foods.

Dr. Melissa Mondala  59:01

Yeah, exactly. As long as you're putting it in your dishes. Every day, some people realize, Oh, I didn't eat flax seeds for a week or a month. I'm like, Okay, well, there you go. Do that regularly, and then you'll get enough.

Dr. Rizwan Bukhari  59:16

Well, I want to tell you, I'm real proud of myself. Because when you were listing all those foods that had healthy cells, okay, I think I had about eight or nine of those in the last day. So, but I realized there's a few more that I can work on.

Maya Acosta  59:27

Yeah, who would I ever thought and we have noticed and we say it over and over again that when we when we went plant based, we naturally felt calmer. So we're just a little bit more easy going because of the diet, I guess all the nutrients and mood enhancing foods that were taken in? Yeah.

Dr. Rizwan Bukhari  59:42

I'm curious. Are you aware of any studies that are going on right now as far as looking at how a whole food plant based diet affects mood in general or in the treatment of depression or mood disorders?

Dr. Melissa Mondala  59:55

Yeah, so that's where I'm like always trying to look for that too. I know there's some PhDs that are looking more at like micronutrients, some of them are looking at patterns. And, and I've been following her for quite some time. And I think, just like everything in science, we, it's good to have more. And we and we need to see him find a collective data to do it. So I can't name like the the new ones on top of my head, I've just kind of looked and kind of see what I found was in this PowerPoint, but I know there's more digging to do. And that's why I'm actually for ACLM. And I'm consuming to the lifestyle medicine residency curriculum course. And there's a mental health, depression, anxiety, and so I'm going to be really looking at the data even more, so I'll let you know.

Dr. Rizwan Bukhari  1:00:46

To be continued. Yeah,

Maya Acosta  1:00:47

Some patients are not diagnosed, because that's not say a priority when they're coming in for other health conditions. And then you said you yourself have seen that a great number of your patients suffer from depression. So what is the first step when you do diagnose an individual? I guess you start with medication? And then do you move on then to the lifestyle? recommendations? 

Dr. Melissa Mondala  1:01:12

Yeah, nonthank you. I see the two questions there. And basically, yes, it's it's not commonly diagnosed, because it is required as physicians that we at least screen at once a year, but what if you do it once a year, but you miss those other months in between. And so you're not necessarily capturing it at the right time, where they're truly depressing, is anxious. So that's why you're kind of missing that window. Another thing is that, definitely with depression, anxiety, it's some a lot of, I would say, US physicians, you know, we do our best to talk about it, but 15 minute visits aren't enough to capture it, unfortunately. And so that's why I did my own private practice. So okay, I'm going to spend an hour so I can capture these. But I would say the the method I always do is, in terms of behavioral counseling is number one, like counseling, getting healthier coping mechanisms of treating the distorted thoughts and feelings that happen over time. And alongside lifestyle I it's sliced lifestyle from beginning to end. So it's not like I skip it at all. Definitely medications, I do more moderate and severe, sometimes only severe. But the moderate cases can also get better just through lifestyle.

Maya Acosta  1:02:30

I'm thinking of our listeners as well, when I asked this question, but what about like, for example, if some of our listeners can't afford that additional costs for say, counseling or kind of group therapy? Can you first talk about how effective group therapy can be? And do you have access for your own patients where you send them if you do see that they're suffering safe from depression? 

Dr. Melissa Mondala  1:02:52

No, I love that question. So there's so many studies now with multidisciplinary group studies, group therapy, specifically are what helps people will get out of their mental health crises or even with other chronic diseases. So it takes a team and it group therapy is so essential, because it's frequent visits, their studies at eight weeks of that to up to 12 weeks, can be really helpful for consistency, not just because it builds healthy habits, we think of healthy habits like night, 90 days, 120 days, there's a range there, but group therapy is nice and focused and concentrated just like AA programs. And so group therapy is a huge thing. I do classes too. I do it either just me or I actually have a registered dietitian, I bring on a yoga, and sacral cra cranial therapists on board. And some, the more tools you have in this group therapy session can really help patients cope and bring practical tools. Sometimes it is covered by insurance, depending on what clinic they're in. If they're at the VA or other types of settings, sometimes they're not. If they're not, then, you know, AA is definitely free. There's also for narcotics for mental health. There are some centers that provide group therapy throughout the nation. I know some just locally here that provided virtually during the pandemic time, but a Facebook groups a free way to do it. There's Facebook groups support groups, like my husband, Micah, there's like the lupus organization. And they have groups that get them together. And they all cope that way. I have patients in anxiety support groups virtually. And they all talk about their condition sharing recipes, and how they're dealing with medications. And that's really powerful too.

Maya Acosta  1:04:43

Sure is. So you did start off by saying that the prevention is key. And I often wonder what has to take place for someone to then fall say into depression. I myself have been trying to pay more attention to my own self in terms of self care. So I'm putting list of things, you know, meditation, yoga exercise, just trying to I guess those are coping mechanisms have been trying to find a way to keep myself because I can suffer from anxiety. So again, I'm thinking our listeners can probably benefit from just working on the preventative and of self care. What do you think?

Dr. Melissa Mondala  1:05:19

100%? Thank you so much for that question. I have people who are either complete healthy, or people in severe anxiety, and are people who are right about to get their procedure, and they're super anxious. But all of that can be helped by deep breathing, literally study after study, either they go to the dentist, or pre or post op, like the breath. And meditation work is so important. So deep breathing is what I teach every patient, you know, inhale, for four seconds, hold for four, and exhale for four and just kind of do this throughout your day. And literally, it can subside all the anxiety in the chest and the stomach. So deep breathing is something I do for patients and with patients three, four or five times a day, you know, I think it has to be carved out of your time to have your breath work, listening to nature sounds, spend time and meditation. And you know, it's easy to say it's not easy to do. So, literally, putting yourself and I'm working on that, too, is like I for me, I've been just going to the beach more because it's the only thing where I'm out of my

Maya Acosta  1:06:30

You're so head lucky

Dr. Melissa Mondala  1:06:33

technology, I'll leave my cell phone in the car or turn it off and just sit there and listen to waves to unplug. And we need that. And I think that's the wake up call a COVID is like we just need to unplug from all the stimulation in our body and in our in our world. So meditation, mindfulness, obviously, is good. And just that self care is really writing down your thoughts and your feelings when you need it and asking, you know, I'm studying acupuncture to meaning like I read a lot of books, and I'm talking to acupuncturist, too. So like these are things that can help open up the, the, the, I would say, energy blockages that we can feel and so I'm just I think we have to be open and and when we do our way of healing can come through many ways. And so I encourage you, if it's like you look, we both look all grooms and well. This is something I do to look forward to. So it's just nice to kind of take care of ourselves and keep ourselves going.

Dr. Rizwan Bukhari  1:07:43

That's right

Maya Acosta  1:07:45

And have compassion for ourselves. Because we, when we get moody, the first person we take it out on is ourselves really internally that is with that inner voice that's like there you're not doing enough or whatever that self criticism, but I love what you're doing with your lifestyle medicine practice. Just quick question about that is do you actually have a physical clinic now? your lifestyle Medicine Center?

Dr. Melissa Mondala  1:08:10

Yeah, we do. It's, it's nice. It's in Newport Beach, my husband and I so we it's like a, it's just, you know, three rooms, that's all we need. But it's because most of our work is done through telemedicine. Micah has 15 state licenses, I have three. And I'm just gonna keep getting more licenses. And you know, he has Texas I'm working on Texas, I have to take an exam. And so yes, we do group classes that are virtual. And it's just been a joy. To do that. You can definitely learn about us more on our website,

Maya Acosta  1:08:49

share that information. And also if our listeners are interested in joining your virtual classes, can they do so as well?

Dr. Melissa Mondala  1:08:54

Yeah, thank you. So my website is drlifestyle.org and you can sign up there to be a new patient or just to even attend our classes. And they're very educational, but very experiential. So you get to do activities there. And we have a health and wellness class coming up in May. So stay tuned. And then we also have these group therapy sessions starting in two weeks, where every week we get to spend time with a registered dietician, yoga and meditation experts. She's in structure and then I'll be there for q&a. And so this is just a way we can reach out to our community. So yes, please find us. We're also on social media. My handles are melissamondala.md on Instagram and then also on Facebook and tik tok. I'm trying that out too. Oh,

Maya Acosta  1:09:41

yes, that's right. We've been seeing so much of your activities, everything from cooking demos to tick tock videos. You guys are so much fun. So your motivation for sure

Dr. Melissa Mondala  1:09:51

you thank you for spending this time with me.

Dr. Rizwan Bukhari  1:09:54

I want to thank you very much. I've enjoyed it. And we'll we'll have you back some time for an update and On those future studies and things, we talked the house right, thank you take care of that.

Maya Acosta  1:10:05

So that was a wonderful conversation that we had with Dr. Mondala. Dr. Riz and I always enjoyed catching up with her. And we just admire all the dedication that she has put into really being an awesome physician going back for another fellowship in psychiatry and out studying acupuncture. Really, this is what we want in our physicians. So it's just so much hope that she gives us and so much inspiration, leave me a comment and let me know what you think you can always email me a comment at plantbasedmaya@gmail.com. And as always, thank you so much for being a listener. You've been listening to the Plant Based DFW Podcast show. If you like our content, please like, share and leave a review. Our goal is to provide quality episodes to help support the community