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"Doc, I just don't feel like drinking alcohol anymore."

Addiction psychiatrist Dr. Nishant Kumar kept hearing it. Patient after patient, unprompted. And nothing in their lives had changed… except one thing. They'd started a GLP-1.

What does that tell us about the brain, addiction, and our relationship with food?

In my recent conversation with Dr. Kumar, we unpacked exactly that. In this post, I share what GLP-1s are revealing about cravings and the brain, how to recognize when your relationship with food has become a problem, how to find the right help, and the lifestyle factors that matter more than you might expect.

GLP-1s and the Brain: Something Unexpected Is Happening

Dr. Kumar started noticing a pattern. Patients on GLP-1 medications, with no changes to their therapy, stress levels, medications, or circumstances, were going into remission from alcohol use disorder.

Some hadn't had a drink in three months. Others, a full year. 

And many who didn't even meet the clinical threshold for a disorder were simply reporting that the desire had faded. The urge just wasn't there anymore.

What makes this significant is that current FDA-approved medications for alcohol use disorder don't produce results like this consistently. 

Dr. Kumar believes we'll likely see GLP-1s formally approved for substance use disorders in the near future, starting with alcohol.

And for patients who stayed on the medication long-term? He's seeing the effects hold. Not just because of the medication, but because of everything that follows: weight loss, renewed confidence, returning to hobbies and exercise, and a life that no longer has room for the thing that was causing so much harm.

But what if the thing you're compelled toward isn't a substance you can remove from your life entirely? 

When Eating Feels Out of Control 

Dr. Kumar is clear: enjoying food isn't a problem. The line gets crossed when control disappears.

Some of the signs he looks for:

• Eating beyond what you intended, in ways you're not fully aware of
• Feeling unable to stop, even when you want to
• Hiding it — stopping at a store on the way home, eating in secret
• Feeling shame, guilt, or lying about what you've consumed
• It's affecting your mood, your health, your relationships

The difference between enjoying cheesecake and having a problem with cheesecake isn't the cheesecake. It's whether you can genuinely choose to save it for Friday, or whether you feel like you can't not have it.

Where to Start If You're Struggling

If someone comes to Dr. Kumar with binge eating disorder, he doesn't jump straight to medication. His first steps are:

• Medical screening first. Even without purging behaviors, he wants to make sure everything looks okay physically because patients and doctors don't always define "compensatory behaviors" the same way.
• Psychoeducation before anything else. For many patients, this is the first time they've ever named what's been happening. There's a lot of shame attached to it. Dr. Kumar spends time helping them understand that this is a recognized disorder with real treatment guidelines, and that help exists.
• Building the right team. That means connecting patients with a therapist who specializes in eating disorders, and a nutritionist who actually has experience in this area. Not someone who will put them on a scale and say "just eat less."
• How to Find a Therapist Who Actually Gets It

Even in a well-resourced system, finding a therapist who is genuinely trained in eating disorders is a real challenge.

Dr. Kumar’s practical advice:

• Contact your insurance's social worker directly. This is their job — to connect you with providers who specialize in what you're dealing with. Most people don't know this is an option.
• Search for eating disorder treatment centers near you. Even if you don't need residential treatment, these programs know who the right therapists are in your area and can point you in the right direction.
• Don't give up if the first person isn't the right fit. The experience gap is real, but the right support is out there.

The Questions He Asks Every Single Patient

Regardless of why someone comes in to see Dr. Kumar, he checks in on the same core areas at every appointment. Because often, these are the factors driving everything else.

Sleep — not just how long, but how consistent. He focuses especially on wake time. Getting up at 8am some days and noon on others affects your mood, energy, metabolism, and concentration more than a lot of people realize.

Caffeine — one of the most overlooked contributors to anxiety and insomnia, especially with the rise of energy drinks. His general rule: no more than two to three servings before 2pm. If you're coming to him with anxiety or sleep issues, this is often the first thing he experiments with.

Food quality — not calorie counting, but looking at where food is actually coming from. If it's coming out of a box, a bag, or a microwave most of the time, that's worth paying attention to. Small shifts like adding some fruit, or swapping one fast food run for a simple sandwich, are where he starts.

Substances — including nicotine, alcohol, and cannabis, which people often don't mention unless asked directly.

Support system — who's in your life? Family, friends, community? This tells him a lot about a patient's overall wellbeing and what they have to work with.

Building a Support System When You Don't Have One

For patients who feel alone, Dr. Kumar doesn't just validate the isolation. He helps patients do something about it. 

For some, it's joining a group around a shared interest like a pickleball club, a hiking group, or an art class. For others, it's recovery communities like Overeaters Anonymous, where the 12 steps matter less than the fact that you're building real friendships with people who genuinely understand.

He also encourages patients to try things even when they're not sure what they like. You can't know until you give something a chance. And if it's not the right fit, that's fine — try something else. There's no pressure or expectation.

This one resonated with me personally. It took me years to figure out that what I needed was something like junk journaling and coloring. Years. And even then, it wasn't just finding the hobby, it was figuring out the right markers, the right paper. There was a lot of trial and error before I found my sweet spot. So if you're out there and nothing has clicked yet, that's normal. Give yourself time. 

It’s not helpful to tell someone to stop overeating and leave it there. You have to help them figure out what fills that space instead.

Movement, Not Exercise

Forget exercise for a moment. The word "exercise" implies mastery… and nobody has mastery when they're just starting out. It can be an instant turnoff before you've even laced up your shoes. 

Think movement. How active are you day-to-day? Do you have stairs? Do you walk around? That's the real starting point.

The biggest mistake people make is setting an ambitious goal. Five days a week at the gym for 45 minutes… and then feeling like a failure by Friday. 

Instead, just start moving. A walk around the block. Some extra steps. Anything. Build a small routine first, and once that feels normal, you can start thinking about what kind of movement you actually enjoy and build on it.

Why Food Is Different From Every Other Addiction 

Food isn't alcohol. It isn't something you can just remove from your life. That's what makes a difficult relationship with it so uniquely hard to navigate. You have to keep showing up to it, every single day, and find a way to make peace with it.

Dr. Kumar's message to anyone in that position? Be patient with yourself. This doesn't have to change overnight. The brain is genuinely wired to seek out certain foods, and that compulsion is real. But it can be worked through with the right therapy, the right support, and sometimes the right medication.

Want to go even deeper? Listen to the full episode with Dr. Kumar for more on what GLP-1s are revealing about addiction, food, and the brain. 

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.  

 Welcome back to another episode of the podcast Today. I am super excited we have Dr. Nhan Kumar. He is a board certified psychiatrist and addiction psychiatrist, and you came highly recommended to me from a good friend and colleague of mine and she said you need to get him on the podcast.

So before we start talking, can you just briefly introduce yourself, just so everybody knows a little bit about who you are and, and how you help patients. Absolutely. Thank you for having me on. So yeah, my name's Nishant Kumar. I'm board certified in Psychiatry and Addiction Psychiatry, and I work with, adults, with just primary mental health issues and psychiatric conditions.

But I also work with adolescents and adults who may have just a primary substance use problem. And that could also be drugs or alcohol. It could also be behavioral addictions. Food addictions, other compulsions as well. And then we have a, a large majority of our patients who really struggle with some element of both, whether it's a co-occurring mental health issue and or a behavioral or substance, use problem.

That's mainly the kind of population that I work with currently. Amazing. You brought up something when we just started talking. I was like, wait, we gotta hit record. Yeah. Um, I did not understand really the difference between there's addiction medicine and then addiction psychiatry. So can you tell us a little bit about what physician can go into each of those?

How does that work? Absolutely. So if anyone's seeking help with a substance use problem and they're looking for a specialist, they'll usually look for a physician with some sort of experience credentialing or birth certification in the addiction field. Now, the addiction field is separated out where there's addiction psychiatry.

The way a physician gets to the addiction psychiatry, fellowship and board certification route is. They have to have completed four years of a psychiatry residency, and then they have to opt in for one year of an addiction psychiatry fellowship, and then have to sit for both board exams, and it can be boarded in psychiatry and then addiction.

Psychiatry. I, when I started my career, I also took the additional step to then study for and apply for the addiction medicine boards, which is slightly different. It's more heavy on the medicine side. Managing blood pressure, other things where the addiction, psychiatry is really looking at like mental health along with substance use problems.

If a physician wants to go the addiction, psychiatry route, yes. They have to first start with the psychiatry path in residency. Now the addiction medicine, which a lot of nons psychiatrists will pursue, and those can be family practice doctors. Those can be internal medicine doctors, pain management doctors, anesthesiologists, because they have some interest in wanting to incorporate that sort of treatment into their practice and help patients with substance use problems.

And they will usually then either complete an addiction medicine fellowship or they'll complete the requirements in order to sit for the board exam and get, obtain that certification. Thank you for clarifying all that. 'cause it always, it's always fascinating how complicated it all is. I think people don't realize when you're coming off of a substance, I know I did it on internal medicine and oh my gosh, when we had people on the wards that maybe alcohol was involved, something like that.

There's a lot you have to it. It is actually life threatening. Everybody who's listening. This is not just, okay, they're in here and we're dealing with other problems. And so it's just thank you for you and everyone that, that takes care of this area because it's really complicated with addiction.

One of the reasons I brought you on, a lot of my people that are listening or, or patients in my world, they're on GLP one medications, and I wanna hear your thoughts about how you see GLP ones, what kind of influence it's having in the addiction world, whether it be with, I mean you talk about a lot of different areas, but whether it be food addiction or alcohol use disorder, are you see, how are you seeing the GLP one start to influence what's happening there? Yeah, we're, seeing it quite a bit, because I learn, I work for a large medical system where we have primary care and internists involved managing medical issues, but then they're seeing specialists like myself or either substance use or addiction issues or mental health issues.

So when there was the big wave of sort of approval and introduction of these GLP one medications. I started to kind of see this pattern in patients, just self-reporting that, you know, doc, I just don't feel like drinking alcohol anymore. And nothing had changed with their life, with events, with stressors, with therapy, with groups, with other medications or their mental health symptoms, they just no longer felt a desire to pick up that drink. They never didn't think about it as much or be pleasure from coming from drinking, just was no longer there. And that was an effect that we didn't see. To that degree that we have with current FDA approved medications for things like alcohol use disorder. A lot of my patients who either had either a mild, moderate, or severe alcohol use disorder specifically.

Started to go into either early remission, meaning they had three months without a drink or sustained remission a year without a drink. And those who had maybe just problematic use, they were probably drinking more than they wanted to, didn't really meet criteria for a, a substance use problem, but they realized, yeah, those two drinks I'm having every day, probably not the best for my health.

Probably not, good for my mood. Probably not the best for my sleep. They on their own just said, yeah, I just, that went away or it's gone down significantly. I don't think about it. I don't want it that the desire, the urge, the reinforcement, was just no longer there. So I started to really ask my patients on these GLP ones, how they're doing and how they're feeling about their relationship with various substances.

And I would say the majority, if not all. Really no longer felt the need or desire to pick it up, and I think that's why we will see. Shortly, hopefully, that some of these medications will actually get approved for substance use disorders. Probably starting with alcohol use disorder. Yeah. It's so incredible 'cause some of these conditions are so resistant to all the different treatments and so just to have another.

Avenue to get at that is amazing. I know it, it has not really been like popular in the mainstream, but for a few years here. If we're in obesity medicine, we've used a lot of years, but my question is, do you see after a few years that they struggle a little bit more?

Or do you find that it sustains for them and I don't know, maybe based on how many people you've seen, if that's for the patients on GLP ones? Yeah. The patients that I can recall that have now been on it for two plus years, and they're remaining on that medications, I'm seeing a sustained effect.

Okay. But I don't want to attribute all of it to the medication. Oh, of course not. Because it, it's like one of those things of you don't know how good you'll, you're gonna feel until you give it a try. So I think once they put that substance aside and they're losing weight. Guess what? They're going back to exercising.

Their confidence is going up. Their personal life is improving. They're more productive at work. They're back to their hobbies, activities, and interests where the desire to wanna potentially even reintroduce something that was causing so much harm in their life, that also goes away. It's a compounding and additive sort of effect.

But it is sustained. I think while they remain on the medication and continue to incorporate all those other lifestyle changes. If we can shift gears a little bit to the food addiction side. How do you distinguish, what are some things you look for that would be a difference between just you enjoy eating a nice meal, something sweet, things like that, versus it's actually become a problem for someone?

Yeah it's similar to when you look at the criteria for even things like gambling, or a behavioral addiction, whether it's pornography, sex, or even a substance, it's is it just an enjoyment or is it a compulsion that you can't control? Mm-hmm. Is it something that you don't, you're not fully aware of your consumption?

You don't have the ability to control it. Control I think is the biggest factor for all of these behaviors or, and food. And food for example, is they really have a sense of loss, of control, of what they're purchasing, what they're consuming, what timeframe they're consuming it in. And I think that lack of either awareness and ability to manage it is when it starts to become really defeating and starts to affect not only their mental health, but then physically.

Yeah. Whether they start to develop, metabolic issues from it or, self-image and confidence issues from it. But I think just sort of Hey, I enjoy cheesecake versus I really have a problem with con over consuming cheesecake or sugar Is. Being able to say, I'm gonna save this for a treat on Fridays, versus, I need to really have it and I can't not have it throughout the week.

And they're sneaking it behind their, significant other, they're stopping on the way home from the store and they're consuming it. They're lying about it. They're feeling shame about it. They're feeling guilt about it. Again, a lot of the things and experiences that people feel from any other behavioral or substance problem too.

Where do you typically, let's say someone comes in, let's say they have binge eating disorder.

Mm-hmm. Um. Where do you typically start with someone? Let's say they don't need inpatient treatment. Okay. We're gonna take that off the table for a moment. Where do you typically start working with someone when they come in with us?

Yeah. So in the role I'm currently in, if someone's coming in and I'm screening all my patients for any type of eating disorder or disordered eating behavior. And I do identify, and the patient also identifies and relates with possibly having a binge eating disorder. From a medical standpoint, I do wanna make sure that they're medically okay.

So maybe some basic screening labs just to ensure, 'cause even though they're not reporting purging or any other compensatory behaviors, just wanna make sure you just never know what we define as compensatory behavior. Maybe very different than the patient's perspective. Yeah. I have patients tell me, no, I only binge, I only, purge once a month.

Well, you know that that's still something that needs to be accounted for. Yeah. So basic medical screening, looking at other comorbid psychiatric conditions and then, before jumping to meds, because oftentimes this is the first time they're even discussing it. Yeah. And the first time they're even identifying it.

And it's very difficult. There's a lot of shame that's associated with it, A lot of fear that's associated with it. The first appointment is usually more of a lot of psychoeducation and kind of helping them understand that this is in a true disorder. And there are treatment guidelines for it.

There is help for it, there's support for it. And then I get them connected with a therapist who can really help them and work with them one-on-one. Mm-hmm. To understand what is their behavior, like, how is it affecting their health negatively, their mood negatively, their life negatively. And what is it they want to do differently to take better control of their eating habits and even compliment that with other sort of groups, and working with a specific nutritionist who is experienced with eating disorder.

Because if you don't have the experience. You're going to not receive the support that you need. It's just gonna be, I'm gonna put you on a scale and I'm gonna tell you do X, Y, and Z. Just don't eat too much. Yeah. That's the worst thing you could tell a patient. Yeah. So they need that level of empathy and support and education and then.

Give them some time to work with a therapist or support groups or even Overeaters Anonymous support group community meetings. Hmm. Um, and then if that is not sufficient for them to help them reach their goals, then we do explore medications. Okay. I find, and I know you're probably in a very well connected center, that sounds like all these parts are integrated, which is a real privilege. Right. Do you have any recommendations for people that in most of the country, this does not exist I'll give you an example. I actually have a hard time finding therapists that are in, are informed in this capacity because they will often tell my patients, I can't help you with that food aspect.

And so is there anything that people can ask or like a way that they could vet the therapist? What would be meaningful when they're trying to seek that person out? Yeah, that's a, that's a great. Question and it's unfortunate that.

Everyone in mental health should really be equipped to treat almost any patient to a certain degree. But to say that was my assumption. But then I hear it too often, you know? Yeah. And, and it is, it is a common and real problem. I, I think, and when I think people struggle because. It's not like they can go to their primary doctor and say, Hey, can you help me with this?

'cause they're going to say, I don't know what you're talking about. You know? Right, right. It's not like, oh, I have a heart murmur. Yeah. Here's a referral to a cardiologist. When people are struggling, there are usually experienced social workers that are connected with someone's insurance. Okay.

And usually they can outreach that specific social worker through their insurance and say, Hey, this is the specific condition. That I would like some assistance with. Mm-hmm. And it's usually the insurance company's social worker responsibility to help get that patient a list of names, numbers and connections.

Oftentimes that may not be possible or might be challenging. There are certain websites and resources where you can screen for what, therapists are specially trained in. Mm-hmm. But there's a lot of certain treatment centers that focus on treating patients with any type of eating disorder or disordered eating.

Mm-hmm. And they're all over the country just like they are for mental health re residential programs or drug and alcohol rehabs. In that situation, you could also have patients just do a search for an eating disorder residential program near their area. Mm-hmm. Because a lot of times those programs, they are bringing in therapists from the community to work at their facility.

Yeah, yeah. To run groups and do therapy. They can also provide resources and referrals as well. That would also be a good option. I'm really glad that you brought this up. 'cause I think people think, oh, I don't need inpatient. They think it's more serious than, oh, well I don't need that level.

But the, but it's exactly what you're talking about, which is they will know who to connect you with. I think that's really important. Do you think we need to be doing more screening like in primary care? Who's supposed to catch that there's a problem? 'cause how would the patient know that this is happening for them?

You know, I think as many touch points. That a patient has with anyone in the medical system, there should be a certain level of screening that occurs for a variety of, of conditions. I would hate to put more on primary care doctors who are already doing so much, but I think for brand new patients, I think basic screening on just

how are your eating habits or what is your relationship with food? It doesn't have to be, do you binge, do you purge, do you use di? That's a little too direct. It's almost when I ask them to screen for substance use, do you use IV drugs? You if they say no, that doesn't mean they don't use drugs.

Yeah. I think we can definitely do a better job screening, overall as a healthcare system. But if it is missed at the primary care level, then I do think it's really the job once someone's entering mental health. That they're screened appropriately for any type of eating disorder and then appropriately referred and connected with all those subspecialists who can really support them.

It's missed in males quite a bit. We know that, they're not asked, there's an assumption that eating disorder is really only associated, with females, which is absolutely not true. Oftentimes we look for the obvious or just the chief complaint of why someone's coming in.

But they could really have, a real struggle with food or body image that needs to be addressed, but it won't get picked up unless they're asked. Do men, have different characteristics with how they present compared to women? Do they have the same diagnostic criteria or does anything differ?

From what I recall, I think the diagnos diagnostic criteria is gonna be very similar. But they may tend to have other. Compensatory behaviors, like over exercising. Mm-hmm. Or, or using sort of, workout supplements, mm-hmm. High caffeine intake, which are appetite suppressants, but it's not a stimulant.

I think they may hide behind maybe a workout regimen or other supplements as a way to. Either manage their concerns about body image or restrict their food intake. But there's definitely a lot of anorexia that goes on. There's a lot of binge eating that goes on. And they may or may not always have a lot of comorbid depression or anxiety.

But definitely trauma can go hand in hand with eating disorders quite a bit. And we see that a lot with our, or with our female population. Do you think if someone, because, so let's assume that someone, they're getting in with a physician, they're getting help. Do you think in general there are any, top few tips that you give just as far as, you know, things like sleep or nutrition, things where you you hit these things with every single patient that they really matter?

There's probably at least five or six things that I'll ask every single patient. Probably at every single appointment. Okay. Because mostly everyone who's coming in to see me is, is coming in because something's gotten to a moderate to severe degree already. Yeah. And usually either that primary condition is affecting other aspects of their life or the other aspects of life are affecting their condition.

So some of those things are definitely sleep. I don't mean sleep duration all the time, but quality of sleep and consistency of sleep. And there's so much focus and emphasis on bedtime when it's actually your wake up time. You should be waking up fairly consistent, but if you're getting up sometimes 8:00 AM and sometimes at noon or 1:00 PM that's gonna affect your mood.

Energy, concentration, metabolism, so sleep, relationship with food, general eating habits, not just how much you eat, but what you eat. Caffeine consumption. I think that gets missed quite a bit and is a big contributor to anxiety and insomnia, especially with, the explosion of energy drinks and all sorts of energy drinks as well.

Mm-hmm., And then I always ask about substances regardless of why the patient's coming in, including nicotine, tobacco, as well as. With the legalization of cannabis and increased potency, um, when it, you know, if you just ask drug use, people will say, no, I don't use any drugs. They'll say, what about marijuana?

Oh, that I use? Yeah, so I'm very specific. THC or any other illicit or illicit drugs. Mm-hmm. And then alcohol use, and then a lot about just their support system, who's in their life, family, friends, spiritual community. Because I think that tells a lot about a, a patient too. Yeah, these are all really good.

I wanna, I wanna talk about all of these, but real quick, the caffeine one, I see that too because I find that as people get older, I, I don't know if the caffeine intake is going up or, or if they're, more sensitive to it. But they're getting palpitations, they're getting headaches, anxiety. So many things are happening, yet no one has ever said.

Caffeine could be the thing. And sometimes they're like, don't hate me, but this might be something that we wanna decrease or eliminate. Let's say that you think it's causing a problem for someone? Is there like a certain level where you're like, we wanna get you under this?

Yeah. So if you look at, an equivalent serving, 40, 60, milligrams of caffeine, depending on how much they're consuming. Sort of, if, if I were to just give sort of a general rule or guidance. I tell everyone, let's see how you do with at most two to three servings before 2:00 PM Love it.

Okay, so I go, if you are consuming a lot more than that and later in the day and you're coming to me with anxiety or insomnia, let's start there. And if you're continuing to struggle, then we might need to reduce it more. But I always like to do experiments with my patients. I was like, let's do this together.

Let's see how it goes. A week with no caffeine, two weeks without caffeine. If it didn't make anything worse or better, okay. You know, maybe we'll reconsider it. But generally, two to three servings before 2:00 PM is what I like to tell people. Yeah, and I find people know, I mean, you know, we can do the, I do sometimes genetic testing with people, and you can tell if they're a slow or fast caffeine metabolizer, but people typically know this about themselves already.

Like I know with me, if I have it past noontime, I'm gonna be up at night. And it's not that I might not be able to get to sleep, but then I'll like get up in the middle of the night. So it's like, that's not fun. We don't wanna do that. Correct. But this is a good, I, I like how you bring up the experimenting with things.

'cause I find people are so panicked when we ask them to do new things that I, I do the same thing. I'm like, let's just try this three days, five days. What are you willing to do? Let's give it a shot. And then you get to see if it works without this being like a lifetime commitment of getting rid of this thing or changing it.

Just like lowering the bar a little bit for them. Yeah, absolutely. Absolutely. And there are a lot of studies in literature. Gosh, from 40 years ago, even just showing if you're predisposed to anxiety, if we give you an infusion of small amount of caffeine, we will precipitate a panic attack.

So those with anxiety disorders are more sensitive to caffeine. And like you said, people know that for themselves, they know how much they can tolerate or whether they can even tolerate it at all. Yeah. Yeah, that's, that's, that's incredible. Um, uh, tell me about with, when you say your relationship with food, and not only the food, but the quality, are there things that you're looking for, like processed food or is there sugar intake?

Like, is there anything that you're having an ear out for? Yeah, I mean, when I hear people living a very busy lifestyle, which most of us are these days, and it is about convenience, and especially if you have kids or a larger family, and unfortunately, with the way our access to food is, things that are convenient are usually not the healthiest.

Yeah. So, you know, if it's coming out of a box or a bag or you're pushing buttons to heat it up, it's probably not gonna be the best. And look, I'm guilty of opening up a bag, a box, and using a microwave. I know. I'm like, we we're not villainizing all of it. Definitely not. Definitely not. I do have patients tell me, they're like, yeah, that's all I eat.

I eat fast food every single day, or processed food or microwave food all the time. Or yes, I need to have, an excess amount of sugar or feel like this is what I'm consuming. So I talk, everyone say, let's just look at where we can. Could you introduce a little bit of fruit in there? Could you introduce a little bit more water and less caffeine? Could we just prepare some simple sandwiches throughout the week to replace some of the fast food runs? I'm just looking at sort of red flags of extremes, and with that, I'm looking at what could possibly be missing.

I've a few patients, quite a few who tell me they do not like water. They do not like the way it tastes. They do, they, they do not drink water. They will drink five, six sodas a day. Yeah. And so we get creative and say, well, can you get some flavored water? Can you get sparkling water? Can you get something else other than.

What's coming in from sodas or coffees or energy drinks. Yeah. So it's partly looking at what we can help introduce, which will then hopefully help reduce some of the things that are probably in excess. Definitely. I, this whole gut microbiome is getting a moment right. And a lot of it, we know it can affect different medications and how it's working even in, in psychiatry.

The thing that's always shocking to me right now, it's, everyone needs to get fermented foods. and I was thinking about it, why are we so obsessed with making sure that everyone's getting it? It's because a lot of people, like you said, everything, they're eating a can of jar. Like Yeah. There are no microbes because, it would mold, it would go bad.

I feel like that's one of the reasons why we have to be so fanatic right now on the horn about getting fermented foods because we're trying to bring back in what the sort of like. I don't wanna say like sterilization with food, but the way in which we're shipping months on end veggies and things like that, we have to replace that.

So it's so interesting when you're bringing this up, the impact on mental health as well. Yeah, I mean that's, that could be a whole podcast in itself about food production, food consumption, food processing. But yeah, if we're ultimately not looking at the actual source of our food. And the unprocessed foods, things that are not in mass production or having a long shelf, shelf life in store with sodium that yeah, we're saying add all these other things, which is not, I'm not saying a bad thing.

But you're not, you're doing it because you're not actually adjusting or fixing your food sources. Yeah. But if we go back to more raw foods and the less processed foods, then I think our guts will get the nutrients we need, in an appropriate fashion. But there is, yeah, there's definitely a lot of benefits to, fermented foods as well, but it's the type of foods and how we're consuming it.

What do you do for people that do not have good support systems in their life? In what ways? Like long-term, what kinds of areas do you guide them toward to get more help? It's really challenging because it depends on the population too. So a lot of time, whether they're the geriatric population, they may have different sources to help build a support system, whether it's through the senior communities and activities or, volunteering somewhere.

But for adolescents, that's challenging, because their support system. Is oftentimes, whether it's their circle of friends at school or through social media and if they're not on social media or not as present as maybe some of their friends that's perceived and felt like they don't have a support system.

And then so for, and then adults in twenties and thirties, so it's looking at what is of interest of yours? I'll tell patients, and when pickleball became a big thing, join a pickleball club. Go, join a hiking club and try to meet some people and that share common interests.

And in the recovery community, that's a great reason why support groups like AA or na or even OA work is. I tell 'em not because you're working the 12 steps over and over. I go. You build a support system, you build a social support system. They become your friends and your family.

You're seeing movies with them, going to lunches, dinners hanging out, and that's a big sort of component. I think that's needed for anyone's wellbeing is having a social support system. A hundred percent. And it's the fact that you don't have to keep re-explaining yourself to those people. Like the friends in your life are not like, every single time I have to say, well, it's hard for me around this thing.

They really get it. But I like this, the finding the shared interest I find when people work with me, yes, we're working on fat loss and metabolic health, things like that, but universally, pretty much on the first visit I say, look, because food is not gonna play as big a role, we have to build out these other things more.

Everyone needs to find a hobby. It's so weird that you think that as a physician, I'm sitting there saying, what hobby are you gonna do? What are you gonna try? What you know? How are you gonna get out there? But they end up hiking, they end up meeting different people. Their whole world changes, and that's really hard if you don't have anyone to do that with.

Yeah it's very isolating, and you can feel very alone. So it is, you have to allow yourself to be a bit vulnerable. You have to take risks, and for those that are religious or spiritual, that's a great place to connect with others too. Yeah. Is through those centers and places as well, or.

Saying, you know what? I have no idea what I like, but I'm going to give something a try and I'm gonna sign up for a class or some sort of project or art class or hobby or sport or something. And people, they don't necessarily always realize what they enjoy and what they like doing until they gave it a chance because.

You can't just tell someone, just don't overeat or stop eating or stop going to fast food, that doesn't work. You have to really say, well, let's, what can you do with that time? Instead? What can you do that might bring you joy and help you feel fulfilled instead? And unless we really help create that sort of plan with them.

They're gonna feel lost. 'cause all they're gonna do is sit and think about what they shouldn't be doing. Exactly. Exactly. I like the, I heard someone say, you're not, we're not sitting there thinking of how to not overeat. We're sitting there thinking, how can I regulate? How can I have fun?

How can I slow down to the speed of joy? How can I do those other things? Yes. For me though, it took me years to find, for me it's like coloring. Like junk journaling and things like that. It took me a long time to find, because it wasn't just the hobby, it was also what kind of mar markers they were.

What kind of paper? There was a lot that had to get figured out until I'm like, now I'm in the sweet spot for a few years. But that was years to figure that out. I think if anyone's out there, it takes time to, to find these things. Oh yeah. These things you're talking about sometimes you're going to unchartered territory.

Which could be scary but also exciting. Mm-hmm. But also you're you're taking risks, but you're discovering this for yourself and you're giving yourself time to do it. If you go down one path and you're like, painting is not my thing. No problem. That's the good thing is there's no pressure or expectation.

You just start picking up and trying something else or something different. Yeah. I love that. I have one, last question for you. What are your thoughts on exercise? Is that something that is really a mandatory thing that you want with your patients yeah, as we were talking, I realized, I was like, there's one more thing that I, I know you had told me that before, so we bring it.

Yeah. Because I was like, I definitely left out something and Yes. And the way I frame exercise with everybody. 'cause that word can be a real turnoff. Yeah. Yeah. I just tell people. Tell me what your movement is what's your just activity level? Do you have a sedentary job?

Do you walk around? Do you walk around the neighborhood, do you have stairs in your house? Do you know? And I get a sense of as soon as they hear movement or activity, they'll either tell me, oh, doc, I go to the gym, five days a week for an hour. I'm like, okay, great. They're moving.

Some people are like, yeah I'll take some steps or I'll try to walk around and so I, right there, I have a sense of. Maybe there's an element here of limited activity that we can touch on and help them improve. Yeah, and so I tell every patient this, the ones that are maybe not having as much movement or exercise as they probably should or would like to is don't be the person to set the New Year's goal and say, I'm going to the gym five days a week for 45 minutes, because then guess what?

Friday rolls around. And if you haven't gone. You're like, what's the point? I didn't reach my goal. So I tell everyone, just move. I don't care for how long, how many days. Just start moving, walking around, going for a stroll. Yeah. And then once you start building up a routine of some sort of movement, then you'll look into, are you a gym person?

Are you a weightlifting person? Are you getting, a bike ride or a run, a hike? Then you start really setting small. And attainable goals and build on it from there. Even if the goal is once a week for 20 minutes, I'm fine with that. If you can maintain that for two weeks, great. Add either another day or extend the time.

But yes, movement is absolutely essential, I think for all of us really in any capacity. Yeah. I love how you're talking about it too. 'cause you're saying, look, anything is better than nothing. And like you have to just start doing something in order to figure out the things that you like or not.

And it can be intimidating. I do the same thing. I use the word movement because I think that exercise implies mastery and no one has mastery when they're starting. You gotta start where you start, right? Yes. One foot in front of the other. Do you think there's anything that we didn't cover here? I think when it comes to food and relationship with food, it's such a delicate topic because it's not like it's. Alcohol or heroin or fentanyl.

Yeah. Where it's something essential. Food is essential. You need it to be a part of your wellbeing, your livelihood, your health. Yeah. So it's not like it's something you have to or can remove. You're having to really learn how to incorporate something into your life. But in a way that you feel good about.

And it's a stable and healthy relationship, and it's not affecting you, whether it's emotionally or physically. So I, I think just a reminder to everybody just to be patient with yourself. And that this doesn't need to change overnight. This doesn't need to happen quickly. But to just like I tell all my patients, just keep coming back.

It doesn't matter what's happened or what's, you went, one step forward and two steps back. Just keep coming back and understand that some of this, as we know through the science now, is the brain really wired in a way to seek out some of these foods and have a difficult time controlling it, and that compulsion's there.

And that compulsion can be broken through appropriate therapy, medications, behavioral changes. But just to be kind, I think to yourself. Yeah, that's so good. Being kind, being patient and the coming back to it. My patients that do the best, they say there's no option to quit. They just know each month they're gonna be seeing me.

We're gonna keep adjusting things and they always end up in a good spot, but they're willing to keep. Add it, which is just really hard with a chronic disease. I know you have a hard stop, so I wanna make sure to respect that. . I definitely learned so much and we're gonna make sure to summarize all of this, we'll have it in the show notes. For anyone that's listening, thank you for taking the time out of your busy clinical schedule to come on today.

Thank you for having me. I really appreciate it.